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HomeMy WebLinkAbout1999-263• • CONTRACT BETWEEN 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 1999-2000 This agreement ("Agreement") 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, 1999. RECITALS A. Pursuant to Chapter 154, F.S., 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. It is necessary for the parties hereto to enter into this Agreement in order to assure 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, 1999, through September 30, 2000, or until a written agreement replacing this d • t .. 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 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. 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, 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 2 • O 10/06/1999 1E1: 49 561-770-5,103 f P k- U. HEALTH DEPT, F'A t UC shall include services mandated on a state or federal level. Examples of primary health care services include, but are not l -mite, 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's, infants, and children; home health; and dental services. 4. FUNDING. The parties further agree that funding for the County Health Department will bQ 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 as provided in Attachment II, Part II is an amount notto exceed $3,525,773. The State'a obligation to pay under this contract is contingent upon an annual appropriation by the Legislature. ii. The County's appropriated responsibility as provided in Attachment II, Part II is an amount not to exceed $709,104. b. overall expenditures will not exceed available funding (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 County Health Department Trust Fund that i© attributed to the CUD 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. The amount and purpose of such fees are listed in Attachments IV and V of this Agreement. Where applicable, such fees shall be automatically adjusted to at least the Medicaid fee schedule. 3 d. Either party may increase or decrease funding of this Agreement during the term hereof. If the State initiates the increase/decrease, then the CHD will amend the core contract and send a copy of the revised contract pages to the County and the Department of Health, Office of Management and Budget within 30 days of the executed amendment to the core contract. If the County initiates the increase/decrease, then the County shall notify the CHD. The CHD will then amend the core contract and send a copy of the revised pages to the Department of Health, Office of Management and Budget within 30 days of the executed amendment to the core contract. e. The name and address of the official payee to who payments shall be made is: County Health Department Trust Fund Indian River County 1900 27th Street Vero Beach, FL 32960 5. CHD DIRECTOR. Both parties agree the director 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 State Health Officer. The director shall be selected by the State with the concurrence of the County. The director of the CHD shall insure that noncategorical sources of funding are used to fulfill public health priorities in the community and the State Strategic Plan. A report detailing the status of public health as measured by outcome measures and similar indicators will be sent by the CHD director to the parties no later than October 1 of each year. 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 Client 4 40 Information System/Health Management Component 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 must sign a justification therefor, 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 VI. c. The CHD shall maintain books, records and documents in accordance with those promulgated by the Generally Recognized Governmental Accounting Procedures and Governmental Accounting Standards Board, and the requirements of federal or state law. These records shall be maintained as required by HRSM 15-1 "Records Management Manual" 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 subparagraph i, 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 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; iii. Financial procedures specified in the Department's Accounting Procedures Manuals, Accounting memoranda, and Comptrollers memoranda; 5 40 i 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. The Indian River County Health Department Trust Fund shall maintain an average trust fund balance of no less than 816 of its annual operating budget. 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, then 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 4-terea't, shall r�iild lIl 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. The planned use of surplus funds shall be reflected in Attachment II, Part I of this contract, with special projects explained in Attachment VII. f. There shall be no transfer of funds between the three levels of services without a contract amendment duly signed by both parties to this contract and the proper budget amendments 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 Health has 6 4D i approved the transfer. The Deputy Secretary for Health 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 recordkeeping 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 manual A-133 and may be in conjunction with audits performed by county government. If audit exceptions are found, then the director 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 excepted 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 455.667, 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, dated September 1997, as amended, the terms of which are 7 40 0 incorporated herein by reference. 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. 1. 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. 