Backup Documents 10/27/2009 Item #16D 4
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 D
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 4
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 .!.!k!: the Board has taken action on the item.)
ROUTING SLIP
Complete routing lines # 1 through #4 as appropriate for additional signatures, dates, and/or information needed. If the document is already complete with the
exception of the Chairman's sie:nature, draw a line through routim1: lines #1 through #4, complete the checklist, and forward to Sue Filson (line #5).
Route to Addressee(s) Office Initials Date
(List in routing order)
I. Alan Portis Health Department AP 10/27/09
2.
3.
4.
A
5. Su,- r;b8fl, Executive Manager Board of County Commissioners )/ tiz:rJo,
I thJl1trr(;~e;vL
6. Minutes and Records Clerk of Court's Office
PRIMARY CONTACT INFORMATION
(The primary contact is the holder of the original document pending Bee 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 Sue Filson, need to contact staff for additionaJ or missing
information. All original documents needing the Bee Chairman's signature are to be delivered to the BeC office only after the BCC has acted to approve the
item.)
Name of Primary Staff Alan Portis Phone Number Extension 5332
Contact t-
Agenda Date Item was 10/27/09 Agenda Item Number I({I /) if
Approved by the BCC
Type of Document Contract Number of Original 4
Attached Documents Attached
1.
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark "N/A" in the Not Applicable column, whichever is
a ro riate.
Original document has been signedlinitialed for legal sufficiency. (All documents to be
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 ossibl State Officials.)
All handwritten strike-through and revisions have been initialed by the County Attorney's
Office and all other arties exce t the BCC Chairman and the Clerk to the Board
The Chairman's signature line date has been entered as the date ofBCC approval of the
document or the final ne otiated contract date whichever is a Iicable.
"Sign here" tabs are placed on the appropriate pages indicating where the Chairman's
si nature and initials are re uired.
In most cases (some contracts are an exception), the original document and this routing slip
should be provided to Sue Filson 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 our deadlines!
The document was approved by the BCC on 10/27/09 (enter date) and all changes
made during the meeting have been incorporated in the attached document. The
Count Attorne 's Office has reviewed the chan es, if a licable.
Yes
(Initial)
AP
N/A (Not
A Iicable)
2.
3.
4.
5.
6.
AP
AP
AP
AP
AP
I: Forms! County Forms/ Bce Forms/ Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
16D4
EXECUTIVE SUMMARY
Recommendation to approve the FY 10 contract between Collier County and the
State of Florida Department of Health for operation of the Collier County Health
Department in the amount of$l,nO,100.
OBJECTIVE: To provide local funding to augment the level of public health services
provided to the residents of Collier County.
CONSIDERATIONS: Each year, the County enters into an agreement with the State of
Florida Department of Health to provide funds and facilities for the provision of public
health services. The attached represents the FY I 0 contract effective October I, 2009
through September 30,2010.
The agreement identifies the services that will be provided with the cost share between
the State and the County. The total amount affected is $1, no, 100.
GROWTH MANAGEMENT IMPACT: There is no Growth Management Plan impact
associated with this item.
LEGAL CONSIDERATIONS: This item has been reviewed and approved by the
County Attorney's Office and is legally sufficient for Board action-SRT.
FISCAL IMPACT: The contract incorporates a 3% budget reduction from FY09. It
includes a cash contribution of $1,407,900 and $312,200 for operating expenses (building
maintenance/utilities) for a total contribution of$l,nO,IOO. These funds are budgeted in
the FYI 0 General Fund (00 I) budget in the Public Health cost center.
RECOMMENDATION: It is recommended that the Board authorize the Chairman to
execute the annual contract with the State of Florida Department of Health for the
operations of the Collier County Health Department.
Prepared by: Alan Portis, Collier County Health Department.
MEMORANDUM
Date:
November 5,2009
To:
Alan Portis, Business Manager
Collier County Health Department
From:
Ann Jennejohn, Sr. Deputy Clerk
Minutes & Records Department
Re:
Contract for FYI0 between Collier County and the
State of Florida's Department of Health for operating
Collier County's Health Department for $1,720,100.00
Attached are four (4) original contracts, referenced above, (Item #16D4),
approved by the Board of County Commissioners on October 27, 2009.
Please forward to the State Surg:eon General for sig:nature and return a
fullv executed orig:inal to the Minutes and Record's Department for the
Board's Official Record.
If you should have any questions, please call me at 252-8406.
Thank you.
Attachments (4)
16Db.
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16D4
FILE NO.:
ROUTED TO:
DO NOT WRITE ABOVE THIS SPACE (Orig, 9/89; Rev. 6/97)
REQUEST FOR LEGAL SERVICES
(please type or print)
Date: 10/06/09
To: Office of the County Attorney,
Attn: Robert Zachary, Assistant County Attorney
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Re: Contract between Collier County Board of County Commissioners and State of
Florida Department of Health for Operation of the County Health Department~~
BACKGROUND OF REQUEST/PROBLEM: ~ U ~
Annual Core Contract between the State and County requires legal review prior to IV) I
submission to BCC for approval.
From: Alan Portis
Finance and Accounting Director
Florida Department of Health
Telephone #: 239-252-8206
This item has/has not been previously submitted.
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ACTION REQUESTED:
Please review as to form and legal sufficiency.
OTHER COMMENTS:
There are no changes to the contractual form or text from last year.
cc: Public Services
16D4
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 2009-2010
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, 2009.
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, 2009, through September 30, 2010, 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 a,
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
16D4
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 fisted on the Schedule C) as provided in
Attachment II, Part II is an amount not to exceed $ 7,130,317 (State General
Revenue, Other State Funds and Federal Funds fisted on the Schedule C). The State's
obligation to pay under this contract is contingent upon an annual appropriation
by the Legislature.
ii. The County's appropriated responsibility (direct contribution excluding any fees,
other cash or local contributions) as provided in Attachment II, Part II is an amount not
to exceed $1,407,900 (amount fisted 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.
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16D4
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
3301 Tamiami Trail E., Bldg. H
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 State Health Officer. 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
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16D4
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
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16D4
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 State
Health Officer has approved the transfer. The Deputy State Health Officer 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 OMS 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 Agreernent 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,
dated April 2005, as amended, the terms of which are incorporated herein by reference.
The CHD shall further adhere to any amendments to the State's security requirements and
shall comply with any applicable professional standards of practice with respect to client
confidentiality.
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
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1604
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 DE385L 1 Contract Management Variance Report and the DE580L 1
Analysis of Fund Equities Report;
ii. A written explanation to the county of service variances reflected in the
DE385L 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.
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16D4
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, 2010 for the report period October 1, 2009 through
December 31,2009;
ii. June 1, 2010 for the report period October 1, 2009 through
March 31, 2010;
iii. September 1, 2010 for the report period October 1, 2009
through June 30,2010; and
iv. December 1, 2010 for the report period October 1, 2009
through September 30,2010.
