Backup Documents 11/12/2013 Item #16D 9 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SL P
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 09
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNA
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 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.
3. County Attorney Office County Attorney Office JAB 11/14/13
4. BCC Office Board of County Gk-\
Commissioners 70- k I\:\
5. Minutes and Records Clerk of Court's Office
1)1‘ 4114A6
PRIMARY CONTACT INFORMATION 4A
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 Hailey Alonso,Public Services Division Phone Number 252-8468
Contact/ Department PLEASE CO TACT WHEN
DOCUME S ARE READY
Agenda Date Item was 11/12/13 Agenda Item Number 16-D-9
Approved by the BCC /
Type of Document Contract with Florida Dept. of Health Number of Original Three Y/
Attached Documents Attached
PO number or account
number if document is N/A
to be recorded
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? JAB
2. Does the document need to be sent to another agency for additional signatures? If yes, JAB Y SEE NOTE
_ provide the Contact Information(Name;Agency;Address; Phone)on an attached sheet. ABOVE
3. Original document has been signed/initialed for legal sufficiency. (All documents to be JAB V
signed by the Chairman,with the exception of most letters,must be reviewed and signed
_ by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's JAB V.
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 JAB 17
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 JAB V
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip JAB
should be provided to the County Attorney Office at the time the item is input into SIRE.
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 11/12/13 and all changes made during JAB
the meeting have been incorporated in the attached document. The County
_ Attorney's Office has reviewed the changes,if applicable.
9. Initials of attorney verifying that the attached document is the version approved by the
BCC, all changes directed by the BCC have been made,and the document is ready for th D` ►+/1
Chairman's signature.
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
Ann P. Jennejohn 16 09
From: Alonso, Hailey
Sent: Monday, November 25, 2013 3:40 PM
To: Ann P.Jennejohn
Cc: Alan Portis
Subject: RE: Florida Dept. of Health Contract (Item #16D9 11-12-13)
Yes please can we do that with the request that they return two copies to Collier County one for you and another for the
Health department.
You are wonderful thank you and happy thanksgiving.
I I,iilev Alonso
() )crations Analyst
Public Service Division
()I[ice: 239-252-8468
Cell: 239-269-1161
c: 239-252-3958
33:19 East Tarniarni Trail Suite 217
\.:pies, Fl. 31112
haileyalonso@colliergov.net
.K>ta•rt bt Cloi,n e w rays vuecess2rkj; t'vteu,rho what's?ossLbl,e; t?ttid eou.axe r oi.A✓a, the Lvv.-p ssLi3Le. -.St. FvavZ;s o f
From: Ann P. Jennejohn [mailto:Ann.Jennejohn @collierclerk.com]
Sent: Monday, November 25, 2013 3:17 PM
To: AlonsoHailey
Subject: Florida Dept. of Health Contract (Item #16D9 11-12-13)
Hi Hai ley,
I have the three FY13/14 contracts between the County and Department of Health
for operation of the County's Health Department (Nov.l2th Item #1609)
Would you like the agreement(s) executed the way we've done it in the past?
We mail them to the Department of Health in Tallahassee for Dr. Armstrong's signature
with the request they're signed and returned to Collier County, etc...
Please let me know how you would like to proceed.
If you want a copy that's been signed by Dr. Colfer and the Chairwoman,
I can email you one of those, too.
Ann Jennejohn, Deputy Clerk
Clerk of the Circuit Court
Clerk of the Value Adjustment Board
Collier County Minutes & Records Dept.
239-252-8406
239-252-8408 (Fax)
1
_
County of Collier 1609
CLERK OF THE,;CIRUIT COURT
Dwight E. Brock COLLIER COUl 'Y COU1THOUSE Clerk of Courts
Clerk of Courts a, Accountant
3315 TAMIAMI TRL E STE 102x, P.O. BOX 413044
NAPLES,FLORIDA '% NAPLES,FLORIDA Auditor
34112-5324 • - 34101-3044 Custodian of County Funds
November 26, 2013
Dr. John H. Armstrong, Surgeon General
Department of Health
Division of Administration
4052 Bald Cypress Way
Room 305G BIN: B02
Tallahassee, FL 32399-1730
Dr. Armstrong,
Attached for signature(s) are three original contracts between Collier County
and State of Florida Department of Health for FY13/14 operation of the Collier
County Health Department. This item was approved by the Collier County Board
of County Commissioners during their meeting held on November 12, 2013.
After signature, please return the original contracts to the Collier County
Minutes and Records Department, serving as Clerk to the Board, for the
Official Record. I have included a mailing label to facilitate processing.
Upon return, I will distribute the fully executed contracts to Staff and
appropriate County Officials.
Thank you.
DWIGHT E. BROCK, CLERK
Ann Jennejohn,
Deputy Clerk
Attachments (3)
Phone- (239) 252-2646 Fax- (239) 252-2755
Website- www.CollierClerk.com Email- CollierClerk @collierclerk.corn
Mission:
To protect, promote & improve the health
of all people in Florida through integrated
state, county & community efforts.
1609
Rick Scott
Governor
HEALTH John H. Armstrong, MD, FACE
State Surgeon General & Secretary
Vision: To be the Healthiest State in the Nation
INTEROFFICE MEMORANDUM
DATE: December 10, 2013
TO: Collier County Government
Minutes & Records Department
FROM: Alan Portis
Florida Department of Health in Collier County
SUBJECT: 2013 -2014 Core Contract
Please find enclosed an original of the signed 2013 -2014 Core Contract. If you have
any questions, please contact me at (239) 252 -8206.
Sincerely,
Alan L. Portis
Finance and Accounting Director
Enclosure
Cc: Collier County Minutes and Records Department — (1) original
Housing, Human and Veteran Services — (1) copy
Steve Carnell, Public Services — (1) copy
Florida Department of Health www.FloridasHealth.com
in COLLIER COUNTY • Office of the Director TWITTER :HealthyFLA
3339 East Tamiami Trail, Ste 145 • Naples, Florida 34112 FACEBOOK:FLDepartmentofHealth
PHONE: 2391252 -8200 • FAX: 239/774 -5653 1 YOUTUBE: tidoh
16D9
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 2013 -2014
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, 2013.
