HomeMy WebLinkAbout2016-136 CONTRACT BETWEEN
INDIAN RIVER COUNTY BOARD OF COUNTY COMMISSIONERS(tDGET00
nP � FO
AND
STATE OF FLORIDA DEPARTMENT OF HEALTH OCT 121016
FOR OPERATION OF THE
INDIAN RIVER COUNTY HEALTH DEPARTMENT
CONTRACT YEAR 2016-2017
This contract is made and entered into between the State of Florida, Department of Health
("State") and the Indian River County Board of County Commissioners ("County"), through
their undersigned authorities, effective October 1, 2016
RECITALS
A. Pursuant to Chapter 154, Florida Statutes, the intent of the legislature is to
"promote, protect, maintain, and improve the health and safety of all citizens and visitors of
this state through a system of coordinated county health department services."
B. County Health Departments were created throughout Florida to satisfy this
legislative intent through "promotion of the public's health, the control and eradication of
preventable diseases, and the provision of primary health care for special populations."
C. Indian River County Health Department ("CHD") is one of the created County
Health Departments.
D. It is necessary for the parties hereto to enter into this contract in order to ensure
coordination between the State and the County in the operation of the CHD.
NOW THEREFORE, in consideration of the mutual promises set forth herein, the
sufficiency of which are hereby acknowledged, the parties hereto agree as follows:
1. RECITALS. The parties mutually agree that the forgoing recitals are true and correct
and incorporated herein by reference.
2. TERM. The parties mutually agree that this contract shall be effective from October 1,
2016, through September 30, 2017, or until a written contract replacing this contract is
entered into between the parties, whichever is later, unless this contract is otherwise
terminated pursuant to the termination provisions set forth in paragraph 8. below.
3. SERVICES MAINTAINED BY THE CHD The parties mutually agree that the CHD
shall provide those services as set forth on Part III of Attachment II hereof, in order to
maintain the following three levels of service pursuant to section 154.01(2), Florida Statutes,
as defined below:
a. "Environmental health services" are those services which are organized and operated
to protect the health of the general public by monitoring and regulating activities in the
environment which may contribute to the occurrence or transmission of disease.
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Environmental health services shall be supported by available federal, state and local funds
and shall include those services mandated on a state or federal level. Examples of
environmental health services include, but are not limited to, food hygiene, safe drinking
water supply, sewage and solid waste disposal, swimming pools, group care facilities,
migrant labor camps, toxic material control, radiological health, and occupational health.
b. "Communicable disease control services" are those services which protect the health
of the general public through the detection, control, and eradication of diseases which are
transmitted primarily by human beings. Communicable disease services shall be supported
by available federal, state, and local funds and shall include those services mandated on a
state or federal level. Such services include, but are not limited to, epidemiology, sexually
transmissible disease detection and control, HIV/AIDS, immunization, tuberculosis control
and maintenance of vital statistics.
c "Primary care services" are acute care and preventive services that are made
available to well and sick persons who are unable to obtain such services due to lack of
income or other barriers beyond their control. These services are provided to benefit
individuals, improve the collective health of the public, and prevent and control the spread of
disease. Primary health care services are provided at home, in group settings, or in clinics.
These services shall be supported by available federal, state, and local funds and shall
include services mandated on a state or federal level. Examples of primary health care
services include, but are not limited to: first contact acute care services; chronic disease
detection and treatment; maternal and child health services; family planning; nutrition; school
health; supplemental food assistance for women, infants, and children; home health; and
dental services.
4. FUNDING. The parties further agree that funding for the CHD will be handled as
follows:
a. The funding to be provided by the parties and any other sources is set forth in Part II
of Attachment II hereof This funding will be used as shown in Part I of Attachment II.
i. The State's appropriated responsibility (direct contribution excluding any state
fees, Medicaid contributions or any other funds not listed on the Schedule C) as
provided in Attachment II, Part II is an amount not to exceed $2,874,970
(State General Revenue, State Funds, Other State Funds and Federal Funds listed on the
Schedule C). The State's obligation to pay under this contract is contingent
upon an annual appropriation by the Legislature.
ii. The County's appropriated responsibility (direct contribution excluding any fees,
other cash or local contributions) as provided in Attachment ll, Part II is an
amount not to exceed $602,829 (amount listed under the "Board of County
Commissioners Annual Appropriations section of the revenue attachment).
b. Overall expenditures will not exceed available funding or budget authority, whichever
is less, (either current year or from surplus trust funds) in any service category. Unless
requested otherwise, any surplus at the end of the term of this contract in the County Health
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Department Trust Fund that is attributed to the CHD shall be carried forward to the next
contract period.
c. Either party may establish service fees as allowed by law to fund activities of the CHID.
Where applicable, such fees shall be automatically adjusted to at least the Medicaid fee
schedule.
d. Either party may increase or decrease funding of this contract during the term hereof
by notifying the other party in writing of the amount and purpose for the change in funding. If
the State initiates the increase/decrease, the CHID will revise the Attachment II and send a
copy of the revised pages to the County and the Department of Health, Office of Budget and
Revenue Management. If the County initiates the increase/decrease, the County shall notify
the CHD. The CHD will then revise the Attachment II and send a copy of the revised pages
to the Department of Health, Office of Budget and Revenue Management.