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
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16D4
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. Availabilitv of Funds. If this Agreement, any renewal hereof, or any term,
performance or payment hereunder, extends beyond the fiscal year beginning July 1,
2010, 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:
For the County:
Joan M. Colfer. MD.. M.P.H.
Name
Marla Olsvio Ramsev
Name
Director. Collier Countv Health Dept
Title
Public Services Administrator
Title
3301 Tamiami Trail E.. Bldo. H
3301 Tamiami Trail E.. Bldo. H
Naples. Florida 34112
Address
Naples. Florida 34112
Address
(239) 252-8201
Telephone
(239) 252-8383
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.
8
16 0 ~//
/
In WITNESS THEREOF, the parties hereto have caused this 27 page agreement to be
executed by their undersigned officials as duly authorized effective the 1 at day of October, 2009.
BOARD OF COUNTY COMMISSIONERS
FOR COLLIER COUNTY
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SIGNED BY: {h'",n.,c._
STATE OF FLORIDA
DEPARTMENT OF HEALTH
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SIGNED BY:
NAME: Donna Fiala
TITLE:
Chairman
NAME: Ana M. Via monte Ros. M.D.. M.P.H.
TITLE: State SurQeon General
DATE:
It?!;? d ort
DATE:
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ATTESTED TO:
SIGNEDB't:.<. ,( .
. ,~' DI,~i~tSi ....
NAME:' OX; 9~. Ii 1 .
TITLE: c-~rf_~J"
DATE:
f.J1
NAME:
. Colfer M.D.
TITLE:
CHD Director/Administrator
DATE: QJobuL I ~ 1 dedi
pro.ed.. 0 rr'}j..11IfIIdeIICy
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DepIIIJ eo.ty AttenIJ
Item
Agenda 'DI,,11.4
Date ~
Date
Reed
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16D4
ATTACHMENT I
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
1.
Sexually Transmitted Disease
Program
Requirements as specified in FAC 640-3, F.S. 381 and
F.S. 384 and the CHD Guidebook.
2.
Dental Health
Monthly reporting on DH Form 1008*.
3.
Special Supplemental Nutrition
Program for Women, Infants
and Children.
Service documentation and monthly financial reports as
specified in OHM 150-24* and all federal, state and county
requirements detailed in program manuals and published
procedures.
4.
Healthy Start!
Improved Pregnancy Outcome
Requirements as specified in the 2007 Healthy Start
Standards and Guidelines and as specified by the Healthy
Start Coalitions in contract with each county health
department.
5.
Family Planning
Periodic financial and programmatic reports as specified
by the program office and in the CHD Guidebook, Internal
Operating Policy FAMPLAN 14*
6.
Immunization
Periodic reports as specified by the department regarding
the surveillance/investigation of reportable vaccine
preventable diseases. vaccine usage accountability, the
assessment of various immunization levels and forms
reporting adverse events following immunization and
Immunization Moduie quarterly quality audits and duplicate
data reports.
Chronic Disease Program
Requirements as specified in the Healthy Communities,
Healthy People Guidebook.
Environmental Health
Requirements as specified in Environmental Health Programs
Manual 150-4* and DHP 50-21*
HIVIAIDS Program
Requirements as specified inF.S. 384.25 and
640-3.016 and 3.017 FAC. and the CHD Guidebook. Case
reporting should be on Adult HIV/AIDS Confidential Case
Report CDC Form 50.42A and Pediatric HIV/AIDS
Confidential Case Report CDC Form 50.428. Socio-
demographic data on persons tested for HIV in CHD clinics
should be reported on Lab Request DH Form 1628
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ATTACHMENT I (Continued)
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.
10.
School Health Services
Requirements as specified in the Fiorida Schooi Health
Administrative Guidelines (April 2007).
'or the subsequent replacement if adopted during the contract period.
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ATTACHMENT II. 16D4
COLLIER COUNTY HEALTH DEPARTMENT
Part II. Sources of Contributious to County Healtb Department
October 1,2009 to September 30, 2010
State CHD County Total CHD
Trust Fund CHD Trust Fund Other
(cash) Trust Fund (cash) Contribution Total
1. GENERAL REVENUE - STATE