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 DE385L1 Contract Management Variance Report and the DE580Ll Analysis of Fund Equities Report; ii. A written explanation to the county and department of service variances reflected in the DE385L1 report if the variance exceeds or falls below 25 percent of the planned expenditure amount. However, if the cumulative amount of the variance between actual and planned expenditures does not exceed one percent of the cumulative expenditures for the level of service in which the type of service is included, a variance explanation is not required; p. The dates for the submission of quarterly reports to the county shall be as follows unless the generation and 8 40 0 distribution of reports is delayed due to circumstances beyond the CHD's control: i. March 1, 2000 for the report period October 1,1999 through December 31, 1999; ii. June 1, 2000 for the report period October 1,1999 through March 31, 2000; iii. September 1, 2000 for the report period October 1, 1999 through June 30, 2000; and iv. December 1, 2000 for the report period October 1,1999 through September 30, 2000. 7. FACILITIES AND EQUIPMENT. The parties mutually agree that: a. CHD facilities shall be provided as specified in t Attachment VI to this contract and the county shall own the facilities used by the CHD unless otherwise provided in Attachment VI. b. The county shall assure 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 assure 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 CHD trust fund shall be sold at fair market value when they are no longer needed by the CHD and the proceeds returned to the CHD trust fund. 9 • :7 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, the State 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 my 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 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. 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, 1999, 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. Modification. This Agreement and its Attachments contain all of the terms and conditions agreed upon between the parties. Modifications of this Agreement shall be enforceable only when reduced to writing and signed by all parties. 10 c. Contract Managers. The name and address of the contract managers for the parties under this Agreement are as follows: For the State: Lori Judge Business Manager III Indian River County Health Department 1900 27`h Street Vero Beach, FL 32960 (561) 770-5405 For the County: Joseph Baird, Director office of Management and Budget Indian River County 1840 25`h Street Vero Beach, FL 32960 (561) 567-8000 ext. 214 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. d. 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. • ENTERED INTO AND AGREED between the parties hereto by the undersigned authorities, effective the I" day of October, 1999. BOARD OF COUNTY COMMISSIONERS FOR INDIAN RIVER �COUNTY SIGNED BY NAME. Kenneth Macht STATE OF FLORIDA DEPARTMENT OF HEALTH SIGNED BY:ilcl3c<i�. Robert G. Brooks, MD Secretary TITLE:Chair,Bd of Co Comm Board approved October 12, 1999 DATE: nr,ttitior 12 1999 DATE: ATTESTED. SIGNED :EIGiTYtCGi!!//2 �/ SIGNED BY: a iYCHD Direc 7LKline, inistrator NAME F'fRICIAM.HIUGELY NAME: ban RN TITLE:LiFfu7YCl.[F1K TITLE: IRCHD Administrator DATE: DATE: October 5, 1999 12 40 0 ATTACHMENT I 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 CIS/HMC minimum data set and the SAMAS 2.2 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 1. Sexually Transmitted Disease Program Dental Health 3. Special Supplemental Food Program for Women, Infants and Children. Improved Pregnancy Outcome Family Planning Requirement Requirements as specified in HRSM 150-22*. Requirements as specified in Policy 87-7-5 regarding State Health Office STD Program review and approval of personnel/budget actions. Monthly reporting on HRSH Form 1008*. Service documentation and monthly financial reports as specified in HRSM 150-24* and all federal, state and county requirements detailed in the program manuals and published procedures. Requirements as specified in HRSM 150-13A*. Quarterly reports of services and outcome on HRSH Form 3096*. Program Quarterly Progress Report, Quarterly Summary Report, Presumptive Eligibility/ Medicaid Determination Log by all providers authorized to determine presumptive eligibility. Periodic financial and programmatic reports as specified in HRSM 150.27*. 40 6 ATTACHMENT I (Continued) Immunization Periodic reports as specified by the department regarding the surveillance/investigation of reportable vaccine preventable diseases, vaccine usage accountability, the assessment of various immunization levels and forms reporting adverse events following immunization. 7. CHD Program 8. Chronic Disease Program 9. Environmental Health 10. AIDS Program Requirements as specified in HRSM 150-3* and HRSM 50-9*. Requirements as specified in the Reference Guide to CHIP and HRS* forms identified in HRSM 150-8* and 150-12*. Requirements as specified in HRSM 50-10*. Requirements in HRSM 150-30* and case reporting on CDC Form 50.42. Socio -demographic data on persons tested for HIV in CHD clinics should be reported on CDC HIV Counseling & Testing Report Form. These reports are to be sent to the Headquarters AIDS office within 30 days of the initial post-test appointment regardless of clients' return. _11_ Rrhool Health Services HRSM 150-25*, including the requirement for an annual plan as a condition for funding. *or the subsequent replacement if adopted during the contract period. 40 e j \ § § @ / 2 m cu .r - LL 0 LLS j)o #ee fi m w»m Cl \ k \ � N m °�) %§ U-\\ /f§§ / 0 E 2 \a)=b[ o /}) ®{ kE {t3 .2 8'cc �& �k 3\) k§ &$ 3jun \ )2] r- Vr- 2 0 m CV) G& / {/E 27{7\k> § %E \/ /\ )wq, _G�®[mak 5� c= S mir c 7) j\\\ 00 wo D-0 N m °�) /f§§ 2Q.) k o /}) � .2 8'cc (f\o 3jun \ r- Vr- 2 0 m CV) 27{7\k> § ; �' a- _G�®[mak §k/k)�� j /\j\ \ D-0 CL k 2k \ \; kEE I)7�coo. kms f ¥§a;k \ CO :3 \ \ /\M�\�\ �cc k �)\(\\ cu £mE=_&m \ ± _oob c & coo (dj E \ CL W - C E M 1 - 0 Ln os E 2/w)§° ) .