HomeMy WebLinkAbout2014-121041oq1-1oi4
CONTRACT BETWEEN ac) 1,4 - to I
INDIAN RIVER COUNTY BOARD OF COUNTY COMMISSIONERS
AND
STATE OF FLORIDA DEPARTMENT OF HEALTH
FOR OPERATION OF
THE INDIAN RIVER COUNTY HEALTH DEPARTMENT
CONTRACT YEAR 2014-2015
This agreement ("Agreement") is made and entered into between the State of Florida,
Department of Health ("State") and the Indian County Board of County Commissioners
("County"), through their undersigned authorities, effective October 1, 2014.
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 County Health
Departments created throughout Florida
D. It is necessary for the parties hereto to enter into this Agreement 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 Agreement shall be effective from
October 1, 2014, through September 30, 2015, or until a written agreement replacing this
Agreement is entered into between the parties, whichever is later, unless this Agreement
is otherwise terminated pursuant to the termination provisions set forth in paragraph 8,
below
3. SERVICES MAINTAINED BY THE CHID 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.
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 are 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 11, Part II is an amount not to exceed $ 2,936,640 (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 11, Part I I is an amount not
to exceed $534,521 (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 Agreement in the
2
County Health 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
CHD 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 Agreement 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 CHD 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 who payments shall be made is.
County Health Department Trust Fund
Indian River County Health Department
Accounts Receivable
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 Statewide Services. 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 CHD director/administrator must sign a justification therefore,
3
and all county -purchasing procedures must be followed in their entirety, and such
compliance shall be documented. Such justification and compliance documentation shall
be maintained by the CHD in accordance with the terms of this Agreement. 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 those
promulgated by the Generally Accepted Accounting Principles (GAAP) and 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.i.,
below. Books, records and documents must be adequate to allow the CHD to comply with
the following reporting requirements.
The revenue and expenditure requirements in the Florida Accounting
System Information Resource (FLAIR)
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 the core
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
4
remain in the trust fund until accounted for in a manner which clearly illustrates the amount
which has been 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 Statewide Services has approved the transfer The Deputy Secretary for Statewide
Services 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 Agreement 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 Agreement for a period of five (5) years after termination of this Agreement. 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. hereof
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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 Agreement.
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
DE3851-1 report if the variance exceeds or falls below 25 percent of the planned
expenditure amount 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.
0
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.
March 1, 2015 for the report period October 1, 2014 through
December 31, 2014,
n. June 1, 2015 for the report period October 1, 2014 through
March 31, 2015,
Iii. September 1, 2015 for the report period October 1, 2014
through June 30, 2015; and
iv December 1, 2015 for the report period October 1, 2014
through September 30, 2015
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.
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 Agreement 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
Agreement become unavailable, either party may terminate this Agreement 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 Agreement may be terminated by one party, upon no
less than thirty (30) days notice, because of the other party's failure to perform an
Vj
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 Agreement 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
Agreement.
9. MISCELLANEOUS The parties further agree:
a. Availability of Funds If this Agreement, any renewal hereof, or any term,
performance or payment hereunder, extends beyond the fiscal year beginning July 1,
2015, it is agreed that the performance and payment under this Agreement 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 Agreement are as follows -
For the State*
Mayur Rao
Name
Business Manager
Title
190027 th Street
Vero Beach, FI , 32960-3383
Address
772-794-7464
Telephone
For the County:
Jason Brown
Name
Budget Director
Title
1801 27th Street
Vero Beach, FI , 32960-3383
Address
772-567-8000 Ext 1214
Telephone
If different contract managers are designated after execution of this Agreement, 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 Agreement.
C. Captions. The captions and headings contained in this Agreement are for
the convenience of the parties only and do not in any way modify, amplify, or give
additional notice of the provisions hereof.