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 County Health
Departments created throughout Florida.
D. It is necessary for the parties hereto to enter into this Agreement 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 Agreement shall be effective from
October 1, 2013, through September 30, 2014, or until a written agreement replacing this
Agreement is entered into between the parties, whichever is later, unless this Agreement
is otherwise terminated pursuant to the termination provisions set forth in paragraph 8,
below.
3. SERVICES MAINTAINED BY THE CHD. The parties mutually agree that the CHD
shall provide those services as set forth on Part III of Attachment II hereof, in order to
maintain the following three levels of service pursuant to Section 154.01(2), Florida
Statutes, as defined below:
a. "Environmental health services" are those services which are organized and
operated to protect the health of the general public by monitoring and regulating activities
in the environment which may contribute to the occurrence or transmission of disease.
�Mr
Environmental health services shall be supported by available federal, state and local
funds and shall include those services mandated on a state or federal level. Examples of
environmental health services include, but are not limited to, food hygiene, safe drinking
water supply, sewage and solid waste disposal, swimming pools, group care facilities,
migrant labor camps, toxic material control, radiological health, and occupational health.
b. "Communicable disease control services" are those services which protect the
health of the general public through the detection, control, and eradication of diseases
which are transmitted primarily by human beings. Communicable disease services shall
be supported by available federal, state, and local funds and shall include those services
mandated on a state or federal level. Such services include, but are not limited to,
epidemiology, sexually transmissible disease detection and control, HIV /AIDS,
immunization, tuberculosis control and maintenance of vital statistics.
c. "Primary care services" are acute care and preventive services that are made
available to well and sick persons who are unable to obtain such services due to lack of
income or other barriers beyond their control. These services are provided to benefit
individuals, improve the collective health of the public, and prevent and control the spread
of disease. Primary health care services are provided at home, in group settings, or in
clinics. These services shall be supported by available federal, state, and local funds and
shall include services mandated on a state or federal level. Examples of primary health
care services include, but are not limited to: first contact acute care services; chronic
disease detection and treatment; maternal and child health services; family planning;
nutrition; school health; supplemental food assistance for women, infants, and children;
home health; and dental services.
4. FUNDING. The parties further agree that funding for the CHD will be handled as
follows:
a. The funding to be provided by the parties and any other sources are set forth in Part
II of Attachment II hereof. This funding will be used as shown in Part I of Attachment 11.
i. The State's appropriated responsibility (direct contribution excluding any state fees,
Medicaid contributions or any other funds not listed on the Schedule C) as provided in
Attachment 11, Part II is an amount not to exceed $ 5,555,567 (State General
Revenue, State Funds, Other State Funds and Federal Funds listed on the Schedule C). The
State's obligation to pay under this contract is contingent upon an annual
appropriation by the Legislature.
ii. The County's appropriated responsibility (direct contribution excluding any fees,
other cash or local contributions) as provided in Attachment 11, Part II is an amount not
to exceed $ 1,258,100 (amount listed under the "Board of County Commissioners Annual
Appropriations section of the revenue attachment).
b. Overall expenditures will not exceed available funding or budget authority,
whichever is less, (either current year or from surplus trust funds) in any service category.
Unless requested otherwise, any surplus at the end of the term of this Agreement in the
K
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County Health 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 Agreement during the term
hereof by notifying the other parry 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 and Revenue Management. If the County initiates the
increase /decrease, the County shall notify the CHD. The CHD will then revise the
Attachment II and send a copy of the revised pages to the Department of Health, Bureau
of Budget and Revenue Management.
e. The name and address of the official payee to who payments shall be made is:
County Health Department Trust Fund
Collier County
3339 E. Tamiami Trail, Suite 145
Naples, FL 34112
5. CHD DIRECTOR/ADMINISTRATOR. Both parties agree the director /administrator
of the CHD shall be a State employee or under contract with the State and will be under
the day -to -day direction of the Deputy Secretary for Statewide Services. The
director /administrator shall be selected by the State with the concurrence of the County.
The director /administrator of the CHD shall ensure that non - categorical sources of funding
are used to fulfill public health priorities in the community and the Long Range Program
Plan. A report detailing the status of public health as measured by outcome measures
and similar indicators will be sent by the CHD director /administrator to the parties no later
than October 1 of each year (This is the standard quality assurance "County Health Profile" report
located on the Division of Public Health Statistics and Performance Management Intranet site).
6. ADMINISTRATIVE POLICIES AND PROCEDURES. The parties hereto agree that
the following standards should apply in the operation of the CHD:
a. The CHD and its personnel shall follow all State policies and procedures, except to
the extent permitted for the use of county purchasing procedures as set forth in
subparagraph b., below. All CHD employees shall be State or State - contract personnel
subject to State personnel rules and procedures. Employees will report time in the Health
Management System compatible format by program component as specified by the State.
b. The CHD shall comply with all applicable provisions of federal and state laws and
regulations relating to its operation with the exception that the use of county purchasing
procedures shall be allowed when it will result in a better price or service and no statewide
Department of Health purchasing contract has been implemented for those goods or
services. In such cases, the CHD director /administrator must sign a justification therefore,
16D9
and all county - purchasing procedures must be followed in their entirety, and such
compliance shall be documented. Such justification and compliance documentation shall
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
4
• 1 'I
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 reflected in Attachment II, Part I of this contract, with special capital
projects explained in Attachment V.
f. There shall be no transfer of funds between the three levels of services without a
contract amendment unless the CHD director /administrator determines that an emergency
exists wherein a time delay would endanger the public's health and the Deputy Secretary
for Statewide Services has approved the transfer. The Deputy Secretary for Statewide
Services shall forward written evidence of this approval to the CHD within 30 days after an
emergency transfer.
g. The CHD may execute subcontracts for services necessary to enable the CHD to
carry out the programs specified in this Agreement. Any such subcontract shall include all
aforementioned audit and record keeping requirements.