�.\o-e { /2f/)ƒ{ g - 0 CL Cl) \)�§�){ § E \2,2222 ,. \ (\§ / 2 _ �- co \[ ° \�/{// §k/ S)§\ E7 $ f $c k)8 �J/&t10 \} < ATTACHMENT lI INDIAN RIVER COUNTY HEALTH DEPARTMENT Part 11. Snurces of rontributinne to County Health Oenartmrpt CHD Trust Fund (cash) Other Contributions Total STATE 1. GENERAL REVENUE 015050 ALG/Conlribulions To CHD (050329) 775.030 0 775,030 015050 ALG/Contr. To CHDs-.5% Holdback (050329) 0 0 0 015011 ALG/Cont to CHD Primary Care (050329) 15,789 0 15,789 015065 ALG/Cont to CHD AIDS Prev & Surv(050329) 0 0 0 015050 ALG/Cont to CHD Mig Lbr Camp San(050329) 3.032 0 3,032 015050 ALG/Cont to CHD Home 111th Pilot Proj (050329) 0 0 0 015050 Sovereign Immunity (050329) 0 0 0 015050 ALG/Cool to CHDs Pinellas Indigent Dentl Clinic -UF (050329) 0 0 0 015050 ALG/Cont to CHDs-Dental Praogram (Cat. 050329) 0 0 0 015050 ALG/Cont to CHD Immun Outreach (050329) 20,400 0 20,400 015050 ALG/Cont to CHD Comm TB Program (050329) 70,586 0 70,586 015050 ALG/Cont to CHD Indoor Air Assist(050329) 25,039 0 25,039 015050 ALG/Cont to CHD Fant Trans PRG (050329) 0 0 0 015050 ALG/Palm Beach CND -Health Program Office Staff (050329) 0 0 0 015050 ALG/Cesspool Identification and Elimination (Cat 050329) 0 0 0 015048 ALG/Cont to CHD STD Program (050329) 0 0 0 015050 Improve Overall Health of Fla. Comm. St. Lucie (050329) 0 0 0 015037 ALG/Cont to CHDs Mtml & Chid HIth Field StaffCost(05 0 0 0 015050 Epidemiology Traning & Clinical Support (CAT. 050329) 0 0 0 015123 ALG/Family Planning (05000 1) 33,701 0 33,701 015123 ALG/ramily Planning Planned Parenthood NE FL (CAT. 050001) 0 0 0 015123 ALG/Family Planning (CAT. 050001) - Alachua Colposcopy 0 0 0 015065 ALG/Cont to CHD AIDS Pat Care (050026) 0 0 0 015115 ALG/School Health Services (05 1106) 56,607 0 56,607 015140 ALG/School Health Suppl. (051106) 162,945 0 162,945 015124 ALG/IPO-Healthy Start/IPO (050707) 144,440 0 144,440 015124 ALGAPO-Infant Morality Project (CAT. 050707) 0 0 0 015124 ALGAPO - Outreach Social Workers (CAT. 050707) 0 0 0 015137 ALGAPO Healthy Stan Resource Moms & Dads (050707) 0 0 0 015137 ALGAPO Healthy Stan Incr Matemal Health Care (050707) 0 0 0 015137 ALGAPO-Healthy Start -Data Collect. Prj Staff (CAT. 050707) 0 0 0 015124 ALG/MCII-Hcalthy Start/IPO (050870) 5,452 0 5,452 015124 ALG/IPO Outreach Social Workers (CAT 050870) 24,000 0 24,000 015124 ALG/MCII-Infant Mortality Project (CAT. 050870) 0 0 0 015123 Planned Parent Hood - Collier and Sarasota (CAT. 050329) 0 0 0 015029 AIDS/Drugs Reimb. One Time Transfer (CAT I80000/FG TF) 0 0 0 015115 G/A Eye Exams NASA -School Health Occular Sem. (050063) 0 0 0 W5012 uIA Epilepsy Services (01_0082) 0 0 0 015011 ALG/Primary Care (05033 1) 204,314 0 204,314 GENERAL REVENUE TOTAL 1,541,335 0 1,541,335 2. NON GENERAL REVENUE 015010 ALG/Contr. to CHDs-Rebasing (CAT. 050329) Tobacco TF 27,287 0 27,287 015072 ALG/Cont to CI ID Safe Drinking Water -DEP 0 0 0 015026 ALG/Cont to CHD Bio -Medical Waste (DEP) 7,932 0 7,932 015170 Tobacco Coordination (CAT. 105014) Tobacco TF 46,034 0 46,034 015172 Full Service Schools - Tobacco (CAT 102258) Tobacco Tr 91,459 0 91,459 015174 Basic School Health - Tobacco (CAT 051106) Tobacco TF 13,394 0 13,394 015016 GIA Epilepsy Prev, and Educ (CAT. 050083) /Epilepsy TF 0 0 0 015010 Food Hygiene Program 0 0 0 015010 Health Services in Model Cily-Dade County 0 0 0 015084 Varicella Immunization Requirement (CAT 050329) Tobacco TF 6,098 0 6,098 015010 SUPER Act Program (CAT. 050329) Adm TF 0 0 0 015020 Food and Waterbome Disease Program (CAT. 050329) Adm TF 0 0 0 015010 Hlth Svcs for Elderly-Medivan Proj-Broward (050329) Tob. TF 0 0 0 40 ATTACHMENT II INDIAN RIVER COUNTY HEALTH DEPARTMENT Part 11. Sources of Contributions to County Health Department CHD Trust Fund (cash) Other Contributions Total STATE 2. NON GENERAL REVENUE 015010 Pasco CHD Dental Program (CAT 050329) Tobacco TF 0 0 015010 Breast & Cerv. Cancer-Prtshp Prj- Hfllsbor.(052250) Tob.TF 0 0 0 015010 Dunbar Center - Lee County - Lee, CHD (CAT 052250) Tob. TF 0 0 0 015010 Prim Care Outrch-Pnllas/Suncst.Cm Ilsp Res.Pro(052250)Tob TF 0 0 0 015010 Prj SOAR -filthy Mthrs/Hlthy Babies-Plm Bch CHD(052250)Tob TF 0 0 0 015010 Leon County Mobile Health Unit (CAT 052250) Tobacco TF 0 0 0 015010 Telemed Pilot-Plm Bch Cty - Palm Belt CHD (052250) Tob TF 0 0 0 015029 Radiation ProtectionTF/X-Ray Inspection (CAT. 180000) 0 0 0 015029 Radiation Prot. TF/Rad Lie Fee Transfer (CA r. 180000) 0 0 0 011055 Other Grants DOE 0 0 0 015113 SPL Program HRS Reimb 0 0 0 010304 Stationary Pollutant Storage -DEP 77,000 0 77,000 015020 Transfers Interagency 0 0 0 015121 Super Act Transfers 0 0 0 NON GENERAL REVENUE TOTAL 269,204 0 269,204 3. FEDERAL FUNDS 007051 FG TF WIC Admin Transfer (050329) 266,748 0 266,748 015075 FG TF Family Trans Program (050329) 0 0 0 007135 Abstinence Grant Education Program 0 0 0 007065 FG TF AIDS Prevention (050329) 20,148 0 20,148 007064 FG TF AIDS Surv/Setup (050329) 0 0 0 007066 FG TF Ryan White (050329) 0 0 0 007066 FG TF Ryan White- AIDS Drug Assist Program Admin. (050329) 20,000 0 20,000 007062 FG TF/ AIDS Epid research Study (050329) 0 0 0 007049 Cont to CHDs - STD Chlamydia Study (CAT 050329) 0 0 0 007049 FG TF/ALG Contr to CHDs-STD Program (050329) 20,087 0 20,087 007067 FG TF/ALG/Conn to CHDs-Community TB (050329) 0 0 0 007084 Immunization Special Project 3,305 0 3,305 007084 FG TF/ALG/Contr to CHDs-Immunization Action Plan (050329) 16,107 0 16,107 007085 FG TF/ Breast and Cervical Cancer Grant 0 0 0 007084 FG TF/ALG/Contr to CHDs-Project Field Staff(050329) 0 0 0 007084 ALG/Contr. to CHDs-Immun. Action Plan - WIC-lmm Linkages 0 0 0 007000 Brain Injury Prevention Program (CAT. 000700) 0 