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Resolution 330-1986 . Dr. Jose Bofill, M.D., Director Monroe County Public Health Unit RESOLUTION NO. 33<r 1986 A RESOLUTION AUTHORIZING THE ~.AYOR AND CHAIRMAN OF THE BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA, TO EXECUTE A CONTRACT BY AND BETWEEN MONROE COUNTY BOARD OF COUNTY COMMISSIONERS AND STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES CONCERNING COUNTY PUBLIC HEALTH UNIT. BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA, as follows: The Mayor and Chairman of the Board of County Commis- sioners of Monroe County, Florida, is hereby authorized to execute a Contract by and between Monroe County Board of County Commissioners and State of Florida Department of Health and Rehabilitative Services, a copy of same being attached hereto, concerning County Public Health Unit. PASSED AND ADOPTED by the Board of County Commissioners of Monroe County, Florida, at a regular meeting of said Board held on the 7th day of November, A.D. 1986. BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA BY: ~/ .. C/' / ~7~t~ MAYOR/CHAIRMAN (SEAL) ATTEST: DANNX L. KOLHAGE, 91erk ~~~f)L CTjERK APPROVED AS TO FORM AND LEGAL SUFFICIENCY. , 8Y ./.: <.: C? ~,"- ? '/.1;.; "1'-'..--... Attorney's Office (, ... , CONTRACT BETWEEN MONROE COUNTY (BOARD OF COlR'HY COMMISSIOI'ERS) AI'D STATE OF FLORIDA DEPARTMENT OF t-EAL TH AND REHABILITATIVE SERVICES Pursuant to the Laws of Florida, Chapter 83-177, 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 funds and the respective responsibilities of the department and the county in enabling the CPHU "t-o promote, protect, maintain, and improve the health and safety of its citizens and visitors through a statewide system of coordinated public health unit services." I. General Provision: Both parties agree that the CPHU shall: A. provide services according to the conditions specified in Attachment I and all other attachments to this contract; and B. fund the services specified in Attachment II, section IV, at the funding level specified for each program service area in that attachment. D. 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 into this contract as Attachment Ill; 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 Pollution Control Act as amended (33 use 1368 et seq.), if this contract contains federal funds and the total contract amount is over $100,000; and -1- 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: 1. The revenue and expenditure requirements in the State Automated Management Accounting System 2.2 at the coding level specified in Attachment IV of this contract; 2. The client registration and service reporting requirements of the minimum data set as specified in Client Information System/Health Management Component Manual and any revisions subsequent to the January 1, 1984 version, or the equivalent as approved by the Health Program 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. Financial procedures specified in the department's Accounting Procedures Manuals and Accounting Memoranda; 4. All appropriate CPHU employees shall report time, in Client Information System/Health Management Component compatible format by program component for at least the sample periods specified by the department; and 5. 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 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. -2- ~ 80th parties furthr>r agree that: The department shall provide uniform financial statements of program ae,count balances for each level of service on a quarterly basis to the county and to the director or administrator of t:1e CPHU. IV. Monitoring: 80th 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 tiy the CPHU or its subcontractor or assignee. V. Safeguarding Information: 80th 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 50-1), and federal regulations (45 CFR, Part 205.50), except on written consent of the recipient, or his responsible parent or 9uardian 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 departm~nt and the county of any assignment shall be deemed in a: )' 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. AU 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 subcoQtract prior to its execution. No subcontracts shall be deemed in any manner to provide for the incurrence of any obligation of U1e 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. Monroe County Health Department agrees to indemnify and save harmless the Monroe County Commission from and against all claims, actions, or jUdgments for damages to any person or property whatsoever, arising out of any subcontracts associated with this contract. VIII. Payment For Services: A. The department agrees: To pay for services identified in Attachment II as the state's responsibility in an amount not to exceed $ 1.803.486. . This amount includes all revenues from -3- whatever SOUl"'''' ..0 be appropriated by the state to the Public Health Unit Trust Fund, including the State's share of all public, personal or primary care fees. The state's performance and obligation to pay under this contract is contingent upon an annual appropriation by the Legislature. B. The county agrees: IX. To pay for services identified in Attachment 11 as the county's responsibility in an amount not to exceed $ 337, 74~._O~. This amount includes all revenues from whatever sources to be appropriated to the County Public Health Unit Trust Fund for services provided by the county public health unit, including the county's share of all public, personal and primary care fees. This amount includes all revenues from whatever sources to be appropriated by the County Public Health Unit Trust Fund for services provided by the county public health unit, including the county's share of all public, personal and primary care fees. Of the several revenue sources identified in Attachment II, Section II, B (County), the Monr~e Board of County Co~issioners will be responsible only for the-appropriation fjf.$205,201. D~artment and the County Mutually Agree: Effective date: The A. 1. This contract shall begin on October 1, 1986 or the date on which the contract has been signed by both parties, whichev.er is later. 