HomeMy WebLinkAbout2015-166CONTRACT 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 2015-2016
This contract is made and entered into between the State of Florida, Department of Health
("State") and the Indian River County Board of County Commissioners ("County"), through
their undersigned authorities, effective October 1, 2015.
RECITALS
A. Pursuant to Chapter 154, Florida Statutes, the intent of the legislature is to
"promote, protect, maintain, and improve the health and safety of all citizens and visitors of
this state through a system of coordinated county health department services."
B. County Health Departments were created throughout Florida to satisfy this
legislative intent through "promotion of the public's health, the control and eradication of
preventable diseases, and the provision of primary health care for special populations."
C. Indian River County Health Department ("CHD") is one of the created County
Health Departments
D. It is necessary for the parties hereto to enter into this contract in order to ensure
coordination between the State and the County in the operation of the CHD.
NOW THEREFORE, in consideration of the mutual promises set forth herein, the
sufficiency of which are hereby acknowledged, the parties hereto agree as follows:
1. RECITALS. The parties mutually agree that the forgoing recitals are true and correct
and incorporated herein by reference.
2 TERM. The parties mutually agree that this contract shall be effective from October 1,
2015, through September 30, 2016, or until a written contract replacing this contract is
entered into between the parties, whichever is later, unless this contract is otherwise
terminated pursuant to the termination provisions set forth in paragraph 8. below.
3. SERVICES MAINTAINED BY THE CHD. The parties mutually agree that the CHD
shall provide those services as set forth on Part III of Attachment II hereof, in order to
maintain the following three levels of service pursuant to section 154.01(2), Florida Statutes,
as defined below:
a. "Environmental health services" are those services which are organized and operated
to protect the health of the general public by monitoring and regulating activities in the
environment which may contribute to the occurrence or transmission of disease.
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Environmental health services shall be supported by available federal, state and local funds
and shall include those services mandated on a state or federal level. Examples of
environmental health services include, but are not limited to, food hygiene, safe drinking
water supply, sewage and solid waste disposal, swimming pools, group care facilities,
migrant labor camps, toxic material control, radiological health, and occupational health.
b "Communicable disease control services" are those services which protect the health
of the general public through the detection, control, and eradication of diseases which are
transmitted primarily by human beings. Communicable disease services shall be supported
by available federal, state, and local funds and shall include those services mandated on a
state or federal level. Such services include, but are not limited to, epidemiology, sexually
transmissible disease detection and control, HIV/AIDS, immunization, tuberculosis control
and maintenance of vital statistics.
c. "Primary care services" are acute care and preventive services that are made
available to well and sick persons who are unable to obtain such services due to lack of
income or other barriers beyond their control. These services are provided to benefit
individuals, improve the collective health of the public, and prevent and control the spread of
disease. Primary health care services are provided at home, in group settings, or in clinics.
These services shall be supported by available federal, state, and local funds and shall
include services mandated on a state or federal level. Examples of primary health care
services include, but are not limited to: first contact acute care services; chronic disease
detection and treatment; maternal and child health services; family planning; nutrition; school
health, supplemental food assistance for women, infants, and children; home health; and
dental services.
4. FUNDING. The parties further agree that funding for the CHD will be handled as
follows:
a. The funding to be provided by the parties and any other sources is set forth in Part II
of Attachment II hereof. This funding will be used as shown in Part I of Attachment II.
i. The State's appropriated responsibility (direct contribution excluding any state
fees, Medicaid contributions or any other funds not listed on the Schedule C) as
provided in Attachment II, Part II is an amount not to exceed $ 2,931,553
(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 II, Part II is an
amount not to exceed $561,247 (amount listed under the "Board of County
Commissioners Annual Appropriations section of the revenue attachment).
b. Overall expenditures will not exceed available funding or budget authority, whichever
is less, (either current year or from surplus trust funds) in any service category. Unless
requested otherwise, any surplus at the end of the term of this contract in the County Health
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Department Trust Fund that is attributed to the CHD shall be carried forward to the next
contract period.
c. Either party may establish service fees as allowed by law to fund activities of the 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 contract during the term hereof
by notifying the other party in writing of the amount and purpose for the change in funding. If
the State initiates the increase/decrease, the 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 whom payments shall be made is:
County Health Department Trust Fund
Indian River County Health Department
Accounts Receivable, 1900 27th Street
Vero Beach, FL 32960-3383
5. CHD DIRECTOR/ADMINISTRATOR. Both parties agree the director/administrator of
the CHD shall be a State employee or under contract with the State and will be under the
day-to-day direction of the Deputy Secretary for County Health Systems. The
director/administrator shall be selected by the State with the concurrence of the County. The
director/administrator of the CHD shall ensure that non -categorical sources of funding are
used to fulfill public health priorities in the community and the Long Range Program Plan. A
report detailing the status of public health as measured by outcome measures and similar
indicators will be sent by the CHD director/administrator to the parties no later than October 1
of each year (This is the standard quality assurance "County Health Profile" report located on the Division of
Public Health Statistics and Performance Management Intranet site)
6. ADMINISTRATIVE POLICIES AND PROCEDURES. The parties hereto agree that
the following standards should apply in the operation of the CHD.