0 0 007133 Family Planning Title X,(050001) 0 0 0 007133 Fam Planning Title X Spec Proj (050001) 20.942 0 20,942 00071333 Family Planning 1life X Sterilzations (50001) 26,670 0 26,670 015075 ALG/Family Planning - Pregnancy Prev - TANF (CAT 050001) 13,268 0 13,268 007127 MCH BLK Grt. Child Health (050870) 10,535 0 10,535 007127 MCH BLK On. Child Hlth (Ages 0.1 YR),(050870) 3,474 0 3,474 007134 ALG/MCH-MCHBG filthy StafU1P0 (050870) 20.416 0 20,416 007134 ALG/MCH-MCHBG Outr. Soe Workers (050870) 0 0 0 007134 MCH BLK Grt: IPO Infant Mort. Proj. (050870) 0 0 0 007132 MCH BLK Grt. Dental Projects (050870) 47,500 0 47,500 007134 ALG/IPO/MCH-Infant Mortality Project (CAT. 050707) 0 0 0 007134 ALG/IPO/MCH Outr Social Workers (050707) 0 0 0 007134 ALG/IPO-MCH Blk. Grt: IPO (CAT. 050707) -Gadsden Sch Clinic 0 0 0 007134 ALG/IPO-MCHBG filthy Stan/1P0 (050707) 19,044 0 19,044 007058 FG TF/Diabetes Control 0 0 0 007071 FG TF EPI Res Stud. of AIDS/HIV (180000) 0 0 0 007063 PHBG HERR Chronic Dis Init (101505) 89,105 0 89,105 007133 Planned Parenthood 0 0 0 007030 PREV HLTH BLK GRT -Migrant Labor (180000) 1,677 0 1,677 007000 Phiesteria Related Illness Sury & Prev (180000) 0 0 0 007056 FG TF Health Program for Refug. (180000) 0 0 0 C ATTACHMENT 11 INDIAN RIVER COUNTY HEALTH DEPARTMENT Part 11. Sources of Contributions to County Health Deuartment CIID Trust Fulid (cash) .Other Contributions :Total STATE 3. FEDERAL FUNDS 007044 PREV HI.TII BLK GRT -Rape Awareness(180000) 0 0 0 015075 Transfer -FED Grants other Agencies 0 0 0 015060 Entrant Reimb. Transfer 0 0 0 FEDERAL FUNDS TOTAL 599,026 0 599,026 4. FEES ASSESSED BY STATE OR FEDERAL RULES 001091 Communicable Disease Fees 0 0 0 001092 Environmental Health Fees 202,202 0 202,202 001113 Mobile Home and Parks 12,865 0 12,865 001132 Food Hygiene Permit 11,796 0 11,796 001133 OSDS Repair Permit 0 0 0 001134 OSDS Permit Fee 0 0 0 001211 Safe Drinking Water 0 0 0 001136 1& M Zoned Operating Permit 0 0 0 001137 Aerobic Operating Permit 0 0 0 001138 Septic Tank Site Evaluation 0 0 0 001139 Migrant Housing Permit 0 0 0 001140 Biohazard Waste Permit 7,138 0 7,138 001141 Non-SDWA System Permit 0 0 0 001142 Non SDWA Lab Sample 0 0 0 001144 Tanning Facilities 1,152 0 1,152 001145 Swimming Pools 28,903 0 28,903 001164 Public Water Constr Permit 0 0 0 001165 Private Water Constr Permit 0 0 0 001166 Public Water Annual Oper Permit 3,718 0 3,718 001170 Lab Fee Chemical Analysis 0 0 0 001026 Returned Check Ser Fees 0 0 0 010403 Fees -Copy of Public Doc 4,070 0 4,070 015055 Registar Fees (Ch. 382.34) 0 0 0 001135 OSDS Variance Fee 0 0 0 015052 Transfers -Mobile Home/RV Park 0 0 0 FEES ASSESSED BY STATE OR FEDERAL RULES TOTAL 271.844 0 271,844 5. OTHER CASH CONTRIBUTIONS 090001 Draw down from Public Health Unit 0 0 0 OTHER CASH CONTRIBUTIONS TOTAL 0 0 0 6. MEDICAID 001056 CHD Incm:Medicaid-Pharmacy 0 0 0 001080 CHDIncm:Medicaid-Other 21.889 0 21,889 001081 CHD 1ncm:Medicaid-EPSDT 152,601 0 152,601 001082 CHD Incm:Medicaid-Dental 38,412 0 38,412 001083 CHD Incm:Medicaid-FP 52,059 0 52,059 001084 CIID Incm:Medicaid-Physician 0 0 0 001085 CHD Incm:Medicaid-Nursing 0 0 0 001086 CHD Incm:Co-Insurancc 0 0 0 001087 CHDIncm:Medicaid-STD 6,152 0 6,152 001088 CHD Incm:Med Reimb AZT Disp Fee 0 0 0 001089 Medicaid AIDS 880 0 880 001147 Medicaid IIMO Rate 0 0 0 001148 Medicaid-HMOAdmin 150 0 150 001181 CHD Incm:Medicaid Transportation 0 0 0 00119. Health Maintenance Organ. (HMO) 0 0 0 001191 CHD Incm:Medicaid Maternity 47,286 0 47,286 40 C ATTACHMENT 11 INDIAN RIVER COUNTY HEALTH DEPARTMENT Part IL Sources of Contributions to County Health Department CHD Trust Fund (cash) Other Contributions Total STATE 6. MEDICAID 001192 CHD Incm:Medicaid Comp. Child 249,872 0 249,872 001193 CHD Incm:Medicaid Comp. Adult 152,063 0 152,063 001194 CHD Incm:Medicaid Sonagram 0 0 0 001208 Medipass $3.00 Adm. Fee 68,000 0 68,000 MEDICAID TOTAL 789,364 0 789,364 7. ALLOCABLE REVENUE 011007 Cash Donations Private 0 0 0 001029 Third Part Reimbursement 0 0 0 010301 Exp Witness Fee Consulmt Charges 0 0 0 005040 Interest Emed State Investment 40,000 0 40,000 005041 Interest Emed Local Investment 0 0 0 007010 U.S. Grants Direct to CHD 0 0 0 008094 Gmts/Conuacts other Agencies Direct 15,000 0 15,000 011098 Donation School Based Clinic 0 0 0 011099 Other Grants/DonationsDirect 0 0 0 012020 Fines and Forfeitures 0 0 0 018001 Refunds, Salary 0 0 0 018003 Refunds, other Personal Services 0 0 0 018004 Refunds, Expenses 0 0 0 018006 Refunds, Operating Capital Outlay 0 0 0 018010 Refunds, Special Category 0 0 0 018011 Refunds, Other 0 0 0 018099 Refunds, Certified Forward 0 0 0 037000 Prior Year Warrant 0 0 0 038000 12 Month Old Warrant 0 0 0 010300 Sale of Goods and Services 0 0 0 010402 Recycle Paper Sales 0 0 0 010403 Fees -Copies of Documents 0 0 0 010405 Sale of pharmaceuticals 0 0 0 011055 Other Grant DOE 0 0 0 012021 Return Check Charge 0 0 0 018005 Refunds Grants to Local Gov't 0 0 0 029010 Sale of Fixed Assets 0 0 0 ALLOCABLE REVENUE TOTAL 55,000 0 55,000 S. OTHER STATE CONTRIBUTIONS NOT IN CHD TRUST FUND State Pharmacy Services 0 134,217 134,217 State Laboratory Services 0 109,978 109,978 State TB Services 0 0 0 State Immunization Services 0 141,273 141,273 State STD Services 0 0 0 State Construction/Renovation 0 0 0 WIC Food 0 1,375,615 1,375,615 Other (specify) 0 0 0 Other (specify) 0 0 0 Other (specify) 0 0 0 other (specify) 0 0 0 OTHER STATE CONTRIBUTIONS NOT IN CHD TRUST FUND TOTAL 0 1,761,083 1,761,083 TOTAL STATE CONTRIBUTIONS 3,525,773 1,761,083 5,286,856 40 0 ATTACHMENT 11 INDIAN RIVER COUNTY HEALTH DEPARTMENT Part 11. Sources of Contributions to County Health Department r CHI Trust Fund (cash) . Other Contributions Total COUNTY 1. BOARD OF COUNTY COMMISSIONERS ANNUAL APPROPRIATIONS: 008030 Grants -County Tax Direct 355,000 0 355,000 008034 Grants Cnty Commsn Other 