Agenda 12/08/2015 Item #16D25 Proposed Agenda Changes
Board of County Commissioners Meeting
December 8,2015
Add-On Item 4A: Proclamation designating January 16,2016 as National Religious Freedom Day in
Collier County. To be accepted by Greg Harper, Father Michael Orsi,Father Philemon Patitsas,Pastor Rick
Baldwin and Pastor Tom Harris. (Commissioner Henning's request)
Continue Item 16A22 to the January 12.2015 BCC Meeting:Recommendation to approve the name
of a Collier County artificial reef site pursuant to the Memorandum of Understanding with the
Community Foundation of Collier County and accept and appropriate a donation in the amount of
$98,000 for Artificial Reef Donations Project No.44038. (Community Foundation request)
Continue Item 16D25 to the January 12,2016 BCC Meeting: Recommendation to approve FY15-16
contract with the State of Florida Department of Health for the operation of the Collier County Health
Department in the amount of$1,378,200 and also to allocate additional funds in the amount of
$249,220 to fill a funding gap due to state non-funding of the ACHA Medicaid match programs.
(Staff s request)
Move Item 16E13 to Item 11F: Recommendation to accept a report on the status of the North
Collier Fire Control and Rescue District's second submission of a Certificate of Public Convenience and
Necessity for an Advanced Life Support Class 3 Certificate and not to process the application.
(Commissioner Hiller's request)
Move Item 16D22 to Item 11G: Recommendation to approve a resolution amending the Collier County
State Housing Initiatives Partnership (SHIP)Local Housing Assistance Plan(LHAP)for Fiscal Years
13/14-15/16,to add a tiered structure approach for the purchase assistance program including
increasing the maximum award to$50,000,and the addition of two new strategies to include Rental
Rehabilitation and Rental Acquisition;and reaffirm implementation as administrative and
ministerial. (Commissioner Henning's request)
Time Certain Requests:
Item 10C to be heard at 9:30 a.m.
Item 10D to be heard immediately following Item 10C
Item 10A to be heard at 9:45 a.m.
Item 12A to be heard immediately following Item 10A
Item 11C to be heard at 10:00 a.m.
Item 9C to be heard at 10:15 a.m.
Item 11E to be heard following Item 9C
Items 9A and 9B may be heard no sooner than 1:00 p.m.
Item 11A to be heard immediately following Item 9A
10B to be heard at 1:05 p.m.
12/8/2015 8:35 AM
12/8/2015 16.D.25.
EXECUTIVE SUMMARY
Recommendation to approve FY15 -16 contract with the State of Florida Department of Health for
the operation of the Collier County Health Department in the amount of $1,378,200 and also to
allocate additional funds in the amount of $249,220 to fill a funding gap due to state non - funding of
the ACHA Medicaid match programs.
OBJECTIVE: To approve the FYI 5-16 Collier County Health Department annual core contract and an
addendum to the contract providing additional local funding to fill a funding gap due to state non - funding
of the ACHA Medicaid match programs.
CONSIDERATIONS: Each year, the County enters into a core contract with the State of Florida
Department of Health to provide funds and facilities for the provision of public health services. The
attached represents the FY15 -16 contract effective October 1, 2015 through September 30, 2016.
The contract identifies the services that will be provided as well as the estimated cost share between the
State and the County. The total amount of funding to be provided directly to the Department of Health in
Collier County under the contract is $1,378,200. The County also provides $350,500 for Health
Department facility and motor pool operating costs.
In recent years, Collier County has been eligible to participate in Intergovernmental Transfer Programs
(IGT's) with the State Agency for Health Care Administration (AHCA) whereby local governmental
funding allocated for health- related service provision was matched with federal dollars. The use of the
local dollars budgeted in the Collier County budget along with the additional match funds, went to
community partners such as the County Health Department and David Lawrence Center. Under these
programs, in the prior fiscal year, the County Health Department received a 20% match increase over and
above the funds allocated in the County budget (an additional $249,220). These funds were used to
provide a variety of public health services to include dental services to those in need in Collier County.
The authorization for the state /federal matching programs was not renewed at the state level for the fiscal
year beginning July 1, 2015. Therefore, the additional match funding noted above is not available to the
County Health Department for the current fiscal year.
The County is prepared to fill the funding gap in FYI 5-16 but may not be able to cover this funding loss
in future fiscal years. Loss of this funding in future years will impact adult clients seen for emergent
issues in the pediatric dental clinic. These adult clients are typically uninsured with no ability to pay and
their only other access to dental care would be in the hospital ERs. The County Health Department has
been and will be working with the Community and Human Services staff and other appropriate agencies
to develop strategies and alternative sources of funding (such as any ER diversion grants) to enable the
continuation of these services at the County Health Department.
FISCAL IMPACT: The core contract presented for approval includes the base County- Health
Department contract payment of $1,378,200. Funding for the base contract is provided in the current
County General Fund (001) budget. In addition to the contract payment, the county has budgeted
$350,500 to provide for Health Department facility and.motor pool operating costs.
If county funding is provided, relative to the contract addendum, to close the IGT funding gap, a FY16
budget amendment moving dollars within the General Fund (001) and /or a General Fund supported
operation in the amount of $249,300 will be necessary. This budget amendment will not impact current
operations. While the State originally crafted a funding mechanism through the State Agency for Health
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Care Administration to support public health services, it is obvious that Counties will be left to identify
local funding sources in FY17 and beyond or simply eliminate the programs.
LEGAL CONSIDERATIONS: The contract is a standard form prepared by the State Department of
Health. The Addendum was prepared by the County Attorney's Office to incorporate the supplemental
funding of $249,220. This item is approved for form and legality, and requires majority vote for approval.
-JAB
GROWTH MANAGEMENT IMPACT: There is no Growth Management Plan impact associated with
this executive summary.
RECOMMENDATION: That the Board of County Commissioners approve and authorize the Chairman
to execute the annual core contract and the contract addendum with the State of Florida Department of
Health for the operation of the Collier County Health Department and to authorize all necessary budget
amendments.
Prepared by: Alan Portis, Collier County Health Department
Attachment: Core Contract
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COLLIER COUNTY
Board of County Commissioners
Item Number: 16.16.D.16.D.25.
Item Summary: Recommendation to approve FY15 -16 contract with the State of Florida
Department of Health for the operation of the Collier County Health Department in the amount
of $1,378,200 and also to allocate additional funds in the amount of $249,220 to fill a funding
gap due to state non - funding of the ACHA Medicaid match programs.
