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Backup Documents 11/14/2023 Item #16D 2 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 16 D a THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later than Monday preceding the Board meeting. **NEW** ROUTING SLIP Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office. Route to Addressee(s) (List in routing order) Office Initials Date 1. Todd Henry Public Services Department TIF 11/15/23 2. Jeffrey A. Klatzkow County Attorney Office 9 fA› l II 4. BCC Office Board of County Commissioners �Ly/13fr !(f!7 5. Minutes and Records Clerk of Court's Office 11 Ili 2-3 PRIMARY CONTACT INFORMATION 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,may need to contact staff for additional or missing information. Name of Primary Staff Phone Number x-8206 Contact / Department Alan Portis,DOH Finance&Accounting 252-8206 Please Call for Pick-up Agenda Date Item was Agenda Item Number Approved by the BCC 11/14/23 16.D.2 Type of Document Resolution for the Florida Department Number of Original Attached of Health in Collier County allowing the Documents Attached Health Department to establish the 1 proposed updated Fee Schedule. PO number or account number if document is 2 U Z 2� to be recorded (7 INSTRUCTIONS & CHECKLIST Initial the Yes column or mark"N/A" in the Not Applicable column,whichever is Yes N/A(Not appropriate. (Initial) Applicable) 1. Does the document require the chairman's original signature?STAMPED SIGNATURE IS OK 2. Does the document need to be sent to another agency for additional signatures? If yes, N/A provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet. 3. Original document has been signed/initialed for legal sufficiency. (All documents to be signed by the Chairman,with the exception of most letters,must be reviewed and signed AP by the Office of the County Attorney. 4. 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 5. The Chairman's signature line date has been entered as the date of BCC approval of the AP document or the final negotiated contract date whichever is applicable. 6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's AP signature and initials are required. 7. In most cases(some contracts are an exception),the original document and this routing slip should be provided to the County Attorney Office at the time the item is input into SIRE. N/A 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! 8. The document was approved by the BCC on 11/14/2023 (enter date)and all changes made during the meeting have been incorporated in the attached document. AP :s optio,: The County Attorney's Office has reviewed the changes,if applicable. is line 9. Initials of attorney verifying that the attached document is the version approved by the N/A is i BCC,all changes directed by the BCC have been made,and the document is ready for the 5A►` an optio Chairman's signature. this line. I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12 6 D2 RESOLUTION NO. 2023-2 0 6 A RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS OF COLLIER COUNTY, FLORIDA, SUPERSEDING RESOLUTION NO. 2016-224 AND ALL PRIOR RATE RESOLUTIONS AND SCHEDULES FOR THE FLORIDA DEPARTMENT OF HEALTH AND ESTABLISHING THE FEES, RATES AND CHARGES FOR SERVICES RENDERED BY THE COUNTY HEALTH DEPARTMENT. WHEREAS, under the authority of Section 154.06 of the Florida Statutes, The Department of Health may establish fee schedules for public health services rendered through the Health Department. WHEREAS, said statutory authority grants the Department of Health the power to