h. At the request of either party, an audit may be conducted by an independent CPA
on the financial records of the CHD and the results made available to the parties within
180 days after the close of the CHD fiscal year. This audit will follow requirements
contained in OMB Circular A -133 and may be in conjunction with audits performed by
county government. If audit exceptions are found, then the director /administrator of the
CHD will prepare a corrective action plan and a copy of that plan and monthly status
reports will be furnished to the contract managers for the parties.
i. The CHD shall not use or disclose any information concerning a recipient of
services except as allowed by federal or state law or policy.
j. The CHD shall retain all client records, financial records, supporting documents,
statistical records, and any other documents (including electronic storage media) pertinent
to this Agreement for a period of five (5) years after termination of this Agreement. If an
audit has been initiated and audit findings have not been resolved at the end of five (5)
years, the records shall be retained until resolution of the audit findings.
k. The CHD shall maintain confidentiality of all data, files, and records that are
confidential under the law or are otherwise exempted from disclosure as a public record
under Florida law. The CHD shall implement procedures to ensure the protection and
confidentiality of all such records and shall comply with sections 384.29, 381.004, 392.65
and 456.057, Florida Statutes, and all other state and federal laws regarding
confidentiality. All confidentiality procedures implemented by the CHD shall be consistent
with the Department of Health Information Security Policies, Protocols, and Procedures.
The CHD shall further adhere to any amendments to the State's security requirements and
shall comply with any applicable professional standards of practice with respect to client
confidentiality.
I. The CHD shall abide by all State policies and procedures, which by this reference
are incorporated herein as standards to be followed by the CHD, except as otherwise
permitted for some purchases using county procedures pursuant to paragraph 6.b. hereof.
5
•1TOI
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 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 DE385L1 Contract Management Variance Report and the DE580L1
Analysis of Fund Equities Report;
ii. A written explanation to the county of service variances reflected in the
DE385L1 report if the variance exceeds or falls below 25 percent of the planned
expenditure amount. However, if the amount of the service specific variance
between actual and planned expenditures does not exceed three percent of the
total planned expenditures for the level of service in which the type of service is
included, a variance explanation is not required. A copy of the written
explanation shall be sent to the Department of Health, Bureau of Budget and
Revenue Management.
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1609
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, 2014 for the report period October 1, 2013 through
December 31, 2013;
ii. June 1, 2014 for the report period October 1, 2013 through
March 31, 2014;
iii. September 1, 2014 for the report period October 1, 2013
through June 30, 2014; and
iv. December 1, 2014 for the report period October 1, 2013
through September 30, 2014.
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 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 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
1609
obligation hereunder. Said notice shall be delivered by certified mail, return receipt
requested, or in person to the other party's contract manager with proof of delivery.
Waiver of breach of any provisions of this Agreement shall not be deemed to be a waiver
of any other breach and shall not be construed to be a modification of the terms of this
Agreement.
9. MISCELLANEOUS. The parties further agree:
a. Availability of Funds. If this Agreement, any renewal hereof, or any term,
performance or payment hereunder, extends beyond the fiscal year beginning July 1,
2014, it is agreed that the performance and payment under this Agreement are contingent
upon an annual appropriation by the Legislature, in accordance with section 287.0582,
Florida Statutes.
b. Contract Managers. The name and address of the contract managers for
the parties under this Agreement are as follows:
For the State:
Joan M. Colfer, MD-M.P.H.
Name
For the County:
Steve Carnell
Name
Director, Florida Department of Health Public Services Division Interim
Collier County Administrator
Title
3339 E. Tamiami Trail, Suite 145
Naples, Florida 34112
Address
(239) 252 -8201
Telephone
Title
3339 E. Tamiami Trail, Suite 217
Naples, Florida 34112
Address
(239) 252 -8468
Telephone
If different contract managers are designated after execution of this Agreement, the name,
address and telephone number of the new representative shall be furnished in writing to
the other parties and attached to originals of this Agreement.
C. Captions. The captions and headings contained in this Agreement are for
the convenience of the parties only and do not in any way modify, amplify, or give
additional notice of the provisions hereof.
16D9
In WITNESS THEREOF, the parties hereto have caused this 24 page agreement to be
executed by their undersigned officials as duly authorized effective the 1sTday of October, 2013.
BOARD OF COUNTY COMMISSIONERS
FOR COLLII
SIGNED BY
NAME: GEORGIA A. HILLER, ESQ.
TITLE: CHAIRWOMAN
DATE: November 12., 2,013
STATE OF FLORIDA
DEPARTMENT OF HEALTH
SIGNED BY:( - 1/ "(/ G, /
NAMFohn H. Armstrong, MD
TITLE: Surgeon General /Secretary of Health
DATE: L 3
ATTESTED TO:.bWTGHT E. BROCK, CLERK
SIGNED BY: L SIGNED :oan .
NAME: ANN E x CLERK NAME: . Colfer, M.D. M. .H.
A;ttes as to COMM, 5
TITLE: DEPUTY Cj4NAUre0n1V.
DATE: NOVEMBER 26, 2 01 3
TITLE: CHD Director /Administrator
DATE: / X30 l,3
Approved as to form and legality
Assi t County Att*5:::�
1609
ATTACHMENT
COLLIER COUNTY HEALTH DEPARTMENT
PROGRAM SPECIFIC REPORTING REQUIREMENTS AND PROGRAMS REQUIRING
COMPLIANCE WITH THE PROVISIONS OF SPECIFIC MANUALS
Some health services must comply with specific program and reporting requirements in addition to the Personal Health
Coding Pamphlet (DHP 50 -20), Environmental Health Coding Pamphlet (DHP 50 -21) and FLAIR requirements because
of federal or state law, regulation or rule. If a county health department is funded to provide one of these services, it
must comply with the special reporting requirements for that service. The services and the reporting requirements are
listed below:
Service
Requirement
1. Sexually Transmitted Disease
Requirements as specified in F.A.C. 64D -3, F.S. 381 and
Program
F.S. 384.
2. Dental Health
Monthly reporting on DH Form 1008`. Additional reporting
requirements, under development, will be required. The
additional reporting requirements will be communicated upon
finalization.