015040 ALG/CONTR. TO CHDS-MCH HEALTH - FIELD STAFF COST 0 0 0 0 0
015040 ALG/CONTRIBUTION TO CHDS-PRIMARY CARE 26,267 0 26,267 0 26,267
015040 ALG/IPO HEALTHY START/IPO 0 0 0 0 0
015040 ALG/SCHOOL HEALTH/SUPPLEMENTAL 0 0 0 0 0
015040 CLOSING THE GAP PROGRAM 0 0 0 0 0
015040 COMMUNITY SMILES. DADE 0 0 0 0 0
015040 COUNTY SPECIFIC DENTAL PROJECTS - ESCAMBIA 0 0 0 0 0
015040 DUVAL TEEN PREGNANCY PREVENTION 0 0 0 0 0
015040 FL CLPPP SCREENING & CASE MANAGEMENT 0 0 0 0 0
015040 HEAL THY BEACHES MONITORING 23,856 0 23,856 0 23,856
015040 HEALTHY START MED-WAIVER - CLIENT SERVICES 0 0 0 0 0
015040 MANA TEE COUNTY RURAL HEALTH SERVICES 0 0 0 0 0
015040 MINORITY OUTREACH-PENAL VER CLINIC-DADE 0 0 0 0 0
015040 SPECIAL NEEDS SHELTER PROGRAM 0 0 0 0 0
0]5040 STD GENERAL REVENUE 0 0 0 0 0
015040 ALG/CONTR TO CHDS-DENTAL PROGRAM 19,802 0 19,802 0 19,802
0]5040 ALG/CONTR. TO CHDS-IMMUNIZA TION OUTREACH TEAMS 26,589 0 26,589 0 26,589
015040 ALG/CONTR TO CHDS-AIDS PATIENT CARE ] 00,000 0 100,000 0 100,000
0]5040 ALG/CONTR TO CHDS-AIDS PREV & SURV & FIELD STAFF 92,344 0 92,344 0 92.344
015040 ALG/CONTR. TO CHDS.INDOOR AIR ASSIST PROG 0 0 0 0 0
015040 ALG/CONTR TO CHDS-MIGRANT LABOR CAMP SANITATION 102,806 0 102,806 0 102.806
0]5040 ALGIF AMIL Y PLANNING 47,028 0 47.028 0 47,028
015040 ALG/CONTR. TO CHDS-SOVEREIGN IMMUNITY 0 0 0 0 0
015040 VARICELLA IMMUNIZATION REQUIREMENT 14,214 0 14,214 0 14,214
015040 STATEWIDE DENTISTRY NETWORK - ESCAMBIA 0 0 0 0 0
015040 PRIMARY CARE SPECIAL DENTAL PROJECTS 0 0 0 0 0
015040 METRO ORLANDO URBAN LEAGUE TEENAGE PREG PREV 0 0 0 0 0
015040 LA LIGA CONTRA EL CANCER 0 0 0 0 0
015040 HEALTHY START MED WAIVER - SOBRA 0 0 0 0 0
0]5040 FL HEPATITIS & LIVER FAILURE PREVENTION/CONTROL 186,012 0 186,012 0 186,012
015040 ENHANCED DENTAL SERVICES 0 0 0 0 0
015040 DENTAL SPECIAL INlTIA TIVE PROJECTS 0 0 0 0 0
015040 COMMUNITY TB PROGRAM 64,974 0 64,974 0 64,974
015040 COMMUNITY ENVIRONMENTAL HEALTH ADVISORY BOARD 0 0 0 0 0
0]5040 CA TE - ESCAMBIA 0 0 0 0 0
015040 ALG/PRIMARY CARE 320.678 0 320.678 0 320.678
015040 ALG/CESSPOOL IDENTIFICATION AND ELIMINATION 0 0 0 0 0
015050 ALG/CONTR TO CHDS 2,526,982 0 2,526,982 0 2,526,982
GENERAL REVENUE TOTAL 3,551,552 0 3,551.552 0 3,551,552
2_ NON GENERAL REVENUE - STATE
0]50]0 IMMUNIZATION SPECIAL PROJECT 12.368 0 12,368 0 12,368
0]50]0 PUBLIC SWIMMING POOL PROGRAM 0 0 0 0 0
0]5010 SUPPLEMENT ALlCOMPREHENSIVE SCHOOL HEALTH - TOB TF 0 0 0 0 0
0]5010 ALG/CONTR TO CIIDS-REBASING TOBACCO TF 32.134 0 32,134 0 32,134
015010 ALG/CONTR. TO CHDS-BIOMEDlCAL W ASTElDEP ADM TF 9.177 0 9,177 0 9,177
0]50]0 ALG/CONTR. TO CHDS-SAFE DRINKING WATER PRG/DEP ADM 0 0 0 0 0
0]5010 BASIC SCHOOL HEALTH - TOBACCO TF ]37,2]8 0 137,218 0 137,218
ATTACBMENT II. 16114 "!
COLLIER COUNTY HEALTH DEPARTMENT
Part II. Sources of Coutributious to County Healtb Department
October 1, 2009 to September 30, 2010
State CHD County Total CHD
Trust Fund CHD Trust Fund Other
(cash) Trust Fund (cash) Contribution Total
2. NON GENERAL REVENUE - STATE
015010 CHD PROGRAM SUPPORT 0 0 0 0 0
015010 ENVIRONMENTAL HEALTH PACE PROJECTS 0 0 0 0 0
015010 FOOD AND WATERBORNE DISEASE PROGRAM ADM TFIDACS 0 0 0 0 0
015010 FULL SERVICE SCHOOLS - TOBACCO TF 114,545 0 II4,545 0 114,545
015020 ALG/CONTR. TO CHDS-BIOMEDICAL W ASTElDEP ADM TF 0 0 0 0 0
015020 ALG/CONTR. TO CHDS-SAFE DRINKING WATER PRGIDEP ADM 0 0 0 0 0
015020 FOOD AND WATERBORNE DISEASE PROGRAM ADM TF/DACS 0 0 0 0 0
NON GENERAL REVENUE TOTAL 305,442 0 305,442 0 305.442
3. FEDERAL FUNDS - State
007000 CHILDHOOD LEAD POISONING PREVENTION 0 0 0 0 0
007000 DIABETES PREVENTION & CONTROL PROGRAM 0 0 0 0 0
007000 FAMILY PLANNING EXPANSION FUNDS 2008-09 0 0 0 0 0
007000 FGTFIBREAST & CERVICAL CANCER-ADMIN/CASE MAN 0 0 0 0 0
007000 FGTFIFAMIL Y PLANNING-TITLE X 82,101 0 82,101 0 82,101
007000 FGTF/WIC ADMINISTRATION 1.834,480 0 1,834,480 0 1.834.480
007000 HEAL THY PEOPLE HEAL THY COMMUNITIES 19,155 0 19.155 0 19,155
007000 IMMUNIZATION FIELD STAFF EXPENSE 0 0 0 0 0
007000 IMMUNIZATION WIC-LINKAGES 0 0 0 0 0
007000 MCH BGTF-GADSDEN SCHOOL CLINIC 0 0 0 0 0
007000 PHP - CITIES READINESS INITIATIVE 0 0 0 0 0
007000 RAPE PREVENTION & EDUCATION GRANT 0 0 0 0 0
007000 RYAN WHITE 0 0 0 0 0
007000 BIOTERRORJSM PLANNING & READINESS 13,504 0 13,504 0 13,504