assess fees, co-payments, sliding fee scales, fee waivers and fee exemptions. WHEREAS, the funds collected under Section 154.06 of the Florida Statutes shall be expended solely for the purpose of providing health services and facilities within the county served by the county health department. Fees collected by the county health department pursuant to department rules shall be deposited with the Chief Financial Officer and credited to the County Health Department Trust Fund. WHEREAS, the fees collected by the county health department for public health services or personal health services shall be allocated to the state and the county based upon the pro rata share of funding for each service. WHEREAS, the Board of County Commissioners, shall provide for the transmittal of funds collected for its pro rate share of personal health services or primary care services rendered under the provisions of this section to the State Treasury for credit to the County Health Department Trust Fund, but in any events the proceeds from such fees may only be used to fund county health department services. NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF COLLIER COUNTY, FLORIDA, that: Section 1. Resolution No. 2016-224 is hereby superseded in its entirety. Section 2. The schedule of rates, changes and fees set forth are attached and made an integral component of this Resolution. Section 3. This Resolution shall become effective upon adoption. / [23-G RC-01404/1817946/1] • b 4 This Resolution adopted upon majority vote this (y day of floien,be! , 2023. ATTEST: BOARD OF COUNTY COMMISSIONERS Crystal K. Kinzel, Clerk of Courts COLLIER COUNTY, FLORIDA ( 1�— By: 1�— By: J�^� Clalrai's Rick LoCastro, o, Chairman Siqr ath only. Approved is t fe •ality: iii MINIM r Jeffrey A. K; •ko , County Attorney CAO [23-GRC-01404/1817946/1] 16ua FLORIDA DEPARTMENT OF HEALTH COLLIER COUNTY - FEE SCHEDULE This fee schedule is established as authorized by Florida Statutes Section 154.06. All funds collected shall be expended soley for the purpose of providing public health services within Collier County. Financial Eligibility: Shall be determined for all clients receiving personal health services for which a sliding fee is to be charged, and shall be re-determined a minimum of once a year or shorter if income or family size changes. Clients that waive the financial eligibility determination shall be assigned to the full fee category and attest to their decision by signing the HMS generated fact sheet. Clients will not be charged in the following circumstances: (1) Clients enrolled in Medicaid. however charges may apply for non-covered services. (2) Childhood immunizations required for school (pre-K- 12th). Third party payers shall be billed an administration (injection) fee. (3)Anonymous HIV testing if there is an inability to pay. (4) No charge to a minor's parent(s) if the minor is without parental consent, has no income and is receiving STD or HIV services. (5) Clients that are part of a contact or at-risk group related to the investigation of a communicable disease. Charges may apply for any subsequent clinical examination and treatment. MEDICAL SERVICES CPT Code Current Fee Proposed 99201 New Prob Focused(MD or APRN Visit) 50.00 70.00 99202 New Expanded Prob Focused 80.00 90.00 99203 New Detailed Low 120.00 120.00 99204 New Comp Moderate 180.00 180.00 99205 New Comp High 220.00 220.00 99211 Min Visit MD/Nurse Visit(RN Visit) 40.00 50.00 99212 Est Prob Focused(MD or APRN Visit) 50.00 60.00 99213 Est Expanded Prob Focused 80.00 90.00 99214 Est Detailed