3. Special Supplemental Nutrition
Service documentation and monthly financial reports as
Program for Women, Infants
specified in DHM 150 -24" and all federal, state and county
and Children (including the WIC
requirements detailed in program manuals and published
Breastfeeding Peer Counseling
procedures.
Program)
4. Healthy Start/
Requirements as specified in the 2007 Healthy Start
Improved Pregnancy Outcome
Standards and Guidelines and as specified by the Healthy
Start Coalitions in contract with each county health
department.
5. Family Planning
Periodic financial and programmatic reports as specified
by the program office.
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- 3.046,
F.A.C. In addition, periodic reports as specified by the
department pertaining to the surveillance /investigation of
reportable vaccine - preventable diseases, adverse events,
vaccine accountability, and assessment of immunization
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. 64D -3.030 and 64D- 3.031. Case reporting should be
on Adult HIV /AIDS Confidential Case Report CDC Form
DH2139 and Pediatric HIV /AIDS Confidential Case Report
CDC Form DH2140.
10
ATTACHMENT I (Continued)
16D9
Requirements as specified in F.A.C. 64D -2 and 64D -3, F.S.
381 and F.S. 384. Socio- demographic and risk data on
persons tested for HIV in CHD clinics should be reported
on Lab Request DH Form 1628 in accordance with the Forms
Instruction Guide. Requirements for the HIV /AIDS Patient
Care programs are found in the Patient Care Contract
Administrative Guidelines.
9. School Health Services Requirements as specified in the Florida School Health
Administrative Guidelines (May 2012).
10. Tuberculosis Tuberculosis Program Requirements as specified in F.A.C.
64D -3 and F.S. 392.
11. General Communicable Disease Control Carry out surveillance for reportable communicable and other
acute diseases, detect outbreaks, respond to individual cases
of reportable diseases, investigate outbreaks, and carry out
communication and quality assurance functions, as specified
in F.A.C. 64D -3, F.S. 381, F.S. 384 and the CHD
Epidemiology Guide to Surveillance and Investigations.
`or the subsequent replacement if adopted during the contract period.
11
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ATTACHMENT II.
COLLIER COUNTY HEALTH DEPARTMENT
Part II. Sources of Contributions to County Health Department
October 1, 2013 to September 30, 2014
aim
GENERAL REVENUE TOTAL 2,730,526 0 2,730,526 0 2,730,526
2. NON GENERAL REVENUE - STATE
015010
ALG /CONTR. TO CHDS - BIOMEDICAL WASTE
State CHD
County
Total CHD
0
13,131
015010
DOH INDIRECT
Trust Fund
CHD
Trust Fund
Other
135,126
015010
€
(cash)
Trust Fund
Wahl
Contribution
Total
1. GENERAL REVENUE - STATE
SCHOOL HEALTH TOBACCO TT
137,218
0
137,218
0
015040
AIDS PREVENTION
19,261
0
19,261
0
19,261
015040
ALG /CESSPOOL IDENTIFICATION AND ELIMINATION
0
0
0
0
0
015040
ALG /CONTR TO CHDS -AIDS PATIENT CARE NETWORK
0
0
0
0
0
015040
ALG/IPO HEALTHY START/IPO
0
0
0
0
0
015040
COMMUNITY SMILES - MIAMI-DADE
0
0
0
0
0
015040
COUNTY SPECIFIC DENTAL PROJECTS - ESCAMBIA
0
0
0
0
0
015040
DUVAL TEEN PREGANCY PREVENTION - DUVAL
0
0
0
0
0
015040
FL CLPPP SCREENING & CASE MANAGEMENT
0
0
0
0
0
015040
HEALTHY START GENERAL REVENUE CHD
0
0
0
0
0
015040
HEALTHY START MED- WAIVER - CLIENT SERVICES
0
0
0
0
0
015040
LA LIGA - LEAGUE AGAINST CANCER - MIAMI -DADE
0
0
0
0
0
015040
METRO ORLANDO URBAN LEAGUE - ORANGE
0
0
0
0
0
015040
MINORITY OUTREACH - PENALVER CLINIC - MIAMI-DADE
0
0
0
0
0
015040
PREPAREDNESS GRANT MATCH
73,643
0
73,643
0
73,643
015040
SCHOOL HEALTH GENERAL REVENUE
80,855
0
80,855
0
80,855
015040
STATEWIDE DENTISTRY NETWORK - ESCAMBIA
0
0
0
0
0
015040
STD GENERAL REVENUE
0
0
0
0
0
015040
TREASURE COAST MIDWIFERY - MARTIN
0
0
0
0
0
015040
AIDS SURVEILLANCE
50,310
0
50,310
0
50,310
015040
ALG /CONTR TO CHDS -AIDS PATIENT CARE
140,000
0
140,000
0
140,000
015040
ALG /CONTR TO CHDS - SOVEREIGN IMMUNITY
0
0
0
0
0
015040
ALG/PRIMARY CARE
313,432
0
313,432
0
313,432
015040
COMMUNITY TB PROGRAM
167,738
0
167,738
0
167,738
015040
DENTAL SPECIAL INITIATIVES
6,542
0
6,542
0
6,542
015040
FAMILY PLANNING GENERAL REVENUE
36,794
0
36,794
0
36,794
015040
FL HEPATITIS & LIVER FAILURE PREVENTION /CONTROL
89,286
0
89,286
0
89,286
015040
HEALTHY START MED WAIVER - SOBRA
0
0
0
0
0
015040
JESSIE TRICE CANCER CTR/IEALTH CHOICE - MIAMI-DADE
0
0
0
0
0
015040
MANATEE COUNTY RURAL HEALTH SERVICES
0
0
0
0
0
015040
MIGRANT LABOR CAMP SANITATION
74,533
0
74,533
0
74,533
015050
NON - CATEGORICAL GENERAL REVENUE
1,678,132
0
1,678,132
0
1,678,132
GENERAL REVENUE TOTAL 2,730,526 0 2,730,526 0 2,730,526
2. NON GENERAL REVENUE - STATE
015010
ALG /CONTR. TO CHDS - BIOMEDICAL WASTE
13,131
0
13,131
0
13,131
015010
DOH INDIRECT
135,126
0
135,126
0
135,126
015010
PREPAREDNESS GRANT MATCH
0
0
0
0
0
015010
SCHOOL HEALTH TOBACCO TT
137,218
0
137,218
0
137,218
015010
TOBACCO COMMUNITY INTERVENTION
224,230
0
224,230
0
224,230
015010
ALG /CONTR. TO CHDS -SAFE DRINKING WATER PRG
0
0
0
0
0
015010
MEDICAID INCENTIVE FOR ELECTRONIC HEALTH RECORDS
47,046
0
47,046
0
47,046
015010
PUBLIC SWIMMING POOL PROGRAM
0
0
0
0
0
015010
TOBACCO ADMINISTRATION & MANAGEMENT
0
0
0
0
0
015020
TRANSFER FROM ANOTHER STATE AGENCY
0
0
0
0
0
015020
TRANSFER FROM ANOTHER STATE AGENCY
0
0
0
0
0
015020
TRANSFER FROM ANOTHER STATE AGENCY
0
0
0
0
0
015060
NON - CATEGORICAL TOBACCO REBASING
3,097
0
3,097
0
3,097
Version: 2 Page 1 of 7
ATTACHMENT II.