2. This contract shall end on September 30, 1 ~7. B. Termination: ) 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 then twenty-four (24) 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 their respective funds as applicable. In case of cancellation due to the unavailabili ty 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 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. -4- C. Notice and contact: The contract manager for the department for this contract is Susan Wi} son . The representative of the county for this contract is Kerrni t Lewin . 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 only be enforceable 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: Public Health Unit Trust Fund, Monroe County, Public Service Building, Junior College Road, Key West, Florida 33040 F. All terms and conditions included: This contract and its attachments as referenced, (Attachments I through JOU...), contain all the terms and conditions agreed upon by the parties. IN WITNESS THEREOF, the parties hereto have caused this R- page contract to be executed by their undersigned officials as duly authorized. COUNTY BY: ST ATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILIT AlIVE SERVICES BY: (Departmental Authority) NAME: NAME: Linda R~rkowi t7. TITLE: TITLE: Di~trict 11 Administrator DA TE: DA TE: A TTES TED TO: BY: (County Clerk) (County Public Health Unit Director) NAME: .Tn~p:1" R("\'fi 11 M n . BY: NAME: TITLE: DA TE: TITLE: County Public Health Unit Director DA TE: -5- APPROVED AS TO FORM AND LEGAL SUFFICIENCY. ') BY J .., i /;~ I.,"!." ;_ l..~(/VV-C'-j -__ A'~or~ey's Office A TT ACf-NENT 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 Public Health Unit Trust Fund 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, except that 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 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. D. That CPHU surplus funds accumulated prior to October 1, 1984 are county funds to be used solely for public health purposes in the county where they were genel'ated. The planned use of all such surplus funds plus surplus accummulated subsr quent to October 1, 1984 must be included in the contract as: 1. county and state contributions to the annual budget and shown in Sections I and II of Attachment II; and/or 2. CPHU reserve to cover cash flow problems or public health emergencies as specified in Sectipn I of Attachment II; and/or 3. one time special projects which directly enhance the delivery of services by the CPHU. The amount for such projects shall be reflected in Attachment II, Section I and explained in Attachment IX. E. That any surplus funds, including fees or accrued interest, remaining in the CPHU account at the end of the contract year, excluding funds accrued prior to October 1, 1984, shall be credited to the state or county, as appropriate, in such amounts as may be determined by multiplying 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 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. F. That under no circumstances shall there be 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 -6- delay would endanger the public's health and the director of the Health Program Office has approved the transfer. The director of the Health Progra 11 Office shall forward written evidence of this approval to the CPH U within 30 days after the transfer. The contract shall include as part of Attachment n a section entitled "Planned Staffing, Clients/Services and Expenditures by Program Service Area Within Each Level of Service." This section shall include the fOllowing information for each program service area within each level of service: the planned number of fulltime 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. Adjustments in the planned expenditure of funds for program service areas within each level of service are permitted without a modification to this contract or a budget amendment. If the CPH U exceeds the tolerance levels as specified below as of the end of the re{?ort period, the director/administrator of the CPHU must prepare a written explanation for each program service area which is out of compliance: 1. The cumulative percent variance cannot exceed by more than 25 percent the planned expenditures for a particular program service area or fall below planned expenditures by more than 25 percent. 2. 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 program service area is included, a variance explanation is not required. G. The required dates for the CPHU director's/administrator's quarterly report to the county and the department shall be as follows: 1. l\1arch 1, 1987 for the report periOd October 1, 1986 through December 31, 1986; , 2. June 1, 1987 for the report period October 1, 1986 through March 31, 1987; 3. September 1, 1987 for the report period October 1, 1986 through June 30, 1987; and 4. December 1, 1987 for the report period October 1, 1986 through September 30, 1987. H. Quarterly reports submitted by CPHU directors/administrators to the county and the department shall include at least the following sections: 1. A transmittal letter briefly summarizing CPHU activity year-t~-date; .q- 2. A contract variance analysis which: a. explains the reason for the variances in expenditures in any program service area which exceeds the tolerance levels established in paragraph F. 1 and 2 above; b. specifies steps that will be taken to comply with the contract expenditure plan, including a contract amendment, if necessary; and c. gives 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. 3. DE140Ll - "CPHU Contract Management Report;" 4. DE235Ll - "Analysis of Fund Equities;" and 5. DE250Ll - "Statement of Budget and Actual Expenditures Per Revenue Contribution Ratio." ll. Fees: A. Environmental regulatory fees: The department shall establish by rule fees for environmental regulatory functions designated in this contract and 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. Public health services fees: ~ The department may establish by rule fees for public health services, other than environmental regulatory services, designated in this contract and conducted by the CPHU. Such fees shall supersede any other fees for a public health service which existed 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. All state or federally authorized public health services fees shall be listed in Attachment V of this contract. All county authorized public health services fees shall be listed in Attachment VI of this contract. C. Personal health and primary care fees: Either party may establish fees for personal health and 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: -8- 1. That such fees shall be established by resolution of the Board of County Commissioners, if promulgated by the county, or by rule, if promulgated by the department; 2. That there shall be no duplication of fees by the department and the county for personal health or primary care services provided by the CPHU; 3. That personal health and primary care fees shall be listed in Attachments V (state) and VI (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 public, personal, 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; and 3. N/A (Specific Fee) NfA is exempted from the above provisions until N/A because this fee was committed prior to July 1, 1983 toward retirement of the obligation on N fA (Specific Public Health Facility) 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 as a guide for providing each funded service specified in Attachment II of this contract where such manuals or guidelines exist.' IV. 