Backup Documents 11/13/2012 Item #16D 81
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 160
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. Original documents should be hand delivered to the Board Office. The completed routing slip and original
documents are to be forwarded to the Board Office only after the Board has taken action on the item.)
ROUTING SLIP
Complete routing lines #I through #4 as appropriate for additional signatures, dates, and/or information needed. If the document is already complete with the
excention of the Chairman's signature. draw a line through routing lines #I through #4, complete the checklist, and forward to Sue Filson (line #5).
Route to Addressee(s)
(List in routing order)
Office
Initials
Date
1.Jennifer White
CAO
,� �j
Applicable)
2. Fred Coyle
BCC
Agenda Item Number
16D8
3.
signed by the Chairman, with the exception of most letters, must be reviewed and signed
4.
Core Contract
Number of Original
4
5.
resolutions, etc. signed by the County Attorney's Office and signature pages from
Documents Attached
V
6. Board of Minutes and Records
Cle k o Cou
6 r-OviW
M.
PRIMAR N A T !W6AMhTIO3Vj
(The primary contact is the holder of the original document pending BCC approval. Normally the primary contact is the person who created/prepared the executive
summary. Primary contact information is needed in the event one of the addressees above, including Executive Manager, need to contact staff for additional or
missing information. All original documents needing the BCC Chairman's signature are to be delivered to the BCC office only after the BCC has acted to approve
the item.)
Name of Primary Staff
Hailey Alonso
Phone Number
252 -8468
Contact
appropriate.
(Initial)
Applicable)
Agenda Date Item was
1 1/13/12
Agenda Item Number
16D8
Approved by the BCC
signed by the Chairman, with the exception of most letters, must be reviewed and signed
Type of Document
Core Contract
Number of Original
4
Attached
resolutions, etc. signed by the County Attorney's Office and signature pages from
Documents Attached
V
INSTRUCTIONS & CHECKLIST
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Initial the Yes column or mark "N /A" in the Not Applicable column, whichever is
Yes
N/A (Not
appropriate.
(Initial)
Applicable)
1.
Original document has been signed/initialed for legal sufficiency. (All documents to be
HMA
signed by the Chairman, with the exception of most letters, must be reviewed and signed
by the Office of the County Attorney. This includes signature pages from ordinances,
resolutions, etc. signed by the County Attorney's Office and signature pages from
contracts, agreements, etc. that have been fully executed by all parties except the BCC
Chairman and Clerk to the Board and possibly State Officials.)
2.
All handwritten strike - through and revisions have been initialed by the County Attorney's
N/A
Office and all other parties except the BCC Chairman and the Clerk to the Board
3.
The Chairman's signature line date has been entered as the date of BCC approval of the
HMA
document or the final negotiated contract date whichever is applicable.
4.
"Sign here" tabs are placed on the appropriate pages indicating where the Chairman's
HMA
signature and initials are required.
5.
In most cases (some contracts are an exception), the original document and this routing slip
should be provided to the Executive Manager in the BCC office within 24 hours of BCC
approval. Some documents are time sensitive and require forwarding to Tallahassee within
a certain time frame or the BCC's actions are nullified. Be aware of your deadlines!
6.
The document was approved by the BCC on enter date) and all changes made
HMA
during the meeting have been incorporated ' the attached document. The County
Attorney' Office has reviewed the chan , if a licable.
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Co per County 160 81
Public Services Division
INTEROFFICE MEMORANDUM
TO: Board Minutes and Records
FROM: Hailey Alonso, Operations Analyst; Public Service Division Administration
DATE: November 15, 2012
RE: November 13, 2012, Agenda Item 16 D. 8
Please send the four contracts that are signed or stamped by the Board Chairman to John H.
Armstrong, MD and request that all four be executed by John H. Armstrong, MD, Surgeon
General /Secretary of Health, and returned to your office for County records. Once all four
contracts have been returned to your office, please keep one and return the other three to my
office.
John H. Armstrong, MD's contact information is:
John H. Armstrong, MD
Surgeon General /Secretary of Health
Department of Health
Division of Administration
4052 Bald Cypress Way
Floor: 03 Room: 305G BIN: B -02
Tallahassee, FL 32399 -1730
Thank you for your assistance.
U?
Public Seances Administration • 3339 Tamiami Trail East, Suite 214 • Naples, Florida 34112 -5361 •239- 252 -8468 • FAX 239 - 252 -3958
CLERK OF THE '-IRCI
Dwight E. Brock COLLIER COUNTY LOUR
Clerk of Courts 3301 TAMIAMI IL
P.O. BOX 413044
November 27, 2012
llier
:T COURT
OUSE
ST
NAPLES, FLORIDA 14101 -3
Surgeon General /Secretary of Health
Department of Health
Attn: John H. Armstrong, MD
Division of Administration
4052 Bald Cypress Way
3rd Floor, Room 305G, Bin B -02
Tallahassee, Florida 32399 -1730
Clerk of Courts
Accountant
Auditor
Custodian of County Funds
Re: Contract between Collier County Board of Commissioners and
State of Florida Department of Health — For the operation of the Collier
County Health Department Contract Year 2012 -2013
Dear Mr. Armstrong:
Transmitted herewith, you will find four (4) originals for your signature, of the
above referenced contracts, adopted by the Board of County Commissioners of
Collier County, Florida, Tuesday, November 13th, 2012 during Regular Session.
Please return the four (4) fully executed contracts, our office has provided a
return envelope.
Thank you.
Very truly yours,
DWIGHT E. BROCK, CLERK
Martha Vergara,
Deputy Clerk
Enclosure
Phone (239) 252 -2646 Fax (239) 252 -2755
Website: www.collierclerk.com Email: collierclerkracollierclerk.com
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CONTRACT BETWEEN
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
AND
STATE OF FLORIDA DEPARTMENT OF HEALTH
FOR OPERATION OF
THE COLLIER COUNTY HEALTH DEPARTMENT
CONTRACT YEAR 2012 -2013
This agreement ( "Agreement ") is made and entered into between the State of Florida,
Department of Health ( "State ") and the Collier County Board of County Commissioners
( "County "), through their undersigned authorities, effective October 1, 2012.
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. Collier 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, 2012, through September 30, 2013, or until a written agreement replacing this
Agreement is entered into between the parties, whichever is later, unless this Agreement
is otherwise terminated pursuant to the termination provisions set forth in paragraph 8,
below.
3. SERVICES MAINTAINED BY THE 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
16D 8
funds and shall include those services mandated on a state or federal level. Examples of
environmental health services include, but are not limited to, food hygiene, safe drinking
water supply, sewage and solid waste disposal, swimming pools, group care facilities,
migrant labor camps, toxic material control, radiological health, and occupational health.
b. "Communicable disease control services" are those services which protect the
health of the general public through the detection, control, and eradication of diseases
which are transmitted primarily by human beings. Communicable disease services shall
be supported by available federal, state, and local funds and shall include those services
mandated on a state or federal level. Such services include, but are not limited to,
epidemiology, sexually transmissible disease detection and control, HIV /AIDS,
immunization, tuberculosis control and maintenance of vital statistics.
c. "Primary care services" are acute care and preventive services that are made
available to well and sick persons who are unable to obtain such services due to lack of
income or other barriers beyond their control. These services are provided to benefit
individuals, improve the collective health of the public, and prevent and control the spread
of disease. Primary health care services are provided at home, in group settings, or in
clinics. These services shall be supported by available federal, state, and local funds and
shall include services mandated on a state or federal level. Examples of primary health
care services include, but are not limited to: first contact acute care services; chronic
disease detection and treatment; maternal and child health services; family planning;
nutrition; school health; supplemental food assistance for women, infants, and children;
home health; and dental services.
4. FUNDING. The parties further agree that funding for the CHD will be handled as
follows:
a. The funding to be provided by the parties and any other sources are set forth in Part
II of Attachment II hereof. This funding will be used as shown in Part I of Attachment II.
i. The State's appropriated responsibility (direct contribution excluding any state fees,
Medicaid contributions or any other funds not listed on the Schedule C) as provided in
Attachment II, Part II is an amount not to exceed $ 5,712,799 (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,
othercash orlocal contributions) as provided in Attachment II, Part II is an amount not
to exceed $1,258,100 (amount listed under the "Board of County Commissioners Annual
Appropriations section of the revenue attachment).
b. Overall expenditures will not exceed available funding or budget authority,
whichever is less, (either current year or from surplus trust funds) in any service category.
Unless requested otherwise, any surplus at the end of the term of this Agreement in the
County Health Department Trust Fund that is attributed to the CHD shall be carried
forward to the next contract period.
2
c. Either party may establish service fees as allowed by law to fund activities of the
CHD. Where applicable, such fees shall be automatically adjusted to at least the
Medicaid fee schedule.
d. Either party may increase or decrease funding of this Agreement during the term
hereof by notifying the other party in writing of the amount and purpose for the change in
funding. If the State initiates the increase /decrease, the CHD will revise the Attachment II
and send a copy of the revised pages to the County and the Department of Health,
Bureau of Budget 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, Bureau of Budget Management.
e. The name and address of the official payee to who payments shall be made is:
County Health Department Trust Fund
Collier County
3339 E. Tamiami Trail, Suite 145
Naples, FL 34112
5. CHD DIRECTOR /ADMINISTRATOR. Both parties agree the director /administrator
of the CHD shall be a State employee or under contract with the State and will be under
the day -to -day direction of the Deputy Secretary for Statewide Services. The
director /administrator shall be selected by the State with the concurrence of the County.
The director /administrator of the CHD shall insure 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 Office of Planning, Evaluation & Data Analysis 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
compliance shall be documented. Such justification and compliance documentation shall
160 s 4
be maintained by the CHD in accordance with the terms of this Agreement. State
procedures must be followed for all leases on facilities not enumerated in Attachment IV.
c. The CHD shall maintain books, records and documents in accordance with those
promulgated by the Generally Accepted Accounting Principles (GAAP) and Governmental
Accounting Standards Board (GASB), and the requirements of federal or state law. These
records shall be maintained as required by the Department of Health Policies and
Procedures for Records Management and shall be open for inspection at any time by the
parties and the public, except for those records that are not otherwise subject to disclosure
as provided by law which are subject to the confidentiality provisions of paragraph 6.i.,
below. Books, records and documents must be adequate to allow the CHD to comply with
the following reporting requirements:
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 of Health's Accounting
Procedures Manuals, Accounting memoranda, and Comptroller's
memoranda;
iv. The CHD is responsible for assuring that all contracts with service
providers include provisions that all subcontracted services be reported
to the CHD in a manner consistent with the client registration and
service reporting requirements of the minimum data set as specified in
the Client Information System /Health Management Component
Pamphlet.
d. All funds for the CHD shall be deposited in the County Health Department Trust
Fund maintained by the state treasurer. These funds shall be accounted for separately
from funds deposited for other CHDs and shall be used only for public health purposes in
Collier County.
e. That any surplus /deficit funds, including fees or accrued interest, remaining in the
County Health Department Trust Fund account at the end of the contract year shall be
credited /debited to the state or county, as appropriate, based on the funds contributed by
each and the expenditures incurred by each. Expenditures will be charged to the program
accounts by state and county based on the ratio of planned expenditures in the core
contract and funding from all sources is credited to the program accounts by state and
county. The equity share of any surplus /deficit funds accruing to the state and county is
determined each month and at contract year -end. Surplus funds may be applied toward
the funding requirements of each participating governmental entity in the following year.
However, in each such case, all surplus funds, including fees and accrued interest, shall
remain in the trust fund until accounted for in a manner which clearly illustrates the amount
which has been credited to each participating governmental entity. The planned use of
4
16U 8
surplus funds shall be reflected in Attachment II, Part I of this contract, with special capital
projects explained in Attachment V.
f. There shall be no transfer of funds between the three levels of services without a
contract amendment unless the CHD director /administrator determines that an emergency
exists wherein a time delay would endanger the public's health and the Deputy Secretary
for Statewide Services has approved the transfer. The Deputy Secretary for Statewide
Services shall forward written evidence of this approval to the CHD within 30 days after an
emergency transfer.
g. The CHD may execute subcontracts for services necessary to enable the CHD to
carry out the programs specified in this Agreement. Any such subcontract shall include all
aforementioned audit and record keeping requirements.
h. At the request of either party, an audit may be conducted by an independent CPA
on the financial records of the CHD and the results made available to the parties within
180 days after the close of the CHD fiscal year. This audit will follow requirements
contained in OMB Circular A -133 and may be in conjunction with audits performed by
county government. If audit exceptions are found, then the director /administrator of the
CHD will prepare a corrective action plan and a copy of that plan and monthly status
reports will be furnished to the contract managers for the parties.
i. The CHD shall not use or disclose any information concerning a recipient of
services except as allowed by federal or state law or policy.
j. The CHD shall retain all client records, financial records, supporting documents,
statistical records, and any other documents (including electronic storage media) pertinent
to this Agreement for a period of five (5) years after termination of this Agreement. If an
audit has been initiated and audit findings have not been resolved at the end of five (5)
years, the records shall be retained until resolution of the audit findings.
k. The CHD shall maintain confidentiality of all data, files, and records that are
confidential under the law or are otherwise exempted from disclosure as a public record
under Florida law. The CHD shall implement procedures to ensure the protection and
confidentiality of all such records and shall comply with sections 384.29, 381.004, 392.65
and 456.057, Florida Statutes, and all other state and federal laws regarding
confidentiality. All confidentiality procedures implemented by the CHD shall be consistent
with the Department of Health Information Security Policies, Protocols, and Procedures.