COLLIER COUNTY HEALTH DEPARTMENT
Part H. Sources of Contributions to County Health Department
October 1, 2013 to September 30, 2014
1609
Version: 2 Page 2 of 7
State CHD
County
Total CHD
Trust Fund
CHD
Trust Fund
Other
t
Trust Fund
Icashl
Contribution
Total
NON GENERAL REVENUE TOTAL
559,848
0
559,848
0
559,848
3. FEDERAL FUNDS - State
007000
ABSTINENCE EDUCATION GRANT PROGRAM
0
0
0
0
0
007000
AIDS PREVENTION
255,477
0
255,477
0
255,477
007000
BIOTERRORISM HOSPITAL PREPAREDNESS
22,374
0
22,374
0
22,374
007000
COASTAL BEACH MONITORING PROGRAM
18,324
0
18,324
0
18,324
007000
DENTAL SERVICES
0
0
0
0
0
007000
EPIDEMIOLOGY & LABORATORY CAPACITY FOR INFECTIOU:
0
0
0
0
0
007000
EXPANDED TESTING INITIATIVE (ETI)
0
0
0
0
0
007000
FGTF/BREAST & CERVICAL CANCER -ADMIN/CASE MAN
0
0
0
0
0
007000
HEPATITIS B VACCINATION PILOT PROJECT
0
0
0
0
0
007000
IMMUNIZATION AFIX
0
0
0
0
0
007000
IMMUNIZATION FIELD STAFF EXPENSE
0
0
0
0
0
007000
MCH BGTF- HEALTHY START COALITIONS
0
0
0
0
0
007000
MINORITY AIDS INITIATIVE
0
0
0
0
0
007000
MINORITY INVOLVEMENT IN HIV /AIDS PROGRAM
0
0
0
0
0
007000
PREGNANCY ASSOCIATED MORTALITY PREVENTION
0
0
0
0
0
007000
PUBLIC HEALTH PREPAREDNESS BASE
127,393
0
127,393
0
127,393
007000
RYAN WHITE
0
0
0
0
0
007000
RYAN WHITE -AIDS DRUG ASSIST PROG -ADMIN
77,945
0
77,945
0
77,945
007000
STATE OFFICE OF RURAL HEALTH
0
0
0
0
0
007000
STD FEDERAL GRANT - CSPS
0
0
0
0
0
007000
SYPHILIS ELIMINATION
0
0
0
0
0
007000
TOBACCO FAITH BASED PROJECT
0
0
0
0
0
007000
UNINTENDED/UNWANTED PREG -TEEN PREGNANCY PREV
25,591
0
25,591
0
25,591
007000
WIC BREASTFEEDING PEER COUNSELING
52,200
0
52,200
0
52,200
007000
ADULT VIRAL HEPATITIS PREVENTION & SURVEILLANCE
0
0
0
0
0
007000
AIDS SURVEILLANCE
0
0
0
0
0
007000
CHRONIC DISEASE PREVENTION & HEALTH PROMOTION
10,500
0
10,500
0
10,500
007000
COLORECTAL CANCER SCREENING
0
0
0
0
0
007000
ENHANCE COMPREHENSIVE PREVENTION PLANNING AND IN/
0
0
0
0
0
007000
EPIDEMIOLOGY & LABORATORY CAPACITY HAI
0
0
0
0
0
007000
FGTF /AIDS MORBIDITY
0
0
0
0
0
007000
FGTF/FAMILY PLANNING -TITLE X
76,501
0
76,501
0
76,501
007000
HIV HOUSING FOR PEOPLE LIVING WITH AIDS
0
0
0
0
0
007000
IMMUNIZATION FEDERAL GRANT ACTIVITY SUPPORT
102,375
0
102,375
0
102,375
007000
MCH BGTF- GADSDEN SCHOOL CLINIC
0
0
0
0
0
007000
MEDICARE RURAL HOSPITAL FLEXIBII,ITY PROGRAM
0
0
0
0
0
007000
MINORITY AIDS INITIATIVE TCE COLLABORATIVE
0
0
0
0
0
007000
PHP - CITIES READINESS INITIATIVE
0
0
0
0
0
007000
PUBLIC HEALTH INFRASTRUCTURE
0
0
0
0
0
007000
RAPE PREVENTION & EDUCATION
0
0
0
0
0
007000
RYAN WHITE - EMERGING COMMUNITIES
0
0
0
0
0
007000
RYAN WHITE- CONSORTIA
0
0
0
0
0
007000
STATEWIDE ASTHMA PROGRAM
0
0
0
0
0
007000
STD PROGRAM INFERTILITY PREVENTION PROJECT (IPP)
5,624
0
5,624
0
5,624
007000
TEENAGE PREGNANCY PREVENTION REPLICATION
0
0
0
0
0
007000
TUBERCULOSIS CONTROL - FEDERAL GRANT
67,702
0
67,702
0
67,702
Version: 2 Page 2 of 7
I.VLL1Gl(l,V Vl� 1 111L'EiL In lJL'1-ivnI ivl iN1
Part H. Sources of Contributions to County Health Department
October 1, 2013 to September 30, 2014
State CHD County Total CHD
Trust Fund CHD Trust Fund
(cash) Trust Fund /eaehl
3. FEDERAL FUNDS - State
007000
WIC ADMINISTRATION
015009
MEDIPASS WAIVER -HLTHY STRT CLIENT SERVICES
015009
MEDIPASS WAIVER -SOBRA
007055
ARRA FEDERAL GRANT - SCHEDULE C
015075
SCHOOL HEALTH TITLE XXI
015075
SCHOOL HEALTH
015075
REFUGEE HEALTH
015075
SCHOOL HEALTH
FEDERAL
FUNDS TOTAL
4. FEES ASSESSED
BY STATE OR FEDERAL RULES - STATE
001020
PUBLIC WATER ANNUAL OPER PERMIT
001020
NON -SDWA SYSTEM PERMIT