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 staff director of the Health Program Office 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. -9- 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, section IV as FTE's, and may be changed as funds become available. D. The number and classification of employees working in the CPHU that are county employees rather than department employees shall be listed in Attachment VII of this contract. V. F acili ties: Both parties agree that: A. CPHU facilities shall be provided as specified in Attachment VIII of this contract. This attachment shall include a description of all the facilities used by the CPHU, including the annual rental equivalent value, and by whom they will be funded; B. responsibility for maintenance of facilities shall be described in Attachment VIII, including the cost of such maintenance and by whom it will be funded; C. the county shall own tl)e facilities used by the CPHU unless otherwise provided in Attachment VIII of this contract; and D. faci.:"ies 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 wi th the operation of the CPHU. VI. Method of Payment: A. In each quarter of the contract year, the county shall deposit at least one fourth of its total annual contribution to the County Public Health Unit 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. B. The department shall release state contributions to this contract as follows: 1. Funds appropriated as "Aid to Local Government, Contributions to County Health Units" shall be released in four equal amounts at the beginning of each quarter of the contract year; 2. With the exception of the WIC program, funds appropriated in a special category for categorical programs shall be released as follows: a. one fourth of the contracted amount for each program will be released at the beginning of the first quarter of the contract year; and b. subsequent releases shall be based on actual expenditures as reflected in the monthly and quarterly CPHU contract management system fiscal reports. -10- 3. Funds for the WIC program shall be released on the basis of actual expenditures as required by federal regulatior'ls. VII. 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. VIII. Other County Public Health Unit Activity: (optional) Attachment X shall contain a listing of all public health activities in the county which supplement or support the activities of the CPHU, but are not financed through the Public Health Unit Trust Fund. The contract manager for the department and the contract representative for the county should be notified in writing of changes in the agreements or amounts listed in Attachment X which occur during the life of this contract, but such changes do not require a contract amendment. IX. Emergencies: Both parties agree, to the extent of their respective resources, that they may assist each other in meeting public health emergencies. -11- . ~--~-_.. 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N M ..c: +J .-4 III Q) ::r:: u .r-f .-4 .a :;j 0.. . co .-4 qo .. co M . qo lO M M M .c +J .-i III Q.l :z:: CD lo.l III U >, lo.l III .~ lo.l 0.. - co ..... o I- en Q) Q) 4. .-4 III s:: o en lo.l Q) a. N qo r-- .. qo o r-t v> a; C\ c: :0 - ':; co . '" . o o o .. co lO .-4 CD :::l - co > ...., c: CD - co > ':; CT W - co ..... c: Q) ~ - co :J c: c: <! . o o o .. o .-4 o o o .. o <<:I' CD :0.: Q) o c: co c: Q) ..... c: 'c; ~ c o .r-f +J III > o c: CD IX: << - . o o o .. co .-4 N v> I \,Q .... I (/) 0\ c: :9 ':; co lo.l o ~ ...:l - co ..... o I- o Z H :0.: I Z H << . . . . 0 0 0 M lO ~ 0 0 0 qo Ltl ~ 0 CO CO Ct'l N ~ - .. .. .. .. .. .. CO Ltl N I' Ltl lO r-f ...., 0 N N L!'I lO M I- l.ll ~ l/l .. .-4 N v> v> '" v> "'0 CD :J c: ...., c: en 0 c: 0 0 0 0 0 .. ,"'Z 0 r-- r-- I Q) :J 0 r-- r-- I- .c~ .. .. ...J ...., .- co N 0 Ob .-4 lO co <! N ..... M W c: 0 v> v> v> I U U - ...J CO :J a. 0 l- V') I ,.... Z "C . .... 0 c: 0 0 0 M lO ~ . :J 0 0 0 qo co N - 0 co co r-- qo N l- lL. .. :J ...., Lfl N r-- r-- M r-f CO en N N M 0 qo - :J M co r-f ct: '" l- I- ..... N. Z :J v> <l)- v> <I)- 0 I U a. 4. U 0 en W U ~ ct: :J ~ 0 CJ') in CIJ . c: ~ - c: 0 CIJ - 0 'Z c: O;:j 0 :J oz ~ :J ..0 :9 'i: :J '" +J ...., :9 ...., c: r- c: Ul 0 ..... ...., 0 CD U c: ~ c: U ,-.. 3 0 :J "'0 >. U 0 - r- :>. ...., I- U CO CO Q) '" c: Q) 0 0 0 :0.: Q) :J ..... I- 0 a:l .c 0 co ...J V') 4-l ...., U ..... ~ '-' 0 0 U1 - '" 0 '" - - - Q) 0 Q) :>. eo CO co .c .c .c +J ...., ..... ..... 5 ..... 0 ..... 'r-f 0 0 0 0 V') 0 U l- I- l- . ~ III. BUDGET BY LEVEL OF SERVICE (Amounts rounded to $1.00) BudQet (CPHUTF) State County Total A. Public Health Level 1- Salaries and Benefi ts $ 449,120. $ 113,574. $ 562,694. 2. OPS $ -0- $ -0- $ -0- 3. Expenses $ 232,608. $ 58,82l. $ 291,429. 4. Operating Capital Outlay $ 48,943. $ 12,380. $ 61,323. Subtotal $ 730,671. $ 184,775. $ 915.446. B. Personal Health Level 1. Salaries and Benefi ts 2. OPS 3. Expenses 4. Operating Capital Outlay Subtotal $ 419,758. $ 180,478. $ 100,61l. $ 21,968. $ 722,815. $ 64,329. $ 36,965. $ 16,636. $ 1,674. $ 119,604. $ 484,087 $ 217,443. $ 117,247. L 33,642. $ 842,419. C. Primary Care Level 1. Salaries and Benefits $ 250,712 $ - 0 - $ 250,712. 2. OPS $ 29,576. $ .. 0 - $ 29,576. 3. Expenses $ 69,712. $ 33,364. $ 103,076. 4. Operating Capital Outlay $ - 0 - $ - n - $ - n - Subtotal $ 350,000. $ 33,364. $ 383,364. D. Total Public Health Services Budget 1. Salaries and Benefits $1,119,590. $ 177 , 903. $1,297,493. 2. OPS $ 210,054. $ 36,965. $ 247,019. 3. Expenses $ 402,931. $ 108,821. $ 511 , 752 . 