007000 AFRJCAN AMERJCAN TESTING INITIATIVE (AA TI) 0 0 0 0 0
007000 AIDS SURVEILLANCE 0 0 0 0 0
007000 RYAN WHITE-AIDS DRUG ASSIST PROG-ADMIN 77,951 0 77,951 0 77,951
007000 STD FEDERAL GRANT - CSPS 0 0 0 0 0
007000 STD PROGRAM - PHYSICIANS TRAINING CENTER 0 0 0 0 0
007000 STD PROGRAM-INFERTILITY PREVENTION PROJECT (IPP) 2,812 0 2,812 0 2,812
007000 TITLE X HIV/AIDS PROJECT 158,338 0 158,338 0 158.338
007000 WIC BREASTFEEDING PEER COUNSELING 44,056 0 44,056 0 44.056
007000 TUBERCULOSIS CONTROL - FEDERAL GRANT 114,972 0 114.972 0 114,972
007000 SYPHILIS ELIMINATION 0 0 0 0 0
007000 STD PROGRAM INFERTILITY PREVENTION PROJECT (IPP) 2,812 0 2,812 0 2,812
007000 STD PROGRAM - PHYSICIAN TRAINING CENTER 0 0 0 0 0
007000 RYAN WHITE-CONSORTIA 0 0 0 0 0
007000 BIOTERRORISM HOSPITAL PREPAREDNESS 28,000 0 28.000 0 28,000
007000 AIDS PREVENTION 208.644 0 208,644 0 208,644
007000 BIOTERRORJSM SURVEILLANCE & EPIDEMIOLOGY 24.658 0 24,658 0 24.658
007000 COASTAL BEACH MONITORJNG PROGRAM 22.367 0 22,367 0 22,367
007000 FGTF/IMMUNIZA TION ACTION PLAN 40,206 0 40.206 0 40.206
007000 FGTF/FAMIL Y PLANNING TITLE X SPECIAL INITIATIVES 56,313 0 56,313 0 56,313
007000 TITLE X MALE PROJECT 80.000 0 80,000 0 80,000
007000 ENVIRONMENTAL & HEALTH EFFECT TRACKING 0 0 0 0 0
007000 RYAN WHITE - EMERGING COMMUNITIES 0 0 0 0 0
007000 RJSK COMMUNICATIONS 0 0 0 0 0
007000 PUBLIC HEALTH PREPAREDNESS BASE 120.010 0 120,010 0 120.010
ATTACHMENT II. 16D4
COLLIER COUNTY HEALTH DEPARTMENT
Part II. Sources of Coutributions to County Health Department
October 1, 2009 to September 30, 2010
State CHD County Total CHD
Trust Fund CHD Trust Fund Other
(cash) Trust Fund (cash) Contribution Total
3. FEDERAL FUNDS - State
007000 HINI MASS VACCINATION IMPLEMENTATION 235,073 0 235,073 0 235.073
007000 IMMUNIZATION-WIC LINKAGES 0 0 0 0 0
007000 IMMUNIZATION SUPPLEMENTAL 40.408 0 40,408 0 40,408
007000 HIV INCIDENCE SURVEILLANCE 0 0 0 0 0
007000 HEALTH PROGRAM FOR REFUGEES 67,463 0 67,463 0 67,463
015009 MEDIPASS WAIVER.HLTHY STRT CLIENT SERVICES 0 0 0 0 0
015009 MEDIPASS WAIVER-SOBRA 0 0 0 0 0
015075 REFUGEE SCREENING 248,000 0 248,000 0 248,000
015075 Summer Feeding Program 0 0 0 0 0
007050 ARRA-School Health Seasonal Flu Vaccinations 0 0 0 0 0
FEDERAL FUNDS TOTAL 3,521.323 0 3,521,323 0 3,521,323
4. FEES ASSESSED BY STATE OR FEDERAL RULES - STATE
001020 TANNING FACILITIES 3,500 0 3,500 0 3,500
001020 BODY PIERCING 0 0 0 0 0
001020 MIGRANT HOUSING PERMIT 59,775 0 59,775 0 59,775
001020 MOBILE HOME AND PARKS 17,000 0 17,000 0 17,000
001020 FOOD HYGIENE PERMIT 30,000 0 30,000 0 30,000
001020 BIOHAZARD WASTE PERMIT 32,000 0 32,000 0 32.000
001020 PRIVATE WATER CONSTR PERMIT 0 0 0 0 0
001020 PUBLIC WATER ANNUAL OPER PERMIT 8,500 0 8.500 0 8,500
001020 PUBLIC WATER CONSTR PERMIT 0 0 0 0 0
001020 NON-SDW A SYSTEM PERMIT 0 0 0 0 0
001020 SAFE DRINKING WATER 0 0 0 0 0
001020 SWIMMING POOLS 300,000 0 300,000 0 300,000
001092 OSDS PERMIT FEE 130,000 0 130,000 0 130.000
001092 1& M ZONED OPERATING PERMIT 0 0 0 0 0
001092 AEROBIC OPERATING PERMIT 0 0 0 0 0
001092 SEPTIC TANK SITE EV ALUA TlON 0 0 0 0 0
001092 NON SDW A LAB SAMPLE 0 0 0 0 0
001092 OSDS VARIANCE FEE 0 0 0 0 0
001092 ENVIRONMENTAL HEALTH FEES 30,470 0 30,470 0 30,470
001092 OSDS REPAIR PERMIT 0 0 0 0 0
001170 LAB FEE CHEMICAL ANALYSIS 0 0 0 0 0
001170 WATER ANALYSIS-POTABLE 0 0 0 0 0
001170 NONPOT ABLE WATER ANALYSIS 0 0 0 0 0
010304 MQA INSPECTION FEE 12.500 0 12.500 0 12,500
FEES ASSESSED BY STATE OR FEDERAL RULES TOTAL 623,745 0 623,745 0 623,745
S. OTHER CASH CONTRIBUTIONS - STATE
010304 STATIONARY POLLUTANT STORAGE TANKS 0 0 0 0 0
090001 DRAW DOWN FROM PUBLIC HEALTH UNIT 199.894 0 199,894 0 199,894
OTHER CASH CONTRIBUTIONS TOTAL 199,894 0 199,894 0 199,894
6. MEDICAID - STATE/COUNTY
001056 MEDICAID PHARMACY 145,620 304,380 450.000 0 450,000
001076 MEDICAID TB 8,090 16.910 25,000 0 25.000
ATTACHMENT n. 16D4
COLLIER COUNTY HEALTH DEPARTMENT
Part n. Sources of Contributions to County Health Department
October I, 2009 to September 30, 2010
State CUD County Total CUD
Trust Fund CHD Trust Fund Other
(cash) Trust Fund (cash) Contribution Total
6. MEDICAID - STATEICOUNTY
001078 MEDICAID ADMINISTRA nON OF VACCINE 17,190 17,190 34.380 0 34,380