The CHD shall further adhere to any amendments to the State's security requirements and
shall comply with any applicable professional standards of practice with respect to client
confidentiality.
I. The CHD shall abide by all State policies and procedures, which by this reference
are incorporated herein as standards to be followed by the CHD, except as otherwise
permitted for some purchases using county procedures pursuant to paragraph 6.b. hereof.
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
i
WOMIU010
CHD will advise applicants of the right to appeal a denial or exclusion from services, of
failure to take account of a client's choice of service, and of his /her right to a fair hearing to
the final governing authority of the agency. Specific references to existing laws, rules or
program manuals are included in Attachment I of this Agreement.
n. The CHD shall comply with the provisions contained in the Civil Rights Certificate,
hereby incorporated into this contract as Attachment III.
o. The CHD shall submit quarterly reports to the county that shall include at least the
following:
i. The DE3851-1 Contract Management Variance Report and the DE580L1
Analysis of Fund Equities Report;
ii. A written explanation to the county of service variances reflected in the
DE3851-1 report if the variance exceeds or falls below 25 percent of the planned
expenditure amount. However, if the amount of the service specific variance
between actual and planned expenditures does not exceed three percent of the
total planned expenditures for the level of service in which the type of service is
included, a variance explanation is not required. A copy of the written
explanation shall be sent to the Department of Health, Bureau of Budget
Management.
� ' f
p. The dates for the submission of quarterly reports to the county shall be as follows
unless the generation and distribution of reports is delayed due to circumstances beyond
the CHD's control:
i. March 1, 2013 for the report period October 1, 2012 through
December 31, 2012;
ii. June 1, 2013 for the report period October 1, 2012 through
March 31, 2013;
iii. September 1, 2013 for the report period October 1, 2012
through June 30, 2013; and
iv. December 1, 2013 for the report period October 1, 2012
through September 30, 2013.
7. FACILITIES AND EQUIPMENT. The parties mutually agree that:
a. CHD facilities shall be provided as specified in Attachment IV to this contract and
the county shall own the facilities used by the CHD unless otherwise provided in
Attachment IV.
b. The county shall 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
County Health Department Trust Fund shall be sold at fair market value when they are no
longer needed by the CHD and the proceeds returned to the County Health Department
Trust Fund.
8. TERMINATION.
a. Termination at Will. This Agreement may be terminated by either party without
cause upon no less than one - hundred eighty (180) calendar days notice in writing to the
other party unless a lesser time is mutually agreed upon in writing by both parties. Said
notice shall be delivered by certified mail, return receipt requested, or in person to the
other party's contract manager with proof of delivery.
b. Termination Because of Lack of Funds. In the event funds to finance this
Agreement become unavailable, either party may terminate this Agreement upon no less
than twenty -four (24) hours notice. Said notice shall be delivered by certified mail, return
receipt requested, or in person to the other party's contract manager with proof of delivery.
c. Termination for Breach. This Agreement may be terminated by one party, upon no
less than thirty (30) days notice, because of the other party's failure to perform an
160 s
obligation hereunder. Said notice shall be delivered by certified mail, return receipt
requested, or in person to the other party's contract manager with proof of delivery.
Waiver of breach of any provisions of this Agreement shall not be deemed to be a waiver
of any other breach and shall not be construed to be a modification of the terms of this
Agreement.
9. MISCELLANEOUS. The parties further agree:
a. Availability of Funds. If this Agreement, any renewal hereof, or any term,
performance or payment hereunder, extends beyond the fiscal year beginning July 1,
2013, 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 Manaqers. The name and address of the contract managers for
the parties under this Agreement are as follows:
For the State:
Joan M. Colfer, M.D. M.P.H.
Name
Director, Collier County Health Dept
Title
3339 E. Tamiami Trail, Suite 145
Naples, Florida 34112
Address
(239) 252 -8201
Telephone
For the County:
Steve Carnell
Name
Public Services Interim Administrator
Title
3339 E. Tamiami Trail, Suite 214
Naples, Florida 34112
Address
(239) 252 -8468
Telephone
If different contract managers are designated after execution of this Agreement, the name,
address and telephone number of the new representative shall be furnished in writing to
the other parties and attached to originals of this Agreement.
C. Captions. The captions and headings contained in this Agreement are for
the convenience of the parties only and do not in any way modify, amplify, or give
additional notice of the provisions hereof.
.1
In WITNESS THEREOF, the parties hereto have caused this 24 page agreement to be
executed by their undersigned officials as duly authorized effective the 1St day of October, 201`2.
BOARD OF COUNTY COMMISSIONERS
FOR COLLIER COUNTY
SIGNED BY:- �,.s�_1J.
NAME: Fed &I,, Co vie-
STATE OF FLORIDA
DEPARTMENT OF HEALTH
SIGNED BY:
NAME: John H. Armstrong, MD
TITLE: G A u ;2 a TITLE: Surgeon General /Secretary of Health
DATE: /� DATE:
ATTESTED T
SIGNED BY:
NAME:
TITLE: � I b
- . y CI ev
DATE: 1\11�°�1V1
Attest si o chi s ra*
tipnae �e.�.;
SIGNED B"
NAME: oan M. Colfer. M.D. M.P.H.
TITLE: CHD Director /Administrator
DATE: L
AppMvod as to form & legal Su?ftjqfty
Assis ant County Attorney
i
160 8-1
ATTACHMENT
COLLIER 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:
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5.
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7
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Service Requirement
Sexually Transmitted Disease Requirements as specified in F.A.C. 64D -3, F.S. 381 and
Program F.S. 384.
Dental Health Monthly reporting on DH Form 1008 *. Additional reporting
requirements, under development, will be required. The
additional reporting requirements will be communicated upon
finalization.
Special Supplemental Nutrition Service documentation and monthly financial reports as
Program for Women, Infants specified in DHM 150 -24* and all federal, state and county
and Children (including the WIC requirements detailed in program manuals and published
Breastfeeding Peer Counseling procedures.
Program)
Healthy Start/
Requirements as specified in the 2007 Healthy Start
Improved Pregnancy Outcome
Standards and Guidelines and as specified by the Healthy
Start Coalitions in contract with each county health
department.
Family Planning
Periodic financial and programmatic reports as specified
by the program office.
Immunization
Periodic reports as specified by the department regarding
the surveillance /investigation of reportable vaccine
preventable diseases, vaccine usage accountability as
documented in Florida SHOTS, the assessment of various
immunization levels as documented in Florida SHOTS and
forms reporting adverse events following immunization.
Environmental Health Requirements as specified in Environmental Health Programs
Manual 150-4* and DHP 50 -21*
HIV /AIDS Program Requirements as specified in F.S. 384.25 and
F.A.C. 64D -3.030 and 6413- 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.
10
ATTACHMENT I (Continued)
Socio- demographic data on persons
tested for HIV in CHD clinics should be reported on Lab
Request DH Form 1628 or Post -Test Counseling DH Form
1628C. These reports are to be sent to the Headquarters
HIV /AIDS office within 5 days of the initial post -test counseling
appointment or within 90 days of the missed post -test
counseling appointment.
9. School Health Services Requirements as specified in the Florida School Health
Administrative Guidelines (May 2012).
10. Tuberculosis Tuberculosis Program Requirements as specified in F.A.C.
64D -3 and F.S. 392.
11. General Communicable Disease Control Carry out surveillance for reportable communicable and other
acute diseases, detect outbreaks, respond to individual cases
of reportable diseases, investigate outbreaks, and carry out
communication and quality assurance functions, as specified
in the CHD Guide to Surveillance and Investigations.
*or the subsequent replacement if adopted during the contract period.
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Version: 1 Page 1 of 7
ATTACHMENT
II.
COLLIER COUNTY HEALTH DEPARTMENT
Part II. Sources of Contributions to County
Health Department
October 1, 2012 to September 30,
2013
:x
State CHD
County
Total CHD
Trust Fund
CHD
Trust Fund
Other
(cash)
Trust Fund
(cash)
Contribution
Total
1. GENERAL
REVENUE - STATE
015040
AIDS PREVENTION
19,261
0
19,261
0
19,261
015040
AIDS SURVEILLANCE
50,310
0
50,310
0
50,310
015040
ALG /CESSPOOL IDENTIFICATION AND ELIMINATION
0
0
0
0
0
015040
ALG /CONTR TO CHDS -AIDS PATIENT CARE
140,000
0
140,000
0
140,000
015040
ALG /CONTR TO CHDS -AIDS PATIENT CARE NETWORK
0
0
0
0
0
015040
ALG /CONTR TO CHDS - SOVEREIGN IMMUNITY
0
0
0
0
0
015040
MINORITY OUTREACH - PENALVER CLINIC - MIAMI -DADE
0
0
0
0
0
015040
PREPAREDNESS GRANT MATCH
82,824
0
82,824
0
82,824
015040
SCHOOL HEALTH GENERAL REVENUE
80,855
0
80,855
0
80,855
015040
STATEWIDE DENTISTRY NETWORK - ESCAMBIA
0
0
0
0
0
015040
STD GENERAL REVENUE
0
0
0
0
0
015040
TREASURE COAST MIDWIFERY - MARTIN
0
0
0
0
0
015040
HEALTHY START MED- WAIVER - CLIENT SERVICES
0
0
0
0
0
015040
JESSIE TRICE CANCER CTR/HEALTH CHOICE - MIAMI -DADS
0
0
0
0
0
015040
LA LIGA- LEAGUE AGAINST CANCER - MIAMI -DADS
0
0
0
0
0
015040
MANATEE COUNTY RURAL HEALTH SERVICES
0
0
0
0
0
015040
METRO ORLANDO URBAN LEAGUE - ORANGE
0
0
0
0
0
015040
MIGRANT LABOR CAMP SANITATION
74,533
0
74,533
0
74,533
015040
DENTAL SPECIAL INITIATIVES
6,542
0
6,542
0
6,542
015040
DUVAL TEEN PREGANCY PREVENTION - DUVAL
0
0
0
0
0
015040
FAMILY PLANNING GENERAL REVENUE
36,794
0
36,794
0
36,794
015040
FL CLPPP SCREENING & CASE MANAGEMENT
0
0
0
0
0
015040
FL HEPATITIS & LIVER FAILURE PREVENTION /CONTROL
89,286
0
89,286
0
89,286
015040
HEALTHY START MED WAIVER - SOBRA
0
0
0
0
0
015040
ALG/IPO HEALTHY STARTAPO
0
0
0
0
0
015040
ALG/PRIMARY CARE
313,432
0
313,432
0
313,432
015040
BREAST & CERVICAL - ADMINISTRATION /CASE MANAGEMENT
0
0
0
0
0
015040
COMMUNITY SMILES - MIAMI -DADE
0
0
0
0
0
015040
COMMUNITY TB PROGRAM
78,326
0
78,326
0
78,326
015040
COUNTY SPECIFIC DENTAL PROJECTS - ESCAMBIA
0
0
0
0
0
015050
NON - CATEGORICAL GENERAL REVENUE
1,638,824
0
1,638,824
0
1,638,824
GENERAL REVENUE TOTAL
2,610,987
0
2,610,987
0
2,610,987
2. NON GENERAL REVENUE - STATE
015010
ALG /CONTR. TO CHDS - BIOMEDICAL WASTE
14,050
0
14,050
0
14,050
015010
ALG /CONTR. TO CHDS -SAFE DRINKING WATER PRG
0
0
0
0
0
015010
CHD PROGRAM SUPPORT
0
0
0
0
0
015010
FOOD AND WATERBORNE DISEASE PROGRAM ADM TF/DACS
0
0
0
0
0
015010
PREPAREDNESS GRANT MATCH
0
0
0
0
0
015010
PUBLIC SWIMMING POOL PROGRAM
0
0
0
0
0
015010
SCHOOL HEALTH TOBACCO TF
137,218
0
1 37,218
0
137,218
015010
TOBACCO ADMINISTRATION & MANAGEMENT
0
0
0
0
0
015010
TOBACCO COMMUNITY INTERVENTION
224,230
0
224,230
0
224,230
015020
TRANSFER FROM ANOTHER STATE AGENCY
0
0
0
0
0
015020
TRANSFER FROM ANOTHER STATE AGENCY
0
0
0
0
0
015020
TRANSFER FROM ANOTHER STATE AGENCY
0
0
0
0
0
015060
NON - CATEGORICAL TOBACCO REBASING
3,097
0
3,097
0
3,097
Version: 1 Page 1 of 7
Version: 1 Page 2 of 7
ATTACHMENT II.