4. Operating Capital Outlay $ 70.91L $ 14,054. $ 84.965. TOT AL BUDGET Sl,803,486. $ .337,743. $2,141,229. -18- w u :> a:: w III ~ ..J W > W ..J 1: U c( w z I I- ~ c( w a:: c( w u :> a:: w '" ~ c( tY Cl o cr a.. >- co In W cr :J I- a z w a.. x w ~ c( vi w u :> cr w III -- In I- Z w :J u d' z i: ~ I- In o ~ c( ..J a.. ::= '" - >- ell"" ""c o ~ 1-0 ,..., co '" ~ CJ~ '" '- (I) .a E (I) ... a. (I) U'l o ... "'I co '" .... c ctl a: (I) '-"0 .~~ "0 c: (I) )( W "0 - c: ~N <- ell ::> o ...; - 0", .. (I) (I).~ .D> E .. ~(I) zU'l .. (I) .D o ... (J o '0-; '-~.. Q.):9 .~ .D>C E:o:J ~ C z- ca o I- "0 c: ctl cJ ... '" .... .. GJ I- 4.. .s ca (I) 1: .S! D ~ a.. <i. co :) '" ,... u) :~J .". rl M M co ,... c"l U) '" o co '" .... '" o co '" M :t o :c "" M '" o co '" .... '" " " U) '" .. '" M ~ '" ~ ~ CJ o C ,9 'cQ N 5 E .5 ':J '" '-r " ,") M ,Xl " D ,., '" c'. o ,... U) ,... o '" co .". M o U) co .". (~ o U) 'D .". M o U) co .". M o o .... .". U) '" o M ,... 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Lfl o Lfl M '" 0 N Lfl Lfl '" 'M Lfl o Lfl '" 0 '" Lfl U) '" M M U) o U) co 0 '" U) N r- ,..., .-< M U) o III M OJ 0 N Lfl N '" .-t M o o U) Lfl '" .,. 0\ M rot o III N x CO X .-t X X CO M <D ... ~ \0 .... af \0 .... ,..: \0 .... ",' \0 C ~ 4 o .. II U '): .. (I) III ca (J :0 (I) ~ >. (J c (I) ClI .. <D E w e ... C o U .. o "" U <D > o o o U) .-t o U) III ",- 8 CO .... ~ .. U Z .. .;; <II ... III ca ... :> '0 .". d' 'n rl U\ ,n r- i' '" co rot rot r-- '" o M '" o rot N '" M N m '" '" ,... rl N c '" r-- "" N N crl '" '" o '" N I '" .-t I Lfl r-- '" <l' M ,., en '" o .... r: N f"l 'iil ... o ... .D ~ III w U :;: oc ~ 4- o .J W > W .J J: U ~ w z I l- i ~ w oc ~ w Sd > '" W l/'l 2 <! n:: r" o n:: 0.. >- :0 l/'l W oc :J I- a z w ~ X w a z ~ 1II~ W U :;: oc W 1II - 1II I- Z w ::i u <5 ~ 4- 4- ~ I- 1II a ~ ~ .J 0.. ~ '" ~~ o ::l I- 0 U ... C ::l o U -co Ill... ... t1l Ill... "'<1) l/'l e '" ii III "'''0 .3 '- ,- '" "0 e re r-I co a- ..... x LC CJ~ '" '- <ll ~ E III ... 0. III Vl o ... 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I' '" '11 en rl N I o '" I '" I' '" ro '" rl I' o I' OJ N '" "'" rrt e- rrt '" .-< o ro o rrt N o ~ ~ .. cu o .; ... cu l/'l <ii ... e cu a tii ... o ... .a ::l <I) w U :> ~ w VI lL. o .J W > W .J I U <( w z :E ~ ~ <( w a::: <( w ~ > ..". b "I V1 co 2:0\ <(.... C:CO (J.... 0'- C!:ll a. E >- III tIle. ~~ cr 0 ~:;;I O~ z.... w ~ a..... X '- wll aE z CJ <(0 VI~ W U :> cr w (j') -- VI ~ Z w ::i U a z ~ lL. <( ~ VI o w Z Z <( .J a. ::= >. ~ -' c o :J ~ 0 U -' C :J o U --lIl lIl.... .... '" "'... ....(j') VI c: '" 0: IlJ '-'0 :J , .~ ~ "" c OJ x W ~ '-N :!J ... ... en :J C .... o CIl IlJ ~ .~ .0 > E ~ :J(j') Z - on; ~~.~ .o>c ~:O:l z.s '" ~ o f- ;2 Cii r'5 .c ~ ... CIl .... CIl W l- ll. ~ u L~ '" M ,~ .... o o o o qo .-< " l"1 l"1 co l"1 " ,.., co , n ,~ c ~ 'JJ co co co co o o N " o o ... N ... 0\ N C IlJ '- '" U >- '- '" E 'C a. .:2 i: U o " CI ("') " o o o o .-< N ... o '" " '" ,0:, " u, '" o '" " ",.1 o o co o .-< o o "" '" <,J) ;:: '" .... ~ IlJ '- '" U >- '- '" E 'C a. ~ "3 -0 <( '1" :0 .., .., M o o o o '" '" .... " '-'? '" J> .... ... (Xl ,n " .-< ... '0 j) .... ... co '" u' o o o co .-< o o o <,J) o .-< -; ... o .D :J (j') ., 'I ., '1' ~ N , r " r-- ,-., co <,J) co ... l"1 o co .-i '" .... " '" .... '" co co '" <~;~ '1' JJ Jl .., '" '0 o N '" '" '" .... (J\ (J\ N N .... <,J) <.0 co .... co C"I :z I- U <( cr f- Z o U .J <( I- o I- w cr <II <( '" U~ c'3 I <( ;>, ~ cr '" ;ia ~ wa ,"" I~ ~ <( a. ::> Q~ :I: ~ W fj aU <II .J U 0 lL. <( .. c o . ~ o ,.., co 'r .;; "' .... .:c r"" M ~ o 21 ; o .... '" '" .... o 0 (J\ 0 <,J) 0 " 0 '" U'l l"1 l"1 " N co '" . (J\ <Xl r-- 0 " <,J) o ... o 0 .... .-< r-- N co (J\ co " 0 " '0 co o "" o 0 ~ .... " rl (Xl '" m l""- I- 0 " <0 o ... o 0 .... .... co N <Xl '" r-- r-- 0 r-- <,J) o ... o 0 .... .... , .... N . '" o o o '" ~I ~ o 010 o 0 000 <,J) '" " " o .-< ::> :r: a. U III o .. C o ..~ :l... fE.o: U2! Gl 0 :co '" 0- ,~ <=: -,"" o.c 0.<11 <( <II '" .Ec7; CJ.... ~.~ CJ U IlJ C 0. ,~ VI<=: ,.., '" . " . ~I ~ ~ '" '" o ... u '" '" ... c o u .a " C/I C/I ~ <-< ~ ATT AC~ENT m CIVIL RIGHTS CER TIFlCA TE ASSURANCE OF COMPLIANCE WITH TITLE VI OF THE CIVIL RIGHTS ACT OF 1964, SECTION 504 OF THE REHABILITATION ACT OF 1973, TITLE IX OF THE EDUCATION AMENDMENTS OF 1972, THE AGE DISCRIMINATION ACT OF 1975, AND THE OMNIBUS BUDGET RECONCILIATION ACT OF 1981. The applicant provides this assurance in consideration of and for the purpose of obtaining federal grants, loans, contracts (except contracts of insurance or guaranty), property, discounts, or other federal financial assistance to programs or activities receiving or benefiting from federal financial assistance. The 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 benefiting from Federal financial assistance. 2. Section 504 of the Rehabilitation Act of 1973, as amended, 29 U.S.C. 794, which prohibits discrimination on the basis of handicap in programs and activities receiving or benefiting from Federal financial assistance. 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 benefiting from federal financial assistance. 4. The Age Discrimination Act of 1975, as amended, 42 U.S.C. 6101 et seq., which prohibits discrimination on the basis of age in programs or activities receiving or benefiting from federal finan.cial assistance. 5. The Omnibus Budget Reconciliation Act of 1981, P.L. 97-35, which prohibits discrimination on the basis of sex and religion in programs and activities receiving or benefiting from federal financial assistance. 