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In WITNESS THEREOF, the parties hereto have caused this 20 page agreement to be
executed by their undersigned officials as duly authorized effective the 1—qday of October, 2014
BOARD OF COUNTY COMMISSIONERS
FOR INDIAN RIVER COUNTY
SIGNED BY:
NAME: Peter D. O'Bryan
TITLE: Chairman
DATE: Spptpmher 9, 201A.-- I
Attest: Jeffrey R. Smith. Clerk of
NAME: Circuit Court and ComptroUw
TITLE:
Deputy Clerk
DATE: G 4
Y,I
STATE OF FLORIDA
TMENT, OF HEALTH
r i �
SIGNED BY:
NAME: John H. Armstrong, MD
TITLE: Surgeon General/Secretary of Health
I
DATE: 7/_S
,�
SIGNED BY:
NAME: Miranda C Hawker
TITLE: CHD Administrator
DATE: 9L�2I't%
ATTACHMENT I
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
Sexually Transmitted Disease Requirements as specified in F.A.0 64D-3, F S 381 and
Program F S 384
Dental Health Periodic financial and programmatic reports as specified by
the program office
Special Supplemental Nutrition Service documentation and monthly financial reports as
Program for Women, Infants specified in DHM 150-24" and all federal, state and county
and Children (including the WIC requirements detailed in program manuals and published
Breastfeeding Peer Counseling procedures.
Program)
4 Healthy Start/ Requirements as specified in the 2007 Healthy Start
Improved Pregnancy Outcome Standards and Guidelines and as specified by the Healthy
Start Coalitions in contract with each county health
department.
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
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.C. 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
0
0
10
11
12
ATTACHMENT I (Continued)
levels as documented in Florida SHOTS and supported by
CHD Guidebook policies and technical assistance guidance
Environmental Health Requirements as specified in Environmental Health Programs
Manual 150-4* and DHP 50-21*
HIV/AIDS Program Requirements as specified in F.S 384.25 and
F.A.C. 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 CHD 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.
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
Tuberculosis Tuberculosis Program Requirements as specified in F.A.0
64D-3 and F S. 392
General Communicable Disease Control Carry out surveillance for reportable communicable and other
acute 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 CHD
Epidemiology Guide to Surveillance and Investigations.
Refugee Health Program Programmatic and financial requirements as specified by the
program office
*or the subsequent replacement if adopted during the contract period
ATTACHMENT II
INDIAN RIVER COUNTY HEALTH DEPARTMENT
PART I. PLANNED USE OF COUNTY HEALTH DEPARTMENT TRUST FUND BALANCES
Estimated State
Share of CHID Trust
Fund Balance
1 CHID Trust Fund Ending Balance 09/30/14 78,336
2 Drawdown for Contract Year (47,305)
October 1, 2014 to September 30, 2015
3 Special Capital Project use for Contract Year 0
October 1, 2014 to September 30, 2015
4 Balance Reserved for Contingency Fund 31,031
October 1, 2014 to September 30, 2015
Estimated County
Share of CHID Trust
Fund Balance Total
1,372,327 1,450,663
(262,291) (309,596)
0 0
1,110,036 1,141,067
Special Capital Projects are new construction or renovation projects and new furniture or equipment associated with these projects, and mobile health vans
:i kvy !
INDIAN RTVZR COUNTY I RALTH DEPARTN ENT
Part A Seems of Contributions to Cow►ty Reaft D%wAmmt
October L 2014 to Sir 3% 2018
1. GENERAL REVENUE - STATE
015040 AIDS PATIENT CARE
015040 CHD - TB COMMUNITY PROGRAM
015040 DENTAL SPECIAL INITIATIVE PROJECTS
015040 FAMILY PLANNING GENERAL REVENUE
015040 PRIMARY CARE PROGRAM
015040 SCHOOL HEALTH SERVICES - GENERAL REVENUE
015040 DOH RESPONSE TO TERRORISM
015050 CHD GENERAL REVENUE NON -CATEGORICAL
GENERAL REVENUE TOTAL
2. NON GENERAL REVENUE - STATE
015010 STATE UNDERGROUND PETROLEUM RESPONSE ACT
015010 ENVIRONMENTAL BIOMEDICAL WASTE PROGRAM
NON GENERAL REVENUE TOTAL
3. FEDERAL FUNDS - STATE
007000 AIDS DRUG ASSISTANCE PROGRAM ADMIN
007000 BIOTERRORISM HOSPITAL PREPAREDNESS
007000 WIC BREASTFEEDING PEER COUNSELING PROG
007000 COASTAL BEACH WATER QUALITY MONITORING
007000 COMPREHENSIVE COMMUNITY CARDIO - PHBG
007000 FAMILY PLANNING TITLE X - GRANT
007000 PUBLIC HLTH INFRASTRUCTURE INDIAN RIVER
007000 IMMUNIZATION ACTION PLAN
007000 MCH SPECIAL PROJCT DENTAL
007000 PHP PUBLIC HEALTH PREPAREDNESS BASE ALLOC
007000 AIDS PREVENTION
007000 RYAN WHITE TITLE II GRANT/CHD CONSORTIAM
007000 WIC PROGRAM ADMINISTRATION
015075 SUPPLEMENTAL SCHOOL HEALTH
FEDERAL FUNDS TOTAL
4. FEES ASSESSED BY STATE OR FEDERAL RULES - STATE
001020 CHD STATEWIDE ENVIRONMENTAL FEES
001092 REVENUE CONTRACT/MOA W/NO REPORTING REQUIREMENT
001092 CHD STATEWIDE ENVIRONMENTAL FEES
001206 ON SITE SEWAGE DISPOSAL PERMIT FEES
001206 SANITATION CERTIFICATES (FOOD INSPECTION)
001206 SEPTIC TANK RESEARCH SURCHARGE
001206 PUBLIC SWIMMING POOL PERMIT FEES -10% HQ TRANSFER
001206 DRINKING WATER PROGRAM OPERATIONS
001206 REGULATION OF BODY PIERCING SALONS
001206 TANNING FACILITIES
State CHD
t essntg
Total em
Trust Fuad
CHI!