COLLIER COUNTY HEALTH DEPARTMENT
Part II. Sources of Contributions to County
Health Department
October 1, 2012 to September 30, 2013
State CHD
County
Total CHD
Trust Fund
CHD
Trust Fund
Other
(cash)
Trust Fund
(cash)
Contribution
Total
NON GENERAL
REVENUE TOTAL
378,595
0
378,595
0
378,595
3. FEDERAL FUNDS - State
007000
ABSTINENCE EDUCATION GRANT PROGRAM
0
0
0
0
0
007000
AIDS PREVENTION
255,477
0
255,477
0
255,477
007000
AIDS SURVEILLANCE
0
0
0
0
0
007000
BIOTERRORISM HOSPITAL PREPAREDNESS
21,208
0
21,208
0
21,208
007000
CHRONIC DISEASE PREVENTION & HEALTH PROMOTION
32,000
0
32,000
0
32,000
007000
COASTAL BEACH MONITORING PROGRAM
19,929
0
19,929
0
19,929
007000
TUBERCULOSIS CONTROL - FEDERAL GRANT
141,770
0
141,770
0
141,770
007000
UNINTENDED/UNWANTED PREG -TEEN PREGNANCY PREV
28,000
0
28,000
0
28,000
007000
WIC ADMINISTRATION
1,462,607
0
1,462,607
0
1,462,607
007000
WIC BREASTFEEDING PEER COUNSELING
70,030
0
70,030
0
70,030
007000
STD FEDERAL GRANT - CSPS
0
0
0
0
0
007000
STD PROGRAM INFERTILITY PREVENTION PROJECT (IPP)
17,624
0
17,624
0
17,624
007000
SYPHILIS ELIMINATION
0
0
0
0
0
007000
TEENAGE PREGNANCY PREVENTION REPLICATION
0
0
0
0
0
007000
TITLE X HIV /AIDS PROJECT
139,108
0
139,108
0
139,108
007000
TOBACCO FAITH BASED PROJECT
0
0
0
0
0
007000
RAPE PREVENTION & EDUCATION
0
0
0
0
0
007000
RYAN WHITE
0
0
0
0
0
007000
RYAN WHITE - EMERGING COMMUNITIES
0
0
0
0
0
007000
007000
RYAN WHITE -AIDS DRUG ASSIST PROG -ADMIN
RYAN WHITE- CONSORTIA
77,945
0
0
0
77,945
0
0
0
77,945
0
007000
SAFE SLEEP EDUCATION
10,386
0
10,386
0
10,386
007000
MINORITY INVOLVEMENT IN HIV /AIDS PROGRAM
0
0
0
0
0
007000
PHP - CITIES READINESS INITIATIVE
0
0
0
0
0
007000
PRECONCEPTION HEALTH CARE
0
0
0
0
0
007000
PREGNANCY ASSOCIATED MORTALITY PREVENTION
0
0
0
0
0
007000
PUBLIC HEALTH INFRASTRUCTURE
0
0
0
0
0
007000
PUBLIC HEALTH PREPAREDNESS BASE
209,697
0
209,697
0
209,697
007000
007000
007000
IMMUNIZATION WIC LINKAGES
MCH BGTF- GADSDEN SCHOOL CLINIC
MCH BGTF - HEALTHY START COALITIONS
0
0
0
0
0
0
0
0
0
0
0
0
007000
MCH QUALITY IMPROVEMENT ACTIVITIES MCHBG
0
0
0
0
0
007000
MINORITY AIDS INITIATIVE
0
0
0
0
0
007000
007000
007000
007000
MINORITY AIDS INITIATIVE ICE COLLABORATIVE
FGTF/FAMILY PLANNING -TITLE X
HEALTHY HOMES AND LEAD POISONING GRANT
HIV HOUSING FOR PEOPLE LIVING WITH AIDS
0
80,527
0
0
0
0
0
0
0
80,527
0
0
0
0
0
0
0
80,527
0
0
007000
HIV INCIDENCE SURVEILLANCE
0
0
0
0
0
007000
IMMUNIZATION FEDERAL GRANT ACTIVITY SUPPORT
123,219
0
123,219
0
123,219
007000
IMMUNIZATION FIELD STAFF EXPENSE
0
0
0
0
0
007000
COLORECTAL CANCER SCREENING 2009 -10
0
0
0'',
0
0
007000
DENTAL SERVICES
0
0
0
0
0
007000
ENHANCE COMPREHENSIVE PREVENTION PLANNING AND IMPL
0
0
0
0
0
007000
EXPANDED TESTING INITIATIVE (ETI)
0
0
0
0
0
007000
007000
FGTF /AIDS MORBIDITY
FGTFBREAST & CERVICAL CANCER -ADMIN/CASE MAN
0
0
0
0
0
0
0
0
0
0
Version: 1 Page 2 of 7
ATTACHMENT H.
COLLIER COUNTY HEALTH DEPARTMENT
Part II. Sources of Contributions to County Health Department
October 1, 2012 to September 30, 2013
State CHD County Total CHD
Trust Fund CHD Trust Fund Other
(cash) Trust Fund (cash) Contribution
3. FEDERAL FUNDS - State
015009
MEDIPASS WAIVER -HLTHY STRT CLIENT SERVICES
015009
MEDIPASS WAIVER -SOBRA
007055
ARRA FEDERAL GRANT - SCHEDULE C
015075
SCHOOL HEALTH TITLE XXI
015075
SUMMER FOOD PROGRAM INSPECTIONS
015075
REFUGEE HEALTH
FEDERAL
FUNDS TOTAL
4. FEES
ASSESSED BY STATE OR FEDERAL RULES - STATE
001020
TANNING FACILITIES
001020
BODY PIERCING
001020
MIGRANT HOUSING PERMIT
001020
MOBILE HOME AND PARKS
001020
FOOD HYGIENE PERMIT
001020
BIOHAZARD WASTE PERMIT
001020
PRIVATE WATER CONSTR PERMIT
001020
PUBLIC WATER ANNUAL OPER PERMIT
001020
PUBLIC WATER CONSTR PERMIT
001020
NON -SDWA SYSTEM PERMIT
001020
SAFE DRINKING WATER
001020
SWIMMING POOLS
001092
OSDS PERMIT FEE
001092
I & M ZONED OPERATING PERMIT
001092
AEROBIC OPERATING PERMIT
001092
SEPTIC TANK SITE EVALUATION
001092
NON SDWA LAB SAMPLE
001092
OSDS VARIANCE FEE
001092
ENVIRONMENTAL HEALTH FEES
001092
OSDS REPAIR PERMIT
001170
LAB FEE CHEMICAL ANALYSIS
001170
WATER ANALYSIS- POTABLE
001170
NONPOTABLE WATER ANALYSIS
010304
MQA INSPECTION FEE
001206
CENTRAL OFFICE SURCHARGE
FEES ASSESSED BY STATE OR FEDERAL RULES TOTAL
5. OTHER CASH CONTRIBUTIONS - STATE
010304
STATIONARY POLLUTANT STORAGE TANKS
090001
DRAW DOWN FROM PUBLIC HEALTH UNIT
OTHER CASH CONTRIBUTIONS TOTAL
6.NIEDICAID - STATE /COUNTY
001056
MEDICAID PHARMACY
001076
MEDICAID TB
001078
MEDICAID ADMINISTRATION OF VACCINE
001079
MEDICAID CASE MANAGEMENT
001081
MEDICAID CHILD HEALTH CHECK UP
Version:
1
LAM*-
Total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
33,690
0
33,690
0
33,690
0
0
0
0
0
231,600
0
231,600
0
231,600
2,954,817
0
2,954,817
0
2,954,817
3,000
0
3,000
0
3,000
0
0
0
0
0
24,575
0
24,575
0
24,575
19,918
0
19,918
0
19,918
28,712
0
28,712
0
28,712
33,400
0
33,400
0
33,400
0
0
0
0
0
10,000
0
10,000
0
10,000
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
274,000
0
274,000
0
274,000
80,000
0
80,000
0
80,000
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1,200
0
1,200
0
1,200
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
50,000
0
50,000
0
50,000
524,805
0
524,805
0
524,805
0
0
0
0
0
306,941
0
306,941
0
306,941
306,941
0
306,941
0
306,941
0
0
0
0
0
0
48,000
48,000
0
48,000
0
20,000
20,000
0
20,000
0
21,720
21,720
0
21,720
0
0
0
0
0
Page 3of7
4
6. MEDICAID - STATE /COUNTY
160
MEDICAID DENTAL
8
ATTACHMENT II.
001087
MEDICAID STD
001089
COLLIER COUNTY HEALTH DEPARTMENT
001147
MEDICAID HMO CAPITATION
001191
Part H. Sources of Contributions to County Health Department
001192
MEDICAID COMPREHENSIVE CHILD
001193
October 1, 2012 to September 30, 2013
001194
MEDICAID LABORATORY
001208
State CHD County Total CHD
001059
MEDICAID LOW INCOME POOL
001051
Trust Fund CHD Trust Fund
Other
MEDICAID - BEHAVIORAL HEALTH
001071
(cash) Trust Fund (cash)
Contribution
MEDICAID - DERMATOLOGY
Total
6. MEDICAID - STATE /COUNTY
001082
MEDICAID DENTAL
001083
MEDICAID FAMILY PLANNING
001087
MEDICAID STD
001089
MEDICAID AIDS
001147
MEDICAID HMO CAPITATION
001191
MEDICAID MATERNITY
001192
MEDICAID COMPREHENSIVE CHILD
001193
MEDICAID COMPREHENSIVE ADULT
001194
MEDICAID LABORATORY
001208
MEDIPASS $3.00 ADM. FEE
001059
MEDICAID LOW INCOME POOL
001051
EMERGENCY MEDICAID
001058
MEDICAID - BEHAVIORAL HEALTH
001071
MEDICAID - ORTHOPEDIC
001072
MEDICAID - DERMATOLOGY
001075
MEDICAID - SCHOOL HEALTH CERTIFIED MATCH
001069
MEDICAID - REFUGEE HEALTH
001055
MEDICAID - HOSPITAL
001148
MEDICAID HMO NON - CAPITATION
001074
MEDICAID - NEWBORN SCREENING
MEDICAID TOTAL
7. ALLOCABLE REVENUE -STATE
018000
REFUNDS
037000
PRIOR YEAR WARRANT
038000
12 MONTH OLD WARRANT
ALLOCABLE REVENUE TOTAL
8. OTHER STATE CONTRIBUTIONS NOT IN CHD TRUST FUND - STATE
0
PHARMACY SERVICES
0
LABORATORY SERVICES
0
TB SERVICES
0
IMMUNIZATION SERVICES
0
STD SERVICES
0
CONSTRUCTION/RENO VATION
0
WIC FOOD
0
ADAP
0
DENTAL SERVICES
0
OTHER (SPECIFY)
0
OTHER (SPECIFY)
OTHER STATE CONTRIBUTIONS TOTAL
9. DIRECT LOCAL CONTRIBUTIONS - BCC/TAX DISTRICT
008010
CONTRIBUTION FROM CITY GOVERNMENT
008020
CONTRIBUTION FROM HEALTH CARE TAX NOT THRU BCC
008040
BCC GRANT /CONTRACT
008030
CONTRIBUTION FROM HEALTH CARE TAX
Version:
1
0
805,724
805,724
0
805,724
0
0
0
0
0
0
8,500
8,500
0
8,500
0
32,276
32,276
0
32,276
0
0
0
0
0
0
0
0
0
0
0
500
500
0
500
0
8.500
8,500
0
8,500
0
0
0
0
0
0
434
434
0
434
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
22,000
22,000
0
22,000
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
967,654
967,654
0
967,654
2,585
0
2,585
0
2,585
0
0
0
0
0
0
0
0
0
0
2,585
0
2,585
0
2,585
0
0
0
146,868
146,868
0
0
0
101,737
101,737
0
0
0
0
0
0
0
0
916,303
916,303
0
0
0
0
0
0
0
0
0
0
0
0
0
6,521,482
6,521,482
0
0
0,
1,258,313
1,258,313
0
0
0:
0
0
0
&
0
0
0
0
0
0
0
0
0
0'
8,944,703
8,944,703
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0'
0
0
Page 4 of 7
ATTACHMENT II.