a. The CHD and its personnel shall follow all State policies and procedures, except to the
extent permitted for the use of County purchasing procedures as set forth in subparagraph
b., below. All CHD employees shall be State or State -contract personnel subject to State
personnel rules and procedures. Employees will report time in the Health Management
System compatible format by program component as specified by the State.
b. The CHD shall comply with all applicable provisions of federal and state laws and
regulations relating to its operation with the exception that the use of County purchasing
procedures shall be allowed when it will result in a better price or service and no statewide
Department of Health purchasing contract has been implemented for those goods or
services. In such cases, the CHD director/administrator must sign a justification therefore,
and all County purchasing procedures must be followed in their entirety, and such
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compliance shall be documented. Such justification and compliance documentation shall be
maintained by the CHD in accordance with the terms of this contract. State procedures must
be followed for all leases on facilities not enumerated in Attachment IV.
c. The CHD shall maintain books, records and documents in accordance with the
Generally Accepted Accounting Principles (GAAP), as promulgated by the Governmental
Accounting Standards Board (GASB), and the requirements of federal or state law. These
records shall be maintained as required by the Department of Health Policies and
Procedures for Records Management and shall be open for inspection at any time by the
parties and the public, except for those records that are not otherwise subject to disclosure
as provided by law which are subject to the confidentiality provisions of paragraph 6.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
Information Resource (FLAIR) System;
ii. The client registration and services reporting requirements of the minimum
data set as specified in the most current version of the Client Information
System/Health Management Component Pamphlet;
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 Indian River County Health Department
Trust Fund maintained by the state treasurer. These funds shall be accounted for separately
from funds deposited for other CHDs and shall be used only for public health purposes in
Indian River County.
e. That any surplus/deficit funds, including fees or accrued interest, remaining in the
County Health Department Trust Fund account at the end of the contract year shall be
credited/debited to the State or County, as appropriate, based on the funds contributed by
each and the expenditures incurred by each. Expenditures will be charged to the program
accounts by State and County based on the ratio of planned expenditures in this contract
and funding from all sources is credited to the program accounts by State and County. The
equity share of any surplus/deficit funds accruing to the State and County is determined each
month and at contract year-end. Surplus funds may be applied toward the funding
requirements of each participating governmental entity in the following year. However, in
each such case, all surplus funds, including fees and accrued interest, shall remain in the
trust fund until accounted for in a manner which clearly illustrates the amount which has been
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credited to each participating governmental entity. The planned use of surplus funds shall be
reflected in Attachment II, Part I_ of this contract, with special capital projects explained in
Attachment V.
f. There shall be no transfer of funds between the three levels of services without a
contract amendment unless the CHD director/administrator determines that an emergency
exists wherein a time delay would endanger the public's health and the Deputy Secretary for
County Health Systems has approved the transfer. The Deputy Secretary for County Health
Systems shall forward written evidence of this approval to the CHD within 30 days after an
emergency transfer.
g. The CHD may execute subcontracts for services necessary to enable the CHD to
carry out the programs specified in this contract. Any such subcontract shall include all
aforementioned audit and record keeping requirements
h. At the request of either party, an audit may be conducted by an independent CPA on
the financial records of the CHD and the results made available to the parties within 180
days after the close of the CHD fiscal year. This audit will follow requirements contained in
OMB Circular A-133 and may be in conjunction with audits performed by County
government. If audit exceptions are found, then the director/administrator of the CHD will
prepare a corrective action plan and a copy of that plan and monthly status reports will be
furnished to the contract managers for the parties.
i. The CHD shall not use or disclose any information concerning a recipient of services
except as allowed by federal or state law or policy
j. The CHD shall retain all client records, financial records, supporting documents,
statistical records, and any other documents (including electronic storage media) pertinent to
this contract for a period of five (5) years after termination of this contract. If an audit has
been initiated and audit findings have not been resolved at the end of five (5) years, the
records shall be retained until resolution of the audit findings.
k. The CHD shall maintain confidentiality of all data, files, and records that are
confidential under the law or are otherwise exempted from disclosure as a public record
under Florida law. The CHD shall implement procedures to ensure the protection and
confidentiality of all such records and shall comply with sections 384.29, 381.004, 392.65
and 456.057, Florida Statutes, and all other state and federal laws regarding confidentiality.
All confidentiality procedures implemented by the CHD shall be consistent with the
Department of Health Information Security Policies, Protocols, and Procedures. The CHD
shall further adhere to any amendments to the State's security requirements and shall
comply with any applicable professional standards of practice with respect to client
confidentiality.
I The CHD shall abide by all State policies and procedures, which by this reference are
incorporated herein as standards to be followed by the CHD, except as otherwise permitted
for some purchases using County procedures pursuant to paragraph 6 b.
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m. The CHD shall establish a system through which applicants for services and current
clients may present grievances over denial, modification or termination of services. The CHD
will advise applicants of the right to appeal a denial or exclusion from services, of failure to
take account of a client's choice of service, and of his/her right to a fair hearing to the final
governing authority of the agency. Specific references to existing laws, rules or program
manuals are included in Attachment I of this contract.
n. The CHD shall comply with the provisions contained in the Civil Rights Certificate,
hereby incorporated into this contract as Attachment III.
o. The CHD shall submit quarterly reports to the County that shall include at least the
following:
1. The DE385L1 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
DE385L1 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.