Trust Fwsd Other
(Dash)
Trust Fuad
(caaw COntr6uttion
Total
100,000
0
100,000
0
100,000
31,605
0
31,605
0
31,605
7,075
0
7,075
0
7,075
34,330
0
34,330
0
34,330
183,226
0
183,226
0
183,226
136,867
0
136,867
0
136,867
29,492
0
29,492
0
29,492
1,308,210
0
1,308,210
0
1,308,210
1,830,805
0
1,830,805
0
1,830,805
2,450
0
2,450
0
2,450
10,903
0
10,903
0
10,903
13,353
0
13,353
0
13,353
35,000
0
35,000
0
35,000
24,000
0
24,000
0
24,000
45,604
0
45,604
0
45,604
14,702
0
14,702
0
14,702
13,668
0
13,668
0
13,668
60,434
0
60,434
0
60,434
17,500
0
17,500
0
17,500
14,880
0
14,880
0
14,880
16,173
0
16,173
0
16,173
132,115
0
132,115
0
132,115
56,406
0
56,406
0
56,406
16,000
0
16,000
0
16,000
552,549
0
552,549
0
552,549
150,068
0
150,068
0
150,068
1,149,099
0
1,149,099
0
1,149,099
109,930
0
109,930
0
109,930
0
6,447
6,447
0
6,447
238,709
0
238,709
0
238,709
17,893
0
17,893
0
17,893
2,154
0
2,154
0
2,154
1,986
0
1,986
0
1,986
681
0
681
0
681
400
0
400
0
400
33
0
33
0
33
217
0
217
0
217
Page 1 of 3
ATTAINT H
INDIAN RIVER COUNTY HEALTH DEPARTMENT
Part A Seamen Of Coutr huboum to County health Ilep b=ut
Octobas L 2014 is Septamher 80, 2015
State CHD Couaip Total CHD
Truss Fund CHD Trust Fund Other
(COW Trust Fund (cash} Contribution Total
001206 ONSITE SEWAGE TRAINING CENTER
984
0
984
0
984
001206 TATTO PROGRAM ENVIRONMENTAL HEALTH
336
0
336
0
336
001206 MOBILE HOME & RV PARK FEES
1,944
0
1,944
0
1,944
FEES ASSESSED BY STATE OR FEDERAL RULES TOTAL
375,267
6,447
381,714
0
381,714
5. OTHER CASH CONTRIBUTIONS - STATE:
0
0
0
0
0
090001 DRAW DOWN FROM PUBLIC HEALTH UNIT
47,305
0
47,305
0
47,305
OTHER CASH CONTRIBUTION TOTAL
0
0
0
0
0
6. MEDICAID - STATE/COUNTY,
001078 CHD CLINIC FEES
0
24,347
24,347
0
24,347
001081 CHD CLINIC FEES
0
172,580
172,580
0
172,580
001082 CHD CLINIC FEES
0
194,400
194,400
0
194,400
001083 CHD CLINIC FEES
0
113,059
113,059
0
113,059
001087 CHD CLINIC FEES
0
32,339
32,339
0
32,339
001089 CHD CLINIC FEES
0
23,039
23,039
0
23,039
001192 CHD CLINIC FEES
0
287,394
287,394
0
287,394
001193 CHD CLINIC FEES
0
143,335
143,335
0
143,335
MEDICAID TOTAL
0
990,493
990,493
0
990,493
7 ALLOCABLE REVENUE - STATE:
018000 CHD GENERAL REVENUE NON -CATEGORICAL
1,000
0
1,000
0
1,000
MEDICAID TOTAL
1.000
0
1,000
0
1,000
8. OTHER STATE CONTRIBUTIONS NOT IN CHD TRUST FUND - STATE
ADAP
0
0
0
246,300
246,300
PHARMACY DRUG PROGRAM
0
0
0
63,633
63,633
STD
0
0
0
0
0
WIC PROGRAM
0
0
0
1,873,130
1,873,130
BUREAU OF PUBLIC HEALTH LABORATORIES
0
0
0
36,198
36,198
IMMUNIZATIONS
0
0
0
354,724
354,724
OTHER STATE CONTRD3UTIONSTOTAL
0
0
0
2,573,985
2,573,985