e. The name and address of the official payee to whom payments shall be made is:
County Health Department Trust Fund
Indian River County Health Department
Accounts Receivable, 1900 27th Street
Vero Beach, FL 32960-3383
5. CHD DIRECTOR/ADMINISTRATOR. Both parties agree the director/administrator of
the CHD shall be a State employee or under contract with the State and will be under the
day-to-day direction of the Deputy Secretary for County Health Systems. The
director/administrator shall be selected by the State with the concurrence of the County. The
director/administrator of the CHD shall ensure that non-categorical sources of funding are
used to fulfill public health priorities in the community and the Long Range Program Plan A
report detailing the status of public health as measured by outcome measures and similar
indicators will be sent by the CHD director/administrator to the parties no later than October 1
of each year (This is the standard quality assurance "County Health Profile"report located on the Division of
Public Health Statistics and Performance Management Intranet site)
6. ADMINISTRATIVE POLICIES AND PROCEDURES. The parties hereto agree that
the following standards should apply in the operation of the CHD
a The CHD and its personnel shall follow all State policies and procedures, except to the
extent permitted for the use of County purchasing procedures as set forth in subparagraph
b., below. All CHD employees shall be State or State-contract personnel subject to State
personnel rules and procedures. Employees will report time in the Health Management
System compatible format by program component as specified by the State.
b. The CHD shall comply with all applicable provisions of federal and state laws and
regulations relating to its operation with the exception that the use of County purchasing
procedures shall be allowed when it will result in a better price or service and no statewide
Department of Health purchasing contract has been implemented for those goods or
services. In such cases, the CHID director/administrator must sign a justification therefore,
and all County purchasing procedures must be followed in their entirety, and such
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compliance shall be documented. Such justification and compliance documentation shall be
maintained by the CHD in accordance with the terms of this contract. State procedures must
be followed for all leases on facilities not enumerated in Attachment IV
c. The CHD shall maintain books, records and documents in accordance with the
Generally Accepted Accounting Principles (GAAP), as promulgated by the Governmental
Accounting Standards Board (GASB), and the requirements of federal or state law. These
records shall be maintained as required by the Department of Health Policies and
Procedures for Records Management and shall be open for inspection at any time by the
parties and the public, except for those records that are not otherwise subject to disclosure
as provided by law which are subject to the confidentiality provisions of paragraph 6.1., below.
Books, records and documents must be adequate to allow the CHD to comply with the
following reporting requirements:
i. The revenue and expenditure requirements in the Florida Accounting
Information Resource (FLAIR) System;
ii. The client registration and services reporting requirements of the minimum
data set as specified in the most current version of the Client Information
System/Health Management Component Pamphlet,
N. Financial procedures specified in the Department of Health's Accounting
Procedures Manuals, Accounting memoranda, and Comptroller's
memoranda;
iv. The CHD is responsible for assuring that all contracts with service
providers include provisions that all subcontracted services be reported to
the CHD in a manner consistent with the client registration and service
reporting requirements of the minimum data set as specified in the Client
Information System/Health Management Component Pamphlet.
d. All funds for the CHD shall be deposited in the County Health Department Trust Fund
maintained by the state treasurer. These funds shall be accounted for separately from funds
deposited for other CHDs and shall be used only for public health purposes in Indian River
County
e. That any surplus/deficit funds, including fees or accrued interest, remaining in the
County Health Department Trust Fund account at the end of the contract year shall be
credited/debited to the State or County, as appropriate, based on the funds contributed by
each and the expenditures incurred by each. Expenditures will be charged to the program
accounts by State and County based on the ratio of planned expenditures in this contract
and funding from all sources is credited to the program accounts by State and County. The
equity share of any surplus/deficit funds accruing to the State and County is determined each
month and at contract year-end. 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 until accounted for in a manner which clearly illustrates the amount which has been
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credited to each participating governmental entity. The planned use of surplus funds shall be
reflected in Attachment II, Part I of this contract, with special capital projects explained in
Attachment V.
f. There shall be no transfer of funds between the three levels of services without a
contract amendment unless the CHD director/administrator determines that an emergency
exists wherein a time delay would endanger the public's health and the Deputy Secretary for
County Health Systems has approved the transfer. The Deputy Secretary for County Health
Systems shall forward written evidence of this approval to the CHD within 30 days after an
emergency transfer.
g. The CHD may execute subcontracts for services necessary to enable the CHD to
carry out the programs specified in this contract Any such subcontract shall include all
aforementioned audit and record keeping requirements.
h. At the request of either party, an audit may be conducted by an independent CPA on
the financial records of the CHD and the results made available to the parties within 180
days after the close of the CHD fiscal year. This audit will follow requirements contained in
OMB Circular A-133 and may be in conjunction with audits performed by County
government. If audit exceptions are found, then the director/administrator of the CHD will
prepare a corrective action plan and a copy of that plan and monthly status reports will be
furnished to the contract managers for the parties.
i. The CHD shall not use or disclose any information concerning a recipient of services
except as allowed by federal or state law or policy.
j. The CHD shall retain all client records, financial records, supporting documents,
statistical records, and any other documents (including electronic storage media) pertinent to
this contract for a period of five (5) years after termination of this contract. If an audit has
been initiated and audit findings have not been resolved at the end of five (5) years, the
records shall be retained until resolution of the audit findings
k. The CHD shall maintain confidentiality of all data, files, and records that are
confidential under the law or are otherwise exempted from disclosure as a public record
under Florida law The CHD shall implement procedures to ensure the protection and
confidentiality of all such records and shall comply with sections 384 29, 381.004, 392.65
and 456.057, Florida Statutes, and all other state and federal laws regarding confidentiality.
All confidentiality procedures implemented by the CHD shall be consistent with the
Department of Health Information Security Policies, Protocols, and Procedures The CHD
shall further adhere to any amendments to the State's security requirements and shall
comply with any applicable professional standards of practice with respect to client
confidentiality.
I. The CHD shall abide by all State policies and procedures, which by this reference are
incorporated herein as standards to be followed by the CHD, except as otherwise permitted
for some purchases using County procedures pursuant to paragraph 6 b.