709,104 0 709.104 BOARD OF COUNTY COMMISSIONERS ANNUAL APPROPRIATIONS TOTAL: 1,064,104 0 1,064,104 2. FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION: 001077 Primary Care Fees 120,915 0 120,915 001093 Communicable Disease Fees 78,340 0 78,340 001094 Environmental Health Fees 63,771 0 63,771 001114 New Birth Certificates 18,235 0 18,235 001115 Death Certificates 106.314 0 106,314 001116 Computer Access Fee 920 0 920 001060 Vital Statistics Fees Other 0 0 0 001004 Child Car Seat Prog 0 0 0 001074 Adult Enter. Permit Fees 0 0 0 001195 Primary Care Transfer Fees 0 0 0 001117 Vital Stats -Adm. Fee 50 cents 1,178 0 1,178 001196 Water Analysis -Potable 0 0 0 FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION TOTAL 389,673 0 389,673 3. OTHER CASH AND LOCAL CONTRIBUTIONS 090002 Draw down from Public Health Unit 0 0 0 001090 Medicare 67,655 0 67,655 008050 Grants-Cnty Sch Board Direct 4,000 0 4,000 008010 Grants Contracts Frm Cities Direct 0 0 0 008033 County Contributions For Facilities 0 0 0 008090 Grants other Local Govn't Direct 300,000 0 300,000 008095 Grants Cnty Sect 403.102 Air Pol 0 0 0 008099 Reimb/Rebare Local Govn't 0 0 0 008031 County AIDS Education 18,000 0 18,000 OTHER CASH AND LOCAL CONTRIBUTIONS TOTAL 389,655 0 389,655 C ALLOCABLE REVENUE 011007 Cash Donations Private 0 0 0 001029 Third Party Reimbursement 16,144 0 16,144 010301 Exp Witness Fee Consultnt Charges 0 0 0 005040 Interest Emed State Investment 0 0 0 005041 Interest Emed Local Investment 0 0 0 007010 U.S. Grants Direct to CIID 0 0 0 008094 Gmts/Contracts other Agencies Direct 0 0 0 011098 Donation School Based Clinic 0 0 0 011099 Other Grants/Donations Direct 46,670 0 46,670 012020 Fines and Forfeitures 0 0 0 018001 Refunds, Salary 42,000 0 42,000 018003 Refunds, other Personal Services 18,000 0 18,000 018004 Refunds, Expenses 3,000 0 3,000 018006 Refunds, Operating Capital Outlay 0 0 0 018010 Refunds, Special Category 0 0 0 018011 Refunds, Other 0 0 0 018099 Refunds, Certified Forward 0 0 0 037000 Prior Year Warrant 0 0 0 038000 12 Month Old Warrant 0 0 0 010300 Sale of Goods and Services 0 0 0 0101,02 Recycle Paper Sales 0 0 0 010403 Fees -Copies of Documents 0 0 0 ATTACHMENT If INDIAN RIVER COUNTY HEALTH DEPARTMENT Part 11. Sources of Contributions to Countv Health n—r!mevr CHD Trust Fund (cash) (COUNTY Other Contributions Total . 4. ALLOCABLE REVENUE 010405 Sale of pharmaceuticals 0 0 0 011055 Other Grant DOE 0 0 0 012021 Return Check Charge 0 0 0 018005 Refunds Grants to Local Gov't 0 0 0 029010 Sale of Fixed Assets 0 0 0 COUNTY ALLOCABLE REVENUE TOTAL 125,814 0 125,814 5, BUILDINGS: Annual Rental Equivalent Vnlue 0 305,000 305,000 Maintenance 0 113,000 113,000 Otter (specify) 0 0 0 Other (specify) 0 0 0 Other(specify) 0 0 0 Other (specify) 0 0 0 Other (specify) 0 0 0 BUILDINGS TOTAL 0 418,000 418,000 6. OTHER COUNTY CONTRIBUTIONS NOT IN CHD TRUST FUND Other County Contribution (specify) 0 0 0 Other County Contribution (specify) 0 0 0 Other County Contribution (specify) 0 0 0 Other County Contribution (specify) 0 0 0 Other County Contribution (specify) 0 0 0 OTHER COUNTY CONTRIBUTIONS NOT IN CHD TRUST FUND TOTAL 0 0 0 TOTAL COUNTY CONTRIBUTIONS 1,969,246 418,000 2,387,246 GRAND TOTAL CHD PROGRAM 5,495,019 2,179,083 7,674,102 40 ATTACHMENT 11 INDIAN RIVER COUNTY HEALTH DEPARTMENT Part 111. Planned Staffing, Clients, Services, And Expenditures By Program Service Area Within. Each Leve! Of Service October 1, 1999 to September 30, 2000 Quarterly Expenditure Plan '9 Clients Ist 'end 3rd 4th t)!)j Uttiv, Bervicos (Whole dollars oily) County State.77 A. COMMUNICABLE DISEASE CONTROL: Immunization (101) 6.83 0 27,000 85,249 85,249 85,249 120,249 184,561 191,435 375,996 STI) (102) 3.91 340 2,930 33,429 33.430 33,429 33,430 51,199 82,519 133,718 A.I.D.S. (103) 4.16 3,800 7,000 38,338 38.339 38,338 38,340 66,370 86,985 153,355 TB Control Services (104) 3.29 2,500 4,700 30,065 30,064 30,065 30,065 37,157 83,102 120,259 Comm. Disease Surv. (106) 0.43 0 260 6,105 6,106 6,105 6,107 7,173 17,250 24,423 Vital Statistics (180) 1.24 0 0 11,250 11,250 11,250 11,250 45,000 0 45,000 COMMUNICABLE DISEASE SUBTOTAL 19.86 6,640 41,890 204,436 204,438 204,436 239,441 391,460 461,291 852,751 B. PRIMARY CARE: Chronic Disease Services (210) 3.40 12,000 26.000 35,450 35,449 35,450 35,450 0 141,799 141,799 Home Health (2.15) 0.00 0 0 0 0 0 0 0 0 0 W.I.C. (221) 8.10 4,900 27,000 69,876 69,876 69,876 69,877 0 279,505 279,505 Family Planning (223) 6.50 1,300 8,650 73,125 73,125 73,125 73,125 146,136 146,364 292,500 Improved Pregnancy Outcome (225) 1.52 595 2,475 17,673 17,673 17,673 17,673 0 70,692 70,692 Healthy Start Prenatal (227) 1.97 200 10,470 27,696 27,696 27,696 27,696 0 110,784 110,784 Comprehen::vcChild Health (229) 19.87 3,170 18,000 258,903 258,903 258,903 258,904 435,441 600,172 1,035,613 Healthy Start Infant (23 1) 2.21 195 13,000 28,039 28,039 28,038 28,039 0 112,155 1,12,155 School Health (234) 6.02 0 55,000 93,096 93,096 93,096 93,095 4,000 368,383 372,383 Comprehensive Adult Health (237) 19.46 6,000 24,000 311,896 311,896 311,896 311,897 756,337 491,248 1,247,585 Dental Health (240) 5.33 2,200 9,065 70,312 70,312 70,312 70,312 184,986 96,262 281,248 PRIMARY CARE SUBTOTAL 74.38 30,560 193,660 986,066 986,065 986,065 986,068 1,526,900 2,417,364 3,944,264 C. ENVIRONMENTAL HEALTH: Private Water System (357) 1.55 400 1,322 13,000 13,000 13,000 13,000 24,606 27,394 52,000 Public Water System (358) 0.23 4 300 3,422 3,422 3,422 3,421 0 13,687 13,687 Individual Sewage Disp. (361) 4.26 2,300 4,770 63,374 63,374 63,375 63,375 58,305 195,193 253,498 Food Hygiene (348) 0.82 70 320 12,120 12,119 12,120 12,119 48,478 0 48,478 Group Care Facility (351) 0.44 115 200 4,500 4,500 4,500 4,500 0 18,000 18,000 Migrant Labor Camp (352) 0.02 4 40 297 298 2O7 298 0 1,190 III% Housing,Public Bldg Safety,Sanitation (353) 0.10 25 100 1,488 1,487 1,488 1,487 5,950 0 5,950 Mobile Home and Parks Services (354) 0.57 85 220 7,000 7,000 7,000 7,000 0 28,000 28,000 Swimming Pools/Bathing (360) 0.66 155 350 9,818 9,818 9,818 9,820 0 39,274 39,274 Biomedical Waste Services (364) 0.84 160 180 12.942 12,943 12,942 12.943 22,778 28,992 51,770 Tanning Facility Services (369) 0.05 15 50 744 744 744 744 0 2,976 2,976 Rabies Surveillance/Control Services (366) 0.18 15 60 2,678 2,678 2,678 2,678 10,712 0 10,712 Arbovirus Surveillance (367) 0.05 0 20 744 744 744 743 2,975 0 2,975 Rodcnt/Arthropod Control (368) 0.04 0 45 595 595 595 595 0 2,380 2,380 Storage Tank Compliance (355) 1.15 100 230 11,250 11,250 11,250 11,250 0 45,000 45,000 Super Act Service (356) 0.09 12 79 1,339 1,339 1,339 1,339 0 5,356 5,356 Occupational Health (344) 0.00 0 0 0 0 0 0 0 0 0 Consumer Product Safety (345) 0.00 0 0 0 0 0 0 0 0 0 Emergency Medical (346) 0.00 0 0 0 0 0 0 0 0 0 Lead Monitoring Services (350) 0.06 5 25 892 892 893 893 3,570 0 3,570 dib ATTACHMENT 11 INDIAN RIVER COUNTY HEALTH DEPARTMENT Part 111. Planned Staffing; CliAntc, Services, And Expenditures By Program Service Area Within Each 1.,wel Of Service October 1, 1999 to September 30, 2000 Qumr4c..y Expenditure Pien rr ; utent, („: tnd 3rd itlt (snit:a (0,00) Illtr F-ekwk s OVljoledollarsonly) Cottaty suite Tolal C. ENVIRONMENTAL HEALTH: Public Sewage (362) 0.14 7 60 2,082 2,083 2,082 2,083 0 8,330 8,330 Solid Waste Disposal (363) 0.04 0 50 595 595 595 595 0 2.380 2,380 Sanitary Nuisance (365) 0.41 46 185 6,099 6.100 6,099 6,100 24,398 0 24,398 Water Pollution (370) 0.46 0 1,500 10,593 10,593 10,593 10,594 26,223 16,150 42,373 Air Pollution (37 1) 0.21 0 75 3,124 3,125 3,124 3,125 0 12,498 12,498 Radiological Health (372) 0.00 0 0 0 0 0 0 0 0 0 Toxic Substances (373) 0.39 110 200 5,802 5,803 5,802 5,802 23,209 0 23,209 ENVIRONMENTAL HEALTH SUBTOTAL 12.76 3,628 10,381 174,498 174,502 174,500 174,504 251,204 446,800 698,004 TOTAL CONTRACT 107.00 40,828 245.931 1,365,000 1,365,005 1.365,001 1,400,013 2,169,564 3,325,455 5,495,019 dD ATTACHMENT III CIVIL RIGHTS CERTIFICATE The applicant provides this assurance in consideration of and for the purpose of obtaining federal grants, loans, contracts (except contracts of insurance or 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, HRS 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. e ATTACHMENT III (continued) 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 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 STATE FEE SCHEDULES, BY SERVICE LEVEL OF SERVICE/SERVICE: I. COMMUNICABLE DISEASE: AIDS, HIV, Alternate Site Testing II, PRIMARY CARE: III. ENVIRONMENTAL HEALTH (See Environmental Health Fee Schedule) Fee $25 (optional) Estimated Annual. Revenue Accruing To The CHD Trust Fund Subtotal $ -0- IT, 0- Subtotal $ -0- Subtotal $ 267,774 Fees - Copies of Public Documents Subtotal $ 4,070 TOTAL STATE FEES: $ 271,844 ATTACHMENT V COUNTY FEE SCHEDULES, BY SERVICE LEVEL OF SERVICE/SERVICE: Fee/Range I. COMMUNICABLE DISEASE_ Immunizations PPD s Miscellaneous Birth Certificates Death Certificates II. PRIMARY CARE: Family Planning Miscellaneous Adult Health Child Health Pharmacy Dental Health III. ENVIRONMENTAL HEALTH: Private Well Permit Well Site Permit Public Well Permit Private Well Samples Public Well Samples Water Sample Collection Chemical Tests Demolition Inspection Site Plan Review Environmental Air Testing Environmental File Review Grease Trap Permit -Installation Grease Trap Permit -Annual Hazardous Substance Storage Tank Plan Review Estimated Annual Revenue Accruing To The CHD Trust Fund 10.00-125.00 10.00 5.00-60.00 11.00-13.00 9.00 Subtotal $ 204,987 20.00-2,200.00 10.00-65.00 30.00-70.00 30.00-70.00 Varied Current Medicaid Rates Subtotal $ 120,915 40.00 100.00 250.00 20.00 20.00 40.00 5.00-25.00 35.00 75.00 40.00 150.00 75.00 50.00 N/A 75.00 Subtotal $ 63,771 Total County Fees $ 389,673 ATTACHMENT VI FACILITIES UTILIZED BY THE COUNTY HEALTH DEPARTMENT Facility Description Location Owned By Clinic, Administrative and 1900 27`h Street County of Environmental Health Vero Beach Indian River Headquarters Satellite Clinic 4690 28`h Court Indian River Gifford County School Board Co -location Site for 12196 CR #512 Fellsmere WIC, PEPW and Public Fellsmere Medical Center Health Services 40 ATTACHMENT VII DESCRIPTION OF USE OF CHD TRUST FUND BALANCES FOR SPECIAL PROJECTS, IF APPLICABLE (From Attachment II, Part I) $70,000 has been set aside for planned renovation of the nursing and general administration areas. General Administration: Renovation of two office spaces(reception secretary and administrator) including an enlargement of the reception area to be more inviting to the public. Also planned is renovation of the data processing area into a more useable administrative conference/computer training room. Also planned is the renovation of the nursing administration area (also located on the second floor). Current use of " cubbies" is not practical and used by staff. Plans are to remove permanent dividers and install modular desk areas that can be shared and/or assigned to field staff. Both areas of renovation includes the installation of new carpet and painting of the areas. DESCRIPTION OF SPECIAL CONTRACTS (Please iist separately) Special contracts are contracts for services for which there are no comparable services in the county health department core programs; no service codes in Departmental coding manuals; projects that are locally designed and have no standard statewide set of services and therefore cannot be accounted for within existing county health department programs. These contracts are coded to SAMAS Level 599 and include some contracts formerly handled at the district offices such as Epilepsy, colposcopy, Project WARM, community planning and special family planning and teen mother projects. 