9. DIRECT LOCAL CONTRIBUTIONS - BCCITAX DISTRICT
008020 CHD LOCAL REVENUE & EXPENDITURES
0
1,948,380
1,948,380
0
1,948,380
008034 CHD LOCAL REVENUE & EXPENDITURES
0
534,521
534,521
0
534,521
008040 HUMAN AND CHILDRENS SERVICES PROGRAM
0
84,949
84,949
0
84,949
008040 CHD FEDERAL & LOCAL INDIRECT EARNINGS
0
0
0
0
0
DIRECT COUNTY CONTRIBUTIONS TOTAL
0
2,567,850
2,567,850
0
2,567,850
10. FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION - COUNTY
001060 VITAL STATISTICS CERTIFIED RECORDS
0
930
930
0
930
001077 CHD CLINIC FEES
0
425,505
425,505
0
425,505
001094 CHD STATEWIDE ENVIRONMENTAL FEES
0
75,805
75,805
0
75,805
Page 2 of 3
ATTAINT II
M AN RIVER COUNTY HEALTH DEPARTMENT
Pert U. B Mnm of Coutdbuiions to County Health Dsparism mt
Oetober I, 2014 to SWUmber 80, 2I16
Stale CHD County Total CHD
Timet Fund CHD Trust Fund Other
6W Trust Fund flus Combibution
001114 VITAL STATISTICS CERTIFIED RECORDS 0 32,903 32,903 0
001115 VITAL STATISTICS CERTIFIED RECORDS 0 165,172 165,172 0
001117 VITAL STATISTICS CERTIFIED RECORDS 0 1,867 1,867 0
FEES AUTHORIZED BY COUNTY TOTAL 0 702,182 702,182 0
11. OTHER CASH AND LOCAL CONTRIBUTIONS - COUNTY
001029 CHD CLINIC FEES
001090 CHD CLINIC FEES
005041 CHI) LOCAL REVENUE & EXPENDITURES
011000 CHD CLINIC FEES
011000 CHD CASH DONATION / NON-SPECIFIC
011000 CHD GENERAL REVENUE NON -CATEGORICAL
011000 ST JOHNS RIVER WATER MANAGEMENT DISTRICT
011000 UNITED WAY CONTRACTS WITH CHDS
011001 CHI) HEALTHY START COALITION CONTRACT
090002 DRAW DOWN FROM PUBLIC HEALTH UNIT
OTHER CASH AND LOCAL CONTRIBUTIONS TOTAL
12. ALLOCABLE REVENUE - COUNTY
COUNTY ALLOCABLE REVENUE TOTAL
13. BUILDINGS - COUNTY
ANNUAL RENTAL EQUIVALENT VALUE
OTHER (Specify)
UTILITIES
BUILDING MAINTENANCE
GROUNDS MAINTENANCE
INSURANCE
OTHER (Specify)
OTHER (Specify)
BUILDINGS TOTAL
14. OTHER COUNTY CONTRIBUTIONS NOT IN CHD TRUST FUND, COUNTY
EQUIPMENT / VEHICLE PURCHASES
VEHICLE INSURANCE
VEHICLE MAINTENANCE
OTHER COUNTY CONTRIBUTION (SPECIFY)
OTHER COUNTY CONTRIBUTION (SPECIFY)
OTHER COUNTY CONTRIBUTIONS TOTAL
GRAND TOTAL CHD PROGRAM
Tutsi
32,903
165,172
1,867
702,182
0 103,084
103,084
0
103,084
0 60,509
60,509
0
60,509
0 3,800
3,800
0
3,800
0 1,936
1,936
0
1,936
0 2,000
2,000
0
2,000
50 0
50
0
50
0 11,297
11,297
0
11,297
0 45,500
45,500
0
45,500
0 2,520
2,520
0
2,520
0 262,291
262,291
0
262,291
50 492,937
492,987
0
492,987
0 0
0
0
0
0 0
0
0
0
0 0
0
329,005
329,005
0 0
0
0
0
0 0
0
181,645
181,645
0 0
0
127,663
127,663
0 0
0
0
0
0 0
0
0
0
0 0
0
0
0
0 0
0
0
0
0 0
0
638,313
638,313
0 0
0
0
0
0 0
0
0
0
0 0
0
0
0
0 0
0
0
0
0 0
0
0
0
0 0
0