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m The CHD shall establish a system through which applicants for services and current
clients may present grievances over denial, modification or termination of services. The CHD
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 I of this contract.
n. The CHD shall comply with the provisions contained in the Civil Rights Certificate,
hereby incorporated into this contract as Attachment III.
o. The CHD shall submit quarterly reports to the County that shall include at least the
following:
i. The DE3851-1 Contract Management Variance Report and the DE580L1
Analysis of Fund Equities Report;
ii. A written explanation to the County of service variances reflected in the
year end DE3851-1 report if the variance exceeds or falls below 25 percent
of the planned expenditure amount for the contract year. However, if the
amount of the service specific variance between actual and planned
expenditures does not exceed three percent of the total planned
expenditures for the level of service in which the type of service is included,
a variance explanation is not required. A copy of the written explanation
shall be sent to the Department of Health, Office of Budget and Revenue
Management.
p. The dates for the submission of quarterly reports to the County shall be as follows
unless the generation and distribution of reports is delayed due to circumstances beyond the
CHD's control:
i. March 1, 2017 for the report period October 1, 2016 through
December 31, 2016;
ii. June 1, 2017 for the report period October 1, 2016 through
March 31, 2017;
iii. September 1, 2017 for the report period October 1, 2016
through June 30, 2017; and
iv. December 1, 2017 for the report period October 1, 2016
through September 30, 2017.
7. FACILITIES AND EQUIPMENT The parties mutually agree that
a. CHD facilities shall be provided as specified in Attachment IV to this contract and the
County shall own the facilities used by the CHD unless otherwise provided in Attachment IV.
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b. The County shall ensure adequate fire and casualty insurance coverage for County-
owned CHD offices and buildings and for all furnishings and equipment in CHD offices
through either a self-insurance program or insurance purchased by the County.
c. All vehicles will be transferred to the ownership of the County and registered as
County vehicles. The County shall ensure insurance coverage for these vehicles is available
through either a self-insurance program or insurance purchased by the County. All vehicles
will be used solely for CHD operations. Vehicles purchased through the County Health
Department Trust Fund shall be sold at fair market value when they are no longer needed by
the CHD and the proceeds returned to the County Health Department Trust Fund.
8. TERMINATION.
a. Termination at Will. This contract may be terminated by either party without cause
upon no less than one-hundred eighty (180) calendar days notice in writing to the other party
unless a lesser time is mutually agreed upon in writing by both parties. Said notice shall be
delivered by certified mail, return receipt requested, or in person to the other party's contract
manager with proof of delivery.
b Termination Because of Lack of Funds. In the event funds to finance this contract
become unavailable, either party may 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 to the other party's contract manager with proof of delivery.
c. Termination for Breach. This contract may be terminated by one party, upon no less
than thirty (30) days notice, because of the other party's failure to perform an obligation
hereunder Said notice shall be delivered by certified mail, return receipt requested, or in
person to the other party's contract manager with proof of delivery. Waiver of breach of any
provisions 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 this contract.
9. MISCELLANEOUS. The parties further agree:
a. Availability of Funds If this contract, any renewal hereof, or any term, performance or
payment hereunder, extends beyond the fiscal year beginning July 1, 2017, it is agreed that
the performance and payment under this contract are contingent upon an annual
appropriation by the Legislature, in accordance with section 287.0582, Florida Statutes.
b. Contract Managers. The name and address of the contract managers for the parties
under this contract are as follows:
For the State: For the County:
Mayur Rao Michael R Symkowski
Name Name
Business Manager Budget Director
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190027 th Street 1801 27th Street
Vero Beach, FI., 32960-3383 Vero Beach, FI., 32960-3383
Address Address
772-794-7464 772-567-8000 Ext. 1214
Telephone Telephone
If different contract managers are designated after execution of this contract, the name,
address and telephone number of the new representative shall be furnished in writing to the
other parties and attached to originals of this contract.
c. Captions. The captions and headings contained in this contract are for the
convenience of the parties only and do not in any way modify, amplify, or give additional
notice of the provisions hereof.
In WITNESS THEREOF, the parties hereto have caused this eight page contract, with its
attachments as referenced, including Attachment I (two pages), Attachment II (six pages),
Attachment III (one pages), Attachment IV (one pages), and Attachment V (one page), to be
executed by their undersigned officials as duly authorized effective the 1St day of October,
2016
BOARD OF COUNTY COMMISSIONERS STATE OF FLORIDA
FOR INDIAN RIVER COUNTY DEPARTMENT OF HEALTH
SIGNED BY: SIGNED BY-
NAME: Bob Solari T;onin`a`Is.�;o, NAME: Celeste Philip, MD, MPH
TITLE: Chairman J` �✓��`�-TITLE: Surgeon General and Secretary
s
DATE: September 13 2016% ? QATE: 9J �
'syo9y i+ o�aQ:
ATTESTED TO:
Jeffrey R. Smith Clerk of �irt,,&d d SIGNED BY:
- Z' /I
Comptrol , / 4�4L
,�v. NAME: Miranda C. Hawker, MPH
TITLE: Deputy Clerk TITLE: CHD Administrator
DATE: september 13, 2016 DATE: g13o /l(0
APPROVED AS TO FORM
AND LEGA
L SUFFICIENCY
BY 1/
DYLAN REINGOLD
COUNTY ATTORNEY 8
ATTACHMENT
INDIAN RIVER COUNTY HEALTH DEPARTMENT
PROGRAM SPECIFIC REPORTING REQUIREMENTS AND PROGRAMS REQUIRING
COMPLIANCE WITH THE PROVISIONS OF SPECIFIC MANUALS
Some health services must comply with specific program and reporting requirements in addition to the Personal Health
Coding Pamphlet(DHP 50-20), Environmental Health Coding Pamphlet(DHP 50-21)and FLAIR requirements because of
federal or state law, regulation or rule If a county health department 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 Requirements as specified in F.A.0 64D-3, F S 381 and F S 384
Program
2. Dental Health Periodic financial and programmatic reports as specified by the
program office
3 Special Supplemental Nutrition Service documentation and monthly financial reports as specified in
Program for Women, Infants and DHM 150-24'and all federal, state and county requirements
Children(including the WIC detailed in program manuals and published procedures
Breastfeeding Peer Counseling
Program)
4 Healthy Start/Improved Pregnancy Requirements as specified in the 2007 Healthy Start Standards and
Outcome Guidelines and as specified by the Healthy Start Coalitions in
contract with each county health department.