6. All regulations, guidelines and standards lawfully adopted under the above statutes. The applicant agrees that compliance with this assurance constitutes a condition of continued receipt of or benefit from federal financial assistance, and that it is binding upon the applicant, its successors, transferees, and assignees for the period during which such assistance is provided. The applicant further assures that all contractors, subcontractors, subgrantees or others with whom it arranges to provide services or benefits to participants or employees in connection with any of its programs and activities are not discriminating against those participants or employees in violation of the above statutes, regulations, guidelines, and standards. In the event of failure to comply, the applicant understands that the grantor may, at its discretion, seek a court order requiring compliance with the terms of this assurance or seek other apporpriate judicial or administrative relief, to include assistance being terminated and further assistance being denied. -22- A TT ACHMENT IV REVENUE AND EXPENDITURE CODING REQUIREMENTS General Principles The automated cost allocation system for the county public health units (ePHUs) will provide for the allocation of expenditures recorded in the County Public Health Unit Trust Fund that cannot be conveniently charged to a specific program component. Career Service and 1200 OPS Salaries will be coded to ORG Code Level 3 (L5 Code = 000) through Personnel Management Data System (PMOS), except central administrative salaries chargeable to L5 Code 400. All 1300 OPS Salaries must be charged in State Automated Management Accounting System (SAMAS) to a specific program component (program service area) at Level 5 of the Organization Code. Similarly, Expenses and OCO will be coded to the lowest uniquely identifiable Level 5 code. County public health unit expenditures coded in SAMAS will be allocated on the basis of data collected through the Client Information System/Health Management Component (CIS/HMC) time reporting system. Employee Activity Records (EAR) are used to record the time each employee spends in various program components. County public health units using their own data systems will provide employee time information to the CIS/HMC system and this data will be processed in the same fashion. Using employee salary information from the PMOS, personnel costs are generated for each program component for which county public health unit staff have coded their time. Time and costs associated with general support program components, such as those for general personal or general public health, will be allocated to direct service program components based on the relative percentage of direct service time in each of the relevant program components. For instance, if family planning direct service time was 20 percent of the direct service time coded in all personal health program components, then 20 percent of the costs associated with general personal health would be distributed to family planning. Once the appropriate time-cost percentages are determined for each program component, then these percentages will be used to distribute allocable expendi tures coded in SAMAS.' CodinQ Plan The SAMAS organization. codes will be used to identify specific program components (program service areas) within each of the three Program Service levels as follows: l5 Codes Program Service levels 100 through 199 200 through 299 300 through 399 Public Health Services Personal Health Services Primary Health Services Codes 400 through 499 will be used for general administrative and support services, and expenditures charged to these accounts will be allocated to the specific Program Components. Revenues and expenditures of each county public health unit funded through the County Health Unit Trust Fund will be coded with the appropriate SAM AS codes for Category, Object, and Other Cost Accumulator (OCA) as prescribed by the State Comptroller and/or as -23- may be determined by the Department's Comptroller. The SAMAS Organization Code will be used as follows: L 1 = 60 L 2 = District L3 = County Code as assigned by the District Fiscal Office (71-89) L4 = Optional use by county public health unit as approved by the District Fiscal Office (limited to 52-89) L5 = Program Service Level and Program Component described below. A complete list of these codes is included at the end of this Attachment. L5 = 000 - Revenues from state and county sources for the general use of the county public health unit and which are available to specific Program Components as specified in the contract. All other revenues will be coded to the appropriate L5 code for the Service Level or Program Component as specified in the contract. Expenditures made specifically for any Program Component not expected to benefit any othE::r Program Component shall be coded to the specific L5 Organization Code representing the Program Component receiving the benefit. Allocpble expenditures will be charged to the following SAMAS accounts: Level 5 Code 000 Allocation Criteria Salaries, OPS (1200) Expenses and Operating Capital Outlay (other than those chargeable to General Administrative and Support Services) that will be allocated on the basis of time/cost percentages to the Program Components within the three major Levels of Service. 109 Expenses and OCO allocable only to Communicable Disease Control Program Components (L5 codes: 101 through 106) in proportion to the time/cost percentages determined for such Program Components. 175 Expense and OCO allocable only to Environmental Health Program Components (L5 codes: 143 through 174) in proportion to the time/cost percentages determined for such Program Components. 200 Expense and OCO allocable only to Personal Health Program Components (L5 codes: 201 through 299) in proportion to the time/cost percentages determined for such Program Components. 300 Expense and OCO allocable only to Primary Care Program Components (L5 codes: 301 through 399) in proportion to the time/cost percentages determined for such Program Components. -24- LevelS Code 400 491 495 Allocation Criteria Salaries and Other Expenditures for General Administrative and Support Services allocable to all other county public health unit Program Components (except codes L5 = 401 through 499) in proportion to the time/cost percentages determined for such Program Components. All expenditures charged to L5 = 400 and 491 will be added to those charged at Level 3 (L5 = 000) for allocaion. Inventory Administrative Services Local projects or sub-unit activities for any of the Program Components identified by the L5 codes may be identified at the county public health unit's option by the L4 Organization Codes. Such identification will allow the county public health unit to develop supplemental cost data from the SAMAS reports, but the county public health unit cost allocation system will ignore L4 codes in making its distributions to the Program Component accounts. Level 4 Level 5 CPHU Option Codes XX 000 XX 101 XX 102 XX 103 XX 104 XX 106 XX 107 XX 108 XX 109 XX 143 XX 144 XX 145 XX 146 XX 148 XX 150 XX 151 XX 152 XX 153 XX 154 XX 155 XX 157 XX 158 XX 159 XX 160 XX 161 XX 162 SAMAS CODES Public Health *CPHU Allocable Costs Immunizatior, Services Sexually Transmitted Disease Services (formerly VD) Acquired Immune Deficiency Syndrome (AIDS) Tuberculosis