0
0
3,416,879 4,759,909 8,176,7883,212,298 11,389,086
Page 3 of 3
Page 1 of 2
ATTA.CHIdENT H
INDIAN RIVER
COUNTY HEALTH DEPARnI E''NT
Part N. Ph011120d Staffing Clients, Services and Expo
By Prqpm Service Area.
Within Rack Level of Service
October 1, 2014 to September $0,
2016
Quarterly fteaditure Plan
Fina
M13ta Servicest
hat
2nd
3rd
4th
Grand
(0.00)
Baits
Visite
(Whale dollars only)
State
County
Total
A. COMMUNICABLE DISEASE CONTROL.
IMNIUNIZATION (101)
4.74
4,380
5,884
96.776
82,929
96,776
96 739
171,017
202.203
353.220
SEXUALLY TRANS. DIS. (102)
4.42
1.081
1,447
67.227
57609
67.227
67.202
81,275
177.990
259,265
HIV/AIDS PREVENTION (03A1)
2.17
2
228
.33.266
28,506
'3:3266
3:3.252
127.307
983
128,290
HIV/AIDS SURVEILANCE (03A2)
0.10
0
0
1.008
86-1
1,008
1.008
3,839
49
:3.888
HIV/AIDS PATIENT CARE (03:131
'2.71
1,046
1.779
55,981
47,971
55.981
55.960
184.103
31.790
215.893
ADAP (03A4)
0.75
1
3
11.803
10,114
11,803
11 797
45,178
3:39
45.517
TUBERCULOSIS (104)
159
442
946
26,589
22,785
26.589
26,579
95.185
7.357
102,542
CONIM. DIS. SURV (106)
1.61
0
777
25.307
21,686
25,307
25.296
96.849
747
97 596
HEPATITIS (109)
000
0
0
0
0
0
0
0
0
0
PREPAREDNESS AND RESPONSE (116)
2.41
0
291
61.150
52,401
61 150
61.126
234.714
1.11:3
2:35.827
REFUGEE HEALTH (118)
0.00
0
0
0
0
0
0
0
0
0
VITAL RECORDS (180)
1.16
6,204
16.269
16.232
13,910
16.232
16,227
0
62.601
62.601
COMMUNICABLE DISEASE SUBTOTAL
21.66
13.156
27 624
395.3:39
:338,775
395.:339
:395,186
1,039 467
485.172
1,524.6.39
B. PRIMARY CARE:
CHRONIC DISEASE PREVENTION PRO (210)
0.15
721
175
3.222
2,761
3,222
3220
10,88:3
1.542
12.425
WIC (21W1)
10.99
4,359
3-1.331
166.509
142.685
166.509
166 444
637 083
5.064
642.147
TOBACCO USE INTERVENTION (212)
0.00
0
0
0
0
0
0
0
0
0
WIC BREASTFEF,DING PEER COUNSELING (21W2)
1.16
0
2,759
15 006
12,859
15,006
14,999
57,214
656
55.870
FAMILY PLANNING (223)
8.76
1.830
3,287
147 531
126.422
147,531
1-17 474
279 611
289.347
568.958
IMPROVED PREGNANCY OUTCOME (225)
0.00
0
0
0
0
0
0
0
0
0
HEALTHY START PRENATAL (227)
001
1
0
136
117
136
137
521
5
526
COMPREHENSIVE CHILD HEALTH (229)
19.96
4,355
10,179
349,888
299,827
349,888
349 754
0
1.349357
1.349 357
HEALTHY START CHILD (231)
0.00
0
0
1
1
1
0
0
3
3
SCHOOL HEALTH (234)
5.21
0
160.776
98.869
84,723
98.869
98.831
378,894
2,398
381.292
COMPREHENSIVE ADULT HEALTH (237)
2383
4,215
10.905
475,782
407,708
475,782
475.598
248,522
1.586.348
1,834.870
COMMUNITY HEALTH DEVELOPMENT (2:38)
0.41
0
0
7,978
6,8:37
7.978
7.975
:30,574
194
30 768
DENTAL HEALTH (240)
10.89
2,850
6,389
22:3.8.51
191,82:3
22:3.8.51
22:3,764