5 Family Planning Requirements as specified in Public Law 91-572,42 U S C 300, et
seq.,42 CFR part 59, subpart A, 45 CFR parts 74&92, 2 CFR 215
(OMB Circular A-110)OMB Circular A-102, F S 381 0051, F.A.0
64F-7, F.A.0 64F-16, and F.A.0 64F-19 Requirements and
Guidance as specified in the Program Requirements for Title X
Funded Family Planning Projects(Title X Requirements)(2014)and
the Providing Quality Family Planning Services(QFP)
Recommendations of CDC and the U S Office of Population Affairs
published on the Office of Population Affairs website.
Programmatic annual reports as specified by the program office as
specified in the annual programmatic Scope of Work for Family
Planning and Maternal Child Health Services, including the Family
Planning Annual Report(FPAR), and other minimum guidelines as
specified by the Policy Web Technical Assistance Guidelines.
6 Immunization Periodic reports as specified by the department pertaining to
immunization levels in kindergarten and/or seventh grade pursuant
to instructions contained in the Immunization Guidelines-Florida
Schools, Childcare Facilities and Family Daycare Homes(DH Form
150-615)and Rule 64D-3 046, F.A.0 In addition, periodic reports
as specified by the department pertaining to the
surveillance/investigation of reportable vaccine-preventable
diseases, adverse events, vaccine accountability, and assessment
of immunization
ATTACHMENT I (Continued)
Attachment-1-Page 1 of 2
levels as documented in Florida SHOTS and supported by CHID
Guidebook policies and technical assistance guidance.
7 Environmental Health Requirements as specified in Environmental Health Programs
Manual 150-4'and DHP 50-21'
8. HIV/AIDS Program Requirements as specified in F S 384.25 and F.A.0 64D-3 030
and 64D-3 031 Case reporting should be on Adult HIV/AIDS
Confidential Case Report CDC Form DH2139 and Pediatric
HIV/AIDS Confidential Case Report CDC Form DH2140
Requirements as specified in F.A.0 64D-2 and 64D-3, F S 381 and
F S 384 Socio-demographic and risk data on persons tested for
HIV in CHID clinics should be reported on Lab Request DH Form
1628 in accordance with the Forms Instruction Guide
Requirements for the HIV/AIDS Patient Care programs are found in
the Patient Care Contract Administrative Guidelines.
9 School Health Services Requirements as specified in the Florida School Health
Administrative Guidelines (May 2012) Requirements as specified
in F S 381 0056, F S 381 0057, F S 402.3026 and F.A.0 64F-6
10 Tuberculosis Tuberculosis Program Requirements as specified in F.A.0 64D-3
and F S 392.
11 General Communicable Disease Carry out surveillance for reportable communicable and other acute
Control diseases, detect outbreaks, respond to individual cases of
reportable diseases, investigate outbreaks, and carry out
communication and quality assurance functions, as specified in
F.A.0 64D-3, F S 381, F S 384 and the CHID Epidemiology Guide
to Surveillance and Investigations.
12. Refugee Health Program Programmatic and financial requirements as specified by the
program office
'or the subsequent replacement if adopted during the contract period.
Attachment-1-Page 2 of 2
ATTACHMENT II
INDIAN RIVER COUNTY HEALTH DEPARTMENT
PART I. PLANNED USE OF COUNTY HEALTH DEPARTMENT TRUST FUND BALANCES
Estimated State Estimated County
Share of CHD Trust Share of CHD Trust
Fund Balance Fund Balance Total
1 CHD Trust Fund Ending Balance 09/30/16
164,864 384,682 549,546
2. Drawdown for Contract Year
October 1, 2016 to September 30, 2017
(11,422) (17,604) (29,026)
3 Special Capital Project use for Contract Year