COLLIER COUNTY HEALTH DEPARTMENT
Part 11. Sources of Contributions to County
Health Department
October 1, 2012 to September 30, 2013
State CHD
County
Total CHD
Trust Fund
CHD
Trust Fund
Other
(cash)
Trust Fund
(cash)
Contribution
Total
9. DIRECT LOCAL CONTRIBUTIONS - BCC/T:A_X DISTRICT
008034
BCC CONTRIBUTION FROM GENERAL FUND
0
1,258,100
1,258,100
0
1,258,100
DIRECT COUNTY CONTRIBUTION TOTAL
0
1,258,100
1,258,100
0
1,258,100
10. FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION - COUNTY
001060
VITAL STATISTIC -FEES & SERVICES
0
200
200
0
200
001077
RABIES VACCINE
0
0
0
0
0
001077
CHILD CAR SEAT PROG
0
0
0
0
0
001077
PERSONAL HEALTH FEES
0
193,377
193,377
0
193,377
001077
AIDS CO -PAYS
0
0
0
0
0
001094
ADULT ENTER. PERMIT FEES
0
0
0
0
0
001094
LOCAL ORDINANCE FEES
0
557,900
557,900
0
557,900
001114
NEW BIRTH CERTIFICATES
0
60,000
60,000
0
60,000
001115
VITAL STATISTICS - DEATH CERTIFICATE
0
240,800
240,800
0
240,800
001117
VITAL STATS -ADM. FEE 50 CENTS
0
4,000
4,000
0
4,000
001073
CO -PAY FOR THE AIDS CARE PROGRAM
0
0
0
0
0
001025
CLIENT REVENUE FROM GRC
0
0
0
0
0
001040
CELL PHONE ADMINISTRATIVE FEE
0
p
0
0
0
FEES AUTHORIZED BY COUNTY TOTAL
0
1,056,277
1,056,277
0
1,056,277
11. OTHER CASH AND LOCAL CONTRIBUTIONS - COUNTY
001009
RETURNED CHECK ITEM
0
0
0
0
0
001029
THIRD PARTY REIMBURSEMENT
0
732,245
732,245
0
732,245
001029
HEALTH MAINTENANCE ORGAN. (HMO)
0
p
0
0
0
001054
MEDICARE PART D
0
0
0
0
0
001077
RYAN WHITE TITLE II
0
0
0
0
0
001090
MEDICARE PART B
0
30,018
30,018
0
30,018
001190
HEALTH MAINTENANCE ORGANIZATION
0
0
0
0
0
005040
INTEREST EARNED
0
0
0
0
0
005041
INTEREST EARNED -STATE INVESTMENT ACCOUNT
0
0
0
0
0
007010
U.S. GRANTS DIRECT
0
0
0
0
0
008050
SCHOOL BOARD CONTRIBUTION
0
0
0
0
0
008060
SPECIAL PROJECT CONTRIBUTION
0
0
0
0
0
010300
SALE OF GOODS AND SERVICES TO STATE AGENCIES
0
300
300
0
300
010301
EXP WITNESS FEE CONSULTNT CHARGES
0
0
0
0
0
010405
SALE OF PHARMACEUTICALS
0
0
0
0
0
010409
SALE OF GOODS OUTSIDE STATE GOVERNMENT
0
0
0
0
0
011001
HEALTHY START COALITION CONTRIBUTIONS
0
412,562
412,562
0
412,562
011007
CASH DONATIONS PRIVATE
0
250
250
0
250
012020
FINES AND FORFEITURES
0
1,692
1,6921
0
1,692
012021
RETURN CHECK CHARGE
0
0
0
0
0
028020
INSURANCE RECOVERIES -OTHER
0
0
01
0
0
090002
DRAW DOWN FROM PUBLIC HEALTH UNIT
0
652,247
652,247
0
652,247
011000
GRANT DIRECT -NOVA UNIVERSITY CHD TRAINING
0
0
0
0
0
011000
GRANT - DIRECT
0
293,816
293,816
0
293,816
011000
GRANT DIRECT- COUNTY HEALTH DEPARTMENT DIRECT SERVICES 0
0
0
0
0
011000
COUNTY COMMISSION - LIP FUND
0
226,260
226,260
0
226,260
011000
GRANT -DRECT
0
0
0'
0
0
Version:
1
Page 5 of 7
160 s
ATTACHMENT II.
COLLIER COUNTY HEALTH DEPARTMENT
Part II. Sources of Contributions to County Health Department
October 1, 2012 to September 30, 2013
State CHD
County
Total CHD
Trust Fund
CHD
Trust Fund
Other
(cash)
Trust Fund
(cash)
Contribution
Total yR
11. OTHER CASH AND LOCAL CONTRIBUTIONS - COUNTN"
011000 GRANT - DIRECT
0
0
0
0
0
011000 GRANT - DIRECT
0
0
0
0
0
011000 GRANT DIRECT -ARROW
0
0
0
0
0
011000 GRANT DIRECT - QUANTUM DENTAL
0
0
0
0
0
011000 GRANT DIRECT - HEALTH CARE DISTRICT PAHOKEE
0
0
0
0
0
011000 GRANT - DIRECT
0
0
0
0
0
011000 GRANT - DIRECT
0
0
0
0
0
011000 GRANT - DIRECT
0
0
0
0
0
011000 GRANT - DIRECT
0
0
0
0
0
010402 RECYCLED MATERIAL SALES
0
0
0
0
0
010303 FDLE FINGERPRINTING
0
2,000
2,000
0
2,000
007050 ARRA FEDERAL GRANT
0
0
0
0
0
001010 RECOVERY OF BAD CHECKS
0
0
0
0
0
008065 FCO CONTRIBUTION
0
0
0
0
0
011006 RESTRICTED CASH DONATION
0
0
0
0
0
028000 INSURANCE RECOVERIES
0
0
0
0
0
001033 CMS MANAGEMENT FEE - PMPMPC
0
0
0
0
0
010400 SALE OF GOODS OUTSIDE STATE GOVERNMENT
0
0
0
0
0
010500 REFUGEE HEALTH
0
0
0
0
0
005045 INTEREST EARNED -THIRD PARTY PROVIDER
0
0
0
0
0
005043 INTEREST EARNED - CONTRACT /GRANT
0
0
0
0
0
010306 DOH/DOC INTERAGENCY AGREEMENT
0
0
0
0
0
011002 ARRA FEDERAL GRANT - SUB - RECIPIENT
0
0
0
0
0
011004 LOW INCOME POOL - SUBRECIPIENT
0
0
0
0
0
OTHER CASH AND LOCAL CONTRIBUTIONS TOTAL
0
2,351,390
2,351,390
0
2,351,390
12. ALLOCABLE REVENUE - COUNTY
018000 REFUNDS
037000 PRIOR YEAR WARRANT
038000 12 MONTH OLD WARRANT
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
COUNTY ALLOCABLE REVENUE TOTAL
0
0
0
0
0
13. BUILDINGS -COUNTY
ANNUAL RENTAL EQUIVALENT VALUE
0
p
0
525,048
525,048
GROUNDS MAINTENANCE
0
0
0
195,149
195,149
IT ALLOCATION & GOLDEN GATE RENT
0
0
0
84,900
84,900
INSURANCE
0
0
0
0
0
UTILITIES
0
0
0,
209,800
209,800
OTHER (SPECIFY)
0
0
0
0
0
BUILDING MAINTENANCE
0
0
0
0
0
BUILDINGS TOTAL
0
0
0
1,014,897
1,014,897
14. OTHER COUNTY CONTRIBUTIONS NOT IN CHD TRUST FUND
- COUNTY
EQUIPMENTNEHICLE PURCHASES
0
0
0
0
0
VEHICLE INSURANCE
0
0
0
16,300
16,300
VEHICLE MAINTENANCE
0
0
0
0
0
OTHER COUNTY CONTRIBUTION (SPECIFY)
0
0
01
0
0
Version: 1
Page 6 of 7
16U
g a:
ATTACHMENT II.
COLLIER COUNTY HEALTH DEPARTMENT
Part II. Sources of Contributions to County Health Department
October 1, 2012 to September 30, 2013 z
State CHD County Total CHD
Trust Fund CHD Trust Fund Other
(cash) Trust Fund ( Contribution Total
14. OTHER COUNTY CONTRIBUTIONS NOT IN CHD TRUST FUND - COUNTY
OTHER COUNTY CONTRIBUTION (SPECIFY) 0 0
0 0 0
OTHER COUNTY CONTRIBUTIONS TOTAL 0 0 0 16,300 16,300
GRAND TOTAL CHD PROGRAM 6,778,730 5,633,421 12,412,1 1 9,975,900 22,388,051
Version: 1 Page 7 of 7
ATTACHMENT II.
COLLIER COUNTY HEALTH DEPARTMENT
Part III. Planned Staffing, Clients, Services, And Expenditures By Program Service Area Within Each Level Of Service
October 1, 2012 to September 30, 2013
Quarterly Expenditure Plan
FTE's
Clients
Services/
Ist
2nd
3rd
4th
Grand
(0.00)
Units
Visits
(Whole dollars only)
State
County
Total
A. COMMUNICABLE DISEASE CONTROL:
IMMUNIZATION(101)
12.61
8,678
22,230
169,861
167,185
183,381
167,185
344,228
343,384
687,612
STD (102)
5.14
738
1,254
63,200
68,775
80,239
68,775
22,408
258,581
280,989"
HIV /AIDS PREVENTION (03A1)
5.44
1,500
15,000
76,479
79,024
80,529
79,024
212,295
102,761
315,056
HIV /AIDS SURVEILLANCE (03A2)
1.35
60
300
15,690
31,644
19,418
31,644
98,396
0
98,396
HIV /AIDS PATIENT CARE (03A3)
9.30
576
9,173
156,913
275,847
230,156
275,847
578,152
360,611
938,763
ADAP (03A4)
2.07
36
120
27,185
22,892
26,708
22,892
99,677
0
99,677
TB CONTROL SERVICES (104)
1 1.34
791
5,193
154,069
177,047
189,056
177,047
408,756
288,463
697,219
COMM. DISEASE SURV. (106)
6.38
0
6,278
110,026
112,410
131,146
112,410
0
465,992
465,992
HEPATITIS PREVENTION (109)
2.04
1,570
2,130
28,816
31,445
36,686
31,445
128,392
0
128,392
PUBLIC HEALTH PREP AND RESP (116)
5.55
0
0
136,257
103,043
120,218
103,043
415,831
46,730
462,561
VITAL STATISTICS (180)
3.34
10,957
37,551
36,927
45,977
47,808
45,977
0
176,689
176,689
COMMUNICABLE DISEASE SUBTOTAL
64.56
24,906
99,229
975,423
1,115,289
1,145,345
1,115,289
2,308,135
2,043,211
4,351,346
B. PRIMARY CARE:
CHRONIC DISEASE SERVICES (2 10)
0.60
173
3,445
8,246
9,926
11,580
9,926
39,678
0
39,678
TOBACCO PREVENTION (212)
3.00
0
5,551
42,920
59,489
54,404
59,489
216,302
0
216,302
WIC (21W1)
35.00
11,544
98,927
474,711
498,663
319,774
298,663
1,591,811
0
1,591,811
WIC BREASTFEEDING PEER COUNSELING (21W2)
3.00
4,356
2,908
27,294
15,053
19,029
15,053
76,429
0
76,429
FAMILY PLANNING (223)
2.75
2,628
3,080
103,320
115,760
105,885
115,760
439,596
1,129
440,725
IMPROVED PREGNANCY OUTCOME (225)
5.82
1,140
7,586
143,875
176,490
180,903
176,490
247,020
430,738
677,758
HEALTHY START PRENATAL (227)
12.02
1,106
6,462
129,171
177,136
177,492
177,1316
181,948
478,987
660,935
COMPREHENSIVE CHILD HEALTH (229)
2.01
234
700
28,999
75,846
59,321
75,846
0
240,012
240,012
HEALTHY START INFANT (23 1)
4.20
787
4,578
54,833
47,864
55,842
47,864
206,403
0
206,403
SCHOOL HEALTH (234)
7.33
0
222,756
67,103
114,579
133,676
114,579
328,977
100,960
429,937
COMPREHENSIVE ADULT HEALTH (237)
6.07
1,615
3,893
171,310
215,482
193,061
215,482
364,698
430,637
795,335
COMMUNITY HEALTH DEVELOPMENT (238)
026
0
26
11,973
641
415
641
13,670
0
13,670
DENTAL HEALTH (240)
14.39
5,052
10,812
184,567
401,477
350,603
401,477
6,427
1,331,697
1,338,124
PRIMARY CARE SUBTOTAL
96.45
28,635
370,724
1,448,322
1,908,406 1,661,985
1,708,406 3,712,959
3,014,160
6,727,119
C. ENVIRONMENTAL HEALTH:
Water and Onsite Sewage Programs
COASTAL BEACH MONITORING (347)
0.13
501
501
4,876
6,196
7,230
6,196
24,498
0
24,498
LIMITED USE PUBLIC WATER SYSTEMS (357)
0.22
488
1,404
2,696
5,169
6,032
5,169
6,355
12,711
19,066
PUBLIC WATER SYSTEM (358)
0.00
0
0
129
21
26
21
97
100
197
PRIVATE WATER SYSTEM (359)
0.00
0
0
116
45
51
45
0
257
257
INDIVIDUAL SEWAGE DISP. (361)
8.03
2,713
5,542
91,580
122,874
143,352
122,874
226,202
254,478
480,680
Group Total
8.38
3,702
7,447
99,397
134,305
156,691
134,305
257,152
267,546
524,698
Facility Programs
FOOD HYGIENE (348)
0.61
60
290
13,234
19,930
11,585
19,930
64,679
0
64,679
BODY PIERCING FACILITIES SERVICES
0.02
3
3
0
228
265
228
356
365
721
GROUP CARE FACILITY (35 1)
0.93
320
503
12,350
12,354
14,414
12,354
0
51,472
51,472
MIGRANT LABOR CAMP (352)
3.23
256
1,882
37,495
51,491
60,072
51,491
137,836
62,713
200,549
HOUSING,PUBLIC BLDG SAFETY,SANITATION (353)0.00
0
0
53
38
45
38
86
88
174
Version: 3
Page 1 of 2
X01
ATTACHMENT II.