001079 MEDICAID CASE MANAGEMENT 15.000 15,000 30,000 0 30.000
001081 MEDICAID CHILD HEALTH CHECK UP 0 0 0 0 0
001082 MEDICAID DENTAL 452.064 944,919 1,396,983 0 1.396,983
001083 MEDICAID FAMILY PLANNING 0 0 0 0 0
001087 MEDICAID STD 3,883 8,117 12,000 0 12,000
001089 MEDICAID AIDS 25.888 54,112 80,000 0 80,000
001147 MEDICAID HMO RATE 0 0 0 0 0
001191 MEDICAID MATERNITY 0 0 0 0 0
001192 MEDICAID COMPREHENSIVE CHILD 0 0 0 0 0
001193 MEDICAID COMPREHENSIVE ADULT 1,294 2,706 4.000 0 4,000
001194 MEDICAID LABORATORY 0 0 0 0 0
001208 MEDlPASS $3.00 ADM. FEE 150 150 300 0 300
001059 Medicaid Low Income Pool 0 0 0 0 0
001051 Emergency Medicaid 0 0 0 0 0
001058 Medicaid - Behavioral Health 0 0 0 0 0
001071 Medicaid - Orthopedic 0 0 0 0 0
001072 Medicaid - Dennatology 0 0 0 0 0
001075 Medicaid - School Health Certified Match 0 0 0 0 0
001069 Medicaid - Refugee Health 0 0 0 0 0
001055 Medicaid - Hospital 0 0 0 0 0
MEDICAID TOTAL 669,179 1,363,484 2,032,663 0 2.032,663
7. ALLOCABLE REVENUE - STATE
018000 REFUNDS 0 0 0 0 0
037000 PRIOR YEAR WARRANT 0 0 0 0 0
038000 12 MONTH OLD WARRANT 0 0 0 0 0
ALLOCABLE REVENUE TOTAL 0 0 0 0 0
8. OTHER STATE CONTRIBUTIONS NOT IN CHD TRUST FUND - STATE
PHARMACY SERVICES 0 0 0 157,387 157,387
LABORATORY SERVICES 0 0 0 150,470 150,470
TB SERVICES 0 0 0 0 0
IMMUNIZATION SERVICES 0 0 0 955,869 955,869
STD SERVICES 0 0 0 0 0
CONSTRUCTIONIRENOV A nON 0 0 0 0 0
WIC FOOD 0 0 0 8,433,340 8,433.340
ADAP 0 0 0 2,005,480 2,005,480
DENTAL SERVICES 0 0 0 0 0
OTHER (SPECIFY) 0 0 0 0 0
OTHER (SPECIFY) 0 0 0 0 0
OTHER STATE CONTRIBUTIONS TOTAL 0 0 0 11.702,546 11,702,546
9, DIRECT COUNTY CONTRIBUTIONS - COUNTY
008030 Bee Contribution from Health Care Tax 0 0 0 0 0
008034 Bee Contribution from General Fund 0 1,407,900 1,407,900 0 1.407,900
ATTACHMENT II. 1604
COLLIER COUNTY HEALTH DEPARTMENT
Part II. Sources of Contributions to County Health Department
October 1, 2009 to September 30, 2010
State CHD County Total CHD
Trust Fund CHD Trust Fund Other
(cash) Trust Fund (cash) Contribution Total
DIRECT COUNTY CONTRIBUTION TOTAL 0 1,407,900 1.407.900 0 1,407,900
10. FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION - COUNTY
001060 VITAL STATISTICS - FESS & SERVICES 0 1.000 1.000 0 1,000
001077 RABIES VACCINE 0 0 0 0 0
001077 CHILD CAR SEAT PROG 0 0 0 0 0
001077 PERSONAL HEALTH FEES 0 131,189 131,189 0 131,189
001077 AIDS CO-PA YS 0 0 0 0 0
001094 ADULT ENTER. PERMIT FEES 0 0 0 0 0
001094 LOCAL ORDINANCE FEES 0 601,087 601,087 0 601,087
001114 NEW BIRTH CERTIFICATES 0 60,000 60,000 0 60.000
0011 IS Vital Statistics - Death Certificate 0 215.000 215,000 0 2[5,000
001117 VITAL STATS-ADM. FEE 50 CENTS 0 3,500 3,500 0 3,500
001073 Co-Pay for the AIDS Care Program 0 0 0 0 0
001025 Client Revenue from ORC 0 0 0 0 0
FEES AUTHORIZED BY COUNTY TOTAL 0 1,011,776 1,011,776 0 1.011,776
11. OTHER CASH AND LOCAL CONTRIBUTIONS - COUNTY
001009 RETURNED CHECK ITEM 0 0 0 0 0
001029 THIRD PARTY REIMBURSEMENT 0 450,160 450,160 0 450,160
001029 HEALTH MAINTENANCE ORGAN. (HMO) 0 0 0 0 0
001054 MEDICARE PART D 0 525,000 525,000 0 525,000
001077 RYAN WHITE TITLE II 0 0 0 0 0
001090 MEDICARE PART B 0 [55,200 155,200 0 155.200
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
008010 Contribution from City Government 0 0 0 0 0
008020 Contribution from Health Care Tax not thru Bee 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 0 0 0 0
010301 EXP WITNESS FEE CONSUL TNT CHARGES 0 0 0 0 0
010405 SALE OF PHARMACEUTICALS 0 57,000 57.000 0 57,000
010409 SALE OF GOODS OUTSIDE STATE GOVERNMENT 0 0 0 0 0
011000 GRANT DIRECT-NO V A UNIVERSITY CHD TRAINING 0 0 0 0 0
011000 GRANT-DIRECT 0 357,858 357,858 0 357,858
011001 HEALTHY START COALITION CONTRIBUTIONS 0 377.480 377,480 0 377.480
011007 CASH DONATIONS PRIVATE 0 8.000 8,000 0 8,000
012020 FrNES AND FORFEITURES 0 0 0 0 0
012021 RETURN CHECK CHARGE 0 0 0 0 0
028020 INSURANCE RECOVERIES-OTHER 0 0 0 0 0
090002 DRAW DOWN FROM PUBLIC HEALTH UNIT 0 133,263 133.263 0 133,263
011000 GRANT DIRECT-COUNTY HEALTH DEPARTMENT DIRECT SERVICES 0 0 0 0 0
011000 DIRECT-ARROW 0 0 0 0 0
011000 COUNTY COMMISSION - LIP FUND 0 160,050 160,050 0 160.050
011000 GRANT-DIRECT 0 0 0 0 0
011000 GRANT-DIRECT 0 0 0 0 0
ATTACHMENT II.