Meeting Date: 12/8/2015
Prepared By
Name: AlonsoHailey
Title: Operations Analyst, Public Services Department
11/16/2015 8:22:36 PM
Approved By
Name: AlonsoHailey
Title: Operations Analyst, Public Services Department
Date: 11/16/2015 8:42:55 PM
Name: GrantKimberley
Title: Division Director - Cmnty & Human Svc, Community & Human Services
Date: 11/16/2015 8:44:10 PM
Name: TownsendAmanda
Title: Division Director - Operations Support, Public Services Department
Date: 11/17/2015 8:28:57 AM
Name: CarnellSteve
Title: Department Head - Public Services, Public Services Department
Date: 11/18/2015 10:13:33 AM
Name: FinnEd
Title: Management/Budget Analyst, Senior, Office of Management & Budget
Date: 11/20/2015 4:27:09 PM
Name: KlatzkowJeff
Title: County Attorney,
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Date: 11/23/2015 9:48:00 AM
12/8/2015 16.D.25.
Go
Name: IsacksonMark
Title: Division Director - Corp Fin & Mgmt Svc, Office of Management & Budget
Date: 11/24/2015 8:44:40 AM
Name: OchsLeo
Title: County Manager, County Managers Office
Date: 11/24/2015 1:37:45 PM
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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 2015 -2016
This contract 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, 2015.
RECITALS
A. Pursuant to Chapter 154, Florida Statutes, the intent of the legislature is to
"promote, protect, maintain, and improve the health and safety of all citizens and visitors of
this state through a system of coordinated county health department services."
B. County Health Departments were created throughout Florida to satisfy this
legislative intent through "promotion of the public's health, the control and eradication of
preventable diseases, and the provision of primary health care for special populations."
C. Collier County Health Department ( "CHD ") is one of the created County Health
Departments.
D. It is necessary for the parties hereto to enter into this contract in order to ensure
coordination between the State and the County in the operation of the CHD.
NOW THEREFORE, in consideration of the mutual promises set forth herein, the
sufficiency of which are hereby acknowledged, the parties hereto agree as follows:
1. RECITALS. The parties mutually agree that the forgoing recitals are true and correct
and incorporated herein by reference.
2. TERM. The parties mutually agree that this contract shall be effective from October 1,
2015, through September 30, 2016, or until a written contract replacing this contract is
entered into between the parties, whichever is later, unless this contract is otherwise
terminated pursuant to the termination provisions set forth in paragraph 8. below.
3. SERVICES MAINTAINED BY THE CHD. The parties mutually agree that the CHD
shall provide those services as set forth on Part III of Attachment II hereof, in order to
maintain the following three levels of service pursuant to section 154.01(2), Florida Statutes,
as defined below:
a. "Environmental health services" are those services which are organized and operated
to protect the health of the general public by monitoring and regulating activities in the
environment which may contribute to the occurrence or transmission of disease.
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Environmental health services shall be supported by available federal, state and local funds
and shall include those services mandated on a state or federal level. Examples of
environmental health services include, but are not limited to, food hygiene, safe drinking
water supply, sewage and solid waste disposal, swimming pools, group care facilities,
migrant labor camps, toxic material control, radiological health, and occupational health.
b. "Communicable disease control services" are those services which protect the health
of the general public through the detection, control, and eradication of diseases which are
transmitted primarily by human beings. Communicable disease services shall be supported
by available federal, state, and local funds and shall include those services mandated on a
state or federal level. Such services include, but are not limited to, epidemiology, sexually
transmissible disease detection and control, HIV /AIDS, immunization, tuberculosis control
and maintenance of vital statistics.
c. "Primary care sery ices" 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 CHID will be handled as
follows:
a. The funding to be provided by the parties and any other sources is set forth in Part II
of Attachmen# If hereof. This funding will be used as shown in Part I of Attachment il.
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 $ 5,330,128
(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.
H. 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 $ 1,376,200 (amount listed under the "Board of County
Commissioners Annual Appropriations section of the revenue attachment).
b. Overall expenditures will not exceed available funding or budget authority, whichever
is less, (either current year or from surplus trust funds) in any service category. Unless
requested otherwise, any surplus at the end of the term of this contract in the County Health
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Department Trust Fund that is attributed to the CHD shall be carried forward to the next
contract period.
c. Either party may establish service fees as-allowed by law to fund activities of the CHD.
Where applicable, such fees shall be automatically adjusted to at least the Medicaid fee
schedule.
d. Either party may increase or decrease funding of this contract-during the term hereof
by notifying the other party in writing of the amount and purpose for the change in funding. If
the State initiates the increase /decrease, the CHD will revise the Attachment 11 and send a
copy of the revised pages to the County and the Department of Health, Office of Budget and
Revenue Management. If the County initiates the increase /decrease, the County shall notify
the CHD. The CHD will then revise the Attachment 11 and send a copy of the revised pages
to the Department of Health, Office of Budget and Revenue Management.
e. The name and address of the official payee to whom payments shall be made is:
County Health Department Trust Fund
Collier County
3339 E. Tamiami Trail, Suite 145
Naples, FL 34112
5. CHD DIRECTOR/ADMINISTRATOR. Both parties agree the directorladministrator of
the CHD shall be a State employee or under contract with the State and will be under the
day - today direction of the Deputy Secretary for County Health Systems. The
directorladministrator shall be selected by the State with the concurrence of the County. The
director /administrator of the CHD shall ensure that non - categorical sources of funding are
used to fulfill public health priorities in the community and the Long Range Program Plan. A
report detailing the status of public health as measured by outcome measures and similar
indicators will be sent by the CHD director /administrator to the parties no later than October 1
of each year (This is the standard quality assurance "County Health Profits" report located on the Division of
Public Health Statistics and Performance Management Intranet site).