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:
1. March 1, 2016 for the report period October 1, 2015 through
December 31, 2015;
ii. June 1, 2016 for the report period October 1, 2015 through
March 31, 2016,
ill. September 1, 2016 for the report period October 1, 2015
through June 30, 2016; and
iv. December 1, 2016 for the report period October 1, 2015
through September 30, 2016.
7 FACILITIES AND EQUIPMENT. The parties mutually agree that:
a. CHD facilities shall be provided as specified in Attachment IV to this contract and the
County shall own the facilities used by the CHD unless otherwise provided in Attachment IV.
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b. The County shall ensure adequate fire and casualty insurance coverage for County -
owned CHD offices and buildings and for all furnishings and equipment in CHD offices
through either a self-insurance program or insurance purchased by the County.
c. All vehicles will be transferred to the ownership of the County and registered as
County vehicles. The County shall ensure insurance coverage for these vehicles is available
through either a self-insurance program or insurance purchased by the County. All vehicles
will be used solely for CHD operations. Vehicles purchased through the County Health
Department Trust Fund shall be sold at fair market value when they are no longer needed by
the CHD and the proceeds returned to the County Health Department Trust Fund.
8. TERMINATION.
a Termination at Will. This contract may be terminated by either party without cause
upon no Tess than one -hundred eighty (180) calendar days notice in writing to the other party
unless a lesser time is mutually agreed upon in writing by both parties. Said notice shall be
delivered by certified mail, return receipt requested, or in person to the other party's contract
manager with proof of delivery.
b. Termination Because of Lack of Funds. In the event funds to finance this contract
become unavailable, either party may terminate this contract upon no less than twenty-four
(24) hours notice. Said notice shall be delivered by certified mail, return receipt requested, or
in person to the other party's contract manager with proof of delivery.
c. Termination for Breach. This contract may be terminated by one party, upon no less
than thirty (30) days notice, because of the other party's failure to perform an obligation
hereunder. Said notice shall be delivered by certified mail, return receipt requested, or in
person to the other party's contract manager with proof of delivery Waiver of breach of any
provisions of this contract shall not be deemed to be a waiver of any other breach and shall
not be construed to be a modification of the terms of this contract.
9. MISCELLANEOUS. The parties further agree:
a. Availability of Funds. If this 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 contract are as follows:
For the State: For the County:
Mayur Rao Jason Brown
Name Name
Business Manager Budget Director
Title Title
1900 27th Street 1801 27th Street
Vero Beach, FI., 32960-3383 Vero Beach, FI., 32960-3383
Address Address
772-794-7464 772-567-8000 Ext. 1214
Telephone Telephone
If different contract managers are designated after execution of this contract, the name,
address and telephone number of the new representative shall be furnished in writing to the
other parties and attached to originals of this contract.
c. Captions. The captions and headings contained in this contract are for the
convenience of the parties only and do not in any way modify, amplify, or give additional
notice of the provisions hereof.
In WITNESS THEREOF, the parties hereto have caused this eight page contract, with its
attachments as referenced, including Attachment I (two pages), Attachment II (six pages),
Attachment III (one page), Attachment IV (one page), and Attachment V (one page), to be
executed by their undersigned officials as duly authorized effective the 1S day of October,
2015.
BOARD OF COUNTY COMMISSIONERS STATE OF FLORIDA
FOR INDIAN RIVER COUNTY
DEPARTMENT OF HEALTH
SIGNED BY:C��G� SIGNED BYE
NAME: we. 1 y naNT;G ',.!\SS!°NERs Z\NAME: John H. Armstrong, MD
TITLE: Chapman-?
o;
DATE: September 15, 2015
ATTESTED TO:
SIGNED
NAME: Maureen Gelfo
ti
•`\TLE: Surgeon General/Secretary of Health
3ATE: 1,41
�OJ2
TITLE: Deputy Clerk
DATE: September 15, 2015
APPROVED As TO FORM
AND LEGAL SUFFICIEN
BY
DYLAN R E I NP7- ^' ^
COLN rY /a-,___.(
8
SIGNED BY:
NAME: Miranda C Hawker
TITLE: CHD Administrator
DATE: q/31//5
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.
1
2.
3
Service
Sexually Transmitted Disease
Program
Dental Health
Special Supplemental Nutrition
Program for Women, Infants and
Children (including the WIC
Breastfeeding Peer Counseling
Program)
4 Healthy Start/ Improved Pregnancy
Outcome
5 Family Planning
6 Immunization
Requirement
Requirements as specified in F.A.0 64D-3, F S 381 and F S 384
Periodic financial and programmatic reports as specified by the
program office
Service documentation and monthly financial reports as specified in
DHM 150-24* and all federal, state and county requirements
detailed in program manuals and published procedures
Requirements as specified in the 2007 Healthy Start Standards and
Guidelines and as specified by the Healthy Start Coalitions in
contract with each county health department.
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.