COLLIER COUNTY HEALTH DEPARTMENT
Part III. Planned Staffing, Clients, Services, And Expenditures By Program Service Area Within Each Level Of Service
October 1, 2012 to
September
30, 2013
Quarterly Expenditure Plan
FTE's
Clients
Services/
1st
2nd
3rd
4th
Grand
(0.00)
Units
Visits
(Whole dollars only)
State
County
Total
C. ENVIRONMENTAL HEALTH:
Facility Programs
MOBILE HOME AND PARKS SERVICES (354)
0.58
94
243
10,931
8,520
9,939
8,520
37,910
0
37,910
SWIMMING POOLS/BATHING (360)
3.37
1,484
18,477
65,550
60,206
70,241
60,206
104,379
151,824
256,203
BIOMEDICAL WASTE SERVICES (364)
0.55
359
376
25,211
11,719
13,672
11,719
62,321
0
62,321
TANNING FACILITY SERVICES (369)
0.02
5
12
1,181
248
291
248
1,968
0
1,968
Group Total
931
2,581
21,786
166,005
164,734
180,524
164,734
409,535
266,462
675,997
Groundwater Contamination
STORAGE TANK COMPLIANCE (355)
0.00
0
0
0
0
0
0
0
0
0
SUPER ACT SERVICE (356)
0.04
52
74
927
584
681
584
1,370
1,406
2,776
Group Total
0.04
52
74
927
584
681
584
1,370
1,406
2,776
Community Hygiene
TATTOO FACILITIES SERVICES
0.01
0
0
1,400
132
153
132
896
921
1,817
COMMUNITY ENVIR. HEALTH (345)
0.00
0
0
0
0
0
0
0
0
0
INJURY PREVENTION (346)
0.07
0
57
444
1,391
1,621
1,391
2,391
2,456
4,847
LEAD MONITORING SERVICES (350)
0.00
0
0
0
6
7
6
10
9
19
PUBLIC SEWAGE (362)
0.00
0
0
0
2
2
2
4
2
6
SOLID WASTE DISPOSAL (363)
0.00
0
0
-6
0
0
6
0
0
0
SANITARY NUISANCE (365)
0.02
0
0
27
303
353
303
486
500
986
RABIES SURVEILLANCE /CONTROL SERVICES (366)0.00
0
0
0
0
0
0
0
0
0
ARBOVIRUS SURVEILLANCE (367)
0.00
0
0
0
0
0
0
0
0
0
RODENT /ARTHROPOD CONTROL (368)
0.00
0
0
0
53
53
53
78
81
159
WATER POLLUTION (370)
0.00
0
0
0
0
0
0
0
0
0
INDOOR AIR (371)
0.00
0
0
0
0
0
0
0
0
0
RADIOLOGICAL HEALTH (372)
0.00
0
0
0
0
0
0
0
0
0
TOXIC SUBSTANCES (373)
0.00
0
0
0
0
0
0
0
0
0
Group Total
0.10
0
57
1,865
1,887
2,189
1,893
3,865
3,969
7,834
ENVIRONMENTAL HEALTH SUBTOTAL
17.83
6,335
29,364
268,194
301,510
340,085
301,516
671,922
539,383
1,211,305
D. NON- OPERATIONAL COSTS:
NON-OPERATIONAL COSTS (599)
0.00
0
0
18,788
16,143
22,168
15,282
35,714
36,667
72,381
ENVIRONMENTAL HEALTH SURCHARGE (399)
0.00
0
0
13,336
5,500
3,000
28,164
50,000
0
50,000
NON - OPERATIONAL COSTS SUBTOTAL
0.00
0
0
32,124
21,643
25,168
43,446
85,714
36,667
122,381
TOTAL CONTRACT
178.84
59,876
499,317
2,724,063
3,346,848 3,172,583
3,168,657
6,778,730
5,633,421
12,412,151
Version: 3 Page 2 of 2
We"I re
ATTACHMENT III
COLLIER 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:
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.
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.
22
ATTACHMENT IV
COLLIER COUNTY HEALTH DEPARTMENT
FACILITIES UTILIZED BY THE COUNTY HEALTH DEPARTMENT
Facility
Description
Collier County Health
Department & Public
Services Building H
Immokalee Satellite
Golden Gate WIC Office
•1
Location Owned By
3339 E. Tamiami Trail Collier County
Suite 145, Naples
419 North First Street Collier County
Immokalee
4945 Golden Gate Parkway Benderson
Unit 102, Naples Development
23
16u
ATTACHMENT V
COLLIER COUNTY HEALTH DEPARTMENT
SPECIAL PROJECTS SAVINGS PLAN
IDENTIFY THE AMOUNT OF CASH THAT IS ANTICIPATED TO BE SET ASIDE ANNUALLY FOR THE PROJECT.
CONTRACT YEAR
2010 -2011
2011 -2012
2012 -2013
2013 -2014
2014 -2015
PROJECT TOTAL
STATE
$ 0
$ 0
COUNTY
$
$ 0
$ 0
SPECIAL PROJECT CONSTRUCTION /RENOVATION PLAN
PROJECT NAME:
LOCATION/ ADDRESS:
PROJECT TYPE:
NEW BUILDING
ROOFING
RENOVATION
PLANNING STUDY
NEW ADDITION
OTHER
SQUARE FOOTAGE:
PROJECT SUMMARY: Describe scope of work in reasonable detail.
ESTIMATED PROJECT INFORMATION:
START DATE (initial expenditure of funds) :
COMPLETION DATE:
DESIGN FEES:
CONSTRUCTION COSTS:
FURNITURE/EQUIPMENT
TOTAL PROJECT COST:
COST PER SQ FOOT:
$
TOTAL
$ 0
$ 0
Special Capital Projects are new construction or renovation projects and new furniture or equipment
associated with these projects and mobile health vans.
24
16D 8'
CONTRACT BETWEEN
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
AND
STATE OF FLORIDA DEPARTMENT OF HEALTH
FOR OPERATION OF
THE COLLIER COUNTY HEALTH DEPARTMENT
CONTRACT YEAR 2012 -2013
This agreement ( "Agreement") is made and entered into between the State of Florida,
Department of Health ( "State ") and the Collier County Board of County Commissioners
( "County "), through their undersigned authorities, effective October 1, 2012.
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. Collier 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, 2012, through September 30, 2013, or until a written agreement replacing this
Agreement is entered into between the parties, whichever is later, unless this Agreement
is otherwise terminated pursuant to the termination provisions set forth in paragraph 8,
below.
3. SERVICES MAINTAINED BY THE 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
160 a
funds and shall include those services mandated on a state or federal level. Examples of
environmental health services include, but are not limited to, food hygiene, safe drinking
water supply, sewage and solid waste disposal, swimming pools, group care facilities,
migrant labor camps, toxic material control, radiological health, and occupational health.
b. "Communicable disease control services" are those services which protect the
health of the general public through the detection, control, and eradication of diseases
which are transmitted primarily by human beings. Communicable disease services shall
be supported by available federal, state, and local funds and shall include those services
mandated on a state or federal level. Such services include, but are not limited to,
epidemiology, sexually transmissible disease detection and control, HIV /AIDS,
immunization, tuberculosis control and maintenance of vital statistics.
c. "Primary care services" are acute care and preventive services that are made
available to well and sick persons who are unable to obtain such services due to lack of
income or other barriers beyond their control. These services are provided to benefit
individuals, improve the collective health of the public, and prevent and control the spread
of disease. Primary health care services are provided at home, in group settings, or in
clinics. These services shall be supported by available federal, state, and local funds and
shall include services mandated on a state or federal level. Examples of primary health
care services include, but are not limited to: first contact acute care services; chronic
disease detection and treatment; maternal and child health services; family planning;
nutrition; school health; supplemental food assistance for women, infants, and children;
home health; and dental services.
4. FUNDING. The parties further agree that funding for the CHD will be handled as
follows:
a. The funding to be provided by the parties and any other sources are set forth in Part
II of Attachment II hereof. This funding will be used as shown in Part I of Attachment 11.
i. The State's appropriated responsibility (direct contribution excluding any state fees,
Medicaid contributions or any other funds not listed on the Schedule C) as provided in
Attachment 11, Part II is an amount not to exceed $ 5,712,799 (State General
Revenue, State Funds, Other State Funds and Federal Funds listed on the Schedule C). The
State's obligation to pay under this contract is contingent upon an annual
appropriation by the Legislature.
ii. The County's appropriated responsibility (direct contribution excluding any fees,
other cash or local contributions) as provided in Attachment 11, Part II is an amount not
to exceed $1,258,100 (amount listed under the "Board of County Commissioners Annual
Appropriations section of the revenue attachment).
b. Overall expenditures will not exceed available funding or budget authority,
whichever is less, (either current year or from surplus trust funds) in any service category.
Unless requested otherwise, any surplus at the end of the term of this Agreement in the
County Health Department Trust Fund that is attributed to the CHD shall be carried
forward to the next contract period.
16D u
c. Either party may establish service fees as allowed by law to fund activities of the
CHD. Where applicable, such fees shall be automatically adjusted to at least the
Medicaid fee schedule.
d. Either party may increase or decrease funding of this Agreement during the term
hereof by notifying the other party in writing of the amount and purpose for the change in
funding. If the State initiates the increase /decrease, the CHD will revise the Attachment II
and send a copy of the revised pages to the County and the Department of Health,
Bureau of Budget 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, Bureau of Budget Management.
e. The name and address of the official payee to who payments shall be made is:
County Health Department Trust Fund
Collier County
3339 E. Tamiami Trail, Suite 145
Naples, FL 34112
5. CHD DIRECTOR/ADMINISTRATOR. Both parties agree the director /administrator
of the CHD shall be a State employee or under contract with the State and will be under
the day -to -day direction of the Deputy Secretary for Statewide Services. The
director /administrator shall be selected by the State with the concurrence of the County.
The director /administrator of the CHD shall insure 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 Office of Planning, Evaluation & Data Analysis 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
compliance shall be documented. Such justification and compliance documentation shall
16D 8
be maintained by the CHD in accordance with the terms of this Agreement. State
procedures must be followed for all leases on facilities not enumerated in Attachment IV.
c. The CHD shall maintain books, records and documents in accordance with those
promulgated by the Generally Accepted Accounting Principles (GAAP) and Governmental
Accounting Standards Board (GASB), and the requirements of federal or state law. These
records shall be maintained as required by the Department of Health Policies and
Procedures for Records Management and shall be open for inspection at any time by the
parties and the public, except for those records that are not otherwise subject to disclosure
as provided by law which are subject to the confidentiality provisions of paragraph 6.i.,
below. Books, records and documents must be adequate to allow the CHD to comply with
the following reporting requirements:
The revenue and expenditure requirements in the Florida Accounting
System Information Resource (FLAIR).
ii. The client registration and services reporting requirements of the
minimum data set as specified in the most current version of the Client
Information System /Health Management Component Pamphlet;
iii. Financial procedures specified in the Department of Health's Accounting
Procedures Manuals, Accounting memoranda, and Comptroller's
memoranda;
iv. The CHD is responsible for assuring that all contracts with service
providers include provisions that all subcontracted services be reported
to the CHD in a manner consistent with the client registration and
service reporting requirements of the minimum data set as specified in
the Client Information System /Health Management Component
Pamphlet.
d. All funds for the CHD shall be deposited in the County Health Department Trust
Fund maintained by the state treasurer. These funds shall be accounted for separately
from funds deposited for other CHDs and shall be used only for public health purposes in
Collier County.
e. That any surplus /deficit funds, including fees or accrued interest, remaining in the
County Health Department Trust Fund account at the end of the contract year shall be
credited /debited to the state or county, as appropriate, based on the funds contributed by
each and the expenditures incurred by each. Expenditures will be charged to the program
accounts by state and county based on the ratio of planned expenditures in the core
contract and funding from all sources is credited to the program accounts by state and
county. The equity share of any surplus /deficit funds accruing to the state and county is
determined each month and at contract year -end. Surplus funds may be applied toward
the funding requirements of each participating governmental entity in the following year.
However, in each such case, all surplus funds, including fees and accrued interest, shall
remain in the trust fund until accounted for in a manner which clearly illustrates the amount
which has been credited to each participating governmental entity. The planned use of
•
�1 On,
surplus funds shall be reflected in Attachment II, Part I of this contract, with special capital
projects explained in Attachment V.
f. There shall be no transfer of funds between the three levels of services without a
contract amendment unless the CHD director /administrator determines that an emergency
exists wherein a time delay would endanger the public's health and the Deputy Secretary
for Statewide Services has approved the transfer. The Deputy Secretary for Statewide
Services shall forward written evidence of this approval to the CHD within 30 days after an
emergency transfer.
g. The CHD may execute subcontracts for services necessary to enable the CHD to
carry out the programs specified in this Agreement. Any such subcontract shall include all
aforementioned audit and record keeping requirements.
h. At the request of either party, an audit may be conducted by an independent CPA
on the financial records of the CHD and the results made available to the parties within
180 days after the close of the CHD fiscal year. This audit will follow requirements
contained in OMB Circular A -133 and may be in conjunction with audits performed by
county government. If audit exceptions are found, then the director /administrator of the
CHD will prepare a corrective action plan and a copy of that plan and monthly status
reports will be furnished to the contract managers for the parties.
i. The CHD shall not use or disclose any information concerning a recipient of
services except as allowed by federal or state law or policy.
j. The CHD shall retain all client records, financial records, supporting documents,
statistical records, and any other documents (including electronic storage media) pertinent
to this Agreement for a period of five (5) years after termination of this Agreement. If an
audit has been initiated and audit findings have not been resolved at the end of five (5)
years, the records shall be retained until resolution of the audit findings.
k. The CHD shall maintain confidentiality of all data, files, and records that are
confidential under the law or are otherwise exempted from disclosure as a public record
under Florida law. The CHD shall implement procedures to ensure the protection and
confidentiality of all such records and shall comply with sections 384.29, 381.004, 392.65
and 456.057, Florida Statutes, and all other state and federal laws regarding
confidentiality. All confidentiality procedures implemented by the CHD shall be consistent
with the Department of Health Information Security Policies, Protocols, and Procedures.
The CHD shall further adhere to any amendments to the State's security requirements and
shall comply with any applicable professional standards of practice with respect to client
confidentiality.
I. The CHD shall abide by all State policies and procedures, which by this reference
are incorporated herein as standards to be followed by the CHD, except as otherwise
permitted for some purchases using county procedures pursuant to paragraph 6.b. hereof.