6. ADMINISTRATIVE POLICIES AND PROCEDURES. The parties hereto agree that
the following standards should apply in the operation of the CHD:
a. The CHD and its personnel shall follow all State policies and procedures, except to the
extent permitted for the use of County purchasing procedures as set forth in subparagraph
b., below. All CHD employees shall be State or State - contract personnel subject to State
personnel rules and procedures. Employees will report time in the Health Management
System compatible format by program component as specified by the State.
b. The CHD shall comply with all applicable provisions of federal and state laws and
regulations relating to its operation with the exception that the use of County purchasing
procedures shall be allowed when it will result in a better price or service and no statewide
Department of Health purchasing contract has been implemented for those goods or
services. In such cases, the CHD directorladministrator must sign a justification therefore,
and all County purchasing procedures must be followed in their entirety, and such
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compliance shall be documented. Such justification and compliance documentation shall be
maintained by the CHD in accordance with the terms of this contract. State procedures must
be followed for all leases on facilities not enumerated in Attachment IV.
c. The CHD shall maintain books, records and documents in accordance with the
Generally Accepted Accounting Principles (GAAP), as promulgated by the Governmental
Accounting Standards Board (GASB), and the requirements of federal or state law. These
records shall be maintained as required by the Department of Health 'Policies and
Procedures for Records Management and shall be open for inspection at any time by. the
parties and the public, except for those records that are not otherwise subject to disclosure
as provided by law which are subject to the confidentiality provisions of paragraph 61, below.
Books, records and documents must be adequate to allow the -CHD to comply with the
following reporting requirements:
L The revenue and expenditure requirements in the Florida Accounting
Information Resource (FLAIR) System;
fl. 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;
N. 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 this contract
and funding from all sources is credited to the program accounts by State and County. The
equity share of any surplus /deficit funds accruing to the State and County is determined each
month and at contract year -end. Surplus funds may be applied toward the funding
requirements of each participating governmental entity in the following year. However, in
each such case, all surplus funds, including fees and accrued interest, shall remain in the
trust fund until accounted for in a manner which clearly illustrates the amount which has been
credited to each participating governmental entity, The planned use of surplus funds shall be
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reflected in Attachment. Il, Part I of this contract, with special capital projects explained in
Attachment V.
f. There shall be no transfer of funds between the three levels of services without a
contract amendment unless the CHD director /administrator determines that an emergency
exists wherein a time delay would endanger the public's health and the Deputy Secretary for
County Health Systems has approved the transfer. The Deputy Secretary for County Health
Systems shall forward written. evidence of this approval to the CHD within 30 days after an
emergency transfer.
g. The CHD may execute subcontracts for services necessary to enable the CHD to
carry out the programs specified in this contract. Any such subcontract shall include all
aforementioned audit and record keeping requirements.
h. At the request of either party, an audit may be conducted by an independent CPA on
the financial records of the CHD and the results made available to the parties within 180
days after the close of the CHD fiscal year. This audit will follow requirements contained in
OMB Circular A -133 and may be in conjunction with audits performed by County
government. If audit exceptions are found, then the director /administrator of the CHD will
prepare a corrective action plan and a copy of that plan and monthly status reports will be
furnished to the contract managers for the parties.
L The CHD shall not use or disclose any information concerning a recipient of services
except as allowed by federal or state law or policy.
j. The CHD shall retain all client records, financial records, supporting documents,
statistical records, and any other documents (including electronic storage media) pertinent to
this contract for a period of five (5) years after termination of this contract. If an audit has
been initiated and audit findings have not been resolved at the end of five (5) years, the
records shall be retained until resolution of the audit findings.
k. The CHD shall maintain confidentiality of all data, files, and records that are
confidential under the law or are otherwise exempted from disclosure as a public record
under Florida law. The CHD shall implement procedures to ensure the protection and
confidentiality of all such records and shall comply with sections 384.29, 381.004, 392.65
and 456.057, Florida Statutes, and all other state and federal laws regarding confidentiality.
All confidentiality procedures implemented by the CHD shall be consistent with the
Department of Health Information Security Policies, Protocols, and Procedures. The CHD
shall further adhere to any amendments to the State's security requirements and shall
comply with any applicable professional. standards of practice with respect to client
confidentiality.
I. The. CHD shall abide by all State policies and procedures, which by this reference are
incorporated herein as standards to be followed by the CHD, except as otherwise permitted
for some purchases using County procedures pursuant to paragraph 6.b.
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m. The CHD shall establish a system. through which applicants for services and current
clients may present grievances over denial, modification or termination of services. The CHD
will advise applicants of the right to appeal a denial or exclusion from services, of failure to
take account of a client's choice of service, and of his/her right to a fair hearing to the final
governing authority of the agency. Specific references to existing laws, rules or program
manuals are included in Attachment I of this contract.
n. The CHD shall comply with the provisions contained in the Civil Rights Certificate,
hereby incorporated into this contract as Attachment III.
o. The CHD shall submit quarterly reports to the County that shall include at least the
following:
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
DE385L1 report if the variance exceeds or falls below 25 percent of the
planned expenditure amount. ' However, if the amount of the service
specific variance between actual and planned expenditures does not
exceed three percent of the total planned expenditures for the level of
service in which the type of service is included, a variance explanation is
not required. A copy of the written explanation shall be sent to the
Department of Health, Office of Budget and Revenue Management.
p. The dates for the submission of quarterly reports to the County shall be as follows
unless the generation and distribution of reports is delayed due to circumstances beyond the
CHD's control:
/. March 1, 2016 for the report period October 1, 2015 through
December 31, 2015;
W. June 1, 2016 for the report period October 1, 2015 through
March 31, 2016;
N. September 1, 2016 for the report period October 1, 2015
through June 30, 2016; and
iv. December 1, 2016 for the report period October 1, 2015
through September 30, 2016.
7. FACILITIES AND EQUIPMENT. The parties mutually agree that:
a. CHD facilities shall be provided as specified in Attachment IV to this contract and the
County shall own the facilities used by the CHD unless otherwise provided in Attachment IV.
N.
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b. The County shall ensure adequate fire and casualty insurance coverage for County -
owned CHD offices and buildings and for all furnishings and equipment in CHD offices
through either a self- insurance program or insurance purchased by the County.
c. All vehicles will be transferred to the ownership of the County and registered as
County vehicles, The County shall ensure insurance coverage for these vehicles is available
through either a self - insurance program or insurance purchased by the County. All vehicles
will be used solely for CHD operations. Vehicles purchased through the County Health
Department Trust Fund shall be sold at fair market value when they are no longer needed by
the CHD and the proceeds returned to the County Health Department Trust Fund.
8. TERMINATION.
a. Termination at Will. This contract may be terminated by either party without cause
upon no 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 contract
become unavailable, either party may terminate this contract upon no less than twenty -four
(24) hours notice. Said notice shall be delivered by certified mail, return receipt requested, or
in person to the other party's contract manager with proof of delivery.
c. Termination for Breach. This contract may be terminated by one party, upon no less
than thirty (30) days notice, because of the other party's failure to perform an obligation
hereunder. Said notice shall be delivered by certified mail, return receipt requested, or in
person to the other party's contract manager with proof of delivery. Waiver of breach of any
provisions of this contract shall not be deemed to be a waiver of any other breach and shall
not be construed to be a modification of the terms of this contract.