Control Services Communicable Disease Surveillance/Investigation *Communicable Disease Pharmacy *Communicable Disease Laboratory *General Communicable Disease Control Non-Communicable Disease Surveillance/Investigation Occupation Health Services Consumer Product Safety Emergency Medical Services Food Hygiene Food Hygiene Training Group Care F acili ties Migrant Lahor Camp Services Housing and Public Building Safety and Sanitation Mobile Home and Recreational Park Services Common Carrier Sanitation Private Water Systems Public Drinking Water Systems (Safe Drinking Water Act) Bottled Water Swimming Pools/Bathing Places Individual Sewage Disposal Public Sewage -25- Level 4 Level 5 CPHU Option Codes XX 163 XX 165 XX 166 XX 167 XX 168 XX 169 XX 170 XX 171 XX 172 XX 173 XX 174 XX 175 XX 180 XX XX XX XX XX XX XX XX XX XX XX XX XX XX XX XX XX 200 210 211 212 213 215 219 220 221 223 225 230 234 236 240 241 242 xx XX XX XX XX 300 329 337 338 339 XX XX XX 400 491 495 * Allocable Accounts Public Healtl1 Solid Waste Disposal Sanitary Nuisance Rabies Surveillance/Control Services Arbovirus Surveillance Rodent Control Arthropod Control Water Pollution Control Air Pollution Control Radiological Health Toxic Substances *Environmental Health Laboratory *General Environmental Health Vital Statistics Personal Health *General Personal Health Cardiovascular Disease Services Hypertension Diabetes Cancer Home Health Health Risk Reduction Nutrition WIC Family Planning Improved Pregnancy Outcome Infant, Child & Adolescent School Health Adult Health Dental Health *Personal Health Pharmacy *Personal Health Laboratory Primary Care *General Primary Health Care Program Child Primary Care Adult Primary Care *Primary Care Pharmacy *Primary Care Laboratory General Administrative and Support Services *General Administrative and Support Services *Inventory * Administrative Services -26- ;. ,___~~_-.ol-N;-......~...:I.:..........:-.'....._-~.:._',i'.:J" '. ,......,.~T.-~,,-,......-.....>o....:-~_ ATTACHMENT V STATE FEE SCHEDULES, BY SERVICE Level of Service/Service I . PUBLIC HEALTH Mobile Home & Recreational Vehicle Park: 6-10 spaces 11-50 spaces 51-200 spaces Over 200 spaces Swimming Pool Individual Sewage Disposal: Site Evaluation & Permits Reinspection Variance Aerobic Treatment Plant Fees ($10.00 of this & soil survey, Fee/Range 25.00 50.00 75.00 100.00 25.00 to 75.00 70.00-90.00 15.00 80.00 150.00 goes for research and is not in TF) SUBTOTAL II. PERSONAL HEALTH Family Planning Statewide Fee Schedules SUBTOTAL III. PRIMARY CARE N/A SUBTOTAL TOTAL STATE FEES 27 ~'-"-""'--'---"""~"'--='-~'>~'~''''---''''"''''--'- Estimated Annual Evenue Accruing To the CPHU Trust Fund 6,800. 10,575. 86,770. 3,150. 31,02l. 64,950. 203,266. 65,000. 65,000. -0- 268,266. ATTACHMENT VI COUNTY FEE SCHEDULES, BY SERVICE Level of Service/Service F ee/RanQe Estimated Annual Revenue Accruing To the CPHU Trust Fund I. Public Health STD Services TB (Skin Test Screening) Vital Records (Certified Copies) Pre-Marital Bllod Test $5.00-$10.00 $4.00 $3.00 $10.00 12,000. 1,600. 18,700. 660. Subtotal $ 32,960 II. Personal Health Infant, Child, Adolescent Health $0 - $12.00 28,000. School Physicals $16.00 Well-Child Clinic $8.00-$12.00 Adult Health 0 -$10.00 4,200. Dental Health $5.00 5,008. IPO: Initial visits $10.00 61 . Medication Handling Fees $ 2.00 608. Subtotal $ 38,418. III. Primary Care Adul t and Child o - $ 30.00 33,364. Subtotal $ 33,364. $ 104,742. Total County Fees -28- A IT ACHMENT VII CLASSIFICATION AND NUMBER OF EMPLOYEES WORKING IN THE COUNTY PUBLIC HEALTH UNIT WHO ARE PAID BY THE COUNTY. BY LEVEL OF SERVICE, if applicable Level of Service/Service Position Classification Number I. Personal Health NOT APPLICABLE II. Primary Care NOT APPLICABLE .29- A TT ACHMENT VIII FACILITIES UTILIZED BY THE CPHU Facility Description Location Annual Rental EQuivalent Value Owned By Key West Clinic Key West 120,000. Monroe County Mid Key Clinic Marathon 24,000. Monroe County Upper Keys Clinic Tavernier 24,000. Monroe County $ 168,000. Total Rental Facility Maintenance: Responsible Party: Monroe County (Department, County, Other Party) Maintenance Cost: $10,000. Maintenance Provider: Monroe County Public Works Department Total Rental and Maintenance $ 178,000. -30- AITACHMENT IX DESCRIPTION OF USE OF PUBLIC HEAL TH UNIT TRUST FUND BALANCES FOR SPECIAL PROJECTS, IF APPLICABLE (From Attachment II, Section I) NOT APPLICABLE -31- ..... . . . c: ~ I' N N co lI'l :::l r-t Ltl 0 ~ CO CO 0 CO CO l/l lI'l .-4 N E .. .. .. .. 0 lO .-i CO lO 0 <( M <<:I' 1.0 '" Q) :g > 5 :;) ::J ::J :;) ::J I- 0 :z:: :z:: :z:: :z:: :z:: - '" Z_ a. 0.. Po. 0.. 0.. Po. 0.. :Joo u u u u u u II 5 ~1-lL. I-l..... ;: <! en w:::l '" >I'= 0 I-u.... ell c:..... 5 .- o c -c: oeS:J a.Q) V')E u:Jf3 '" Q) o QJ ,-.. wa.ai '" U) U) U) '" U) U) U) - I>a> l:lO l:lO l:lO l:lO ~ ~ co E<! c: I-I-I 6 :z:: :z:: :z:: :z:: :z:: 0 Zo o c: 0 0 .0 0 0 ..... Z:J= co eo '" Q. -0..0 .....- 0 (/) U :::l c: 0 - w a. 0 X i=WCD u % -I.t: , ~I-I- N '" ~ 1-lL..t: , Uo 0\ <( lJ') 5 Iw'" I-_.t: 1-1- ... ...J-oo I- <!>Q) c:( ~-o I- c: Uctl +J +J +J +J +J +J U <( ,5 s:: c c s:: s:: s:: CD Q) CD ~ Q.l CD ::iW4. 8 8 8 8 8 8 coI..... Q) Q) CD Q) Q) CD :JI- 0 Q.l Q) CD CD Q) .,-i >, lo.l .. -0 > u CD 00 ..... lo.l III U) Ul Q) Q) Q) e s:: 00 > "0 U) en c: Ul 0 c: c: III CD 0 CD o,-i :::l ~ ..... >, ..c: u o,-i U +J lL. z 0 :J <! lr... \.I 0.. .,-i +J 'r-f III 0 0 ~ III > N Z Q) +J < . :;j lo.l 0 V') ~ ~ al e 0 Q) U . E-< +J ...:l 0 E-< H U) U) A TT ACHMENT XI PROGRAM SPECIFIC REPORTINCi REQUIREMENTS Some health services must comply with specific 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 Requirement 1. Sexually Transmitted Disease Program Morbidity, screening and surveillance reports specified by the department. ( 2. Dental Health Monthly reporting on HRSH Form 1008 and HRSM 50-H.' . 3. WIC Service documentation and monthly financial reports as specified in HRSM 150-24. 4. Improved Pregnancy Outcome Program Quarterly reports on services, results of services and expendi tures on HRSH 3096. 5. Improved Pregnancy Outcome! Vital Records Reporting Code all certificates of live birth and certificates of fetal death to delineate the source of the prenatal care as required in HRSM 150-13 and the Florida Vital Statistics Code Manual. 6. Family Planning Periodic financial and programmatic reports as specified in HRSM 150-27. 