001020
SWIMMING POOLS
001020
TATTO FACILITY
001020
MOBILE HOME AND PARKS
001020
BIOHAZARD WASTE PERMIT
001020
TANNING FACILITIES
001020
MIGRANT HOUSING PERMIT
001020
FOOD HYGIENE PERMIT
001020
PRIVATE WATER CONSTR PERMIT
001020
PUBLIC WATER CONSTR PERMIT
001020
SAFE DRINKING WATER
001092
OSDS PERMIT FEE
001092
AEROBIC OPERATING PERMIT
001092
NON SDWA LAB SAMPLE
001092
ENVIRONMENTAL HEALTH FEES
001092
I & M ZONED OPERATING PERMIT
001092
SEPTIC TANK SITE EVALUATION
001092
OSDS VARIANCE FEE
001092
OSDS REPAIR PERMIT
001170
LAB FEE CHEMICAL ANALYSIS
001170
NONPOTABLE WATER ANALYSIS
001170
WATER ANALYSIS- POTABLE
001206
CENTRAL OFFICE SURCHARGE
001093
CHD ON -LINE BILLING FEE
FEES ASSESSED BY STATE OR FEDERAL RULES TOTAL
5. OTHER CASH CONTRIBUTIONS - STATE
010304
STATIONARY POLLUTANT STORAGE TANKS
090001
DRAW DOWN FROM PUBLIC HEALTH UNIT
031005
CHDTF CASH TRANSFER
010306
DOH/DOC INTERAGENCY AGREEMENT
OTHER CASH CONTRIBUTIONS TOTAL
6. MEDICAID - STATE /COUNTY
001056 MEDICAID PHARMACY
Version: 2
L•]
Other
Contribution Total
SASS
1,389,497
0
1,389,497
0
1,389,497
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
33,690
0
33,690
0
33,690
0
0
0
0
0
360,000
0
360,000
0
360,000
0
0
0
0
0
2,625,193
0
2,625,193
0
2,625,193
10,750
0
10,750
0
10,750
0
0
0
0
0
377,000
0
377,000
0
377,000
8,000
0
8,000
0
8,000
22,000
0
22,000
0
22,000
35,500
0
35,500
0
35,500
3,600
0
3,600
0
3,600
19,000
0
19,000
0
19,000
34,000
0
34,000
0
34,000
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1,100
0
1,100
0
1,100
0
0
0
0
0
0
0
0
0
0
97,500
0
97,500
0
97,500
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
43,500
0
43,500
0
43,500
0
0
0
0
0
651,950
0
651,950
0
651,950
0
0
0
0
0
672,955
0
672,955
0
672,955
0
0
0
0
0
0
0
0
0
0
672,955
0
672,955
0
672,955
0
0
0
0
0
Page 3 of 7
COLLIER COUNTY HEALTH DEPARTMENT
Part H. Sources of Contributions to County Health Department
October 1, 2013 to September 30, 2014
State CHD County Total CHD
Trust Fund CHD Trust Fund Other
1. (cash) Trust Fund /cashl Contribution
6. MEDICAID - STATE /COUNTY
001076
MEDICAID TB
001078
MEDICAID ADMINISTRATION OF VACCINE
001079
MEDICAID CASE MANAGEMENT
001081
MEDICAID CHILD HEALTH CHECK UP
001082
MEDICAID DENTAL
001083
MEDICAID FAMILY PLANNING
001087
MEDICAID STD
001089
MEDICAID AIDS
001147
MEDICAID HMO CAPITATION
001191
MEDICAID MATERNITY
001192
MEDICAID COMPREHENSIVE CHILD
001193
MEDICAID COMPREHENSIVE ADULT
001194
MEDICAID LABORATORY
001208
MEDIPASS $3.00 ADM. FEE
001059
MEDICAID LOW INCOME POOL
001051
EMERGENCY MEDICAID
001058
MEDICAID - BEHAVIORAL HEALTH
001071
MEDICAID - ORTHOPEDIC
001072
MEDICAID - DERMATOLOGY
001075
MEDICAID - SCHOOL HEALTH CERTIFIED MATCH
001069
MEDICAID - REFUGEE HEALTH
001055
MEDICAID - HOSPITAL
001148
MEDICAID HMO NON - CAPITATION
001074
MEDICAID - NEWBORN SCREENING
001180
DENTAL MEDICAID HMO
MEDICAID TOTAL
7. ALLOCABLE
REVENUE - STATE
018000
REFUNDS
037000
PRIOR YEAR WARRANT
038000
12 MONTH OLD WARRANT
ALLOCABLE REVENUE TOTAL
8. OTHER STATE CONTRIBUTIONS NOT IN CHD TRUST FUND - STATE
0
ADAP
0
OTHER (SPECIFY)
0
PHARMACY SERVICES
350
TB SERVICES
350
STD SERVICES
0
WIC FOOD
0
DENTAL SERVICES
0
OTHER (SPECIFY)
0
LABORATORY SERVICES
0
IMMUNIZATION SERVICES
0
CONSTRUCTION/RENO VATION
OTHER STATE CONTRIBUTIONS TOTAL
•1�
Total
0
25,000
25,000
0
25,000
0
16,000
16,000
0
16,000
0
15,000
15,000
0
15,000
0
0
0
0
0
0
42,111
42,111
0
42,111
0
0
0
0
0
0
5,000
5,000
0
5,000
0
35,000
35,000
0
35,000
0
0
0
0
0
0
0
0
0
0
0
1,500
1,500
0
1,500
0
3,500
3,500
0
3,500
0
0
0
0
0
0
350
350
0