9. MISCELLANEOUS. The parties further agree:
a. Availability of Funds. If this Agreement, any renewal hereof, or any term, performance
or payment hereunder, extends beyond the fiscal year beginning July 1, 2015, it is agreed
that the performance and payment under this Agreement are contingent upon an annual
appropriation by the Legislature, in accordance with section 287.0582, Florida Statutes.
b. Contract Managers. The name and address of the contract managers for the parties
under this contract are as follows:
For the State: Forth e County:
Stephanie Vick M.S..B.S.N., R.N. Steve Camell
Name Name
_Administrator Florida Department of Public Services Division Administrator
Health in Collier County
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......
Title
3339E Tamiami Trail, Suite 145
Naples Florida 34112
Address
(239) 252 -5332
Telephone
Title
3339E Tamiami Trail, Suite 217
Naples Florida 34112
Address
(239) 252 -8468
Telephone
12/8/2015 16.D.25.
If different contract managers are designated after execution of this contract, the name,
address and telephone number of the new representative shall be furnished in writing to the
other parties and attached to originals of this contract.
c. Captions. The captions and headings contained in this contract are for the
convenience of the parties only and do not in any way modify, amplify, or give additional
notice of the provisions hereof.
In WITNESS THEREOF, the parties hereto have caused this 19 page contract, with its
attachments as referenced, including Attachment I (two pages), Attachment 11 (six pages),
Attachment III (one page), Attachment IV (one page), and Attachment V (one page), to be
executed by their undersigned officials as duly authorized effective the 15t day of October,
2015.
BOARD OF COUNTY COMMISSIONERS STATE OF FLORIDA
FOR COLLIER COUNTY DEPARTMENT OF HEALTH
SIGNED BY:
NAME: Ti M N A ty CA
TITLE: C "A
DATE:
ATTESTED TO:
SIGNED BY:
SIGNED BY:
NAME: John H Armstrong, MD
TITLE: Surgeon General/Secretary of Health
DATE:
SIGNED BY:
NAME: NAME: Stephanie Vick, M.S.. B.S.N., R.N.
TITLE:
DATE:
TITLE: CHD Director /Administrator
DATE:
Approvcd as to form and legality
Assis t County Att ey packet Page -1576- }`
J
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ATTACHMENT 1
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 Reouirement
1. Sexually Transmitted Disease Requirements as specified In F.A.C. 64D -3, F.S. 381 and F.S.
Program 384.
2. Dental Health Periodic financial and programmatic reports as specified by the
program office.
3. Special Supplemental Nutrition Service documentation and monthly financial reports as specified
Program for Women, Infants and in DHM 150 -24' and all federal, state and county requirements
Children (including the WIC detailed In program manuals and published procedures.
Breastfeeding Peer Counseling
Program)
4. Healthy Start! Improved Pregnancy Requirements as specified In the 2007 Healthy Start Standards
Outcome and Guidelines and as specified by the Healthy Start Coalitions in
contract with each county health department.
5. Family Planning Requirements as specified in Public Law 91-572.42 U.S.C. 300,
et seq., 42 CFR part 59, subpart A, 45 CFR parts 74 & 92, 2 CFR
215 (OMB Circular A -110) OMB Circular A -102, F.S. 381.0051,
F.A.C. 64F -7, F.A.C. 64F -16, and F.A.C. 64F -19. Requirements
and Guidance as specified in the Program Requirements for Title
X Funded Family Planning Projects (Title X Requirements)(2014)
and the Providing Quality Family Planning Services (QFP):
Recommendations of CDC and the U.S. Office of Population
Affairs published on the Office of Population Affairs website.
Programmatic annual reports as specified by the program office
as specified in the annual programmatic Scope of Work for Family
Planning and Maternal Child Health Services, including the Family
Planning Annual Report (FPAR), and other minimum guidelines
as specified by the Policy Web Technical Assistance Guidelines,
6. Immunization Periodic reports as specified by the department pertaining to
immunization levels in kindergarten and/or seventh grade
pursuant to Instructions contained in the Immunization Guidelines-
Florida Schools, Childcare Facilities and Family Daycare Homes
(DH Form 150 -615) and Rule 64D -3.045, F.A.C. In addition,
periodic reports as specified by the department pertaining to the
surveiliancefinvestigation of reportable vaccine - preventable
diseases, adverse events, vaccine accountability, and
assessment of immunization
ATTACHMENT I (Continued)
Attachment-11 - Page 1 of 2
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levels as documented in Florida SHOTS and supported by CHD
Guidebook policies and technical assistance guidance.
7. Environmental Health Requirements as specified in Environmental Health Programs
Manual 150-4' and DHP 50-21•
8. HIV/AIDS Program Requirements as specified in F.S. 384.25 and F.A.C. 640 -3.030
and 64D- 3.031. Case reporting should be on Adult HIV/AIDS
Confidential Case Report CDC Form DH2139 and Pediatric
HIV /AIDS Confidential Case Report CDC Form DH2140.
Requirements as specified in F.A.C. 64D -2 and 6413-3, F.S. 381
and F.S. 384. Socio- demographic and risk data on persons
tested for HIV in CHD clinics should be reported on Lab Request
DH Form 16281n accordance with the Forms Instruction Guide.
Requirements for the HIV /AIDS Patient Care programs are found
in the Patient Care Contract Administrative Guidelines.
9. School Health Services Requirements as specified in the Florida School Health
Administrative Guidelines (May 2012). Requirements as specified
In F.S. 381.0056, F.S. 381.0057, F.S. 402.3026 and F.A.C. 64F-6.
10. Tuberculosis Tuberculosis Program Requirements as specified In FA,C. 64D -3
and F.S. 392.
11. General Communicable Disease Carry out surveillance for reportable communicable and other
Control acute diseases, detect outbreaks, respond to individual cases of
reportable diseases, investigate outbreaks, and carry out
communication and quality assurance functions, as specified in
F.A.C. 6413-3, F.S. 381, F.S. 384 and the CHD Epidemiology
Guide to Surveillance and Investigations.
12. Refugee Health Program Programmatic and financial requirements as specified by the
program office.
'or the subsequent replacement if adopted during the contract period.
Attaahment_I - Page 2 of 2
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1. GENERAL REVENUE - STATE
0
140,000
D
140,090
015040 AIDS PATIENT CARE
140,000
0
60.671.