Visit 120.00 130.00 99215 Est Comp Visit 160.00 170.00 BUNDLED SERVICES IMMPE Immigration PE(Adult)with CXR.T-Spot. RPR, HIV 180.00 250.00 IMMPE Immigration(Child under 14) 120.00 230.00 ANCILLARY MEDICAL SERVICES CPT Code Current Fee Proposed 36415 Venous Blood Draw 10.00 12.00 46924 TCA Anal(per treatment) 50.00 50.00 54065 TCA Male(per treatment) 50.00 50.00 56501 TCA Female(per treatment) 50.00 50.00 710XX Chest X-ray(1 view)includes an RN visit 70.00 90.00 (2 view)includes an RN visit 80.00 100.00 86580 PPD Placement and reading-includes an RN visit 60.00 80.00 86480 Quantiferon, includes an RN visit 79.00 99.00 86481 T-Spot, includes an RN visit 79.00 99.00 86703 HIV Testing 20.00 20.00 1693 MD Completion of 1-693 INS Immigration Form 50.00 100.00 Page 1 CAO,I 16De. TITERS CPT Code 86765 Measles $20.00 86735 Mumps $20.00 86762 Rubella $20.00 86787 Varicella $20.00 86704 Hepatitis B $25.00 86704 Hepatitis Panel-A,B and C-NO RISK IDENTIFIED $25.00 VACCINES CPT Code Current Fee Proposed 90471 Immunization Administration 27.00 30.00 90472 Immunization Administration Each Additional Vaccine 13.00 15.00 90632 IM HEP A-Single Dose 30.00 30.00 90636 IM HEP A& HEP B-Twinrix 56.00 97.00 90649 HPV Vaccine(each dose) 132.00 247.00 90662 New-High Dose Influenza Vaccine-Patients over 65 ONLY 37.00 64.00 90686 New-Quadrivalent Influenza Vaccine 19.00 19.00 90732 New-Pneumococcal Vaccine 65.00 107.00 90675 Rabies Vaccine. Intramuscular Pre/Intramuscular Post 215.00 382.33 90707 IM MMR Vaccine 55.00 83.00 90716 Varicella Vaccine(VZ)a.k a. Chicken Pox 92.00 147.00 90718 TDAP Vaccine 35.00 38.00 90718 IM TD or Tetnus Vaccine 25.00 25.00 90736 IM Shingle Vaccine(ZOSTER) 161.00 168.00 90746 IM HEP B-Single Dose 35.00 44.00 90746 IM HEP B-3 Series 132.00 FAMILY PLANNING SERVICES CPT Code Current Fee Proposed 99403 Minimal(Counseling/PT) 130.00 130.00 99384 12-17 Yrs Initial Evaluation 175.00 175.00 99385 18-39 Yrs Initial Evaluation 175.00 175.00 99386 40-64 Yrs Initial Evaluation 190.00 190.00 99387 65 and Over Initial Evaluation 210.00 210.00 99394 12-17 Yrs Annual(Periodic)Evaluation 155.00 155.00 99395 18-39 Yrs Annual(Periodic)Evaluation 155.00 155.00 99396 40-64 Yrs Annual(Periodic)Evaluation 155.00 155.00 99397 65 and Over Annual(Periodic)Evaluation 175.00 175.00 PROCEDURES 11981 Nexplanon Insertion 125.00 125.00 11982 Nexplanon Removal 135.00 140.00 11983 Nexplanon Removal and Insertion 185.00 195.00 58300 IUD Insertion 125.00 125.00 58301 IUD Removal 140.00 140.00 J1050 Depo-Provera+Injec Adm 135.00 135.00 J7297 Liletta 700.00 J7298 Mirena Device 700.00 J7300 Paragard Device 700.00 850.00 J7303 NuvaRing 120.00 J7307 Nexplanon Device 850.00 850.00 J7301 SKYLA 13.5 MG 660.00 660.00 S4993 Contraceptive Pills 11.50 Page 2 €!_k.7\01 6 LABS LABS-($10 draw fee total for ALL five labs) 81002 Urine, Dip Stick 2.00 2.00 81025 Pregnancy Test(Urine) 2.00 2.00 82948 Blood Sugar 2.00 2.00 85018 HgB 2.00 2.00 87210 Wet Mount 2.00 2.00 LABS-$10 draw fee not included 80053 Comp Metab Panel(pre-op) 1.51 1.51 80061 LIPID Panel 1.75 1.75 80076 Hepatic Panel 1.16 1.16 81003 MICRO UA 1.50 1.50 83001 FSH+LH 7.00 7.00 83036 Hemoglobin A1C 2.00 2.00 83540 IRON.TOTAL(TIBC) 10.00 10.00 84443 TSH 2.00 2.00 84450 AST(SGOT),ALT(SGPT) 0.88 1.22 84479 T3,T4 1.10 1.10 85025 CBC with Diff 1.10 1.10 86592 RPR with Confirmatory 2.00 12.00 86692 Chronic Hepatitis Screen 25.00 27.00 86695 HSV TYPE 1&2 IGC 15.00 15.00 86701 HIV Screening 7.00 20.00 87070 Nose/Throat/Other(Culture) 7.50 7.50 87086 Urine(Culture) 3.00 3.00 87255 HERPES(Culture) 53.60 53.60 87389 HIV 