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
i � •
CHD will advise applicants of the right to appeal a denial or exclusion from services, of
failure to take account of a client's choice of service, and of his /her right to a fair hearing to
the final governing authority of the agency. Specific references to existing laws, rules or
program manuals are included in Attachment I of this Agreement.
n. The CHD shall comply with the provisions contained in the Civil Rights Certificate,
hereby incorporated into this contract as Attachment III.
o. The CHD shall submit quarterly reports to the county that shall include at least the
following:
L 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, Bureau of Budget
Management.
160 8
p. The dates for the submission of quarterly reports to the county shall be as follows
unless the generation and distribution of reports is delayed due to circumstances beyond
the CHD's control:
March 1, 2013 for the report period October 1, 2012 through
December 31, 2012;
ii. June 1, 2013 for the report period October 1, 2012 through
March 31, 2013;
iii. September 1, 2013 for the report period October 1, 2012
through June 30, 2013; and
iv. December 1, 2013 for the report period October 1, 2012
through September 30, 2013.
7. FACILITIES AND EQUIPMENT. The parties mutually agree that:
a. CHD facilities shall be provided as specified in Attachment IV to this contract and
the county shall own the facilities used by the CHD unless otherwise provided in
Attachment IV.
b. The county shall 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
County Health Department Trust Fund shall be sold at fair market value when they are no
longer needed by the CHD and the proceeds returned to the County Health Department
Trust Fund.
8. TERMINATION.
a. Termination at Will. This Agreement may be terminated by either party without
cause upon no less than one - hundred eighty (180) calendar days notice in writing to the
other party unless a lesser time is mutually agreed upon in writing by both parties. Said
notice shall be delivered by certified mail, return receipt requested, or in person to the
other party's contract manager with proof of delivery.
b. Termination Because of Lack of Funds. In the event funds to finance this
Agreement become unavailable, either party may terminate this Agreement upon no less
than twenty -four (24) hours notice. Said notice shall be delivered by certified mail, return
receipt requested, or in person to the other party's contract manager with proof of delivery.
c. Termination for Breach. This Agreement may be terminated by one party, upon no
less than thirty (30) days notice, because of the other party's failure to perform an
16D 8
obligation hereunder. Said notice shall be delivered by certified mail, return receipt
requested, or in person to the other party's contract manager with proof of delivery.
Waiver of breach of any provisions of this Agreement shall not be deemed to be a waiver
of any other breach and shall not be construed to be a modification of the terms of this
Agreement.
9. MISCELLANEOUS. The parties further agree:
a. Availability of Funds. If this Agreement, any renewal hereof, or any term,
performance or payment hereunder, extends beyond the fiscal year beginning July 1,
2013, it is agreed that the performance and payment under this Agreement are contingent
upon an annual appropriation by the Legislature, in accordance with section 287.0582,
Florida Statutes.
b. Contract Managers. The name and address of the contract managers for
the parties under this Agreement are as follows:
For the State:
Joan M. Colfer, M.D.,M.P.H.
Name
Director, Collier County Health Dept
Title
3339 E. Tamiami Trail, Suite 145
Naples, Florida 34112
Address
(239) 252 -8201
Telephone
For the County:
Steve Carnell
Name
Public Services Interim Administrator
Title
3339 E. Tamiami Trail, Suite 217
Naples, Florida 34112
Address
(239) 252 -8468
Telephone
If different contract managers are designated after execution of this Agreement, the name,
address and telephone number of the new representative shall be furnished in writing to
the other parties and attached to originals of this Agreement.
C. Captions. The captions and headings contained in this Agreement are for
the convenience of the parties only and do not in any way modify, amplify, or give
additional notice of the provisions hereof.
16D 8 1
In WITNESS THEREOF, the parties hereto have caused this 24 page agreement to be
executed by their undersigned officials as duly authorized effective the 1 st day of October, 2012.
BOARD OF COUNTY COMMISSIONERS
FOR COLLIER COUNTY
SIGNED BY: "
NAME: TCrees/ G' Co
STATE OF FLORIDA
DEPARTMENT OF HEALTH
SIGNED BY: �1� R
NAME: John H. Armstrong, MD
TITLE:
TITLE:
Surgeon General /Secretary of Health
DATE:
DATE:
1 Z J Z I 1 2
ATTESTE O:
a
SIGNED BY:,A"'�
NAME -1 t
TITLE•
DATE: W1tF �U
A"'Ast as to ClUffs 'r
$19041 01-
SIGNE
NAME:
irktrCs TITLE: CHD Director /Administrator
DATE: 02
Appmved as to form & legal SufftlMOy
�Assis ant County Attorney
w
I=
ATTACHMENT
COLLIER COUNTY HEALTH DEPARTMENT
PROGRAM SPECIFIC REPORTING REQUIREMENTS AND PROGRAMS REQUIRING
COMPLIANCE WITH THE PROVISIONS OF SPECIFIC MANUALS
Some health services must comply with specific program and reporting requirements in addition to the Personal Health
Coding Pamphlet (DHP 50 -20), Environmental Health Coding Pamphlet (DHP 50 -21) and FLAIR requirements because
of federal or state law, regulation or rule. If a county health department is funded to provide one of these services, it
must comply with the special reporting requirements for that service. The services and the reporting requirements are
listed below:
Service Requirement
Sexually Transmitted Disease Requirements as specified in F.A.C. 64D -3, F.S. 381 and
Program F.S. 384.
2. Dental Health Monthly reporting on DH Form 1008 *. Additional reporting
requirements, under development, will be required. The
additional reporting requirements will be communicated upon
finalization.
3. Special Supplemental Nutrition Service documentation and monthly financial reports as
Program for Women, Infants specified in DHM 150 -24* and all federal, state and county
and Children (including the WIC requirements detailed in program manuals and published
Breastfeeding Peer Counseling procedures.
Program)
4
5.
A
7
91
Healthy Start/ Requirements as specified in the 2007 Healthy Start
Improved Pregnancy Outcome Standards and Guidelines and as specified by the Healthy
Start Coalitions in contract with each county health
department.
Family Planning Periodic financial and programmatic reports as specified
by the program office.
Immunization Periodic reports as specified by the department regarding
the surveillance /investigation of reportable vaccine
preventable diseases, vaccine usage accountability as
documented in Florida SHOTS, the assessment of various
immunization levels as documented in Florida SHOTS and
forms reporting adverse events following immunization.
Environmental Health Requirements as specified in Environmental Health Programs
Manual 150-4* and DHP 50 -21*
HIV /AIDS Program Requirements as specified in F.S. 384.25 and
F.A.C. 64D -3.030 and 64D- 3.031. Case reporting should be
on Adult HIV /AIDS Confidential Case Report CDC Form
DH2139 and Pediatric HIV /AIDS Confidential Case Report
CDC Form DH2140.
10
ATTACHMENT I (Continued)
9. School Health Services
10. Tuberculosis
11. General Communicable Disease Control
160 s
Socio- demographic data on persons
tested for HIV in CHD clinics should be reported on Lab
Request DH Form 1628 or Post -Test Counseling DH Form
1628C. These reports are to be sent to the Headquarters
HIV /AIDS office within 5 days of the initial post -test counseling
appointment or within 90 days of the missed post -test
counseling appointment.
Requirements as specified in the Florida School Health
Administrative Guidelines (May 2012).
Tuberculosis Program Requirements as specified in F.A.C.
6413-3 and F.S. 392.
Carry out surveillance for reportable communicable and other
acute diseases, detect outbreaks, respond to individual cases
of reportable diseases, investigate outbreaks, and carry out
communication and quality assurance functions, as specified
in the CHD Guide to Surveillance and Investigations.
"or the subsequent replacement if adopted during the contract period.
11
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015040
AIDS PREVENTION
19,261
0
19,261
0
19,261
015040
AIDS SURVEILLANCE
50,310
0
50,310
0
50,310
015040
ALG /CESSPOOL IDENTIFICATION AND ELIMINATION
0
0
0
0
0
015040
ALG /CONTR TO CHDS -AIDS PATIENT CARE
140,000
0
140,000
0
140,000
015040
ALG /CONTR TO CHDS -AIDS PATIENT CARE NETWORK
0
0
0
0
0
015040
ALG /CONTR TO CHDS - SOVEREIGN IMMUNITY
0
0
0
0
0
015040
MINORITY OUTREACH - PENALVER CLINIC - MIAMI -DADE
0
0
0
0
0
015040
PREPAREDNESS GRANT MATCH
82,824
0
82,824
0
82,824
015040
SCHOOL HEALTH GENERAL REVENUE
80,855
0
80,855
0
80,855
015040
STATEWIDE DENTISTRY NETWORK - ESCAMBIA
0
0
0
0
0
015040
STD GENERAL REVENUE
0
0
0
0
0
015040
TREASURE COAST MIDWIFERY - MARTIN
0
0
0
0
0
015040
HEALTHY START MED- WAIVER - CLIENT SERVICES
0
0
0
0
0
015040
JESSIE TRICE CANCER CTR/HEALTH CHOICE - MIAMI -DADE
0
0
0
0
0
015040
LA LIGA- LEAGUE AGAINST CANCER - MIAMI -DADE
0
0
0
0
0
015040
MANATEE COUNTY RURAL HEALTH SERVICES
0
0
0
0
0
015040
METRO ORLANDO URBAN LEAGUE - ORANGE
0
0
0
0
0
015040
MIGRANT LABOR CAMP SANITATION
74,533
0
74,533
0
74,533
015040
DENTAL SPECIAL INITIATIVES
6,542
0
6,542
0
6,542
015040
DUVAL TEEN PREGANCY PREVENTION - DUVAL
0
0
0
0
0
015040
FAMILY PLANNING GENERAL REVENUE
36,794
0
36,794
0
36,794
015040
FL CLPPP SCREENING & CASE MANAGEMENT
0
0
0
0
0
015040
FL HEPATITIS & LIVER FAILURE PREVENTION /CONTROL
89,286
0
89,286
0
89,286
015040
HEALTHY START MED WAIVER - SOBRA
0
0
0
0
0