016040 AIDS PREVENTION & SURVEILLANCE - GENERAL REVENUE
19,671
0
19,671
016040 CHD - TB COMMUNITY PROGRAM
218,724
0
218,724
0
218,724
016040 DENTAL SPECIAL INITIATIVE PROJECTS
0.477
0
6,477
0
6,477
016040 FAMILY PLANNING GENERAL REVENUE
60,650
0
60,660
0
60,660
016040 HEPATITIS AND LIVER FAILURE PREVENTION & CONTROL
89,286
0
89.286
0
89,286
016040 MIGRANT LABOR CAMP SANITATION
74,533
0
74,533
0
74,533
016040 PRIMARY CARE PROGRAA9
313,432
0
313,432
O
313,432
016040 SCHOOL HEALTH SERVICES • GENERAL REVENUE
218,073
0
218,073
0
218,073
015040 DOH RESPONSE TO TERRORISM
73,643
0
73,643
0
73,643
016060 CHD GENERAL REVENUE NON-CATEGORICAL
1,742,380
0
1,742,380
0
1.742.380
3.005.669
0
3,005,669
0
3,005,669
GENERAL REVENUE TOTAL
2. NON GENERAL REVENUE • STATE
0
14,038
016010 ENVIRONMENTAL BIOMEDICAL WASTE PROGRAM
14,038
0
14,038
016010 TOBACCO STATE AND COMMUNITY INTERVENTIONS
183,885
0
183,886
0
183,885
197,923
0
I97,923
0
197,923
NON GENERAL REVENUE TOTAL
8. FEDERAL FUNDS • STATE
0
60,713
0
80,763
007000 AIDS DRUG ASSISTANCE PROGRAM ADMIN
60,763
007000 AIDS DRUG ASSISTANCE PROGRAM ADMIN HQ
19,918
0
19,918
0
19,918
007000 BIOTERRORISM HOSPITAL PREPAREDNESS
20,243 .
0
20,249
0
20,2x3
007000 WIC BREASTFEEDiNG PEER COUNSELING PROG
67,672
0
17,672
0
87,172
007000 COASTAL BEACH WATER QUALITY MONITORING
17,144
0
17,144
0
17,144
007000 COMPREHENSIVE COMMUNITY CARDIO • PHBG
40,000
0
40,000
0
40,000
007000 FAMILY PLANNING TITLE X • GRANT
101,689
0
101,689
0
106,589
_
007000 IMMUNIZATION ACTION PLAN
72,562
0
72,652
0
0
72,652
27,629
007000 MCH SPECIAL PROJECT PRAMS
27,629
0
27,629
8,956
007000 HPP AND PHEP COOP AGRMT PHEP EBOLA SUPPLEMENT #2
8,956
0
8,966
0
007000 PHP PUBLIC HEALTH PREPAREDNESS BASE ALLOC
132,101
0
132,101
0
132,101
234,788
0
234,788
0
234,788
007000 AIDS PREVENTION
0
5,624
0
5,624
007000 IMPROVING STD PROGRAMS
5.624
0
1,375,111
007000 WIC PROGRAM ADMINISTRATION
1,375,111
0
1.376,111
INSPECTIONS OF SUMMER FEEDING PROGRAM • DOE
1,600
0
1,600
0
I,00
016076
016076 SUPPLEMENTAL SCHOOL HEALTH
33,690
0
93,690
0
33,690
016076 REFUGEE HEALTH SCREENING REUtIBURSEMENT
633,000
0
533,000
0
633,000
2,767,180
0
2,767,180
0
2,757,180
FEDERAL FUNDS TOTAL
I
4. FEES ASSESSED BY STATE OR FEDERAL RULES - STATE
001020 CHD STATEWIDE ENVIRONMENTAL FEES
424, 342
0
424, 342
0
424,342
I
001092 CHD STATEWIDE ENVIRONMENTAL FEES
100,660
0
100,660
0
100,660 j
I1I
0013 06 ON SITE SEWAGE DISPOSAL PERMIT FEES
1,000
0
1.000
0
1,000
001206 SANITATION CERTIFICATES (FOOD INSPECTION)
3,000
0
3,000
0
3,000
001206 SEPTIC TANK RESEARCH SURCHARGE
Boo
0
800
0
800
00120G PUBLIC SWIMMING POOL PERMIT FEES-10% HQ TRANSFER
$0.000
0
30,000
D
0
30,000
0,00
001206 DRINKING WATER PROGRAM OPERATIONS
1,200
0
1,200
0
Attschmam_II_P9N_II • Pap 1 of 3
Packet Page
-1580-
.
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12/8/2015 16.D.25.