40 ENVIRONMENTAL HEALTH FEE qr.,TV Td - FY 1999-2000 (Revised 06/28/1999) DESCRIPTION FEE AMOUNTJ AMOUNTti18CHD_�T11St;OUn(I DEPOSIT161.50 Est mated Anrtttsl . t�eYen'te �aGC1Ong t0 PUBLIC SWIMMING POOLS AND BATHING PLACE$ 1. Annual Permit - Up to (and including) 25,000 gallons 75.00 5,535 Ila. Transfer to headquarters 750 2. More than 25,000 gallons 160.00 144.00 21,253 2a. Transfer to headquarters 16.00 3. Exempted Condo Pools (over 32 units) 50.001 45.00 2,115 3a. Transfer to headquarters 5.00 OTHER FEES Collected by the 12 delegated counties Broward, Dade, Duval, Hillsborough, Lee, Manatee, Collier, Palm Beach, Pinellas, Polk, Sarasota, Volusia. Escambia. Variances for Okalosse, Santa Rosa, Walton counties are processed by Escambia County as follows: i. Plan review (new construction) 275.00 275.00 _ 2. Plan review for modification of original construction 100.00 100.00 3. Plan/application review for bathing place development 275.00 275.00 4. Initial operating permit 125.00 125.00 5. Variance applications 240.00 216.00 5.a. Transfer to Headquarters 24.00 All other counties are to send the fee to Bureau of Facility Programs in Tallahassee or the Environmental Engineering section in Orlando as follows: 1. Plan review (new construction) 275.001 275.00 2. Plan review for modification of original construction 100.00 100.00 3. Plan/application review for bathing place development 275.00 275.00 4. Initial operating permit 125.00 125.00 5. Variance applications 240.00 240.00 MOBILE HOMF & RECREATIONAL VEHICLE PARKS (FEES ARE PRORATED ON A QUARTERLY BASIS) 1. Annual permit for 5 to 14 spaces 50.00 45.00 900 1a. Transfer to headquarters 5.00 2. Annual permit for 15 to 171 spaces 3.50 per space 6,035 2a. Transfer to headquarters 10% 3. Annual permit for 172 and above spaces 600.001 540.00 5,930 3a. Transfer to headquarters 60.00 MIGRANT LABOR CAMPS 1. Annual permit for facilities with 5-50 occupants 1 125.001 125-00 2. Annual permit for facilities with 51-100 occupants 1 225.001 225.00 3. Annual permit for facilities with over 100 occupants 500.00 500.00 BIOMEDICAL WASTE_GENNERAI-ORS 1. Initial permit 55.00 55.00 Page 1 10/4/99 40 Eiv v IRuNKEWEAL HEALTH FEE SCHEDULE FY 1999-2000 (Revised 06/28/1999) DESCRIPTION FEE AMOUNT DEPOSIT AMOUNT R6Y8I1U8 ACGfUIO t0 r . s Euq ca> the CHD`Truilirnd'; 2. Renewal of annual permil(except physician office generating less than 25lbs/30 days) postmarked by October 1 55.00 55.00 7,138 2. Renewal of annual permit(except physician office generating less than 25lbs/30 days) postmarked after October 1 75.00 75.00 3. Storage facilities permit postmarked by October 1 55.00 55.00 3. Storage facilities permit postmarked after October 1 75.00 75.00 4. Treatment facilities operating permit by October 55.00 55.00 4. Treatment facilities operating permit after October 1 75.00 75.00 FEES COLLECTED AT HEADQUARTERS 5. Transporter registration (one vehicle) postmarked by 10/1 55.001 For headquarters use only 5. Transporter registration (one vehicle) after 10/1 75.00 For headquarters use only 6. Transporter registration additional vehicle 10.00 For headquarters use only TANNING FACILITIES 1. Annual license fee 1 150.00 135.00 810 1 Ila. Transfer to headquarters I 1 15.00 2. Fee for each additional device 55.00 49.50 342 2.a. Transfer to headquarters 5.50 3. Late fee 25.001 25.00 FOOD ESTABLISHMENTS 1. Annual Permit for Fraternal/Civic 160.00 144.00 2,360 la. Transfer to headquarters 16.00 2. Annual Permit School Cafeteria Operating for 9 months or less 13000 117.00 2,900 2a. Transfer to headquarters 13.00 3. Annual Permit School Cafeteria Operating for more than 9 months 160.00 144.00 3a. Transfer to headquarters 16.00 4. Annual Permit for Hospital/Nursing Food Service 210.00 189.00 1.714 4a Transfer to h^^dqucrt--_ ..--.�,.�, ��r � - - 21.00 5. Annual Permit for Movie Theaters 160.00 144.00 388 5a. Transfer to headquarters 16.00 6. Annual Permit for Jails/Prisons 210.00 189.00 478 6a. Transfer to headquarters _ 21.00 7. Annual Permit for Bars/Lounges (Drink Service Only) 160.00 144.00 1,684 7a. Transfer to headquarters 16.00 8. Annual Permit for Residential Facilities 110.00 99.00 1,487 8a. Transfer to headquarters 11.00 9. Annual Permit for Child Care Centers without C&F license 85.00 76.50 253 9a. Transfer to headquarters 8.50 10. Annual Permit for Limited Food Service 185.00 76.50 1 532 10a. Transfer to headquarters 8.50 11. Annual Permit Other Food Service 160.00 144.00 Page 2 10/4/99 40 e uiv v'iic0ivD1PiN'LAL HEALTH FEE SCHEDULE FY 1999-2000 (Revised 06/28%1999) FEE DEPOSIT DESCRIPTION AMOUNT AMOUNT RoY®�t�i� c rurng o. It1e;CRDT1USrFund: 11 a. Transfer to headquarters 16.00 12. Plan Review $35/hour $35/hour 13. Food Worker Training 10.00 10.00 14. Request for Inspection 40.00 40.00 15. Reinspection (after the first reinspection) 3000 30.00 16. Late Renewal _ 2500 25.00 17. Alcoholic Beverage Inspection Approval 3000 30.00 ONSITE SEWAGE DISPOSAL PROGRAM (O_STDS) 1. Application for permitting of an onsite sewage 25.00 23.00 27.760 treatment and disposal system which includes application and plan review for new and repair permits Ia. Transfer to headquarters 2.00 2. Site evaluation for a new system 60.00 55.20 36,548 2a. Transfer to headquarters 4.80 3. Site evaluation for a system repair 40.00 36.80 19,400 3a. Transfer to headquarters 3.20 4. Site re-evaluation, new or repair 40.00 36.80 836 4a. Transfer to headquarters 3.20 5. Permit for new systems, including standard subsurface, 55.00 50.60 36,972 filled or mounded systems 5a. Transfer to headquarters 4.40 6. New system installation inspection 55.00 50.60 36,372 6a. Transfer to headquarters 4.40 7. Research fee to be collected in addition, and concurrent with 5.00 5.00 the permit for a new system installation fee until 6/30/2002. 