October 1, 2016 to September 30, 2017
4 Balance Reserved for Contingency Fund
October 1, 2016 to September 30, 2017
153,442 367,078 520,520
Special Capital Projects are new construction or renovation projects and new furniture or equipment associated with these projects, and mobile health vans
Attach ment_II_Part_I-Page 1 of 1
ATTACHMENT II
INDIAN RIVER COUNTY HEALTH DEPARTMENT
Part II,Sources of Contributions to County Health Department
October 1,2016 to September 30,2017
State CHD County_ Total CHD
Trust Fund CHD Trust Fund Other
(cash) Trust Fund .(cash) Contribution Total
1.GENERAL REVENUE-STATE
015040 AIDS PATIENT CARE 100.000 0 100.000 0 100,000
015040 CHD-TB COMMUNITY PROGRAM 31,938 0 31,938 0 31,938
015040 DENTAL SPECIAL INITIATIVE PROJECTS 5,806 0 5.806 0 5,806
015040 FAMILY PLANNING GENERAL REVENUE 38,250 0 38,250 0 38,250
015040 PRIMARY CARE PROGRAM 183,226 0 183,226 0 183,226
015040 SCHOOL HEALTH SERVICES-GENERAL REVENUE 136,867 0 136.867 0 136,867
015050 CHD GENERAL REVENUE NON-CATEGORICAL 1,274.666 0 1.274.666 0 1.274,666
GENERAL REVENUE TOTAL 1,770,753 0 1.770.753 0 1.770.753
2.NON GENERAL REVENUE-STATE
015010 STATE UNDERGROUND PETROLEUM RESPONSE ACT 2,381 0 2.381 0 2,381
015010 ENVIRO\14ENTAL BIOMEDICAL WASTE PROGRAM 9 569 0 9,569 0 9,569
NON GENERAL REVENUE TOTAL 11.950 0 11.950 0 11,950
3.FEDERAL FUNDS-STATE
007000 RYAN WHITE TITLE II ADAP DRUG REBATES 7.279 0 7,279 0 7,279
007000 AIDS DRUG ASSISTANCE PROGRAM ADMIN HQ 35.000 0 35,000 0 35,000
007000 WIC BREASTFEEDING PEER COUNSELING PROG 42.250 0 42,250 0 42.250
007000 COASTAL BEACH WATER QUALITY MONITORING 13,611 0 13.611 0 13.611
007000 COMPREHENSIVE COMMUNITY CARDIO-PHBG 35.000 0 35.000 0 35,000
007000 FAMILY PLANNING TITLE Y-GRANT 67 333 0 67,333 0 67,333
007000 IMMUNIZATION ACTION PLAN 14.880 0 14,880 0 14.880
007000 MCH SPEC PRJ SOCIAL DETERMINANTS HLTH COMM EDU 25.574 0 25,574 0 25,574
007000 BASE COMMUNITY PREPAREDNESS CAPABILITY 91.990 0 91,990 0 91,990
007000 BASE PUB HLTH SURVEILLANCE&EPI INVESTIGATION 78.852 0 78,852 0 78,852
007000 AIDS PREVENTION 56,405 0 56,405 0 56"405
007000 RYAN WHITE TITLE II GRANT/CHD CONSORTIUM 60,000 0 60,000 0 60,000
007000 WIC PROGRAM ADMINISTRATION 427.602 0 427,602 0 427,602
015075 SUPPLEMENTAL SCHOOL HEALTH 150.068 0 150,068 0 150.068
FEDERAL FUNDS TOTAL 1.105,844 0 1,105.844 0 1,105,844
4.FEES ASSESSED BY STATE OR FEDERAL RULES-STATE
001020 CHD STATEWIDE ENVIRONMENTAL FEES 126.834 0 126,834 0 126,834
001092 CHD STATEWIDE ENVIRONMENTAL FEES 301,763 0 301,763 0 301,763
001206 ON SITE SEWAGE DISPOSAL PERMIT FEES 19.623 0 19.623 0 19,623
001206 SANITATION CERTIFICATES(FOOD INSPECTION) 2,161 0 2,161 0 2,161
001206 SEPTIC TANK RESEARCH SURCHARGE 4.934 0 4.934 0 4.934
001206 SEPTIC TANK VARIANCE FEES 50% 240 0 240 0 240
001206 PUBLIC SWIMMING POOL PERMIT FEES-10%HQ TRANSFER 264 0 264 0 264
001206 DRINKING WATER PROGRAM OPERATIONS 459 0 459 0 459
001206 REGULATION OF BODY PIERCING SALONS 72 0 72 0 72
001206 TANiNING FACILITIES 192 0 192 0 192
001206 ONSITESEWAGETRAINING CENTER 42 0 42 0 42
001206 TATTO PROGRAM ENVIRONMENTAL HEALTH 773 0 773 0 773
Attachment-11—Part-11-Page 1 of 3
ATTACHMENT II
INDIAN RIVER COUNTY HEALTH DEPARTMENT
Part II,Sources of Contributions to County Health Department
October 1,2016 to September 30,2017
State CHD County Total CHD
Trust Fund CHD. Trust Fund Other
(cash) Trust Fund (cash) Contribution Total
001206 MOBILE HOME&RV PARK FEES 1.623 0 1,623 0 1.623
FEES ASSESSED BY STATE OR FEDERAL RULES TOTAL 458,980 0 458.980 0 458,980
5.OTHER CASH CONTRIBUTIONS-STATE:
0 0 0 0 0
090001 DRAW DOWN FROM PUBLIC HEALTH UNIT 11.422 0 11.422 0 11,422
OTHER CASH CONTRIBUTION TOTAL 1L422 0 11.422 0 11,422
6.MEDICAID-STATE/COUNTY
001057 CHD CLINIC FEES 0 220,690 220,690 0 220.690
001148 CHD CLINIC FEES 0 833,030 833.030 0 833.030
MEDICAID TOTAL 0 1,053,720 1.053.720 0 1,053,720
7 ALLOCABLE REVENUE-STATE:
001004 CHD STATEWIDE ENVIRONNIENTAL FEES 1,817 0 1,817 0 1,817
ALLOCABLE REVENUE TOTAL 1.817 0 1.817 0 1,817
8.OTHER STATE CONTRIBUTIONS NOT IN CHD TRUST FUND-STATE
ADAP 0 0 0 174.958 174.958
PHARMACY DRUG PROGRAM 0 0 0 15.553 15,553
WIC PROGRAM 0 0 0 1,901,087 1,901,087
BUREAU OF PUBLIC HEALTH LABORATORIES 0 0 0 21.632 21,632
IMMUNIZATIONS 0 0 0 448.132 448.132
OTHER STATE CONTRIBUTIONS TOTAL 0 0 0 2,561,362 2.561.362
9.DIRECT LOCAL CONTRIBUTIONS-BCC/TAX DISTRICT
008005 HUMAN AND CHILDRENS SERVICES PROGRAM 0 64.946 64.946 0 64,946
008005 CHD FEDERAL&LOCAL INDIRECT EARNINGS 0 11.446 11.446 0 11,446
008020 CHD LOCAL REVENUE&EXPENDITURES 0 2,450.727 2.450 727 0 2.450.727
008040 CHD LOCAL REVENUE&EXPENDITURES 0 602,829 602,829 0 602.829
DIRECT COUNTY CONTRIBUTIONS TOTAL 0 3.129,948 3,129,948 0 3,129.948
10.FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION-COUNTY
001025 CHD CLINIC FEES 0 5,071 5.071 0 5.071
001077 CHD CLINIC FEES 0 303,462 303,462 0 303,462
001094 CHD LOCAL ENVIRONMENTAL FEES 0 91,141 91.141 0 91,141
001110 N7ITAL STATISTICS CERTIFIED RECORDS 0 207,866 207 866 0 207,866
FEES AUTHORIZED BY COUNTY TOTAL 0 607,540 607 540 0 607 540
11.OTHER CASH AND LOCAL CONTRIBUTIONS-COUNTY
001029 CHD CLINIC FEES 0 129.921 129.921 0 129.921
001090 CHD CLINIC FEES 0 41,935 41.935 0 41,935
005000 CHD LOCAL REVENUE&EXPENDITURES 0 11.544 11.544 0 11,544
010300 DEP AGRMT INVENTORY ONSITE SEWAGE TREAT/DISP SYS 0 111,568 111.568 0 111,568
010400 CHD SALE OF SERVICES IN OR OUTSIDE OF STATE GOVT' 0 1.568 1.568 0 1.568
011000 REVENUE CONTRACT/.-MOA WINO REPORTING REQUIREMENT 0 15.040 15.040 0 15,040
Attachment-11-Part-ii-Page 2 of 3
AT-TACIMENT II _ e
INDIAN RIVER COUNTY�HEALTH DEPARTMENT
" Part
-
II;_Sources of Contributions to County Health Department
Obtober 1,2016.to Septembei 30,2017 -
" State CHD._ County- Total CHD ' -
` Trust Fund CHD Trust Fund ' Other '
(cash) Trust Fund .(cash) Contribution Total
011000 ST JOHNS RIVER WATER MANAGEMENT DISTRICT 0 26,707 26,707 0 26,707
011001 CHD HEALTHY START COALITION CONTRACT 0 2,503 2.503 0 2,503
090002 DRAW DOWN FROM PUBLIC HEALTH UNIT 0 17 604 17 604 0 17 604
OTHER CASH AND LOCAL CONTRIBUTIONS TOTAL 0 358.390 358.390 0 358.390
12.ALLOCABLE REVENUE-COUNTY
001004 CHD STATEWIDE ENVIRONMENTAL FEES 0 1.817 1.817 0 1.817
COUNTY ALLOCABLE REVENUE TOTAL 0 1.817 1.817 0 1,817
13.BUILDINGS-COUNTY
ANNUAL RENTAL EQUIVALENT VALUE 0 0 0 329,005 329,005
OTHER(Specify) 0 0 0 0 0
UTILITIES 0 0 0 181.645 181,645
BUILDING MAINTENANCE 0 0 0 133.134 133.134
GROUNDS MAINTENANCE 0 0 0 0 0
INSURANCE 0 0 0 0 0
OTHER(Specify) 0 0 0 0 0
OTHER(Specify) 0 0 0 0 0
BUILDINGS TOTAL 0 0 0 643.784 643.784
14.OTHER COUNTY CONTRIBUTIONS NOT IN CHD TRUST FUND-COUNTY
EQUIPMENT/VEHICLE PURCHASES 0 0 0 0 0
VEHICLE INSURANCE 0 0 0 0 0
VEHICLE MAINTENANCE 0 0 0 0 0
OTHER COUNTY CONTRIBUTION(SPECIFY) 0 0 0 0 0
OTHER COUNTY CONTRIBUTION(SPECIFY) 0 0 0 0 0
OTHER COUNTY CONTRIBUTIONS TOTAL 0 0 0 0 0
GRAND TOTAL CHD PROGRAM 3.360.766 5.151,415 8,512.181 3205.146 11.717,327
Attachment_II_Part_II-Page 3 of 3
ATTACHMENT II _
INDIAN RIVER COUNTY HEALTH DEPARTMENT
Part III,Planned Staffing.Clients,Services and Expenditures By Program Service Area Within Each Level of Service