0012oG REGULATION OF BODY PIERCING SALONS
0012OG TANNING FACILITIES
001206 ONSITE SEWAGE TRAINING CENTER
001206 TATTO PROGRAM ENVIRONMENTAL HEALTH
00106 MOBILE HOME & RV PARK FEES
FEES ASSESSED BY STATE OR FEDERAL RULES TOTAL
6, OTHER CASH CONTRIBUTIONS • STATE:
090001 DRAW DOWN FROM PUBLIC HEALTH UNIT
OTHER CASH CONTRIBUTION TOTAL
6. MEDICAID - STATVCOUNTY:
001067 CHD CLINIC FEES
001148 CHD CLINIC FEES
MEDICAID TOTAL
7. ALLOCABLE REVENUE • STATE:
018000 CHD CLINIC FEES
ALLOCABLE REVENUE TOTAL
8, OTHER STATE CONTRIBUTIONS NOT IN CHD TRUST FUND STATE
ADAP
PHARMACY DRUG PROGRAM
WIC PROGRAM
BUREAU OF PUBLIC HEALTH LABORATORIES
IMMUNIZATIONS
OTHER STATE CONTRIBUTIONS TOTAL
9. DIRECT LOCAL CONTRIBUTIONS • BCCITAX DISTRICT
008005 CHD LOCAL REVENUE & EXPENDITURES
DIRECT COUNTY CONTRIBUTIONS TOTAL
10. FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION COUNTY
001077 CHD CLINIC FEES
001077 GENERAL CLINIC RABIES SERVICES & DRUG PURCHASES
001094 CHD LOCAL ENVIRONMENTAL FEES
001110 VITAL STATISTICS CERTIFIED RECORDS
FEES AUTHORIZED BY COUNTY TOTAL
11. OTHER CASH AND LOCAL CONTRIBUTIONS • COUNTY
3u
u
av
-
--
350
0
350
0
360
1000
0
1,000
0
1,000
1,000
0
1,000
0
1,000
2 000
0
2,000
0
2,000
570,372
0
570,372
0
670,372
0
0
0
0
0
159,143
0
159,143
0
169,143
159,143
0
159,143
0
159,143
0
7G,100
76,100
0
76,100
0
1,019,600
1,019,600
0
1,019,600
0
1,096,700
1,095,700
0
1,095,700
1.000
0
1,000
0
1,000
1,000
0
1,600
0
1,000
0
0
0
1,987,361
1,987,361
0
0
0
14.1,248
144,248
0
0
0
6,731,922)
6,731,922
0
0
0
52,359
52,359
0
0
0
956,394
955,394
0
0
0
8,871284
8,871,264
0
1,378,200
1,378,200
0
1,378,200
0
1,378,200
1,378,200
0
1,378,200
0
217,830
217,830
0
217,830
0
9,400
9.400
0
9,400
0
694,700
594,700
0
694,700
0
335,000
336,000
0
335,000
0
1,156,930
1,166,930
0
1,166,930
001029 CHD CLINIC FEES 0
001029 GENERAL CLINIC RABIES SERVICES & DRUG PURCHASES 0
001090 CHD CLINIC FEES 0
002090 GENERAL CLINIC RABIES SERVICES & DRUG PURCHASES 0
010303 CHD SALE OF SERVICES IN OR OUTSIDE OF STATE GOVT 0
010600 CHD SALE OF SERVICES IN OR OUTSIDE OF STATE GOVT 0
011000 RYAN WHITE 0
Packet Page -1581-
37,100
37,100
0 37,100
3,000
3,000
0 3,000
43,000
43,000
0 43,000
Go
600
0 600
600
600
0 600
3,000
3,000
0 3,000
282,692
282,692
0 282,692
AltwhnveM_II_Perl_II - Page 2 of 3 -
12/8/2015 16.D.25.
011000 CHD CASH DONATION/NON-SPECIFIC
011000 EARLY LEARNING COALITION OF SOUTHWEST FLORIDA
011000 CHD LOCAL REVENUE & EXPENDITURES
011001 CHD HEALTHY START COALITION CONTRACT
090002 DRAW DOWN FROM PUBLIC HEALTH UNIT
OTHER CASH AND LOCAL CONTRIBUTIONS TOTAL
12. ALLOCABLE REVENUE - COUNTY
O18D00 CHD CLINIC FEES
COUNTY ALLOCABLE REVENUE TOTAL
13. BUILDINGS - COUNTY
ANNUAL RENTAL EQUIVALENT VALUE
IT ALLOCATION & GOLDEN GATE RENTAL
UTILITIES
BUILDING MAINTENANCE
GROUNDS MAINTENANCE
INSURANCE
OTHER (Specify)
OTHER (Specify)
BUILDINGS TOTAL
14. OTHER COUNTY CONTRIBUTIONS NOT IN CHD TRUST FUND - COUNTY
EQUIPMENT I VEHICLE PURCHASES
VEHICLE INSURANCE
VEHICLE MAINTENANCE
OTHER COUNTY CONTRIBUTION (SPECIFY)
OTHER COUNTY CONTRIBUTION (SPECIFY)
OTHER COUNTY CONTRIBUTIONS TOTAL
GRAND TOTAL CHD PROGRAM
0
2,100
2.100
0
2,100
0
60,900
60,900
0
60,900
0
262,720
252,720
0
262,720
0
644,960
644,960
D
644,950
0
216,025
215,025
0
215,025
0
1,445,687
1,446,687
0
1,446,687
0
11000
1,000
0
I,00D
0
1,000
1,0D0
0
1,000
0
0
0
625,048
626,048
0
0
0
83,100
83,100
0
0
0
193,800
193,800
p
0
0
0
0
0
0
0
195,149
I95,149
0
0
0
0
0
0
p
0
6
0
0
0
0
D
0
0
0
0
997,097
997,097
D
0
0
0
0
0
0
0
16,300
16,300
0
0
0
0
0
0
0
D
0
0
0
0
0
0
0
0
0
0
16,300
16,300
6,691,287
6,077,617
11,768,804
9,884,681
21,653,485
Packet Page -1582-
Aflachmant II Part_II - Papa 1 of
12/8/2015 16.D.25.
A. COMMUNICABLE DISEASE CONTROL
IMMUNIZATION (101)
11.88
0,205
12.242
162,283
189,284
162,293
289,284
404.520
298.614
703,134
SEXUALLY TRANS.DIS. (102)
5.37
1,212
2,186
75,948
88,685
76,948
88,585
179,767
149,299
329,066
HIV /AIDS PREVENTION (03A1)
4.62
1,380
1,033
&.873
78,000
66,873
78,000
281,746
8,000
89,746
HIVIAIDSSURVEILLANCE (03A2)
1.24
33
as
17.265
20,138
17,206
20,137
74,805
0
74,805
HIV /AIDS PATIENT CARE (03A3)
7.58
460
2,350
126,028
14996
126,028
140,995
2L3,342
334,705
546,047
ADAP (03A4)
2.24
7
31
92,220
37,588
32.226
37,588
139,628
0
139,628
TUBERCULOSIS (104)
7,13
826
4.000
110,309
135,660
116,309
135,660
318,728
185,210
503,938
COM161. DIS. SURV. (106)
0.31
I
2,752
100,906
124.098
106,900
12402
293,186
170,011
4G3,197
HEPATITIS (1D0)
2.14
2,322
3,084
35,265
41,121
35,256
41,121
162,582
I7D
152,752
PREPAREDNESS AND RESPONSE (110)
6.03
0
39
8818:0
103,598
88.820
103,699
298.026
86,921
384,837
REFUGEE HEALTH (118)
6.47
1.680
5,036
187,209
218,357
187,209
218,367
761,132
30,000
811,132
VITAL RECORDS (180)
2.35
8,723
84,433
$0,785
35,906
30,785