1604
COLLIER COUNTY HEALTH DEPARTMENT
Part II. Sources of Contributions to County Health Department
October 1, 2009 to September 30, 2010
State CHD County Total CHD
Trust Fund CHD Trust Fund Other
(cash) Trust Fund (cash) Contribution Total
11. OTHER CASH AND LOCAL CONTRIBUTIONS - COUNTY
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
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
010402 Recycled Material Sales 0 0 0 0 0
010303 FDLE Fingerprinting 0 0 0 0 0
007050 ARRA Federal Grants Direct to CHD 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 eMS 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
OTHER CASH AND LOCAL CONTRIBUTIONS TOTAL 0 2,224,011 2,224,0 II 0 2,224,011
12. ALLOCABLE REVENUE - COUNTY
018000 REFUNDS 0 0 0 0 0
037000 PRIOR YEAR WARRANT 0 0 0 0 0
038000 12 MONTH OLD WARRANT 0 0 0 0 0
COUNTY ALLOCABLE REVENUE TOTAL 0 0 0 0 0
13. BUILDINGS - COUNTY
ANNUAL RENTAL EQUIVALENT VALUE 0 0 0 525,048 525,048
GROUNDS MAINTENANCE 0 0 0 195.149 195,149
OTHER (SPECIFY) 0 0 0 0 0
INSURANCE 0 0 0 0 0
UTILITIES - TELEPHONE. ELECTRIC, WATER & SEWER 0 0 0 243,000 243,000
RENT - WIC GOLDEN GATE SITE 0 0 0 49,000 49.000
BUILDING MAINTENANCE 0 0 0 74,342 74,342
BUILDINGS TOTAL 0 0 0 1.086,539 1,086,539
14. OTHER COUNTY CONTRIBUTIONS NOT IN CHD TRUST FUND - COUNTY
EQUIPMENTIVEHICLE PURCHASES 0 0 0 0 0
VEHICLE INSURANCE 0 0 0 20,200 20,200
VEHICLE MAINTENANCE 0 0 0 0 0
OTHER COUNTY CONTRIBUTION (SPECIFY) 0 0 0 0 0
OTHER COUNTY CONTRIBUTION (SPECIFY) 0 0 0 0 0
OTHER COUNTY CONTRIBUTIONS TOTAL 0 0 0 20,200 20,200
GRAND TOTAL CHD PROGRAM 8,871,135 6,007.171 14,878.306 12,809,285 27,687,591
ATTACHMENT II. 16D4
COLLIER COUNTY HEALTH DEPARTMENT
Part III. Planned Staffmg, Clients, Services, And Expenditures By Program Service Area Within Each Level Of Service
October I, 2009 to September 30, 2010
Quarterly Expenditure Plan
FrE's Clients 1st 2nd 3rd 4th Grand
(0.00) Units Services (Whole dollars only) State County Total
A. COMMUNICABLE DISEASE CONTROL:
VITAL STATISTICS (180) 3.08 10,805 39,723 40,377 35,074 48,578 39,823 0 163.852 163,852
IMMUNIZATION (101) 15.85 15,449 34,709 339,262 238,254 231,906 168,903 373.004 605,321 978,325
STD (102) 8.37 1,007 10,396 133,447 131,251 155.035 121,959 362,553 179,139 541,692
AJ.D.S. (103) 20.40 2.288 18,597 476,656 458,907 523,046 640,226 771,017 1,327,818 2.098,835
TB CONTROL SERVICES (104) 12.99 1,549 9,299 179,876 158,358 188.600 118,135 504,108 140.861 644,969
COMM. DISEASE SURV. (106) 6.39 0 7,388 135.764 107,785 127,348 117,712 300,690 187,919 488,609
HEPATITIS PREVENTION (109) 3.39 2,578 5,836 54,317 39,241 89.065 98,540 279.701 1,462 281,163
PUBLIC HEALTH PREP AND RESP (116) 5.70 0 266 247,720 239.746 217,079 213,242 834,513 83,274 917,787
COMMUNICABLE DISEASE SUBTOTAL 76.17 33.676 126,214 1,607,419 1,408,616 1,580,657 1,518,540 3,425,586 2,689,646 6,115,232
B. PRIMARY CARE:
CHRONIC DISEASE SERVICES (210) 1.33 65 1.552 47,818 41,453 45,676 33,154 129.539 38,562 168,101
TOBACCO PREVENTION (212) 2.70 0 2,049 78,271 23.565 64,630 55,659 160,548 61,577 222,125
HOME HEALTH (215) 0.00 0 0 0 0 0 0 0 0 0
W.I.C.(221) 37.07 16.811 125,656 489,681 481,398 493,612 425.841 1,890,532 0 1,890,532
F AMIL Y PLANNING (223) 1.14 2,599 5,015 107,618 76,556 104,675 63,676 351,538 987 352,525
IMPROVED PREGNANCY OUTCOME (225) 5.49 1,478 13,524 202,117 114,791 210,701 184,659 121,299 590,969 7 I 2.268
HEALTHY START PRENATAL (227) 16.21 1.644 43,813 270,129 231,844 255.453 194,019 410,739 540.706 951,445
COMPREHENSIVE CHILD HEALTH (229) 2.36 408 4,480 64,366 41,784 50,814 38,542 83.462 112,044 195,506
HEALTHY START INFANT (231) 3.84 752 16,541 53.117 48,288 59,115 48,573 158,884 50,209 209,093
SCHOOL HEALTH (234) 7.29 0 164,937 142,124 135,492 143.909 84,144 362,778 142,891 505,669
COMPREHENSIVE ADULT HEALTH (237) 4.36 1,440 6,961 206,815 165,609 161,384 123,216 339,287 317,737 657,024
DENTAL HEALTH (240) 15.20 3,994 25,565 308,683 254,392 328,359 275,328 433,569 733,193 1,166,762
Healthy Start Interconception Woman (232) 0.00 0 0 0 0 0 0 0 0 0
PRIMARY CARE SUBTOTAL 96.99 29,191 410.093 1,970.739 1.615,172 1,918,328 1,526,811 4,442,175 2,588,875 7,031,050
C. ENVIRONMENTAL HEALTH:
Water and Onsite Sewage Programs
COASTAL BEACH MONITORING (347) 0.33 980 980 6,411 5,416 14,222 6,210 32,259 0 32,259
LIMITED USE PUBLIC WATER SYSTEMS (357) 0.90 364 1.896 13,768 12,21 I 14,643 21,859 22,612 39,869 62,481
PUBLIC WATER SYSTEM (358) 0.00 0 0 0 0 0 0 0 0 0
PRIVATE WATER SYSTEM (359) 0.00 0 3 110 68 300 200 377 301 678
INDIVIDUAL SEWAGE DISP. (361) 5.79 1.690 7.492 124.866 109,164 125,035 96,457 331,438 124,084 455.522
Group Total 7.02 3,034 10.371 145.155 126,859 154,200 124,726 386,686 164,254 550,940
Facility Programs
FOOD HYGIENE (348) 3.63 344 1,810 69,880 68,978 67,967 52,563 188,014 71,374 259,388
BODY ART (349) 0.01 2 7 780 756 0 0 1,536 0 1,536
GROUP CARE FACILITY (351) 1.40 368 760 10.836 16.604 10,289 16,744 4.723 49,750 54.473
MIGRANT LABOR CAMP (352) 5.89 248 1,569 66,758 69.168 90.773 71,688 121.563 176,824 298,387
HOUSING,PUBLIC BLDG SAFETY,SANITATION (3~.)l0 0 0 0 0 0 0 0 0 0
MOBILE HOME AND PARKS SERVICES (354) 0.53 98 261 5,538 3.834 6,581 7.551 23,504 0 23.504
SWIMMING POOLS/BA THING (360) 6.62 1,608 19,436 96,735 86.145 135.458 132,889 188,793 262,434 451.227
BIOMEDICAL WASTE SERVICES (364) 0.99 522 761 16,258 9,331 13,550 13,863 50,222 2.780 53,002
ATTACHMENT II. 16D4
COLLIER COUNTY HEALTH DEPARTMENT
Part III. Planned Staffing, Clients, Services, And Expenditures By Program Service Area Within Each Level Of Service
October 1, 2009 to September 30, 2010
Quarterly Expenditure Plan
FrE's Clients 1st 2nd 3rd 4tb Grand
(0.00) Units Services (Whole dollars only) State County Total
C. ENVIRONMENTAL HEALTH:
Facility Programs