7. Immunization Periodic reports as specified by the department regarding the surveillance/investigation of reportable vaccine preventable diseases, vaccine usage accountability and the assessment of various immunization levels. 8. Primary Care Periodic financial and proqrammatic reports as specified in HRSM -33- A TT ACHMENT XII PROGRAMS REQUIRING COMPLIANCE WITH THE PROVISIONS OF SPECIFIC MANUALS Some health services must comply with the specifics of their program manual to satisfy federal and state law, regulation or rule. If the county public health unit contract includes funds to provide one of these programs, the county public health unit must comply with the details of the manual(s) related to that program. The programs and their required manual are as follows: Service ReQuire'Tlent 1. Improved Pregnancy Outcome HRSM 150-13, all other manuals pertaininQ to the IPO ProQram and March of Dimes TraininQ Module 5, Pre term Labor HRSM 150-25, including the require'Tlent for an annual plan as a condition for receipt of funding. . 2. School Health Services 3. Family Planning HRSM 150-27 and all other manuals pertaining to the Family Planning Program. HRSM 150-24, and all other manuals pertaining to the WIC program. 4. WIC 5. AIDS HRSM 150-30 -34- A IT ACHMENT XIII F AMIL Y PLANNING PROGRAM (This attachment must be completed by all county public health units) A. Special Provisions 1. The county public health unit will provide family planning services to the number of clients as stated on Attachment II, Section IV by September 30, 1987. 2. The county public health unit will assure that at least 90 percent of the clients served by the county public health unit in the family planning program have incomes at or below 150 percent of the OMB poverty guidelines. 3. The county public health unit will work to assure that 60 percent of family planning clients maintain a method of family planning for one year or until a pregnancy is desired. 4. The county public health unit will provide family pI :.ning for infor- mation/counseling to 90 percent of all Maternal and Child Heblth/IPO clients by September 30, 1987. 5. The county public health unit will work to assure that 75 percent of all IPO clients adopt a method of family planning in the postpartum period. 6. The county public health unit will work to assure that clients are being provided integrated services and receiving appropriate referrals to other programs. r 7. The county public health unit will report annually, or upon request, on information necessary to meet federal requirements, including the Family Planning Supplement, and on the goals and objectives listed in the Florida Statewide Plan for Family Planning Services. Data included in the CPHU Contract Management System will not be requested in these reports. 8. The planned budget for the county public health unit family planning program, by source of revenue, is included as part B of this Attachment. -35- . . . . M ~ n 0 M l/l CO M U'l l/l 0 .oct CO N ~ M l/l 0 a:r N r-t - .. .. .. .. .. .. <> )of ct= . b ~ ~ 0 0 me.. 0 0 0 0 ~ <1.1'0 .. .. <1.1 ... Ltl l/l = ~"" 1.0 lO E-- Z 0 U Cd - 0 tlD . :.. c ..~ -.2 - Q) &; -Q) lIlc ~i ,$I S 8 ci~a.. Q)~ 0 .bO>> . E 0 OQ)- ~ ~ i~ CD "/ c.. ....,.... 0 0 Q)CD~E rl ..... SblI 0: .c'Oo~ .. < .5 !... ~31~ ..... .-i OaCr... ..... r-f ~ Ze coo c: <tG _<<: 8Q) -Q. :ECD 05 I ~ . . U) <CIJ 0 0 ~'g "" c:a..2 CD 0 0 I Q -DI - 0 0 .... <>c: -0 ..2... - '... 0 A.,8 f E Q) 1:2 >>CD <<I.c: :::c ~~ zo SCDQ) - .... =0 < ~C: CD ~CCD {I) 0 - <<Ic= ~ ::J :S.... I "'0 ~s :eCj Q) a.. . Q) .c en C) (,l en ::3 >< CQ = CD ~ A. - . . . :x: - M ~ N 0 <<:I' l/l ,~ 0. .... >t e.- M Lfl <<:I' 0 M CO r-t 0 ~ M qo 0 I' N 0 ..... ~ .. .. .. .. .. .. .. .-4 Z Ltl qo r-- M 0 0 .-4 :;:) qo N CO lO qo >< 0 rl 111 U 0 ~ . ~ U) CQ ~ . ~ .... . ::J fIl .... 2- ~ ~ .~ '0 .3 oS~ H r... m C ::s ~ oS - (,l ... a.. c: ,... >1:- I O>>Q) !''''~ ~ < oft; 0 S c: -0 () "'0 '... Q) ~ - CD fIl'''' :s C:S~ -;:~2 C) Q) CO -- - c:r.!l <<! c:a.. <<I ..2 E-< 0 ... ::::c:o ~ Q) ~ ~ Q) _. 2ii.sS~ 'i: .a :: en ,- oS c:'" e ::J 8 ,... 8~ .g:l!~::s~ Q) .... a. ~ r... E-< a.. c.. 0 fI)_ F-oM :"eo or ATTACHMENT XIV ____ _,QVED PREGNANCY OUTCOME PROGRAM (IPO) A. The county public health unit shall: 1. Provide maternity services in accordance with HRSM 150-13. 2. Ensure that women whose income is at or below 100' of poverty are not charged a fee for services. a) Women whose income is above 100' of the Office of Management and Budget poverty guidelines and at or below 185\ of poverty will be charged a $10.00 one-time fee for IPO services. b) Women whose income is above 185\ of poverty are not eligible for the IPO Program. 3. Ensure that all applicants for IPO services are screened for possible eligibility for third party reimbursement and that providers bill third party payers for all clients determined eligible. . 4. Ensure that state and federal IPO funds will not be used to pay any hospital costs associated with any client's pregnancy. 5. Ensure that funds provided by the state, and any fees collected for IPO services provided, do not supplant funds from any other sources used to support IPO services proviaed by the CPHU and its subcontractors. 6. Input into the CIS/HMC system on a timely basis, the number of services provided and the number of clients served by all subcontractors who are funded by it to provide IPO services. 7. Provide outcome data required to complete the IPO quarterly status report according to the schedule specified by the Health Program Office. B. Special Requirements For Subcontractors: The following requirements shall be included in all subcontracts with any agency, organization or person whom the county public health unit funds to provide IPO services: 1. The subcontractor shall provide whatever service and client data the county public health unit requires to enable the county public health unit to enter this information for the subcontract into the CIS/HMC contract management system. The subcontractor shall submit such data in the format and according to the schedule specified by the county public health unit. 2. The subcontractor shall provide whatever outcome data the county public health unit requires to enable the county public health unit to complete its Quarterly IPO Status Reports. The subcontractor shall submit such data in the format and according to the schedule specified by the county public health unit. 3. The subcontractor shall comply with the personal health clinic standards and the IPO standards specified in the department's Performance Review System and HRSM 150-13. 