1/2 Antinge/Antibody Combo Immunoassay 7.00 20.00 87490 DNA Probe Chlamydia/GC 12.00 12.00 87491 Amplified GC/CT 12.00 12.00 88142 Thin Prep(Pap) 12.60 12.60 DENTAL SERVICES CDT Code Current Fee Proposed D0120 Periodic oral evaluation-established patient 43.00 43.00 D0140 Limited oral evaluation-problem focused 64.00 64.00 D0150 Comprehensive oral evaluation-new or established patient 73.00 73.00 D0210 Intraoral-complete series(including bitewings) 121.00 121.00 D0220 Intraoral-periapical first film 26.00 26.00 D0230 Intraoral-periapical each additional film 22.00 22.00 D0240 Intraoral-occlusal film 35.00 35.00 D0270 Bitewing-single film 22.00 22.00 D0272 Bitewings-two films 41.00 41.00 D0273 Bitewings-three films 51.00 51.00 D0274 Bitewings-four films 58.00 58.00 D0277 Vertical bitewings-7 to 8 films 89.00 89.00 D0330 Panoramic film 103.00 103.00 PREVENTIVE D1110 Prophylaxis-adult 83.00 83.00 D1120 Prophylaxis-child 62.00 62.00 D1206 Topical fluoride varnish;therapeutic application for moderate to high 35.00 35.00 D1208 Topical application of fluoride 33.00 33.00 D1330 Oral Hygiene Instructions 22.00 22.00 D1351 Sealant-per tooth 48.00 48.00 D1354 Interim caries arresting medicament application Y8.98 D1510 Space maintainer-fixed-unilateral 298.00 298.00 Page 3 bpz D1550 Re-cementation of space maintainer 83.00 83.00 D1555 Removal of fixed space maintainer 104.00 104.00 RESTORATIVE D2140 Amalgam-one surface, primary or permanent 127.00 127.00 D2150 Amalgam-two surfaces, primary or permanent 158.00 158.00 D2160 Amalgam-three surfaces, primary or permanent 189.00 189.00 D2161 Amalgam-four or more surfaces, primary or permanent 221.00 221.00 D2330 Resin-based composite-one surface, anterior 149.00 149.00 D2331 Resin-based composite-two surfaces,anterior 181.00 181.00 D2332 Resin-based composite-three surfaces.anterior 220.00 220.00 D2335 Resin-based composite-four or more surfaces or involving incise! 271.00 271.00 D2390 Resin-based composite crown, anterior 389.00 389.00 D2391 Resin-based composite-one surface.posterior 162.00 162.00 D2392 Resin-based composite-two surfaces, posterior 206.00 206.00 D2393 Resin-based composite-three surfaces,posterior 253.00 253.00 D2394 Resin-based composite-four or more surfaces, posterior 297.00 297.00 D2915 Recement cast or prefabricated post and core 121.00 D2920 Recement crown 94.00 94.00 D2930 Prefabricated stainless steel crown-primary tooth 270.00 270.00 D2931 Prefabricated stainless steel crown-permanent tooth 297.00 297.00 D2940 Protective restoration 104.00 104.00 ENDODONTICS D3110 Pulp cap-direct(excluding final restoration) 71.00 71.00 D3120 Pulp cap-indirect(excluding final restoration) 69.00 69.00 D3220 Therapeutic pulpotomy(excluding final restoration)-removal of pulp 172.00 172.00 application of medicament D3221 Pulpal debridement, primary and permanent teeth 173.00 173.00 PERIODONTICS D4321 Provisional splinting-extracoronal 369.00 369.00 D4341 Periodontal scaling and root planing-four or more teeth per quadrant 233.00 233.00 D4342 Periodontal scaling and root planing-one to three teeth per quadrant 163.00 163.00 D4346 Scaling moderate or severe inflamation full mouth 155.00 D4355 Full mouth debridement to enable comprehensive evaluation and 160.00 160.00 ORAL AND MAXILLOFACIAL SURGERY D7111 Extraction, coronal remnants-deciduous tooth 111.00 111.00 D7140 Extraction,erupted tooth or exposed root(elevation and/or forcepts 157.00 157.00 D7210 Surgical removal of erupted tooth requiring removal of bone and/or 251.00 251.00 mucoperiosteal flap if indicated D7250 Surgical