015040
ALG/IPO HEALTHY START/IPO
0
0
0
0
0
015040
ALG/PRIMARY CARE
313,432
0
313,432
0
313,432
015040
BREAST & CERVICAL - ADMINISTRATION /CASE MANAGEMENT
0
0
0
0
0
015040
COMMUNITY SMILES - MIAMI -DADE
0
0
0
0
0
015040
COMMUNITY TB PROGRAM
78,326
0
78,326
0
78,326
015040
COUNTY SPECIFIC DENTAL PROJECTS - ESCAMBIA
0
0
0
0
0
015050
NON - CATEGORICAL GENERAL REVENUE
1,638,824
0
1,638,824
0
1,638,824
GENERAL REVENUE TOTAL
2,610,987
0
2,610,987
0
2,610,987
2. NON GENERAL REVENUE - STATE
015010
ALG /CONTR. TO CHDS - BIOMEDICAL WASTE
14,050
0
14,050
0
14,050
015010
ALG /CONTR. TO CHDS -SAFE DRINKING WATER PRG
0
0
0
0
0
015010
CHD PROGRAM SUPPORT
0
0
0
0
0
015010
FOOD AND WATERBORNE DISEASE PROGRAM ADM TF/DACS
0
0
0
0
0
015010
PREPAREDNESS GRANT MATCH
0
0
0
0
0
015010
PUBLIC SWIMMING POOL PROGRAM
0
0
0
0
0
015010
SCHOOL HEALTH TOBACCO IF
137,218
0
137,218
0
137,218
015010
TOBACCO ADMINISTRATION & MANAGEMENT
0
0
0
0
0
015010
TOBACCO COMMUNITY INTERVENTION
224,230
0
224,230
0
224,230
015020
TRANSFER FROM ANOTHER STATE AGENCY
0
0
0
0
0
015020
TRANSFER FROM ANOTHER STATE AGENCY
0
0
0
0
0
015020
TRANSFER FROM ANOTHER STATE AGENCY
0
0
0
0
0
015060
NON - CATEGORICAL TOBACCO REBASING
3,097
0
3,097
0
3,097
Version:
1
Page 1 of 7
3. FEDERAL FUNDS - State
378,595 0 378,595 0 378,595
007000
ABSTINENCE EDUCATION GRANT PROGRAM
0
0
0
0
0
007000
AIDS PREVENTION
255,477
0
255,477
0
255,477
007000
AIDS SURVEILLANCE
0
0
0
0
0
007000
BIOTERRORISM HOSPITAL PREPAREDNESS
21,208
0
21,208
0
21,208
007000
CHRONIC DISEASE PREVENTION & HEALTH PROMOTION
32,000
0
32,000
0
32,000
007000
COASTAL BEACH MONITORING PROGRAM
19,929
0
19,929
0
19,929
007000
TUBERCULOSIS CONTROL - FEDERAL GRANT
141,770
0
141,770
0
141,770
007000
UNINTENDED/UNWANTED PREG -TEEN PREGNANCY PREV
28,000
0
28,000
0
28,000
007000
WIC ADMINISTRATION
1,462,607
0
1,462,607
0
1,462,607
007000
WIC BREASTFEEDING PEER COUNSELING
70,030
0
70,030
0
70,030
007000
STD FEDERAL GRANT - CSPS
0
0
0
0
0
007000
STD PROGRAM INFERTILITY PREVENTION PROJECT (IPP)
17,624
0
17,624
0
17,624
007000
SYPHILIS ELIMINATION
0
0
0
0
0
007000
TEENAGE PREGNANCY PREVENTION REPLICATION
0
p
0
0
0
007000
TITLE X HIV /AIDS PROJECT
139,108
0
139,108
0
139,108
007000
TOBACCO FAITH BASED PROJECT
0
0
0
0
0
007000
RAPE PREVENTION & EDUCATION
0
0
0
0
0
007000
RYAN WHITE
0
p
0
0
0
007000
RYAN WHITE - EMERGING COMMUNITIES
0
0
0
0
0
007000
RYAN WHITE -AIDS DRUG ASSIST PROG -ADMIN
77,945
0
77,945
0
77,945
007000
RYAN WHITE - CONSORTIA
0
p
0
0
0
007000
SAFE SLEEP EDUCATION
10,386
0
10,386
0
10,386
007000
MINORITY INVOLVEMENT IN HIV /AIDS PROGRAM
0
0
0
0
0
007000
PHP - CITIES READINESS INITIATIVE
0
p
0
0
0
007000
PRECONCEPTION HEALTH CARE
0
0
0
0
0
007000
PREGNANCY ASSOCIATED MORTALITY PREVENTION
0
0
0
0
0
007000
PUBLIC HEALTH INFRASTRUCTURE
0
0
0
0
0
007000
PUBLIC HEALTH PREPAREDNESS BASE
209,697
0
209,697
0
209,697
007000
IMMUNIZATION WIC LINKAGES
0
0
0
0
0
007000
MCH BGTF - GADSDEN SCHOOL CLINIC
0
0
0
0
0
007000
MCH BGTF - HEALTHY START COALITIONS
0
0
0
0
0
007000
MCH QUALITY IMPROVEMENT ACTIVITIES MCHBG
0
0
0
0
0
007000
MINORITY AIDS INITIATIVE
0
0
0
0
0
007000
MINORITY AIDS INITIATIVE TCE COLLABORATIVE
0
0
p
p
0
007000
FGTF/FAMILY PLANNING -TITLE X
80,527
0
80,527
0
80,527
007000
HEALTHY HOMES AND LEAD POISONING GRANT
0
0
0
0
0
007000
HIV HOUSING FOR PEOPLE LIVING WITH AIDS
0
0
0
0
0
007000
HIV INCIDENCE SURVEILLANCE
0
0
0
0
0
007000
IMMUNIZATION FEDERAL GRANT ACTIVITY SUPPORT
123,219
0
123,219
0
123,219
007000
IMMUNIZATION FIELD STAFF EXPENSE
0
0
p
0
0
007000
COLORECTAL CANCER SCREENING 2009 -10
0
0
0
0
0
007000
DENTAL SERVICES
0
0
0
0
0
007000
ENHANCE COMPREHENSIVE PREVENTION PLANNING AND IMPL
0
0
0
p
0
007000
EXPANDED TESTING INITIATIVE (ETI)
0
0
0
p
0
007000
FGTF /AIDS MORBIDITY
0
p
0
0
0
007000
FGTFBREAST & CERVICAL CANCER -ADMIN/CASE MAN
0
0
0
0
0
Version:
1
Page 2 of 7
0
0
0
0
0
0
0
irk��-� M
0
0
0
0
0
0
0
33,690
0
.....or'
3. FEDERAL FUNDS - State
015009
MEDIPASS WAIVER -HLTHY STRT CLIENT SERVICES
015009
MEDIPASS WAIVER -SOBRA
007055
ARRA FEDERAL GRANT - SCHEDULE C
015075
SCHOOL HEALTH TITLE )OU
015075
SUMMER FOOD PROGRAM INSPECTIONS
015075
REFUGEE HEALTH
FEDERAL FUNDS TOTAL
4. FEES ASSESSED BY STATE OR FEDERAL RULES - STATE
001020
TANNING FACILITIES
001020
BODY PIERCING
001020
MIGRANT HOUSING PERMIT
001020
MOBILE HOME AND PARKS
001020
FOOD HYGIENE PERMIT
001020
BIOHAZARD WASTE PERMIT
001020
PRIVATE WATER CONSTR PERMIT
001020
PUBLIC WATER ANNUAL OPER PERMIT
001020
PUBLIC WATER CONSTR. PERMIT
001020
NON -SDWA SYSTEM PERMIT
001020
SAFE DRINKING WATER
001020
SWIMMING POOLS
001092
OSDS PERMIT FEE
001092
I & M ZONED OPERATING PERMIT
001092
AEROBIC OPERATING PERMIT
001092
SEPTIC TANK SITE EVALUATION
001092
NON SDWA LAB SAMPLE
001092
OSDS VARIANCE FEE
001092
ENVIRONMENTAL HEALTH FEES
001092
OSDS REPAIR PERMIT
001170
LAB FEE CHEMICAL ANALYSIS
001170
WATER ANALYSIS- POTABLE
001170
NONPOTABLE WATER ANALYSIS
010304
MQA INSPECTION FEE
001206
CENTRAL OFFICE SURCHARGE
FEES ASSESSED BY STATE OR FEDERAL RULES TOTAL
5. OTHER CASH CONTRIBUTIONS - STATE
010304
STATIONARY POLLUTANT STORAGE TANKS
090001
DRAW DOWN FROM PUBLIC HEALTH UNIT
OTHER CASH
CONTRIBUTIONS TOTAL
6. MEDICAID - STATE /COUNTY
001056
MEDICAID PHARMACY
001076
MEDICAID TB
001078
MEDICAID ADMINISTRATION OF VACCINE
001079
MEDICAID CASE MANAGEMENT
001081
MEDICAID CHILD HEALTH CHECK UP
Version:
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
33,690
0
33,690
0
33,690
0
0
0
0
0
231,600
0
231,600
0
231,600
2,954,817
0
2,954,817
0
2,954,817
3,000
0
3,000
0
3,000
0
0
0
0
0
24,575
0
24,575
0
24,575
19,918
0
19,918
0
19,918
28,712
0
28,712
0
28,712
33,400
0
33,400
0
33,400
0
0
0
0
0
10,000
0
10,000
0
10,000
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
274,000
0
274,000
0
274,000
80,000
0
80,000
0
80,000
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1,200
0
1,200
0
1,200
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
50,000
0
50,000
0
50,000
524,805
0
524,805
0
524,805
0
0
0
0
0
306,941
0
306,941
0
306,941
306,941
0
306,941
0
306,941
0
0
0
0
0
0
48,000
48,000
0
48,000
0
20,000
20,000
0
20,000
0
21,720
21,720
0
21,720
0
0
0
0
0
Page 3 of 7
CEfL�.tE�, �rRJI� IY�J7
rant « SOi11�4 O toutn`bwioas
OctobwIlt!"2 4
�y
A
6. MEDICAID - STATE /COUNTY
001082 MEDICAID DENTAL
001083 MEDICAID FAMILY PLANNING
001087 MEDICAID STD
001089 MEDICAID AIDS
001147 MEDICAID HMO CAPITATION
001191 MEDICAID MATERNITY
001192 MEDICAID COMPREHENSIVE CHILD
001193 MEDICAID COMPREHENSIVE ADULT
001194 MEDICAID LABORATORY
001208 MEDIPASS $3.00 ADM. FEE
001059 MEDICAID LOW INCOME POOL
001051 EMERGENCY MEDICAID
001058 MEDICAID - BEHAVIORAL HEALTH
001071 MEDICAID - ORTHOPEDIC
001072 MEDICAID - DERMATOLOGY
001075 MEDICAID - SCHOOL HEALTH CERTIFIED MATCH
001069 MEDICAID - REFUGEE HEALTH
001055 MEDICAID - HOSPITAL
001148 MEDICAID HMO NON - CAPITATION
001074 MEDICAID -NEWBORN SCREENING
MEDICAID TOTAL
7. ALLOCABLE REVENUE -STATE
018000 REFUNDS
037000 PRIOR YEAR WARRANT
038000 12 MONTH OLD WARRANT
ALLOCABLE REVENUE TOTAL
8. OTHER STATE CONTRIBUTIONS NOT IN CHD TRUST FUND - STATE
PHARMACY SERVICES
LABORATORY SERVICES
TB SERVICES
IMMUNIZATION SERVICES
STD SERVICES
CONSTRUCTION/RENOVATION
WIC FOOD
ADAP
DENTAL SERVICES
OTHER (SPECIFY)
OTHER (SPECIFY)
OTHER STATE CONTRIBUTIONS TOTAL
9. DIRECT LOCAL CONTRIBUTIONS - BCC/TAX DISTRICT
008010 CONTRIBUTION FROM CITY GOVERNMENT
008020 CONTRIBUTION FROM HEALTH CARE TAX NOT THRU BCC
008040 BCC GRANT /CONTRACT
008030 CONTRIBUTION FROM HEALTH CARE TAX
Version: 1
0
805,724
805,724
0
805,724
0
0
0
0
0
0
8,500
8,500
0
8,500
0
32,276
32,276
0
32,276
0
0
0
0
0
0
0
0
0
0
0
500
500
0
500
0
8,500
8,500
0
8,500
0
0
0
0
0
0
434
434
0
434
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
22,000
22,000
0
22,000
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
967,654
967,654
0
967,654
2,585
0
2,585
0
2,585
0
0
0
0
0
0
0
0
0
0
2,585
0
2,585
0
2,585
0
0
0
146,868
146,868
0
0
0
101,737
101,737
0
0
0
0
0
0
0
0
916,303
916,303
0
0
0
0
0
0
0
0
0
0
0
0
0
6,521,482
6,521,482
0
0
0
1,258,313
1,258,313
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
8,944,703
8,944,703
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Page 4 of 7
1,258,100
t
0
1,258,100
1,258,100
1,258,100
0
1,258,100
200
200
0
9. DIRECT LOCAL CONTRIBUTIONS - BCC/TAX DISTRICT
0
008034
BCC CONTRIBUTION FROM GENERAL FUND
0
DIRECT COUNTY CONTRIBUTION TOTAL
0
10. FEES
AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION - COUNTY
001060
VITAL STATISTIC -FEES & SERVICES
0
001077
RABIES VACCINE
0
001077
CHILD CAR SEAT PROG
0
001077
PERSONAL HEALTH FEES
0
001077
AIDS CO -PAYS
0
001094
ADULT ENTER. PERMIT FEES
0
001094
LOCAL ORDINANCE FEES
0
001114
NEW BIRTH CERTIFICATES
0
001115
VITAL STATISTICS - DEATH CERTIFICATE
0
001117
VITAL STATS -ADM. FEE 50 CENTS
0
001073
CO-PAY FOR THE AIDS CARE PROGRAM
0
001025
CLIENT REVENUE FROM GRC
0
001040
CELL PHONE ADMINISTRATIVE FEE
0
FEES AUTHORIZED BY COUNTY TOTAL
0
11. OTHER CASH AND LOCAL CONTRIBUTIONS - COUNTY
0
001009
RETURNED CHECK ITEM
0
001029
THIRD PARTY REIMBURSEMENT
0
001029
HEALTH MAINTENANCE ORGAN. (HMO)
0
001054
MEDICARE PART D
0
001077
RYAN WHITE TITLE II
0
001090
MEDICARE PART B
0
001190
HEALTH MAINTENANCE ORGANIZATION
0
005040
INTEREST EARNED
0
005041
INTEREST EARNED -STATE INVESTMENT ACCOUNT
0
007010
U.S. GRANTS DIRECT
0
008050
SCHOOL BOARD CONTRIBUTION
0
008060
SPECIAL PROJECT CONTRIBUTION
0
010300
SALE OF GOODS AND SERVICES TO STATE AGENCIES
0
010301
EXP WITNESS FEE CONSULTNT CHARGES
0
010405
SALE OF PHARMACEUTICALS
0
010409
SALE OF GOODS OUTSIDE STATE GOVERNMENT
0
011001
HEALTHY START COALITION CONTRIBUTIONS
0
011007
CASH DONATIONS PRIVATE
0
012020
FINES AND FORFEITURES
0
012021
RETURN CHECK CHARGE
0
028020
INSURANCE RECOVERIES -OTHER
0
090002
DRAW DOWN FROM PUBLIC HEALTH UNIT
0
011000
GRANT DIRECT -NOVA UNIVERSITY CHD TRAINING
0
011000
GRANT - DIRECT
0
011000