Periodic reports as specified by the department pertaining to
immunization levels in kindergarten and/or seventh grade pursuant
to instructions contained in the Immunization Guidelines -Florida
Schools, Childcare Facilities and Family Daycare Homes (DH Form
150-615) and Rule 64D-3 046, F.A.0 In addition, periodic reports
as specified by the department pertaining to the
surveillance/investigation of reportable vaccine -preventable
diseases, adverse events, vaccine accountability, and assessment
of immunization
ATTACHMENT I (Continued
Attachment_I - Page 1 of 2
li
levels as documented in Florida SHOTS and supported by CHD
Guidebook policies and technical assistance guidance.
7 Environmental Health Requirements as specified in Environmental Health Programs
Manual 150-4* and DHP 50-21*
8 HIV/AIDS Program
Requirements as specified in F S 384 25 and F.A.0 64D-3 030
and 64D-3 031 Case reporting should be on Adult HIV/AIDS
Confidential Case Report CDC Form DH2139 and Pediatric
HIV/AIDS Confidential Case Report CDC Form DH2140
Requirements as specified in F.A.0 64D-2 and 64D-3, F S 381 and
F S 384 Socio -demographic and risk data on persons tested for
HIV in 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.
9 School Health Services Requirements as specified in the Florida School Health
Administrative Guidelines (May 2012) Requirements as specified
in F S 381 0056, F S 381 0057, F S 402.3026 and F.A.0 64F-6
10 Tuberculosis Tuberculosis Program Requirements as specified in F.A.0 64D-3
and F S 392.
11 General Communicable Disease Carry out surveillance for reportable communicable and other acute
Control diseases, detect outbreaks, respond to individual cases of
reportable diseases, investigate outbreaks, and carry out
communication and quality assurance functions, as specified in
F.A.0 64D-3, F S 381, F S 384 and the CHD Epidemiology Guide
to Surveillance and Investigations
12. Refugee Health Program Programmatic and financial requirements as specified by the
program office
*or the subsequent replacement if adopted during the contract period.
Attachment _I - Page 2 of 2
ATTACHMENT II
INDIAN RIVER COUNTY HEALTH DEPARTMENT
PART I. PLANNED USE OF COUNTY HEALTH DEPARTMENT TRUST FUND BALANCES
Estimated State
Share of CHD Trust
Fund Balance
Estimated County
Share of CHD Trust
Fund Balance
Total
1 CHD Trust Fund Ending Balance 09/30/15
2. Drawdown for Contract Year
October 1, 2015 to September 30, 2016
3 Special Capital Project use for Contract Year
October 1, 2015 to September 30, 2016
174,828 1,194,027 1,368,855
(99,500) (689,913) (789,413)
4 Balance Reserved for Contingency Fund
October 1, 2015 to September 30, 2016
75,328 504,114
Special Capital Projects are new construction or renovation projects and new furniture or equipment associated with these projects, and mobile health vans
579,442
Attachment_II_Part_I - Page 1 of 1
ATTACHMENT II
INDIAN RIVER COUNTY HEALTH DEPARTMENT
Part II, Sources of Contributions to County Health Department
October 1, 2015 to September 30, 2016
State CHD County Total CHD
Trust Fund CHD Trust Fund Other
(cash) Trust Fund (cash) Contribution Total
1. GENERAL REVENUE - STATE
015040 AIDS PATIENT CARE
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
100,000
36,078
6,597
35,137
183,226
136.867
32,976
1,223.133
1.754.014
O 100.000
O 36,078
O 6.597
O 35.137
0 183,226
O 136.867
O 32.976
0 1,223,133
0 1,754.014
0 100.000
0 36.078
0 6.597
0 35,137
0 183,226
0 136,867
0 32.976
0 1.223,133
0 1,754,014
2. NON GENERAL REVENUE - STATE
015010 STATE UNDERGROUND PETROLEUM RESPONSE ACT 4.234 0 4,234 0 4,234
015010 ENVIRONMENTAL BIOMEDICAL WASTE PROGRAM 10,134 0 10,134 0 10,134
NON GENERAL REVENUE TOTAL 14,368 0 14,368 0 14.368
3. FEDERAL FUNDS • STATE
007000 AIDS DRUG ASSISTANCE PROGRAM ADMIN
007000 AIDS DRUG ASSISTANCE PROGRAM ADMIN HQ