8. Repair permit Issuance which Includes Inspection 50.00 41.40 25,000 Be. Transfer to headquarters 3.60 8b. Transfer to headquarters for training center 5.00 9. Inspection of system orevinusly in vsn 50.0u 46.00 5,600 9a. Transfer to headquarters 4.00 10. Reinspection fee per visit for site inspections after system 25.00 23.00 230 construction approval 10a. Transfer to headquarters 2.00 11. Installation reinspection of non-compliant system per 25.00 23.00 230 each site visit 11 a. Transfer to headquarters 2,00 12. System abandonment permit, includes permit 40.00 36.80 2,104 issuance and inspection 12a. Transfer to headquarters 3.20 13. Annual operating permit fee for systems in IM and 150.00 138.00 9,004 equivalent areas, and for systems receiving commercial waste 3a. Transfer to headquarters 12.00 Page 3 10/4/99 ENVIRONMENTAL HEALTH FEE SCHEDULE FY 1999-2000 (Revised 06/28/1999) DESCRIPTION FEE AMOUNT DEPOSIT AMOUNT Revenue Accruing t0 the CHD Trust Fund 14. Amendments or changes to the operating permit daring 25.00 23.00 the permit period per change or amendment 14a. Transfer to headquarters 15. Aerobic treatment unit operating permit per annum 150.00 _2.00 13m_00 5;4 15a. Transfer to headquarters 12.00 16. Tank manufacturers inspection per annum 100.00 50.00 _ 16a. Transfer to headquarters _ 50.00 17. Septage disposal service permit per annum 50.00 46.00 230 17a. Transfer to headquarters 4.00 18. Additional charge per pumpout vehicle 25.00 23.00 215 18a. Transfer to headquarters 2.00 19. Portable or temporary toilet service permit per annum 50.00 46.00 150 19a. Transfer to headquarters 4.00 I 120. Additional charge per pumpout vehicle 25.00 23.00 215 20a. Transfer to headquarters 2.00 21. Septage stabilization facility inspection fee per annum 150.00 138.00 238 21 a. Transfer to headquarters 12.00 22. Septage disposal site evaluation fee per annum 100.00 92.00 284 22a. Transfer to headquarters 8.00 23. Aerobic treatment unit maintenance entity permit per annum 25.00 23.00 23a. Transfer to headquarters 2.00 24. Variance application for a single family residence per 150.00 75.00 150 each lot or building site 24a. Transfer to headquarters 75.00 25. Variance application for a multi -family or commercial 200.00 100.00 150 building per each building site 25a. Transfer to headquarters 100.00 26. Incnesfinn for r .+=!v^1.icn of an iojeCuon well (FL Keys) 1 125.001 125.00 Performance-based Treatment Systems 1. Application for permitting of a new performance-based 125.00 115.00 treatment system, which includes application and plan review la. Transfer to headquarters 10.00 2. Permit for new performance-based treatment system 125.00 115.00 2a. Transfer to headquarters 10.00 3. Installation inspection for new performance-based systems 75.00 69.00 3a. Transfer to headquarters 1 6.00 6. Research fee to be collected in addition, and concurrent will) 5.00 5.00 the permit for a new performance-based system installation fee 4. Repair permit issuance which includes inspection 125.00 115.00 4a. Transfer to headquarters 10.00 5. Inspection of system previously in use 25.00 23.00 Page 4 10/4/99 40 ENVIRONMENTAL HEALTH FEE SCHEDULE FY 1999-2000 (Revised 06/28/1999) DESCRIPTION FEE AMOUNTAMOUNT DEPOSIT Revenuo Accruing to the CHD Trust Fund 5a. Transfer to headquarters 200 -- 6. Reinspection fee per visit for site inspections after system 25.00 23.00 construction approval 6a. Transfer to headauarters 2.00 7. installation reinspection of non-compliant system per 50.00 46.00 each site visit 7a. Transfer to headquarters 4.00 8. System abandonment permit. includes permit 75.00 69.00 issuance and inspection 8a. Transfer to headquarters 6.00 9. Annual operating permit fee for performance-based 200.00 184.00 treatment system. Fee charged second year of operation 9a. Transfer to headquarters 16.00 10. Review of application due to proposed amendments or 75.00 69.00 changes after initial operating permit issuance. 10a. Transfer to headquarters 6.00 11. Variance application for a single family residence per 150.00 75.00 each lot or building site 11 a. Transfer to headquarters 75.00 FEE COLLECTED AT HEADQUARTERS - Onsite Sewage 1. Application for innovative product approval 2. Application for registration including initial examination 5oo.00 75.00 For headquarters use only For headquarters use only 3. Initial registration 100.00 For headquarters use only 4. Renewal of registration loo.00 For headquarters use only 5. Renewal of inactive certificate of authorization I 250.00l For headquarters use only DRINKING WATER 1. First Year Public Water Annual Operation Permit -Limited Use 75.00 67.50 225 1a. Transfer to headquarters -- 7'50 2. Second Year Public Water Annual Operation Permit - Limited Use 70.00 63.00 2,251 ;. Transfer to headquarters 7.00 3. Public Water Construction Permit - Limited Use 75.00 67.50 270 3a. Transfer to headquarters 7.50 4. Private Water Construction Permit - serving 3 or 4 40.00 36.00 72 non -rental residences 4a. Transfer to headquarters 4.00 5. Initial Operating Permit Fee After March 31 of Any Year 35.00 31.50 5a. Transfer to headquarters 3.50 6. Non-SDWA Lab Sample (Sample Collection/Review of Analytical Results/Health Risk Interpretation): Delineated Area 50.00 50.00 Bacterial Sample Collection 40.00 40.00 Page 5 10/4/99 0 4 ENVIR01MENTAL HEALTH FEE SCHEDULE FY 1999-2000 (Revised 06/28/1999) DESCRIPTION FEE AMOUNT DEPOSIT AMOUNT Revenue Accruing to: the CHD Trust Fund? Chemical Sample Collection 50.00 50.00 Combined Chemical microbiological 55.00 55.00 7. Reinspection of Private Water System 25.00 25.00 8. Reinspection of Public Water System 40.00 40.00 9. Delineated Area Clearance Fee 50.00 50.00 10. Limited Use Commercial Registered System 15.00 15.00 750 11. Limted Use Commercial Public Water System 25.00 25.00 150 Operating Permit Family Day Care Establishment Page 6 10/4199