350
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
28,000
28,000
0
28,000
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
171,461
171,461
0
171,461
2,585
0
2,585
0
2,585
0
0
0
0
0
0
0
0
0
0
2,585
0
2,585
0
2,585
0
0
0
1,923,379
1,923,379
0
0
0
0
0
0
0
0
146,868
146,868
0
0
0
0
0
0
0
0
0
0
0
0
0
6,241,311
6,241,311
0
0
0
0
0
0
0
0
0
0
0
0
0
97,469
97,469
0
0
0
839,509
839,509
0
0
0
0
0
0
0
0
9,248,536
9,248,536
Version: 2 Page 4 of 7
9. DIRECT LOCAL CONTRIBUTIONS - BCC /TAX DISTRICT
008010 CONTRIBUTION FROM CITY GOVERNMENT
008020 CONTRIBUTION FROM HEALTH CARE TAX NOT THRU BCC
008040 BCC GRANT /CONTRACT
008030 CONTRIBUTION FROM HEALTH CARE TAX
008034 BCC CONTRIBUTION FROM GENERAL FUND
DIRECT COUNTY CONTRIBUTION TOTAL
10. FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION - COUNTY
001060 CHD SUPPORT POSITION
001077 RABIES VACCINE
001077 PERSONAL HEALTH FEES
001077 CHILD CAR SEAT PROG
001077 AIDS CO -PAYS
001094 ADULT ENTER. PERMIT FEES
001094 LOCAL ORDINANCE FEES
001114 NEW BIRTH CERTIFICATES
001115 VITAL STATISTICS - DEATH CERTIFICATE
001117 VITAL STATS -ADM. FEE 50 CENTS
001073 CO -PAY FOR THE AIDS CARE PROGRAM
001025 CLIENT REVENUE FROM GRC
001040 CELL PHONE ADMINISTRATIVE FEE
FEES AUTHORIZED BY COUNTY TOTAL
11. OTHER CASH AND LOCAL CONTRIBUTIONS - COUNTY
001009 RETURNED CHECK ITEM
001029 THIRD PARTY REIMBURSEMENT
001029 HEALTH MAINTENANCE ORGAN. (HMO)
001054 MEDICARE PART D
001077 RYAN WHITE TITLE II
001090 MEDICARE PART B
001190 HEALTH MAINTENANCE ORGANIZATION
005040 INTEREST EARNED
005041 INTEREST EARNED -STATE INVESTMENT ACCOUNT
007010 U.S. GRANTS DIRECT
008050 SCHOOL BOARD CONTRIBUTION
008060 SPECIAL PROJECT CONTRIBUTION
010300 SALE OF GOODS AND SERVICES TO STATE AGENCIES
010301 EXP WITNESS FEE CONSULTNT CHARGES
010405 SALE OF PHARMACEUTICALS
010409 SALE OF GOODS OUTSIDE STATE GOVERNMENT
011001 HEALTHY START COALITION CONTRIBUTIONS
011007 CASH DONATIONS PRIVATE
012020 FINES AND FORFEITURES
012021 RETURN CHECK CHARGE
028020 INSURANCE RECOVERIES -OTHER
090002 DRAW DOWN FROM PUBLIC HEALTH UNIT
011000 GRANT- DIRECT
0 0
0
0
0
0 0
0
0
0
0 0
0
0
0
0 0
0
0
0
0 1,258,100
1,258,100
0
1,258,100
0 1,258,100
1,258,100
0
1,258,100
0 0
0
0
0
0 0
0
0
0
0 131,700
131,700
0
131,700
0 0
0
0
0
0 0
0
0
0
0 0
0
0
0
0 580,250
580,250
0
580,250
0 54,000
54,000
0
54,000
0 270,000
270,000
0
270,000
0 3,500
3,500
0
3,500
0 0
0
0
0
0 0
0
0
0
0 0
0
0
0
0 1,039,450
1,039,450
0
1,039,450
0 0
0
0
0
0 1,122,858
1,122,858
0
1,122,858
0 0
0
0
0
0 0
0
0
0
0 0
0
0
0
0 41,500
41,500
0
41,500
0 0
0
0
0
0 0
0
0
0
0 10,000
10,000
0
10,000
0 0
0
0
0
0 0
0
0
0
0 0
0
0
0
0 0
0
0
0
0 0
0
0
0
0 0
0
0
0
0 0
0
0
0
0 385,081
385,081
0
385,081
0 0
0
0
0
0 0
0
0
0
0 0
0
0
0
0 0
0
0
0
0 396,165
396,165
0
396,165
0 256,766
256,766
0
256,766
Version: 2 Page 5 of 7
WI 1
Other
Contribution
011000
DIRECT -ARROW
0
0
0
0
011000
GRANT - DIRECT
0
193,015
193,015
0
011000
GRANT DIRECT -ARROW
0
0
0
0
011000
GRANT DIRECT - HEALTH CARE DISTRICT PAHOKEE
0
0
0
0
011000
GRANT- DIRECT
0
0
0
0
011000
GRANT - DIRECT
0
0
0
0
011000
GRANT DIRECT -NOVA UNIVERSITY CHD TRAINING
0
0
0
0
011000
GRANT DIRECT- COUNTY HEALTH DEPARTMENT DIRECT SER
0
0
0
0
011000
COUNTY COMMISSION - LIP FUND
0
242,940
242,940
0
011000
GRANT- DIRECT
0
0
0
0
011000
GRANT DIRECT - QUANTUM DENTAL
0
0
0
0
011000
GRANT - DIRECT
0
0
0
0
011000
GRANT- DIRECT
0
0
0
0
010402
RECYCLED MATERIAL SALES
0
0
0
0
010303
FDLE FINGERPRINTING
0
2,200
2,200
0
007050
ARRA FEDERAL GRANT
0
0
0
0
001010
RECOVERY OF BAD CHECKS
0
0
0
0
008065