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 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 CONSORTIUM
007000 WIC PROGRAM ADMINISTRATION
015075 SUPPLEMENTAL SCHOOL HEALTH
FEDERAL FUNDS TOTAL
26,786 0 26.786 0 26.786
8.962 0 8,962 0 8,962
24.000 0 24.000 0 24.000
42.725 0 42.725 0 42.725
13,506 0 13,506 0 13,506
15.000 0 15.000 0 15.000
61.853 0 61.853 0 61.853
14.880 0 14,880 0 14.880
22.715 0 22.715 0 22.715
190.991 0 190.991 0 190.991
56.405 0 56,405 0 56.405
60.000 0 60.000 0 60.000
479,514 0 479.514 0 479.514
150,068 0 150.068 0 150.068
1,167,405 0 1,167 405 0 1.167.405
4. FEES ASSESSED BY STATE OR FEDERAL RULES - STATE
001020 CHD STATEWIDE ENVIRONMENTAL FEES 116.600 0 116.600 0 116.600
001092 CHD STATEWIDE ENVIRONMENTAL FEES 273.773 0 273.773 0 273.773
001206 ON SITE SEWAGE DISPOSAL PERMIT FEES 18,906 0 18.906 0 18.906
001206 SANITATION CERTIFICATES (FOOD INSPECTION) 1.810 0 1,810 0 1,810
001206 SEPTIC TANK RESEARCH SURCHARGE 3.465 0 3.465 0 3.465
001206 SEPTIC TANK VARIANCE FEES 50% 200 0 200 0 200
001206 PUBLIC SWIMMING POOL PERMIT FEES -10% HQ TRANSFER 4,978 0 4,978 0 4,978
001206 DRINKING WATER PROGRAM OPERATIONS 351 0 351 0 351
001206 REGULATION OF BODY PIERCING SALONS 45 0 45 0 45
001206 TANNING FACILITIES 181 0 181 0 181
001206 ONSITE SEWAGE TRAINING CENTER 820 0 820 0 820
Attachment_II_Part_II - Page 1 of 3
ATTACHMENT II
INDIAN RIVER COUNTY HEALTH DEPARTMENT
Part II, Sources of Contributions to County Health Department
October 1, 2015 to September 30, 2016
State CHD County Total CHD
Trust Fund CHD Trust Fund Other
(cash) Trust Fund (cash) Contribution Total
001206 TATTO PROGRAM ENVIRONMENTAL HEALTH
001206 MOBILE HOME & RV PARK FEES
FEES ASSESSED BY STATE OR FEDERAL RULES TOTAL
5. OTHER CASH CONTRIBUTIONS - STATE:
090001 DRAW DOWN FROM PUBLIC HEALTH UNIT
OTHER CASH CONTRIBUTION TOTAL
6. MEDICAID • STATE/COUNTY
001057 CHD CLINIC FEES
001148 CHD CLINIC FEES
MEDICAID TOTAL
700
1.620
423.449
O 700
O 1.620
O 423,449
0
0
0
700
1.620
423.449
O 0 0 0 0
99.500 0 99 500 0 99.500
99,500 0 99.500 0 99.500
O 306,283 306.283 0 306.283
O 787,007 787 007 0 787 007
0 1,093,290 1.093,290 0 1,093.290
7 ALLOCABLE REVENUE - STATE:
018000 CHD GENERAL REVENUE NON -CATEGORICAL 500 0 500 0 500
ALLOCABLE REVENUE TOTAL 500 0 500 0 500
8. OTHER STATE CONTRIBUTIONS NOT IN CHD TRUST FUND • STATE
ADAP 0 0 0 227,339 227 339
PHARMACY DRUG PROGRAM 0 0 0 75,553 75.553
WIC PROGRAM 0 0 0 1,967,472 1,967,472
BUREAU OF PUBLIC HEALTH LABORATORIES 0 0 0 21.806 21.806
IMMUNIZATIONS 0 0 0 476.775 476.775
OTHER STATE CONTRIBUTIONS TOTAL 0 0 0 2.768.945 2.768.945
9. DIRECT LOCAL CONTRIBUTIONS • BCC/TAX DISTRICT
008005 HUMAN AND CHILDRENS SERVICES PROGRAM 0 59.945 59,945 0 59,945
008005 CHD FEDERAL & LOCAL INDIRECT EARNINGS 0 10.568 10.568 0 10.568
008020 CHD LOCAL REVENUE & EXPENDITURES 0 1.948,380 1,948,380 0 1,948,380
008040 CHD LOCAL REVENUE & EXPENDITURES 0 561,247 561,247 0 561.247
DIRECT COUNTY CONTRIBUTIONS TOTAL 0 2.580.140 2,580.140 0 2,580.140
10. FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION - COUNTY
001025 CHD CLINIC FEES 0 6.189 6.189 0 6.189
001077 CHD CLINIC FEES 0 339,934 339,934 0 339.934
001094 CHD LOCAL ENVIRONMENTAL FEES 0 90.666 90.666 0 90.666
001110 VITAL STATISTICS CERTIFIED RECORDS 0 217.885 217.885 0 217.885
FEES AUTHORIZED BY COUNTY TOTAL 0 654.674 654.674 0 654.674
11. OTHER CASH AND LOCAL CONTRIBUTIONS - COUNTY
001029 CHD CLINIC FEES 0 120,601 120.601 0 120,601
001090 CHD CLINIC FEES 0 42,408 42.408 0 42.408
004010 CHD CLINIC FEES 0 20 20 0 20
005000 CHD LOCAL REVENUE & EXPENDITURES 0 15,467 15,467 0 15.467
010400 CHD CLINIC FEES 0 1,811 1.811 0 1.811
Attachment_II_Part_II - Page 2 of 3
ATTACHMENT II
INDIAN RIVER COUNTY HEALTH DEPARTMENT
Part II, Sources of Contributions to County Health Department
October 1, 2015 to September 30, 2016
State CHD County - Total CHD