TANNING FACILITY SERVICES (369) 0.11 24 80 1.812 1,140 1,218 1,729 5,842 57 5,899
Group Total 19.18 3,214 24,684 268,597 255.956 325,836 297,027 584,197 563,219 1,147,416
Groundwater Contamination
STORAGE TANK COMPLIANCE (355) 0.00 0 0 0 0 0 0 0 0 0
SUPER ACT SERVICE (356) 0.15 [05 181 2,072 2,483 2,194 2,250 8,999 0 8,999
Group Total 0.15 105 181 2,072 2,483 2,194 2,250 8,999 0 8,999
Community Hygiene
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
OCCUPATIONAL HEALTH (344) 0.45 0 689 6,527 4,655 8.762 4,725 23,492 1,177 24,669
CONSUMER PRODUCT SAFETY (345) 0.00 0 0 0 0 0 0 0 0 0
[NJURY PREVENTION (346) 0.00 0 0 0 0 0 0 0 0 0
LEAD MONITORING SERVICES (350) 0.00 0 0 0 0 0 0 0 0 0
PUBLIC SEWAGE (362) 0.00 0 0 0 0 0 0 0 0 0
SOLID WASTE DISPOSAL (363) 0.00 0 0 0 0 0 0 0 0 0
SANITARY NUISANCE (365) 0.00 0 0 0 0 0 0 0 0 0
RABIES SURVEILLANCE/CONTROL SERVICES (36G)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 0 0 0 0 0 0
WATER POLLUTION (370) 0.00 0 0 0 0 0 0 0 0 0
AIR POLLUTION (371) 0.00 0 0 0 0 0 0 0 0 0
Group Total 0.45 0 689 6,527 4.655 8,762 4.725 23,492 1,177 24,669
ENVIRONMENTAL HEALTH SUBTOTAL 26.80 6,353 35,925 422,351 389,953 490,992 428,728 1.003,374 728,650 1,732,024
D, SPECIAL CONTRACTS:
SPECIAL CONTRACTS (599) 0.00 0 0 0 0 0 0 0 0 0
SPECIAL CONTRACTS SUBTOTAL 0.00 0 0 0 0 0 0 0 0 0
TOTAL CONTRACT [99.96 69.220 572,232 4,000,509 3,4[3,741 3,989,977 3,474,079 8,871,135 6,007,171 14,878,306
16D4
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:
1. Title VI of the Civil Rights Act of 1964, as amended, 42 U.S.C., 2000 Et seq., which prohibits
discrimination on the basis of race, color or national origin in programs and activities receiving or
benefiting from federal financial assistance.
2. Section 504 of the Rehabilitation Act of 1973, as amended, 29 U.S.C. 794, which prohibits discrimination
on the basis of handicap in programs and activities receiving or benefiting from federal financial
assistance.
3. Title IX of the Education Amendments of 1972, as amended, 20 U.S.C. 1681 et seq., which prohibits
discrimination on the basis of sex in education programs and activities receiving or benefiting from
federal financial assistance.
4. The Age Discrimination Act of 1975, as amended, 42 U.S.C. 6101 et seq., which prohibits discrimination
on the basis of age in programs or activities receiving or benefiting from federal financial assistance.
5. The Omnibus Budget Reconciliation Act of 1981, P.L. 97-35, which prohibits discrimination on the basis
of sex and religion in programs and activities receiving or benefiting from federal financial assistance.
6. All regulations, guidelines and standards lawfully adopted under the above statutes. The applicant
agrees that compliance with this assurance constitutes a condition of continued receipt of or benefit from
federal financial assistance, and that it is binding upon the applicant, its successors, transferees, and
assignees for the period during which such assistance is provided. The appiicant 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.
21
16D4
ATTACHMENT IV
COLLIER COUNTY HEALTH DEPARTMENT
FACILITIES UTILIZED BY THE COUNTY HEALTH DEPARTMENT
Facility
Description
Location
Owned Bv
Collier County Health
Department & Public
Services Building H
3301 E. Tamiami Trail
Building H, Naples
Collier County
Immokalee Satellite
419 North First Street
Immokalee
Collier County
Golden Gate WIC Office
4945 Golden Gate Parkway Benderson
Unit 102, Naples Development
22
16D4
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.
133,616
TOTAL
$
$
$
$
$
$ 334,039 Balance
CONTRACT YEAR STATE
2007-2008 $ $
2008-2009 $ $
2009-2010 $ $
2010-2011 $ $
2011-2012 $ $
PROJECT TOTAL $ 200,423 $
COUNTY
SPECIAL PROJECT CONSTRUCTION/RENOVATION PLAN
PROJECT NAME:
LOCATION/ ADDRESS:
PROJECT TYPE:
Renovation of CHD Offices
Building H of the Collier County Government Complex
SQUARE FOOTAGE:
NEW BUILDING
RENOVATION X
NEW ADDITION
o
ROOFING
PLANNING STUDY
OTHER
PROJECT SUMMARY: Describe scope of work in reasonabie detai/.
The Collier County Health Department will be moving its Environmental Health Division from a satellite government complex
to the main building (Building H) of the government complex located on Tamiami Trail during 2005-2006 when the
space becomes available. Medical Records will be recarpeted and the main lobby will get a information Kiosk to be staffed
by administration.
Other operating programs will also be reconfigured during the time frame 2005-20010 including: School Health,
Disaster Preparedness, Family Health, Epidemiology, Vital Stats, Pharmacy, and clinic areas of Communicable
Disease. The Dental clinic will need to be expanded because of growth probably during the 2006-20010 time frame.
Also it is anticipated that Information Systems, Finance & Accounting, Human Resources,
and the Director's Office will be renovated in 2007-2010.
ESTIMATED PROJECT INFORMATION:
START DATE (initial expenditure of funds) :
COMPLETION DATE:
10/1/2005
12/31/2010
DESIGN FEES:
CONSTRUCTION COSTS:
FURNITURE/EQUIPMENT
TOTAL PROJECT COST:
COST PER SQ FOOT:
$
$
$
$
$
1,350,000
#DIV/O!
Special Capital Projects are new construction or renovation projects and new furniture or equipment
associated with these projects and mobile health vans,
23
16D4
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 STATE COUNTY
2007-2008 $ $ $
2008-2009 $ $ $
2009-2010 $ $ $
2010-2011 $ $ $
2011-2012 $ $ $
PROJECT TOTAL $ 49,365 $ 32,906 $
TOTAL
82,271 Balance
SPECIAL PROJECT CONSTRUCTION/RENOVATION PLAN
PROJECT NAME:
LOCATIONI ADDRESS:
PROJECT TYPE:
WIC Renovation
Building H of the Collier County Government Complex
NEW BUILDING ROOFING
RENOVATION X PLANNING STUDY
NEW ADDITION OTHER
2300
SQUARE FOOTAGE:
PROJECT SUMMARY: Describe scope of work in reasonable detail.