35.906
0
133,382
133,382
COMMUNICABLE DISEASE SUBTOTAL
64.28
25,880
68,421
1,046,907
1,210,926
1,045,007
1,219,924
3,13502
1.396,102
4,531,664
B. PRIMARY CARE*
CHRONIC DISEASE PREVENTION PRO (210)
1.41
8
291
21.218
24.745
21.218
24,749
40,000
51,933
91,933
WIC (21W1)
29.75
24,076
104,844
38B4O16
452,572
388,015
452,573
1,681,175
0
1,681,176
TOBACCO USE INTERVENTION (212)
3.17
0
232
47,448
55,343
47.446
65,343
183,885
21.697
205,682
WICDREASTFEEDING PEER COUNSELING (21W2)
2,18
0
9,487
20,197
23,658
20,197
23,558
87,510
0
87,510
FAMILY PLANNING (223)
1,26
1,613
1,704
43,194
50,380
43,194
60,380
187,145
0
187,148
UNPROVED PREGNANCY OUTCOME (225)
0.74
623
627
83,075
97,597
83,675
97,597
27,629
335,016
362,544
HEALTHY START PRENATAL (227)
11.71
1,369
7,697
175,370
204,548
175,370
204.547
156,718
603,119
759,896
COMPREHENSIVE CHILD HEALTH (229)
2.09
362
591
31,880
37,184
3100
37,184
0
139,128
138.128
HEALTHY START CHILD (231)
4.il
G18
4,069
G9,356
80,895
G9,356
80,89G
160,900
16(1,503
300,603
SCHOOLHEALTH (:34)
9.24
0
440,311
120,436
140,472
12D,435
140,472
361,651
160,163
521,814
COMPREHENSIVE ADULT HEALTH U37)
6.69
2,847
4,021
127,601
148,831
127,601
148,83:
148,377
404,488
552,865
CONWUNITY HEALTH DEVELOPMENT (238)
1.64
0
OD
23,750
27,702
23,760
27,702
0
102,904
102.904
DENTAL HEALTH (240)
16.86
4,689
9.625
275,85D
321,766
276,859
321,766
5,477
1.189,763
1,196,290
PRIMARY CARE SUBTOTAL
90.46
30,207
577,639
1,427,D98
1,605,586
1.427,996
1,666,589
3,029,468
3.157,703
6,187,171
C. ENVIRONMENTAL HEALTH
Water and Ooalts Sewage Programs
COSTAL BEACH MONITORING (947)
D.11
881
361
2,702
31151
2,702
31160
11,705
0
11,705
LIMITED USE PUBLIC WATER SYSTEMS (35 7)
0.44
400
1,734
8,472
9,882
8,472
9,881
10,000
20,7D7
36,707
PUBLIC WATER SYSTEM (358)
0,D0
0
0
12
14
12
13
0
51
51
PRIVATE WATER SYSTEM (359)
0.14
0
400
1,848
2,166
1,848
2.16G
0
8.008
81008
ONSITE SEWAGE TREATMENT & DISPOSAL (361)
4,5G
1,186
9,402
70,668
82,300
70,508
82,303
96.000
209,763
305,753
Croup Total
6.25
1,953
5,903
69,602
07,512
83,602
97,606
117.705
244.619
362,224
Facility Programs
TATTOO FACILITY SERVICES (344)
0.25
0
62
3,659
4,268
3,659
4,267
7,000
8,863
15,853
FOOD HYGIENE (348)
0.79
99
455
13,010
16,176
13,010
15,176
28,900
27,471
56,371
BODY PIERCING FACILITIES SERVICES (349)
0.00
0
0
57
67
57
68
249
0
249
Packet Page -1583- A. n1_ Pan ni.PegeI oft
12/8/2015 16.D.25.
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GROUP CARE FACILITY (351)
MIGRANT LABOR CAMP (362)
HOUSING 8: PUB, BLDG. (353)
MOBILE HOME AND PARK (354)
POOLS/BATHING PLACES (360)
BIOMEDICAL WASTE SERVICES (364)
TANNING FACILITY SERVICES (309)
Group Total
Groundwater Contamination
STORAGE TANK COMPLIANCE SERVICES (355)
SUPER ACT SERVICES (356)
Group Total
Community Hypaoe
COMMUNITY ENVIR. HEALTH (346)
INJURY PREVENTION (346)
LEAD MONITORING SERVICES (360)
PUBLIC SEWAGE (362),
SOLID WASTE DISPOSAL SERVICE (363)
SANITARY NUISANCE (365)
RABIES SURVEILLANCE (366)
ARBORVIRUS SURVEIL (387)
RODENT /ARTHROPOD CONTROL (368)
WATER POLLUTION (370)
1NDOORAIR (371)
RADIOLOGICAL HEALTH (372)
TOXIC SUBSTANCES (373)
Group Total
ENVQ{ONMENTAL HEALTH SUBTOTAL
D. NONOPERATIONAL COSTS:
NONOPERATIONAL COSTS (699)
ENVIRONMENTAL HEALTH SURCHARGE (399)
MEDICAID BUYBACK (611)
NONOPERATIONAL COSTS SUBTOTAL
TOTAL CONTRACT
0.37
113
163
6,790
6,753
5,790
0,752
0
26,085
25,085
2.40
140
926
36,305
42,346
36,305
42.345
113.148
44,152
267,300
O.OD
0
0
0
0
0
0
D
0
D
0.43
102
$17
6,2B8
7,335
6,288
7,335
27,246
0
27,246
3.23
11496
15,870
64.163
63.174
54,163
63,174
97,139
137,535
234,674
19
850
899
20.706
24,151
20,706
24,161
89,714
0
89,714
0.02
8
22
304
424
364
424
1,570
0
1,6 i6
8,78
2,BOG
18,738
140,342
163,092
140,342
163,692
304,972
243,096
608,OG8
0.00
0
0
0
0
0
0
0
0
0
0.54
17
20
022
726
G22
727
0
2,697
2,697
0.04
17
20
622
720
622
727
0
2,697
2,697
0.00
0
0
0
0
0
0
0
0
0
0.49
0
0
7,340
8,609
7,846
8,569
0
61,830
31,830
0.00
0
0
2
2
2
3.
0
9
9
0.00
0
0
0
.0
0
0
0
0
0
0.00
0
0
D.
0
0
0
0
0
0
OAI
0
3
236
275
236
276
0
1,033
1,023
0.00
0
0
22
26
22
27
0
97
97
0.00
0
0
0
0
0
0
0
0
0
0,00
0
0
0
0
0
0
0
0
0
0.00
0
0
D
0
0
0
0
0
0
0.00
0
0
10
11
10
11
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42
42
0.00
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92
107
92
108
0
399
399
0,00
D
0
0
0
0
0
D
0
0
0.60
0
3
7,708
8,990
7,708
8,994
0
33,400
33,400
14.67
4,776
24,659
232,274
270,920
232,274
270,921
482,077
523,712
1,006,380
0.00
0
0
0
0
0
0
0
0
0
O.OD
0
0
MAU
11,732
10,058
11,732
43,580
0
43,580
0.00
0
0
0
0
0
0
0
D
0
0.D0
0
0
10,058
11,732
10,058
11,732
43,690
0
43,580
169.28
66,822
BT0,619,
2,716,237
3,168,164
2,716237
3,168,166
6,691287
6,077,517
11,768,804
Attachmonl tl Part_01 • Pape 2 of 2
Packet Page -1584-
12/8/2015 16.D.25.