Trust Fund CHD Trust Fund Other
(cash) Trust Fund (cash) Contribution Total
011000 CHD CLINIC FEES
011000 REVENUE CONTRACT/MOA W/NO REPORTING REQUIREMENT
011000 ST JOHNS RIVER WATER MANAGEMENT DISTRICT
011001 CHD HEALTHY START COALITION CONTRACT
012020 CHD GENERAL REVENUE NON -CATEGORICAL
090002 DRAW DOWN FROM PUBLIC HEALTH UNIT
OTHER CASH AND LOCAL CONTRIBUTIONS TOTAL
0 5,808 5.808
0 6.447 6.447
O 22,452 22,452
O 2.383 2,383
O 74 74
0 689,913 689.913
0 907,384 907,384
0
0
0
0
0
0
0
5.808
6.447
22.452
2.383
74
689.913
907.384
12. ALLOCABLE REVENUE - COUNTY
018000 CHD GENERAL REVENUE NON -CATEGORICAL 0 500 500 0 500
COUNTY ALLOCABLE REVENUE TOTAL 0 500 500 0 500
13. BUILDINGS - COUNTY
ANNUAL RENTAL EQUIVALENT VALUE 0 0 0 329.005 329.005
OTHER (Specify) 0 0 0 0 0
UTILITIES 0 0 0 181.645 181.645
BUILDING MAINTENANCE 0 0 0 133.134 133.134
GROUNDS MAINTENANCE 0 0 0 0 0
INSURANCE 0 0 0 0 0
OTHER (Specify) 0 0 0 0 0
OTHER (Specify) 0 0 0 0 0
BUILDINGS TOTAL 0 0 0 643,784 643,784
14. OTHER COUNTY CONTRIBUTIONS NOT IN CHD TRUST FUND - COUNTY
EQUIPMENT / VEHICLE PURCHASES 0 0 0 0 0
VEHICLE INSURANCE 0 0 0 0 0
VEHICLE MAINTENANCE 0 0 0 0 0
OTHER COUNTY CONTRIBUTION (SPECIFY) 0 0 0 0 0
OTHER COUNTY CONTRIBUTION (SPECIFY) 0 0 0 0 0
OTHER COUNTY CONTRIBUTIONS TOTAL 0 0 0 0 0
I
GRAND TOTAL CHD PROGRAM 3,459,236
5.235.988 8.695.224
3,412.729 12,107 953
Attachment_II_PartII - Page 3 of 3
ATTACHMENT II
INDIAN RIVER COUNTY HEALTH DEPARTMENT
Part III, Planned Staffing. Clients, Services and Expenditures By Program Service Area Within Each Level of Service
October 1, 2015 to September 30, 2016
Quarterly Expenditure Plan
FTE'a Clients Services/ 1st 2nd 3rd 4th Grand
(0.00) Units Visite (Whole dollars only) State County Total
A. COMMUNICABLE DISEASE CONTROL.
IMMUNIZATION (101)
SEXUALLY TRANS. DIS. (102)
HIV/AIDS PREVENTION (03A1)
HIV/AIDS SURVEILLANCE (03A2)
HIV/AIDS PATIENT CARE (03A3)
ADAP (03A4)
TUBERCULOSIS (104)
COMM. DIS. SURV (106)
HEPATITIS (109)
PREPAREDNESS AND RESPONSE (116)
REFUGEE HEALTH (118)
VITAL RECORDS (180)
COMMUNICABLE DISEASE SUBTOTAL
B. PRIMARY CARE:
5.37 4,320 5,760 102,226 119,234 102.226 119,235
5.21 1,262 1,699 72,869 84,993 72,869 84.992
1.98 2 214 27,357 31,908 27,357 31,908
0.01 2 2 164 191 164 191
2.50 627 1,216 49,358 57,570 49,358 57,571
0.97 1 1 10,049 11,722 10,049 11,722
2.14 468 770 30,459 35,527 30,459 35,528
1.16 0 425 16,900 19,712 16,900 19,712
0.00 0 0 0 0 0 0
3.18 0 84 65,003 75,818 65,003 75,819
0.00 0 0 0 0 0 0
1.13 6,160 19,150 14,251 16.622 14.251 16,622
23.65 12,842 29,321 388.636 453,297 388.636
121.790
283,601
118,486
710
163,060
43,520
124,590
73,224
0
281,643
0
321,131
32,122
44
0
50,797
22
7,383
0
0
442,921
315,723
118,530
710
213,857
43,542
131,973
73,224
0
0 281,643
0
0 61,746
453.300 1,210,624
0
61,746
473,245 1,683,869
CHRONIC DISEASE PREVENTION PRO (210) 0.41 412 61 5,751 6,708 5,751 6,709 19,111 5,808 24,919
WIC (21W1) 8.38 7,244 28,155 123,424 143,960 123,424 143,960 534,768 0 534,768
TOBACCO USE INTERVENTION (212) 0.00 0 0 0 0 0 0 0 0 0
WIC BREASTFEEDING PEER COUNSELING (21W2) 1.21 0 3.177 12,787 14,915 12,787 14,916 55,405 0 55,405
FAMILY PLANNING (223) 10.44 1,896 3,197 143,258 167,094 143.258 167,094 354,043 266,661 620,704
IMPROVED PREGNANCY OUTCOME (225) 0.00 0 0 0 0 0 0 0 0 0
HEALTHY START PRENATAL (227) 0.06 0 30 591 690 591 690 0 2,562 2,562
COMPREHENSIVE CHILD HEALTH (229) 17.55 3,399 7,915 275,642 321,502 275,642 321,502 0 1,194,288 1,194,288
HEALTHY START CHILD (231) 0.00 0 0 1 1 1 0 3 0 3
SCHOOL HEALTH (234) 5.54 0 159,654 80,038 93,355 80,038 93,354 346,785 0 346,785
COMPREHENSIVE ADULT HEALTH (237) 31.04 4,745 12,450 515,389 601,138 515,389 601.137 282,726 1,950,327 2,233,053
CO\LMUNITY HEALTH DEVELOPMENT (238) 1.13 0 258 19,063 22.235 19,063 22,236 82,597
DENTAL HEALTH (240) 13.71 2,907 6,839 210,908 245,999 210,908 245,999 72,130 841,684