303,776
559 513
86:3.289
PRIMARY CARE SUBTOTAL
51.37
18.331
228,801
1,488.773
1.275,76:3
1.488,773
1,488.196
1,947078
:3.794.427
5,741.505
C. ENVIRONMENTAL HEALTH'
Water and Onsite Sewage Programs
COSTAI, BEACH MONITORING (347)
0.14
63
63
5.188
4,446
5,188
5.187
14.702
5.307
20009
LIMITED USE PUBLIC WATER SYSTEMS (357)
0.27
67
509
4.869
4,172
4.869
4.866
3.879
11,597
18 776
PUBLIC WATER SYSTEM (358)
0.07
1
104
1.189
1,019
1.189
1,187
0
4.584
4.584
PRIVATE WATER SYSTEM (359)
1.09
48
1 310
20.981
17,979
20.981
20,973
705
80.209
80 914
ONSITE SEWAGE TREATMENT & DISPOSAL (:361)
6.03
1.5.52
6,059
100.763
86,346
100763
1007,26
2:39 156
149 442
.388.598
Group Total
7 60
1,731
8.045
1:32.990
113.962
132,990
1:32.939
258.442
254.439
512.881
Facility Programs
TATTOO FACILITY SERVICES (344)
0.09
0
37
1679
1439
1679
1.679
3,225
3.251
6.476
Page 1 of 2
ATTACHK NT n
INDIAN RIVER COUNTY HEALTH D>3PARTmM
Parti IIS Planned SUf rW, Clients, Sernosa anti &penditures By, Prggratn Service Area Within FFch %vel of Service
October 1, 2014 to September 30, 2015
Quarterly I'enditur+e Plan
FTE's Clients Services/ tat 2nd 3rd 4th
(0.00) Unita Visits (Whole dollars only) State
FOOD HYGIENE (348)
052
94
441
9,461
8,107
9 461
9 457
19.954
BODY PIERCING FACILITIES SERVICES (:349)
0.05
20
:30
490
420
490
491
270
GROUP CARE FACILITY (351)
0.14
70
119
2.414
2,068
2.414
2.412
0
MIGRANT LABOR CAMP (352)
0.0:3
3
14
736
631
736
7:36
0
HOUSING & PUB. BLDG (:35:3)
0.06
0
19
1,137
975
1.137
1 1:37
118
MOBILE HOME AND PARK (354)
0 14
51
131
2.369
2.030
2.:369
2.369
9 1:3-1
POOLS/BATHING PLACES (360)
0.88
351
976
15,8:32
13.567
15.832
15.825
51,235
BIOMEDICAL WASTE SERVICES (364)
0.60
38.5
407
10,586
9,072
10.586
10.582
27952
TANNING FACILITY SERVICES (:369)
0.01
6
15
254
217
251
25:3
978
Group Total
2.52
980
2.189
41958
38.526
44,958
44.941
115.866
Groundwater Contamination
STORAGE TANK COMPLIANCE SERVICES (355)
SUPER ACT SERVICES (356)
Group Total
Community Hygiene
COMMUNITY ENVIR. HEALTH (345)
INJURY PREVENTION (:346)
LEAD MONITORING SERVICES (350)
PUBLIC SEWAGE (:362)
SOLID WASTE DISPOSAL SERVICE (363)
SANITARY NUISANCE (:365)
RABIES SURVEILLANCE (366)
ARBORVIRUS SURVEIL. (367)
RODENT/ARTHROPOD CONTROL (:368)
WATER POLLUTION (:350)
INDOOR AIR (371)
RADIOLOGICAL HEALTH (372)
TOXIC SUBSTANCES (37:3)
Group Total
ENVIRONMENTAL HEALTH SUBTOTAL
D. NONOPERATIONAL COSTS:
SPECIAL CONTRACTS (599)
ENVIRONMENTAL HEALTH SURCHARGE (399)
MEDICAID BITYBACIi (611)
NONOPERATIONAL COSTS SUBTOTAL
TOTAL CONTRACT
16,532
1.6'21
9.:308
2.8:39
-1.268
3
6.821
1'2.87-1
0
57.517
Grana.