GRANT DIRECT - COUNTY HEALTH DEPARTMENT DIRECT SERVICES
0
011000
COUNTY COMMISSION - LIP FUND
0
011000
GRANT- DIRECT
0
1,258,100
1,258,100
0
1,258,100
1,258,100
1,258,100
0
1,258,100
200
200
0
200
0
0
0
0
0
0
0
0
193,377
193,377
0
193,377
0
0
0
0
0
0
0
0
557,900
557,900
0
557,900
60,000
60,000
0
60,000
240,800
240,800
0
240,800
4,000
4,000
0
4,000
0
0
0
0
0
0
0
0
0
0
0
0
1,056,277
1,056,277
0
1,056,277
0
0
0
0
732,245
732,245
0
732,245
0
0
0
0
0
0
0
0
0
0
0
0
30,018
30,018
0
30,018
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
300
300
0
300
0
0
0
0
0
0
0
0
0
0
0
0
412,562
412,562
0
412,562
250
250
0
250
1,692
1,692
0
1,692
0
0
0
0
0
0
0
0
652,247
652,247
0
652,247
0
0
0
0
293,816
293,816
0
293,816
0
0
0
0
226,260
226,260
0
226,260
0
0
0
0
Version: 1 Page 5 of 7
11. OTHER CASH AND LOCAL CONTRIBUTIONS - COUNTY
011000
GRANT - DIRECT
0
011000
GRANT - DIRECT
0
011000
GRANT DIRECT -ARROW
0
011000
GRANT DIRECT - QUANTUM DENTAL
0
011000
GRANT DIRECT - HEALTH CARE DISTRICT PAHOKEE
0
011000
GRANT - DIRECT
0
011000
GRANT - DIRECT
0
011000
GRANT - DIRECT
0
011000
GRANT - DIRECT
0
010402
RECYCLED MATERIAL SALES
0
010303
FDLE FINGERPRINTING
0
007050
ARRA FEDERAL GRANT
0
001010
RECOVERY OF BAD CHECKS
0
008065
FCO CONTRIBUTION
0
011006
RESTRICTED CASH DONATION
0
028000
INSURANCE RECOVERIES
0
001033
CMS MANAGEMENT FEE - PMPMPC
0
010400
SALE OF GOODS OUTSIDE STATE GOVERNMENT
0
010500
REFUGEE HEALTH
0
005045
INTEREST EARNED -TBIRD PARTY PROVIDER
0
005043
INTEREST EARNED - CONTRACT /GRANT
0
010306
DOH/DOC INTERAGENCY AGREEMENT
0
011002
ARRA FEDERAL GRANT - SUB - RECIPIENT
0
011004
LOW INCOME POOL - SUBRECIPIENT
0
OTHER CASH AND LOCAL CONTRIBUTIONS TOTAL
0
12. ALLOCABLE REVENUE -COUNTY
0
018000
REFUNDS
0
037000
PRIOR YEAR WARRANT
0
038000
12 MONTH OLD WARRANT
0
COUNTY
ALLOCABLE REVENUE TOTAL
0
13. BUILDINGS -COUNTY
0
0
ANNUAL RENTAL EQUIVALENT VALUE
0
0
GROUNDS MAINTENANCE
0
2,351,390
IT ALLOCATION & GOLDEN GATE RENT
0
2,351,390
INSURANCE
0
0
UTILITIES
0
0
OTHER (SPECIFY)
0
0
BUILDING MAINTENANCE
0
BUILDINGS TOTAL
0
14. OTHER
COUNTY CONTRIBUTIONS NOT IN CHD TRUST FUND - COUNTY
0
EQUIPMENTIVEHICLE PURCHASES
0
525,048
VEHICLE INSURANCE
0
0
VEHICLE MAINTENANCE
0
0
OTHER COUNTY CONTRIBUTION (SPECIFY)
0
Version:
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2,000
2,000
0
2,000
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2,351,390
2,351,390
0
2,351,390
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
525,048
525,048
0
0
195,149
195,149
0
0
84,900
84,900
0
0
0
0
0
0
209,800
209,800
0
0
0
0
0
0
0
0
0
0
1,014,897
1,014,897
0
0
0
0
0
0
16,300
16,300
0
0
0
0
0
0
0
0
Page 6 of 7
Version: 1 Page 7 of 7
Port Ili. A '
Plswred:S
A. COMMUNICABLE DISEASE CONTROL:
IMMUNIZATION (10 1)
12.61
STD (102)
5.14
HIV /AIDS PREVENTION (03A1)
5.44
HIV /AIDS SURVEILLANCE (03A2)
1.35
HIV /AIDS PATIENT CARE (03A3)
9.30
ADAP (03A4)
2.07
TB CONTROL SERVICES (104)
11.34
COMM. DISEASE SURV. (106)
6.38
HEPATITIS PREVENTION (109)
2.04
PUBLIC HEALTH PREP AND RESP (116)
5.55
VITAL STATISTICS (180)
3.34
COMMUNICABLE DISEASE SUBTOTAL
64.56
B. PRIMARY CARE:
315,056
CHRONIC DISEASE SERVICES (210)
0.60
TOBACCO PREVENTION (212)
3.00
WIC (21 W 1)
35.00
WIC BREASTFEEDING PEER COUNSELING (21W2)
3.00
FAMILY PLANNING (223)
2.75
IMPROVED PREGNANCY OUTCOME (225)
5.82
HEALTHY START PRENATAL (227)
12.02
COMPREHENSIVE CHILD HEALTH (229)
2.01
HEALTHY START INFANT (23 1)
4.20
SCHOOL HEALTH (234)
7.33
COMPREHENSIVE ADULT HEALTH (237)
6.07
COMMUNITY HEALTH DEVELOPMENT (238)
0.26
DENTAL HEALTH (240)
14.39
PRIMARY CARE SUBTOTAL
96.45
C. ENVIRONMENTAL HEALTH:
154,069
Water and Onsite Sewage Programs
189,056
COASTAL BEACH MONITORING (347)
0.13
LIMITED USE PUBLIC WATER SYSTEMS (357)
0.22
PUBLIC WATER SYSTEM (358)
0.00
PRIVATE WATER SYSTEM (359)
0.00
INDIVIDUAL SEWAGE DISP. (36 1)
8.03
Group Total
8.38
Facility Programs
1,570
FOOD HYGIENE (348)
0.61
BODY PIERCING FACILITIES SERVICES
0.02
GROUP CARE FACILITY (35 1)
0.93
MIGRANT LABOR CAMP (352)
3.23
HOUSING,PUBLIC BLDG SAFETY,SANrrATION (353)0.00
0
8,678
22,230
169,861
167,185
183,381
167,185
344,228
343,384
687,612
738
1,254
63,200
68,775
80,239
68,775
22,408
258,581
280,989
1,500
15,000
76,479
79,024
80,529
79,024
212,295
102,761
315,056
60
300
15,690
31,644
19,418
31,644
98,396
0
98,396
576
9,173
156,913
275,847
230,156
275,847
578,152
360,611
938,763
36
120
27,185
22,892
26,708
22,892
99,677
0
99,677
791
5,193
154,069
177,047
189,056
177,047
408,756
288,463
697,219
0
6,278
110,026
112,410
131,146
112,410
0
465,992
465,992
1,570
2,130
28,816
31,445
36,686
31,445
128,392
0
128,392
0
0
136,257
103,043
120,218
103,043
415,831
46,730
462,561
10,957
37,551
36,927
45,977
47,808
45,977
0
176,689
176,689
24,906
99,229
975,423
1,115,289
1,145,345
1,115,289
2,308,135
2,043,211
4,351,346
173
3,445
8,246
9,926
11,580
9,926
39,678
0
39,678
0
5,551
42,920
59,489
54,404
59,489
216,302
0
216,302
11,544
98,927
474,711
498,663
319,774
298,663
1,591,811
0
1,591,811
4,356
2,908
27,294
15,053
19,029
15,053
76,429
0
76,429
2,628
3,080
103,320
115,760
105,885
115,760
439,596
1,129
440,725
1,140
7,586
143,875
176,490
180,903
176,490
247,020
430,738
677,758
1,106
6,462
129,171
177,136
177,492
177,136
181,948
478,987
660,935
234
700
28,999
75,846
59,321
75,846
0
240,012
240,012
787
4,578
54,833
47,864
55,842
47,864
206,403
0
206,403
0
222,756
67,103
114,579
133,676
114,579
328,977
100,960
429,937
1,615
3,893
171,310
215,482
193,061
215,482
364,698
430,637
795,335
0
26
11,973
641
415
641
13,670
0
13,670
5,052
10,812
184,567
401,477
350,603
401,477
6,427
1,331,697
1,338,124
28,635
370,724
1,448,322
1,908,406 1,661,985
1,708,406 3,712,959
3,014,160
6,727,119
501
501
4,876
6,196
7,230
6,196
24,498
0
24,498
488
1,404
2,696
5,169
6,032
5,169
6,355
12,711
19,066
0
0
129
21
26
21
97
100
197
0
0
116
45
51
45
0
257
257
2,713
5,542
91,580
122,874
143,352
122,874
226,202
254,478
480,680
3,702
7,447
99,397
134,305
156,691
134,305
257,152
267,546
524,698
60
290
13,234
19,930
11,585
19,930
64,679
0
64,679
3
3
0
228
265
228
356
365
721
320
503
12,350
12,354
14,414
12,354
0
51,472
51,472
256
1,882
37,495
51,491
60,072
51,491
137,836
62,713
200,549
0
0
53
38
45
38
86
88
174
Version: 3 Page 1 of 2
94
243
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3
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t
8,520
C. ENVIRONMENTAL HEALTH:
0
Facility Programs
1,484
MOBILE HOME AND PARKS SERVICES (354)
0.M
SWIMMING POOLS/BATHING (360)
3.3)
BIOMEDICAL WASTE SERVICES (364)
0.55
TANNING FACILITY SERVICES (369)
0.02
Group Total
9.31
Groundwater Contamination
11,719
STORAGE TANK COMPLIANCE (355)
0.00
SUPER ACT SERVICE (356)
0.04
Group Total
0.04
Community Hygiene
1,181
TATTOO FACILITIES SERVICES
0.01
COMMUNITY ENVIR. HEALTH (345)
0.00
INJURY PREVENTION (346)
0.07
LEAD MONITORING SERVICES (350)
0.00
PUBLIC SEWAGE (362)
0.00
SOLID WASTE DISPOSAL (363)
0.00
SANITARY NUISANCE (365)
0.02
RABIES SURVEILLANCE/CONTROL SERVICES (366)0.00
ARBOVIRUS SURVEILLANCE (367)
0.00
RODENT/ARTHROPOD CONTROL (368)
0.00
WATER POLLUTION (370)
0.00
INDOOR AIR (37 1)
0.00
RADIOLOGICAL HEALTH (372)
0.00
TOXIC SUBSTANCES (373)
0.00
Group Total
0.10
ENVIRONMENTAL HEALTH SUBTOTAL
17.83
D. NON - OPERATIONAL COSTS:
2,776
NON - OPERATIONAL COSTS (599)
0.00
ENVIRONMENTAL HEALTH SURCHARGE (399)
0.00
NON - OPERATIONAL COSTS SUBTOTAL
0.00
TOTAL CONTRACT
178.84
94
243
10,931
8,520
9,939
8,520
37,910
0
37,910
1,484
18,477
65,550
60,206
70,241
60,206
104,379
151,824
256,203
359
376
25,211
11,719
13,672
11,719
62,321
0
62,321
5
12
1,181
248
291
248
1,968
0
1,968
2,581
21,786
166,005
164,734
180,524
164,734
409,535
266,462
675,997
0
0
0
0
0
0
0
0
0
52
74
927
584
681
584
1,370
1,406
2,776
52
74
927
584
681
584
1,370
1,406
2,776
0
0
1,400
132
153
132
896
921
1,817
0
0
0
0
0
0
0
0
0
0
57
444
1,391
1,621
1,391
2,391
2,456
4,847
0
0
0
6
7
6
10
9
19
0
0
0
2
2
2
4
2
6
0
0
-6
0
0
6
0
0
0
0
0
27
303
353
303
486
500
986
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
53
53
53
78
81
159
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
57
1,865
1,887
2,189
1,893
3,865
3,969
7,834
6,335
29,364
268,194
301,510
340,085
301,516
671,922
539,383
1,211,305
0
0
18,788
16,143
22,168
15,282
35,714
36,667
72,381
0
0
13,336
5,500
3,000
28,164
50,000
0
50,000
0
0
32,124
21,643
25,168
43,446
85,714
36,667
122,381
59,876
499,317
2,724,063
3,346,848 3,172,583
3,168,657 6,778,730
5,633,421
12,412,151
Version: 3 Page 2 of 2
16D 8
ATTACHMENT III
COLLIER 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:
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.
22
ATTACHMENT IV
COLLIER COUNTY HEALTH DEPARTMENT
160
FACILITIES UTILIZED BY THE COUNTY HEALTH DEPARTMENT
Facility
Description
Collier County Health
Department & Public
Services Building H
Immokalee Satellite
Golden Gate WIC Office
Location
3339 E. Tamiami Trail
Suite 145, Naples
419 North First Street
Immokalee
Owned By
Collier County
Collier County
4945 Golden Gate Parkway Benderson
Unit 102, Naples Development
r-,
23
16D 8
ATTACHMENT V
COLLIER COUNTY HEALTH DEPARTMENT
SPECIAL PROJECTS SAVINGS PLAN
IDENTIFY THE AMOUNT OF CASH THAT IS ANTICIPATED TO BE SET ASIDE ANNUALLY FOR THE PROJECT.
CONTRACT YEAR
2010 -2011
2011 -2012
2012 -2013
2013 -2014
2014 -2015
PROJECT TOTAL
STATE
$ 0
$
$ 0
COUNTY
S
$
$ 0
$
$ 0
SPECIAL PROJECT CONSTRUCTION /RENOVATION PLAN
PROJECT NAME:
LOCATION/ ADDRESS:
PROJECT TYPE: NEW BUILDING ROOFING
RENOVATION PLANNING STUDY
NEW ADDITION OTHER
SQUARE FOOTAGE:
PROJECT SUMMARY: Describe scope of work in reasonable detail.
ESTIMATED PROJECT INFORMATION:
START DATE (initial expenditure of funds) :
COMPLETION DATE:
DESIGN FEES:
$
CONSTRUCTION COSTS:
$
FURNITURE/EQUIPMENT
$
TOTAL PROJECT COST:
$ -
COST PER SQ FOOT: $
TOTAL
$ 0
!t -
$ 0
Special Capital Projects are new construction or renovation projects and new furniture or equipment
associated with these projects and mobile health vans.
24