PRIMARY CARE SUBTOTAL 89.47 20,603 221,736 1,386,852 1,617,597 1,386,852 1,617,597 1,747.568 4,261,330
C. ENVIRONMENTAL HEALTH'
Water and Onsite Sewage Programs
COSTAL BEACH MONITORING (347) 0.65 182 183 12,241 14,278 12,241 14.279 41,176 11,863
LIMITED USE PUBLIC WATER SYSTEMS (357) 0.30 59 477 4.812 5,613 4,812 5,614 12,251 8,600
PUBLIC WATER SYSTEM (358) 0.06 1 144 893 1,041 893 1,040 0 3,867
PRIVATE WATER SYSTEM (359) 1.14 26 1,000 18,894 22,038 18,894 22,038 0 81,864
ONSITE SEWAGE TREATMENT & DISPOSAL (361) 5.02 1,235 5,235 77,272 90,128 77,272 90,127 247 127 87,672
Group Total 717 1,503 7,039 114,112 133,098 114,112 133,098 300,554 193,866
Facility Programs
TATTOO FACILITY SERVICES (344) 0.09 0 30 1,407 1,641 1,407 1,640 4.921 1,174 6,095
FOOD HYGIENE (348) 0.74 87 470 11,712 13,660 11,712 13,660 37.314 13,430 50,744
0 82,597
913,814
6.008,898
53,039
20,851
3,867
81,864
334,799
494,420
Attachment_II_Part_III - Page 1 of 2
ATTACHMENT II
INDIAN RIVER COUNTY HEALTH DEPARTMENT
Part III, Planned Staffing. Clients, Services and Expenditures By Program Service Area Within Each Level of Service
October 1, 2015 to September 30, 2016
Quarterly Expenditure Plan
FTE's Clients Services/ tat 2nd 3rd 4th Grand
(0.00) Units - Visits (Whole dollars only) State County Total
BODY PIERCING FACILITIES SERVICES (349) 0.02 7 10
GROUP CARE FACILITY (351) 0.16 65 111
MIGRANT LABOR CAMP (352) 0.03 3 17
HOUSING & PUB. BLDG. (353) 0.10 0 77
MOBILE HOME AND PARK (354) 0.11 37 101
POOLS/BATHING PLACES (360) 0.75 329 894
BIOMEDICAL WASTE SERVICES (364) 0.57 388 416
TANNING FACILITY SERVICES (369) 0.02 8 18
Group Total 2.59 924 2,144
Groundwater Contamination
297 347 297 347 943 345 1,288
2,437 2,842 2,437 2.841 0 10.557 10,557
691 805 691 805 0 2,992 2,992
1,614 1,883 1.614 1,884 0 6,995 6,995
1,909 2,227 1,909 2,227 7,210 1.062 8.272
11,490 13,402 11,490 13.402 39,745 10,039 49,784
8,406 9,804 8,406 9.804 25,682 10,738 36,420
273 319 273 319 1,033 151 1,184
40,236 46,930 40,236 46,929 116,848 57,483 174,331
STORAGE TANK COMPLIANCE SERVICES (355) 0.00 0 0 117 136 117 135 0 505 505
SUPER ACT SERVICES (356) 0.09 24 44 1,488 1,736 1,488 1,735 4,781 1,666 6,447
Group Total 0.09 24 44 1,605 1,872 1,605 1,870 4,781 2,171 6,952
Community Hygiene
COMMUNITY ENVIR. HEALTH (345) 0.89 0 600 28,878 33.683 28,878 33.682 8,785 116,336 125,121
INJURY PREVENTION (346) 0.00 0 0 9 11 9 11 0 40 40
LEAD MONITORING SERVICES (350) 0.00 0 0 0 0 0 0 0 0 0
PUBLIC SEWAGE (362) 0.10 5 20 1,449 1,691 1,449 1,691 0 6,280 6,280
SOLID WASTE DISPOSAL SERVICE (363) 0.01 0 2 89 103
SANITARY NUISANCE (365) 0.09 10 25 1,702 1,985
RABIES SURVEILLANCE (366) 0.20 50 120 3,018 3,520
ARBORVIRUS SURVEIL. (367) 0.02 0 2 529 617
RODENT/ARTHROPOD CONTROL (368) 0.00 0 0 54 63
WATER POLLUTION (370) 0.23 0 430 4,279 4,992
INDOOR AIR (371) 0.10 0 31 1.672 1,950
RADIOLOGICAL HEALTH (372) 0.01 0 0 156 183
TOXIC SUBSTANCES (373) 0.24 0 5 3,841 4,480
Group Total 1.89 65 1,235 45,676 53,278
ENVIRONMENTAL HEALTH SUBTOTAL 11.74 2.516 10,462 201,629 235,178
D. NON -OPERATIONAL COSTS:
NONOPERATIONAL COSTS (599) 0.98 0 0 13,563 15,820 13,563 15,821 0 58.767 58.767
ENVIRONMENTAL HEALTH SURCHARGE (399) 0.00 0 0 7,634 8,904 7,634 8,904 33,076 0 33,076
MEDICAID BUYBACK (611) 0.00 0 0 8,540 9,960 8,540 9,960 37,000 0 37,000
NON -OPERATIONAL COSTS SUBTOTAL 0.98 0 0 29.737 34,684 29,737 34.685 70,076 58,767 128,843
TOTAL CONTRACT 125.84 35,961 261,519 2,006,854 2,340,756 2.006,854 2,340,760 3,459,236 5,235.988 8.695.224
89 103 0 384 384
1,702 1,984 0 7.373 7,373
3,018 3.521 0 13,077 13,077
529 618 0 2.293 2,293
54 64 0 235 235
4,279 4,992 0 18,542 18,542
1,672 1,951 0 7.245 7,245
156 183 0 678 678
3.841 4.481 0 16,643 16.643
45,676 53.281 8,785 189,126 197,911
201,629 235,178 430.968 442,646 873.614
Attachment_II_Part_III - Page 2 of 2
ATTACHMENT III