removal of residual tooth roots(cutting procedure) 260.00 260.00 D7270 Tooth reimplantation and/or stabilization of accidentally evulsed or 400.00 400.00 D7510 Incision and drainage of abscess-intraoral soft tissue 175.00 175.00 ADJUNCTIVE GENERAL SERVICES D9110 Palliative(emergency)treatment of dental pain-minor procedure 98.00 98.00 D9210 Local anesthesia not in conjunction with operative or surgical 20.00 20.00 D9910 Application of desensitizing medicament 48.00 48.00 D9920 Behavior management, by report 89.00 89.00 D9999 Unspecified adjunctive procedure,by Report 30.00 30.00 Page 4 Cp' i - i 1 2 ENVIRONMENTAL HEALTH SERVICES Current Fee Proposed FOOD Plan Review(per hour) 50.00 50.00 Operating Permit Fee:Annual and semiannaul(annual fee) 75.00 Operating Permit Fee:Quarterly and triannual(annual fee) 100.00 BIOMEDICAL WASTE Operating Permit Fee(annual fee) 75.00 GROUP Plan Review(per hour) 50.00 50.00 Reinspection(one-time fee) 50.00 50.00 Construction Inspection(one-time fee) 50.00 50.00 Adult Family Care(annual fee) 150.00 150.00 Assisted Living Facilities(annual fee) 250.00 250.00 Residential Facilities(annual fee) 250.00 250.00 Schools>200 persons(annual fee) 500.00 500.00 Schools<200 persons(annual fee) 150.00 150.00 Other Group Facilities(annual fee) 150.00 150.00 MOBILE HOME PARKS Plan Review(per hour) 50.00 50.00 Reinspection(one-time fee) 50.00 50.00 Operating Permit Fee : Up to 149 spaces(annual fee) 75.00 MIGRANT HOUSING Reinspection(one-time fee) 50.00 50.00 Operating Permit Fee;5-50 occupants(annual fee) 100.00 Operating Permit Fee;51 occupants or more(annual fee) 150.00 TANNING Plan Review(per hour) 50.00 50.00 Reinspection (one-time fee) 50.00 50.00 SWIMMING POOLS Reinspection routine inspections(one-time fee) 75.00 75.00 Construction Inspection (one-time fee) 100.00 100.00 Bacteriological Fee(annual fee) 250.00 250.00 Renovation Inspection(one-time fee) 50.00 50.00 Exempt Pool(one-time fee) 100.00 100.00 Operator Certificate(one-time fee) 20.00 20.00 Operator Course(one-time fee) 75.00 75.00 Resurfacing Inspection(one-time fee) 50.00 Critical Health and Safety Reviews(per submission fee) 100.00 Modification Review(one-time fee) 50.00 WATER Water Letter(one-time fee) 30.00 30.00 Bacteriological Sample Non-Regulated(one-time fee) 25.00 25.00 Sample Collection Non-Regulated(one-time fee) 60.00 60.00 Nitrate Sample Non-Regulated(one-time fee) 60.00 60.00 Bacteriological Sample Regulated(one-time fee) 15.00 15.00 Sample Collection Regulated(one-time fee) 40.00 40.00 Nitrate Sample Regulated(one-time fee) 60.00 60.00 Lead Sample(one-time fee) 30.00 30.00 Page 5 1602- Sodium Sample(one-time fee) 25.00 25.00 Chloride Sample(one-time fee) 20.00 20.00 OSTDS Development Plan Review(one-time fee) 20.00 20.00 Incidental Plan Review(one-time fee) 10.00 10.00 Construction Permit Application(one-time fee) 160.00 160.00 Final Cover Inspection(one-time fee) 75.00 75.00 ATU Permit(annual fee) 150.00 150.00 PBT Permit(annual fee) 200.00 200.00 Reinspection(one-time fee) 75.00 75.00 Repair Permit(one-time fee) 200.00 200.00 Septic Letter(one-time fee) 30.00 30.00 ADMINISTRATIVE SERVICES Current Fee Proposed VITAL STATISTICS Birth Certificate(1st Copy) 12.00 12.00 Birth Certificate(each additional copy) 8.00 8.00 Death Certificate 10.00 10.00 Expedited Services 10.00 Protective Sleeve 3.00 MISC FEES Duplication(.15 per page-charges under$5.00 will be waived) 0.15 0.15 *A special service charge will apply for requests that involve large volumes or require extensive personnel or IT resources. Returned Check 25.00 25.00 Page 6