Tata(.
36 486
1 891
9.:308
2.8:39
4.386
9 1:37
61.056
-40.8'26
978
173.38:3
0.01
0
0
1.424
1,221
1-42.4
1.424
0
5.493
5.493
0.14
32
60
2,358
2,020
2.358
2.356
2,450
6.642
9 092
0.15
:32
60
:3.782
3.241
3,782
:3.780
2,450
12.135
14.585
0.24
0
673
:3.502
3,001
3,502
'3,499
0
13.504
13.504
0.00
0
0
0
0
0
0
0
0
0
000
0
0
2
2
2
1
0
7
7
0.10
4
64
1.577
1,352
1.577
1.577
0
6.083
6.083
001
0
0
20:3
174
203
203
0
78:3
783
0.10
6
16
1,776
1,522
1,776
1.775
0
6.849
6849
0.26
41
113
4,744
4,066
4.744
4.743
0
18.297
18.297
0.00
0
0
154
1:32
154
154
0
594
594
0.01
0
3
Ito
120
140
141
0
541
541
0.25
0
142
4.84.3
4,150
4,843
4,84:3
0
18.679
18.679
0.10
0
24
1,780
1,525
1.780
1 778
6.417
416
6.863
0.00
0
0
0
0
0
0
0
0
0
0.24
1
15
4,241
3,635
1241
4.240
0
16.357
16.357
1:31
52
1.050
22,962
19,679
22.962
22.954
6,447
82,110
88.557
11.58
2,795
11,344
204,692
175.408
204.692
204.614
383,205
406.201
789 406
1.25
0
0
24.5.32
21.022
24,532
24.524
20.501
74,109
94.610
0.00
0
0
6.905
5.917
6,905
6.901
26628
0
26.628
000
0
0
0
0
0
0
0
0
0
1.25
0
0
:31437
26,939
31437
:31425
17 129
74.109
121.238
115.86
34,282
267769
2,120,241
1.816,885
2.120,241
2,119421
3,416,879
4.759.909
8.176.788
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
ATTACHMENT IV
INDIAN RIVER COUNTY HEALTH DEPARTMENT
FACILITIES UTILIZED BY THE COUNTY HEALTH DEPARTMENT
Facility
Description
Clinic, Dental, Vital Statistics,
Environmental Health, WIC,
Administrative Headquarters
36,475 sq. ft.
Gifford Health Center
10,642 sq ft
Location
190027 th Street
Vero Beach, FL 32960-3383
467528 th Court
Vero Beach, FL 32967-1330
Owned By
County of
Indian River
Indian River County
Hospital District
Co -Located Site:
WIC 21 South Cypress Street City Of Fellsmere
Fellsmere, FL 32948-6714
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
2013-2014' $ $ $ -
2014-2015** $ $ $ -
2015-2016'' $ $ $ -
2016-2017— $ $ $ -
PROJECT TOTAL $ - $ - $ -
SPECIAL PROJECT CONSTRUCTION/RENOVATION PLAN
PROJECT NUMBER. N/A
PROJECT NAME.
LOCATION/ ADDRESS.
PROJECT TYPE
NEW BUILDING ROOFING
RENOVATION PLANNING STUDY
NEW ADDITION OTHER
SQUARE FOOTAGE
PROJECT SUMMARY Describe scope of work in reasonable detail
START DATE (initial expenditure of funds)
COMPLETION DATE:
DESIGN FEES
$
CONSTRUCTION COSTS'
$
FURNITURE/EQUIPMENT
$
TOTAL PROJECT COST
$ -
COST PER SQ FOOT•
$ #DIV/0!
Special Capital Projects are new construction or renovation projects and new furniture or equipment
associated with these projects and mobile health vans.
*Cash balance as of 9/30/14.
**Cash to be transferred to FCO account.
***Cash anticipated for future contract years.