October 1,2016 to September 30,2017
Quarterly Expenditure Plan
FTE's Clients Services/ lot 2nd 3rd 4th Grand
•(0.00) Units Visits (Whole dollars only)- State County Total
A. COMMUNICABLE DISEASE CONTROL.
BEMUNIZATION (101) 4.46 3,207 4,356 83,928 97,891 83,928 97,891 201,746 161,892 363,638
SEXUALLY TRANS.DIS. (102) 4.92 1,156 1.529 70,572 82,313 70,572 82.313 119,622 186,148 305,770
HIV/AIDS PREVENTION (03AD 1.70 14 210 25,109 29,287 25,109 29,286 108,754 37 108,791
HIV/AIDS SURVEILLANCE (03A2) 0.00 0 0 22 26 22 27 97 0 97
H1V/AIDS PATIENT CARE (03A3) 2.52 454 983 51,881 60.513 51,881 60,512 168,124 56,663 224,787
ADAP (03A4) 0.48 864 160 7,483 8,727 7,483 8,727 32,411 9 32,420
TUBERCULOSIS (104) 2.22 454 730 32.046 37.378 32,046 37,379 130,259 8,590 138,849
CON124.DIS.SURV (106) 2.19 0 997 35.450 41,348 35,450 41,347 153,595 0 153,595
HEPATITIS (109) 0.00 0 0 0 0 0 0 0 0 0
PREPAREDNESS AND RESPONSE (116) 1.83 0 123 36.600 42,690 36,600 42.690 158,580 0 158,580
REFUGEE HEALTH (118) 0.00 0 0 0 0 0 0 0 0 0
VITAL RECORDS (180) 1.14 6,100 18.743 15,297 17,843 15,297 17,843 0 66,280 66,280
COMMUNICABLE DISEASE SUBTOTAL 21.46 12,249 27,831 358.388 418,016 358,388 418,015 1,073,188 479,619 1,552,807
B. PRIMARY CARE:
CHRONIC DISEASE PREVENTION PRO (210) 0.75 2.143 378 13,048 15,218 13,048 15.218 47,939 8,593 56.532
ii'IC (21WD 8.01 4.154 23.714 110.072 128.386 110,072 128,385 476,915 0 476,915
TOBACCO USE INTERVENTION (212) 0.00 0 0 0 0 0 0 0 0 0
WIC BREASTFEEDING PEER COUNSELING (21W2) 1.00 0 2.695 11.273 13.149 11,273 13,148 48,843 0 48,843
FAMILY PLANNING (223) 9.16 1.602 2,700 131.210 153,040 131.210 153.041 125,773 442,728 568,501
IMPROVED PREGNANCY OUTCOME (225) 0.00 0 0 0 0 0 0 0 0 0
HEALTHY START PRENATAL (227) 0.14 45 126 1.506 1,756 1,506 1.756 0 6,524 6,524
COMPREHENSIVE CHILD HEALTH (229) 14.91 2.530 6,274 244,665 285,372 244,665 285.372 0 1,060,074 1,060,074
HEALTHY START CHILD (231) 0.02 1 4 214 250 214 250 0 928 928
SCHOOL HEALTH (234) 5.83 0 30,710 67.321 97,615 84,151 87,518 336,605 0 336,605
COMPREHENSIVE ADULT HEALTH (237) 32.29 4,127 11,308 560.806 654,112 560,806 654,112 194,647 2,235,189 2,429,836
COMMUNITY HEALTH DEVELOPMENT (238) 1.19 0 1,329 21,382 24.939 21,382 24.939 92,642 0 92,642
DENTAL HEALTH (240) 13.81 3,570 7,071 213.694 249,248 213,694 249.247 375,104 550,779 925,883
PRIMARY CARE SUBTOTAL 87 11 18.172 86.309 1,375,191 1,623,085 1.392,021 1,612,986 1,698,468 4,304,815 6,003,283
C. ENVIRONMENTAL HEALTH
Water and Onsite Sewage Programs
COSTAL BEACH MONITORING (347) 0.15 123 123 4,867 6,637 4,646 5,974 22,071 53 22,124
LIMITED USE PUBLIC WATER SYSTEMS (357) 0.35 37 531 5,715 6,665 5,715 6.665 12,931 11,529 24,760
PUBLIC WATER SYSTEM (358) 0.06 2 123 914 1,066 914 1,065 794 3,165 3,959
PRIVATE WATER SYSTEM (359) 1.21 45 1,651 15,365 20.217 72.643 22,643 15,872 64,996 80,868
ONSITE SEWAGE TREATMENT&DISPOSAL (361) 5.45 1.358 6,524 85.495 98.319 132.518 111.144 306,897 120,579 427,476
Group Total 7.22 1,565 8,952 112,356 132.904 166,436 147,491 358,565 200,622 559,187
Facility Programs
TATTOO FACILITY SERVICES (344) 0.08 0 37 939 1.712 1,270 1,601 5,497 25 5,522
FOOD HYGIENE (348) 0.74 103 510 12,158 14.151 12,158 14,181 52,405 273 52,678
Attachment-11-Part-111-Page 1 of 2
ATTACHMENT II
INDIAN RIVER COUNTY HEALTH DEPARTMENT
Part III,Planned Staffing.Clients,Services and Expenditures By Program Service Area•Within Each Level of Service "
October 1,2016 to September 30,2017
Quarterly Expenditure Plan
FTE's theats Services/ 1st 2nd 3rd 4th Grand '
(0.00) Units Visits (Whole dollars only) State County Total
BODY PIERCING FACILITIES SERVICES (349) 0.01 2 4 29 553 496 75 1,147 6 1,153
GROUP CARE FACILITY (351) 0.23 59 203 2,511 4,017 3,180 7,031 3.003 13,736 16,739
MIGRANT LABOR CAMP (352) 0.03 2 15 1,259 480 839 419 2,982 15 2,997
HOUSING R PUB.BLDG. (353) 0.10 1 23 2,448 1,913 689 2,601 18 7,633 7,651
MOBILE HOME AND PARR (354) 0.19 52 149 3,697 6.256 1,848 2,418 14,120 99 14,219
POOLSBATHING PLACES (360) 0.75 291 943 15,022 8,584 17 168 12,876 52,695 955 53,650
BIOMEDICAL WASTE SERVICES (364) 0.39 258 233 5,499 9,999 2,750 6,749 24,876 121 24,997
TANNING FACILITY SERVICES (369) 0.05 9 20 394 1,212 91 1,333 3,014 16 3.030
Group Total 2.57 777 2,137 43,956 48,907 40,489 49,284 159.757 22,879 182,636
Groundwater Contamination
STORAGE TANK COMPLIANCE SER\'ICES (355) 0.00 0 0 23 27 23 27 100 0 100
SUPER ACT SERVICES (356) 0.05 13 23 212 727 485 1.607 3,015 16 3,031
Group Total 0.05 13 23 235 754 508 1,634 3,115 16 3,131
Community Hygiene
COMMUNITY ENYVIR.HEALTH (345) 0.11 0 233 2,208 2.575 2.208 2,576 9,524 43 9,567
INJURY PREVENTION (346) 0.00 0 0 0 0 0 0 0 0 0
LEAD MONITORING SERVICES (350) 0.00 0 0 0 0 0 0 0 0 0