ATTACHMENT 111
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 6 (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 at seq., which prohibits discrimination
on the basis of age in programs or activities receiving or benefiting from federal financial assistance.
5. The Omnibus Budget Reconciliation Act of 1981, P.L. 97 -35, which prohibits discrimination on the basis
of sex and religion in programs and activities receiving or benefiting from federal financial assistance.
6. All regulations, guidelines and standards lawfully adopted under the above statutes. The applicant agrees
that compliance with this assurance constitutes a condition of continued receipt of or benefit from federal
financial assistance, and that it is binding upon the applicant, its successors, transferees, and assignees
for the period during which such assistance is provided. The applicant further assures that all contracts,
subcontractors, subgrantees or others with whom It arranges to provide services or benefits to
participants or employees in connection with any of Its programs and activities are not discriminating
against those participants or employees in violation of the above statutes, regulations, guidelines, and
standards. In the event of failure to comply, the applicant understands that the grantor may, at its
discretion, seek a court order requiring compliance with the terms of this assurance or seek other
appropriate judicial or administrative relief, to Include assistance being terminated and further assistance
being denied.
Attachment III • Page 1 of 1
Packet Page -1585-
12/8/2015 16.D.25.
ATTACHMENT IV
COLLIER COUNTY HEALTH DEPARTMENT
FACILITIES UTILIZED BY THE COUNTY HEALTH DEPARTMENT
Facility
Descrir)tlon Locatio Owned By
COLLIER COUNTY HEALTH 3339 E. Tamlami Trail, Building H, Naples Collier County
DEPARTMENT & PUBLIC SERVICES
BUILDING H
IMMOKALEE SATELLITE 419 North First Srteet, Immokalee Collier County
GOLDEN GATE WIC OFFICE 4945 Golden Gate Parkway, Unit 102, Benderson Development
Naples
CCHD Annex 3.206 Beck Blvd, Naples Florida Department of Environmental
Protection
Attachment —[V - Page 1 of 1
Packet Page -1586-
CONTRACT YEAR
2014 -2015'
2015 - 2016••
2016 - 2017"'
2017 - 2018—
PROJECT TOTAL
PROJECT NUMBER:
PROJECT NAME:
LOCATIONIADDRESS:
PROJECT TYPE:
SQUARE FOOTAGE:
PROJECT SUMMARY:
ATTACHMENT V
COLLIER COUNTY HEALTH DEPARTMENT
SPECIAL PROJECTS SAVINGS PLAN
CASH RESERVED OR ANTICIPATED TO BE RESERVED FOR PROJECTS
STATE
COUNTY
$ 0 $ 0
$ 0 S o
$ 0 $ 0
$ 0 $ 0
$ 0 $ 0
SPECIAL PROJECTS CONSTRUCTIONIRENOVATION PLAN
NEW BUILDING
ROOFING
RENOVATION
PLANNING STUDY
NEW ADDITION
OTHER
0
Describe scope of work in reasonable detail.
START DATE. flnwol expenditure of funds)
COMPLETION DATE:
DESIGN FEES:
CONSTRUCTION COSTS:
FURNITURE/EQUIPMENT:
TOTAL PROJECT COST:
COST PER SO FOOT:
e
0
$ 0
$ 0
$ 0
$ 0
12/8/2015 16.D.25.
TOTAL
$ 0
$ 0
$ 0
$ 0
$ 0
Special Capital Projects are new construction or renovation projects and new furniture or equipment associated with these projects and
mobile health vans.
Cash balance as of 9130115
* Cash to be transferred to FCO account.
••' Cash anticipated for future Contract years.
Attachment V . Page 1 of 10
Packet Page -1587-
12/8/201,5 16.D.25.
ADDENDUM TO CONTRACT BETWEEN COLLIER COUNTY BOARD OF COUNTY
COMMISSIONERS AND STATE DEPARTMENT OF HEALTH FOR OPERATION OF
THE COLLIER COUNTY HEALTH DEPARTMENT CONTRACT YEAR 2015 -2016
This Addendum is made this day of , 2015, and is added to and
amends that certain Contract Between Collier County Board of County Commissioners and State
Department of Health for Operation of the Collier County Health Department Contract Year
2015 -2016 ( "Contract ") by and between the State of Florida, Department of Health ( "State ") and
the Collier County Board of County Commissioners ( "County "), which Contract is dated
day of 52015.
The following provision is added to Paragraph 4 of the Contract as follows:
4. FUNDING. The parties further agree that funding for the CHD will be handled as
follows:
a. The funding to be provided by the parties and any other sources is set forth in Part II of
Attachment II hereof. This funding will be used as shown in Part 1 of Attachment II.
iii. The County's supplemental funding to fill a funding gap due to State non-
funding relative to Intergovernmental Transfer Programs through the State
Agency for Health Care Administration whereby local government funding
allocated for health- related services was matched with federal dollars, as provided
in Attachment II Part II is an amount not to exceed $249,220 (amount included
in the calculation under the CHD Local_ Revenue & Expenditures section of the
revenue attachment).
IN WITNESS WHEREOF, the State and County have hereto executed this Addendum the
day and year first above written.
AS TO THE STATE:
STATE OF FLORIDA
DEPARTMENT OF HEALTH
SIGNED BY:
NAME: John H. Armstrong, MD
TITLE: Surgeon General /Secretary of Health
DATE:
SIGNED BY:
NAME: Stephanie Vick, M.S., B.S.N., R.N.
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Packet Page -1588-
TITLE: CHD Director /Administrator
DATE:
AS TO THE COUNTY:
Attest:,
DWIGHT E. BROCK, Clerk
, Deputy Clerk
Approved as to form and legality:
12/8/2015 16.D.25.
BOARD OF COUNTY COMMISSIONERS FOR
COLLIER COUNTY
Jennifer A. Belpedio, Assistant Cod4ty Attorney
TIM NANCE, CHAIRMAN
2of2
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