4. Subcontracts with providers will be negotiated at the discretion of the CPHU Director. -37- ATTACHMENT XV PRIMAR Y CARE PROGRAM (This attachment must be completed for all county public health units which have a Primary Care Program funded in whole or in part by the Health Care Access Act, Subsection 409.266(6)(b), Florida Statutes. A. The county public health unit shall: 1. Provide the services according to the schedule of hours described, including 24 hour coverage. 2. Provide medical supervision as appropriate and approved by the department. 3. Conduct a quality assurance program satisfactory to the department. 4. Participate in program accreditation activities and costs as requested by the dp.partment with the objective of becoming accredited within five years of the program's inception. . 5. Pp.rticipate in the department's developmental activities related to a standard mE "iical records system that will be used by all primary care providers. 6. Make available to department representatives medical and dental records and any other files and records of program patients for review. 7. Provide the department with utilization, cost and revenue reports in the form and frequency specified by the department. 8. Charge fees for services rendered in accordance with a fee schedule approved by the county and the department and apply a schedule of discounts to fees charged to individuals with family incomes below 200 percent of the federal (OMB) poverty guidelines. Individuals with family incomes below 100% of the OMS poverty level must receive 100 percent discounts. 9. Ensure that funds provided by the Health Care Access Act for the primary care program and any fees collected for services provided in this primary care program do not supplant funds from any other sources used to support public health services provided by the contractor and its subcontractors. 10. Ensure that the primary care program is integrated with other County Public Health Unit programs and services to the maximum extent possible. Interprogram coordination and referral mechanisms will be used to ensure client access to programs and services for which clients are otherwise eligible. 11. Provide the Health Program Office in the department with copies of all subcontracts. -38- . Attachment XV Page Two 12. Identify the fees collected from the primary care program in its accounting system. Primary care fees collected by the county public health unit must be deposited in the County Public Health Unit Trust Fund and shall only be used to support the primary care program funded by this contract. Fees collected by any subcontractors must be used exclusively for the primary care program funded by this contract. All fees collected in excess of budgeted amounts must be used for the primary care program and as approved by the department through a contract amendment. -39- . A. BudQet (Complete for CPHU ProQrams) 1. Total amount of Florida Health Care Access Program contract: $334,690. 2. 3. 4. Total county and other funds: Total in-kind contributions: Total collections: Total amount of budget: $383,364. 515.310. fl.O FTE at Monroe CPHU) S33,~h4 5. B. BudQet (Combines CPHU and Subcontractor BudQets) 1. Total amount of Florida Health Care Access Program Contract: $334,690. 2. 3. 4. 5. Total county and other. funds: Total in-kind contributions: Total estimated collections: Total amount of budget: $ 33,364. $383.364. $ 15.310. (1.0 FTE at Monroe CPHU) C. Total Services and Units (Combine CPHU Subcontract) CPHU Subcontractors Totals 24.000 6.000 Services Units 6 , 000 * 18.000 6.000 o D. Sliding fee scale for the primary care program is attached. *Financia1 Screening Only -40- . PRIMARY CARE October 1 , 1986 Financial El igibi 1 ity-Fee Scal. Income Group Family A 8 C 0 E F G Siz." 1 ~ 5.360 5.361- 6.165- 6.969- 7,773 8,577- 1.10,721 6.164 6.968 7.772 8.~76 10.720 2 1- 7.240 7,241- 8,327- 9,413- 10,499- 11 ,585- 2.14,481 8,326 9,412 10,498 11 .584 14.480 3 1- 9,120 9,121- 10,489- 11 ,857- 13,225- '4,~93- 2..18,241 10.488 11 .856 13,224 14.592 18.240 4 1- 11 ,000 11,001- 12,651- 14,301- 15,951- 17,601- 2..22,001 12.650 14.300 15.950 17.600 22,000 5 1- 12,eSO 12,881- 14,E113- 16,745- 18,677- 20,609- 1.2 5 . 7 6 1 14.812 16.744 18.676 20.608 25.760 6 s.. 14,760 14,761- 16,975- 19,189- 21,403- 23,617- 1.29,521 16.974 1 9 . 1 88 21 .402 23,616 29,520 7 ~ 16,640 16,641- 19.137- 21,633- 24,129- 26.625- 2.33,281 19.136 21.632 24.128 26.624 33.280 8 s.. 18,520 18,521- 21 .299- 24.077- 26.855- 29,634- 1.37,041 21 .298 24.076 26.854 29.633 37,040 9 1- 20.400 20,401- 23 . ,4 6 1 - 26.521- 29.581- 32,641- 1.40,801 23,460 26,520 29,580 32.640 40,800 1 0 1- 22,2S0 22,281- 25.623- 28,965- 32,307- 35,649- 1.44,561 25,622 28.964 32,306 35.648 44.560 % Poverty: ~100 )100-115 )115-130 )130-145 )145-160 )160-200 )200 .=.=====c================================~==========E=====c====.=c~=.==== Fee Group A 8 C 0 E F G ========================================================================= Fee Percent DOI~ 20':/, 40% f 0'.1.: 80% 90% 100';' _==========================================s============================= ------------------------------------------------------------------------- Initial o S6 .'2 ..,8 .24 S27 $30 Office Visit o S4 S8 .12 $16 .18 .20 ------------------------------------------------------------------------- Limited Service o .3 .6 $9 .'2 .,3 .,5 ......=...==...===..............c==.....a.....:.......................... 41 ~ ATl'AOJMEm' XVI AIDS PATIENT CARE PROGRAM MONROE COUK'll' LINE ITEM BUDGET ." " Salaries: Other Personal Services: Expenses: A. Contractual Services: Administrative Assistant Physicians Coverage: Initial Follow-up Dental Services (Reverse Contract w/MCPHU) Clinical Psychologist Social Worker Hospice Care: Nursing 8,800 Homemaker Health Aide 3,600 Continuous Care (Terminal 3,600 Stage) SUBTOTAL HOSPICE CARE: CPA Record Audit Education: Client Education (Reverse contract w/MCPHU) B. Non Contractual Services: Administrative Supplies Transportation: Mileage for Volunteers Taxi Service Ambulance Air Transportation SUBTOTAL TRANSPORTATION: Medical Equipment Rental Education: Marketing Prescribed Drugs Temporary Shelter TOTAL EXPENSES: Operating Capital Outlay: Desk and Chair for Office Center TOTAL BUDGET 42 800 125 1,200 950 -0- -0- 9,000 4,250 900 1,750 2,525 6,000 16,000 4,000 4,000 2,500 3,075 5,000 4,000 8,000 3,500 74,500 500 75,000