The Collier CHD WIC operations are in critical need of additional space in Bldg. H due to rapid growth in recent
years. However, this growth cannot be accomodated within Bldg. H without extensive modifications to the
currentiy occupied spaces. A long-term plan has been developed to accomodate future growth as well as
alleviating the current lack of space. Given the large scope and lengthy time-frame to completion, this project
will be divided into three distinct phases. PHASE I will entail the relocation of all WIC operations in Bldg. H to
another county-owned building or commercially-own facility and all associated moving costs (network setup,
telephones, furniture, etc.) along with the demolition of current WIC spaces in Bldg. H. Phase II will commence
in FY 08 and will involve the actual construction of WIC spaces in Bldg. H. Phase III will start in FY 09 and will
involve relocating WIC operations back to Bldg. H.
ESTIMATED PROJECT INFORMATION:
START DATE (initial expenditure of funds) :
COMPLETION DATE:
DESIGN FEES:
CONSTRUCTION COSTS:
FURNITUREIEQUIPMENT
TOTAL PROJECT COST:
COST PER SQ FOOT:
$
$
$
$
$
10/1/2007
6/30/2010
30,000
300,000
170,000
500,000
217.3913043
Special Capital Projects are new construction or renovation projects and new furniture or equipment
associated with these projects and mobile health vans.
24
1604
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 STATE COUNTY TOTAL
2007-2008 $ $ $
2008-2009 $ 24,000 $ 16,000 $ 40,000
2009-2010 $ $ $
2010-2011 $ $ $
2011-2012 $ $ $
PROJECT TOTAL $ 24,000 $ 16,000 $ 40,000
SPECIAL PROJECT CONSTRUCTION/RENOVATION PLAN
PROJECT NAME:
LOCATIONI ADDRESS:
PROJECT TYPE:
Client Registration - CDCP
Building H of the Collier Government Complex
SQUARE FOOTAGE:
NEW BUiLDING
RENOVATION X
NEW ADDiTION
300
ROOFING
PLANNING STUDY
OTHER
PROJECT SUMMARY: Describe scope of work in reasonable detail.
This project is required to resolve a physical Internal control issue. The Client Registration area in CDCP is
occupied by two senior clerks who function as patient registration clerks and cashiers. This space is also the
location where active patient records are stored for daily direct access by ciinical staff. Although the area is
secure from clients, it is still deemed an internal controi problem in that clinical staff can readily access an area
where cash is collected and cashiers can acccess medicai records. This project will renovate the space to
alleviate these concerns by separating these two functions, greatly reducing internal control risks, improving
space ventilation, and providing a more functional working space for the staff. Renovation will involve demo
work, building wall(s), new flooring, counters, and NC vents.
ESTIMATED PROJECT INFORMATION:
START DATE (initial expenditure of funds) :
COMPLETION DATE:
DESIGN FEES:
CONSTRUCTION COSTS:
FURNITURE/EQUIPMENT
TOTAL PROJECT COST:
$
$
$
$
$
11/1/2009
21112010
5,000
30,000
5,000
40,000
COST PER SQ FOOT:
116.6666667
Special Capital Projects are new construction or renovation projects and new furniture or equipment
associated with these projects and mobile health vans.
25
1604
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 STAlE COUNTY TOTAL
2007-2008 $ $ $
2008-2009 $ 120,000 $ 80,000 $ 200,000
2009-2010 $ $ $
2010-2011 $ $ $
2011-2012 $ $ $
PROJECT TOTAL $ 120,000 $ 80,000 $ 200,000
SPECIAL PROJECT CONSTRUCTION/RENOVATION PLAN
PROJECT NAME:
LOCATION/ ADDRESS:
PROJECT TYPE:
Dental Clinic Renovation and Expansion
Building H of the Collier Government Complex
SQUARE FOOTAGE:
NEW BUILDING
RENOVATION X
NEW ADDITION
1200
ROOFING
PLANNING STUDY
OTHER
PROJECT SUMMARY: Describe scope of work in reasonable detail.
Dental cannot currently meet all the community needs. There are primarily appointments for pediatric patients
and a limited number of adults. The Dental department itself is self-sustaining but cannot currently expand
services due to limited space and equipment. This renovation and re-design of the space will enable the
installation of two additional dental chairs and subsequently an additional dentist. An office and several walls will
be removed to provide space for the additional chairs and equipment whiie dramatically improving
ventilation/temperature which has been an ongoing facilities issue for the past several years.
ESTIMATED PROJECT INFORMATION:
START DATE (initial expenditure of funds) :
COMPLETION DATE:
DESIGN FEES:
CONSTRUCTION COSTS:
FURNITURE/EQUIPMENT
TOTAL PROJECT COST:
$
$
$
$
$
10i1/2011
4/1/2012
25,000
150,000
25,000
200,000
145.8333333
COST PER SQ FOOT:
Special Capital Projects are new construction or renovation projects and new furniture or equipment
associated with these projects and mobile health vans.
26
ATTACHMENT V
COLLIER COUNTY HEALTH DEPARTMENT
SPECIAL PROJECTS SAVINGS PLAN
16D4
IDENTIFY THE AMOUNT OF CASH THAT IS ANTICIPATED TO BE SET ASIDE ANNUALLY FOR THE PROJECT.
CONTRACT YEAR
2007-2008 $
2008-2009 $
2009-2010 $
2010-2011 $
2011-2012 $
PROJECT TOTAL $
STATE
66,000
66,000
COUNTY
$
$
$
$
$
$
44,000
44,000
SPECIAL PROJECT CONSTRUCTION/RENOVATION PLAN
PROJECT NAME:
LOCATION/ ADDRESS:
PROJECT TYPE:
SQUARE FOOTAGE:
Family and Personal Health Renovation
Buildin9 H of the Collier Government Complex
NEW BUILDING
RENOVATION X
NEW ADDITION
2500
ROOFING
PLANNING STUDY
OTHER
PROJECT SUMMARY: Describe scope of work in reasonable detail.
TOTAL
$
$
$
$
$
$
110.000
110,000
This renovation will involve painting. replacing flooring, ceiling tiles, and some of the furniture. It will also re-
design the space to provide a more funtional working area for both staff and clients. A small conference room
will be removed to provide for a more open environment and facilitate improved air circulation/ventilation.
Although not confirmed, some of the staff seated in this area have experienced respiratory issues probably due
to dust and allergens found in the carpet, ceiling tiles, and furniture.
ESTIMATED PROJECT INFORMATION:
START DATE (initial expendilure o!funds) :
COMPLETION DATE:
DESIGN FEES:
CONSTRUCTION COSTS:
FURNITURE/EQUIPMENT
TOTAL PROJECT COST:
COST PER SQ FOOT:
$
$
$
$
$
10/1/2012
2/1/2013
10,000
65,000
35,000
110,000
30
Special Capital Projects are new construction or renovation projects and new furniture or equipment
associated with these projects and mobile health vans.
27