PUBLIC SEWAGE (362) 0.13 1,054 80 1,816 2,119 1,816 2,119 8 7,862 7.870
SOLID WASTE DISPOSAL SERVICE (363) 0.00 0 0 39 46 39 46 0 170 170
SANITARY NUISANCE (365) 0.16 30 9 2,730 2,503 1,707 4,437 3,527 7,850 11,377
RABIES SURVEILLANCE (366) 0.27 1 122 4,645 5.418 4,645 5,418 44 20,082 20,126
ARBORVIRUS SURVEIL. (367) 0.01 0 1 377 440 377 441 540 1,095 1,635
RODENTIARTHROPOD CONTROL (368) 0.00 0 0 91 107 91 107 131 265 396
WATER POLLUTION (370) 0.27 0 199 4,646 8,313 4,646 6,846 41 24,410 24,451
INDOOR AIR (371) 0.11 0 37 1,324 3,266 2,207 2,031 20 8.808 8,828
RADIOLOGICAL HEALTH (372) 0.00 0 0 9 11 9 12 0 41 41
TOXIC SUBSTANCES (373) 0.17 27 41 2,657 3,099 2.657 3,100 3.455 8,058 11,513
Group Total 1.23 1.112 722 20,542 27,897 20,402 27,133 17,290 78,684 95,974
ENVIRONMENTAL HEALTH SUBTOTAL 11.07 3.467 11,834 177,089 210,462 227,835 225,542 538,727 302,201 840,928
D. NONOPERATIONAL COSTS:
NONOPERATIONAL COSTS (599) 1.00 0 0 14,951 17,439 14,951 17,439 0 64,780 64,780
ENVIRONMENTAL HEALTH SURCHARGE (399) 0.00 0 0 6.684 6,380 9,115 8,204 30,383 0 30,383
MEDICAID BUYBACK (611) 0.00 0 0 5,000 5.000 5.000 5,000 20,000 0 20,000
NONOPERATIONAL COSTS SUBTOTAL 1.00 0 0 26,635 28,819 29,066 30,643 50,353 64,780 115,163
TOTAL CONTRACT 120.64 33,888 125,974 1,937,303 2,280.382 2.007,310 2,287,186 3,360,766 5,151,415 8,512,181
Attachment_II_Part_III-Page 2 of 2
ATTACHMENT III
INDIAN RIVER COUNTY HEALTH DEPARTMENT
CIVIL RIGHTS CERTIFICATE
The applicant provides this assurance in consideration of and for the purpose of obtaining federal grants, loans,
contracts (except contracts of insurance or guaranty), property, discounts, or other federal financial assistance to
programs or activities receiving or benefiting from federal financial assistance The provider agrees to complete
the Civil Rights Compliance Questionnaire, DH Forms 946 A and B (or the subsequent replacement if adopted
during the contract period), if so requested by the department.
The applicant assures that it will comply with
1 Title VI of the Civil Rights Act of 1964, as amended, 42 U S C , 2000 Et seq ,which prohibits
discrimination on the basis of race, color or national origin in programs and activities receiving or
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 financial assistance
5 The Omnibus Budget Reconciliation Act of 1981, P L. 97-35,which prohibits discrimination on the basis
of sex and religion in programs and activities receiving or 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 contracts,
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
appropriate judicial or administrative relief,to include assistance being terminated and further assistance
being denied
Atta&ment_III-Page 1 of 1
Attachment IV
Fiscal Year-2016 -2017
Indian River County Health Department
Facilities Utilized by the County Health Department
Complete Location Facility Description Lease/ Type of Complete SQ Employee
(Street Address,City,zip) And Offical Building Agreement Agreement Legal Name Feet Count
Name(if applicable) Number (Private Lease thru of Owner (FTE/OPS/
(Admin,Clinic,Envn Hlth, State or County,other- Contract)
etc.) please define)
Administration, HR, Clinic, Board of County
1900 27th Street, Vero Vital Statistics, Envn Commissioners for
Beach, Florida, 32960-3383 Health, WIC N/A County Owned Indian River County 36,475 131.8
4675 28th Court, Vero Beach, Indian River County Indian River County
Florida, 32967-1330 Clinic N/A Hospital District Hospital District 10,642 15
Facility -a fixed site managed by DOH/CHD personnel for the purpose of providing or supporting public health services. Includes county-owned, state-owned, and
leased facilites. Includes DOH/CHD warehouse and administrative sites. Includes facilities managed by DOH/CHD that may be shared with other organizations.
Does not include schools,jails or other facilities where DOH/CHD staff are out-posted or sites where services are provided on an episodic basis. Attachment_IV-Page 1 of 1
ATTACHMENT V
INDIAN RIVER COUNTY HEALTH DEPARTMENT
SPECIAL PROJECTS SAVINGS PLAN
CASH RESERVED OR ANTICIPATED TO BE RESERVED FOR PROJECTS
CONTRACT YEAR STATE COUNTY TOTAL
2015-2016* $ 0 S 0 S 0
2016-2017** $ 0 $ 0 S 0
2017-2018*** S 0 $ 0 S 0
2018-2019'*' S 0 $ 0 S 0
PROJECT TOTAL S 0 S 0 $ 0
SPECIAL PROJECTS CONSTRUCTION/RENOVATION PLAN
PROJECT NUMBER:
PROJECT NAME. NIA
LOCATION/ADDRESS:
PROJECT TYPE. NEW BUILDING ROOFING
RENOVATION PLANNING STUDY
NEW ADDITION OTHER
SQUARE FOOTAGE. 0
PROJECT SUMMARY Describe scope of work in reasonable detail.
Cash balance as of 9/30/16
'Cash to be transferred to FCO account.
***Cash anticipated for future contract years.
Attachment_V-Page 1 of 1