INDIAN RIVER COUNTY HEALTH DEPARTMENT
CIVIL RIGHTS CERTIFICATE
The applicant provides this assurance in consideration of and for the purpose of obtaining federal grants, loans,
contracts (except contracts of insurance or guaranty), property, discounts, or other federal financial assistance to
programs or activities receiving or benefiting from federal financial assistance The provider agrees to complete
the Civil Rights Compliance Questionnaire, DH Forms 946 A and B (or the subsequent replacement if adopted
during the contract period), if so requested by the department.
The applicant assures that it will comply with
1 Title VI of the Civil Rights Act of 1964, as amended, 42 U S C , 2000 Et seq , which prohibits
discrimination on the basis of race, color or national origin in programs and activities receiving or
benefiting from federal financial assistance
2. Section 504 of the Rehabilitation Act of 1973, as amended, 29 U S C 794, which prohibits discrimination
on the basis of handicap in programs and activities receiving or benefiting from federal financial
assistance
3 Title IX of the Education Amendments of 1972, as amended, 20 U S C 1681 et seq , which prohibits
discrimination on the basis of sex in education programs and activities receiving or benefiting from
federal financial assistance
4 The Age Discrimination Act of 1975, as amended, 42 U S C 6101 et seq , which prohibits discrimination
on the basis of age in programs or activities receiving or benefiting from federal financial assistance
5 The Omnibus Budget Reconciliation Act of 1981, P L. 97-35, which prohibits discrimination on the basis
of sex and religion in programs and activities receiving or benefiting from federal financial assistance
6 All regulations, guidelines and standards lawfully adopted under the above statutes. The applicant agrees
that compliance with this assurance constitutes a condition of continued receipt of or benefit from federal
financial assistance, and that it is binding upon the applicant, its successors, transferees, and assignees
for the period during which such assistance is provided The applicant further assures that all contracts,
subcontractors, subgrantees or others with whom it arranges to provide services or benefits to
participants or employees in connection with any of its programs and activities are not discriminating
against those participants or employees in violation of the above statutes, regulations, guidelines, and
standards In the event of failure to comply, the applicant understands that the grantor may, at its
discretion, seek a court order requiring compliance with the terms of this assurance or seek other
appropriate judicial or administrative relief, to include assistance being terminated and further assistance
being denied
Attachment_III - Page 1 of 1
ATTACHMENT IV
INDIAN RIVER COUNTY HEALTH DEPARTMENT
FACILITIES UTILIZED BY THE COUNTY HEALTH DEPARTMENT
Facility
Description Location Owned By
Clinic, Dental, Vital Statistics,
Environmental Health, WIC,
Administrative Headquarters
36,475 sq. ft.
Gifford Health Center
1900 27th Street County of Indian River
Vero Beach, FI., 32960-3383
4675 28th Court Indian River County Hospital District
10,642 sq. ft. Vero Beach, FI., 32967-1330
Attachment_IV - Page 1 of 1
CONTRACT YEAR
2014-2015*
2015-2016**
2016-2017
2017-2018
PROJECT TOTAL
$
$
$
ATTACHMENT V
INDIAN RIVER COUNTY HEALTH DEPARTMENT
SPECIAL PROJECTS SAVINGS PLAN
CASH RESERVED OR ANTICIPATED TO BE RESERVED FOR PROJECTS
STATE
0 $
0 $
0 $
0 $
COUNTY TOTAL
0 $ 0
0 $ 0
0 S 0
0 S 0
0 $ 0
SPECIAL PROJECTS CONSTRUCTION/RENOVATION PLAN
PROJECT NUMBER. N/A
PROJECT NAME.
LOCATION/ADDRESS.
PROJECT TYPE. NEW BUILDING ROOFING
RENOVATION PLANNING STUDY
NEW ADDITION OTHER
SQUARE FOOTAGE. 0
PROJECT SUMMARY Describe scope of work in reasonable detail.
Attachment_V - Page 1 of 1