FCO CONTRIBUTION
0
0
0
0
011006
RESTRICTED CASH DONATION
0
0
0
0
028000
INSURANCE RECOVERIES
0
0
0
0
001033
CMS MANAGEMENT FEE - PMPMPC
0
0
0
0
010400
SALE OF GOODS OUTSIDE STATE GOVERNMENT
0
0
0
0
010500
REFUGEE HEALTH
0
0
0
0
005045
INTEREST EARNED -THIRD PARTY PROVIDER
0
0
0
0
005043
INTEREST EARNED - CONTRACT /GRANT
0
0
0
0
001053
MEDICARE - PART A
0
0
0
0
011002
ARRA FEDERAL GRANT - SUB - RECIPIENT
0
0
0
0
011004
LOW INCOME POOL - SUBRECIPIENT
0
0
0
0
001003
WIRE TRANSFER FEE
0
0
0
0
OTHER CASH AND LOCAL CONTRIBUTIONS TOTAL
0
2,650,525
2,650,525
0
12. ALLOCABLE REVENUE -COUNTY
018000
REFUNDS
0
0
0
0
037000
PRIOR YEAR WARRANT
0
0
0
0
038000
12 MONTH OLD WARRANT
0
0
0
0
001053
CLIENT REVENUE FROM NCO
0
0
0
0
COUNTY ALLOCABLE REVENUE TOTAL
0
0
0
0
13. BUILDINGS - COUNTY
ANNUAL RENTAL EQUIVALENT VALUE
0
0
0
525,048
IT ALLOCATION & GOLDEN GATE RENTAL
0
0
0
74,500
UTILITIES
0
0
0
220,200
BUILDING MAINTENANCE
0
0
0
0
GROUNDS MAINTENANCE
0
0
0
195,149
INSURANCE
0
0
0
0
OTHER (SPECIFY)
0
0
0
0
BUILDINGS TOTAL 0 0 0 1,014,897
Version: 2
Total
0
193,015
0
0
0
0
0
0
242,940
0
0
0
0
0
2,200
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2,650,525
0
0
0
0
0
525,048
74,500
220,200
0
195,149
0
0
1,014,897
Page 6 of 7
ATTACHMENT IL ...
COLLIER COUNTY HEALTH DEPARTMENT 1609
Part H. Sources of Contributions to County Health Department
October 1, 2013 to September 30, 2014
State CAD County Total CHD
Trust Fund CHD Trust Fund Other
Trust Fund (ca Contribution Total
14. OTHER COUNTY CONTRIBUTIONS NOT IN CHD TRUST FUND - COUNTY
EQUIPMENT /VEHICLE PURCHASES
VEHICLE INSURANCE
VEHICLE MAINTENANCE
OTHER COUNTY CONTRIBUTION (SPECIFY)
OTHER COUNTY CONTRIBUTION (SPECIFY)
OTHER COUNTY CONTRHBUTIONS TOTAL
GRAND TOTAL CHD PROGRAM
0
0
0
0
0
0
0
0
16,300
16,300
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
16,300
16,300
7,243,057
5,119,536
12,362,593
10,279,733
22,642,326
Version: 2 Page 7 of 7
ATTACHMENT II.
COLLIER
COUNTY HEALTH DEPARTMENT
1609
Part III. Planned Staffing, Clients,
Services, And
Expenditures By Program
Service Area Within Each Level Of Service
October 1, 2013 to September 30, 2014
Quarterly Expenditure Plan
FTE's
Clients
Services /
1st
2nd
3rd
4th
Grand
(0.00)
Units
Visits
(Whole dollars
only)
State
County
Total
A. COMMUNICABLE DISEASE CONTROL:
IMMUNIZATION (101)
9.42
8,385
11,423
203,457
161,500
188,457
153,397
245,312
461,499
706,811
STD (102)
5.24
1,151
1,729
82,275
70,503
82,275
82,242
27,234
290,061
317,295
1-HV /AIDS PREVENTION (03A1)
6.21
1,789
2,249
92,010
78,845
92,010
91,974
265,348
89,491
354,839
HIV /AIDS SURVEILLANCE (03A2)
1.32
6
7
18,839
16,143
18,839
18,831
72,652
0
72,652
HIV /AIDS PATIENT CARE (03A3)
7.78
347
1,969
152,529
130,706
162,529
152,471
238,169
360,066
598,235
ADAP (03A4)
2.34
25
72
34,995
29,988
34,995
34,983
134,961
0
134,961
TB CONTROL SERVICES (104)
8.40
819
3,620
156,978
145,949
166,978
151,921
465,356
156,470
621,826
COMM. DISEASE SURV. (106)
6.20
0
6,230
120,245
103,041
120,245
120,199
0
463,730
463,730
HEPATITIS PREVENTION (109)
1.87
2,139
2,970
32,568
27,908
32,568
32,555
125,599
0
125,599
PUBLIC HEALTH PREP AND RESP (116)
4.64
0
468
86,521
74,142
86,521
86,489
289,484
44,189
333,673
REFUGEE HEALTH (118)
6.29
1,234
4,743
133,624
114,505
133,624
133,573
478,137
37,189
515,326
VITAL STATISTICS (180)
2.71
10,496
40,150
37,706
32,311
37,706
37,692
0
145,415
145,415
COMMUNICABLE DISEASE SUBTOTAL
62.42
26,391
75,630
1,151,747
985,541
1,156,747
1,096,327
2,342,252
2,048,110
4,390,362
B. PRIMARY CARE:
CHRONIC DISEASE SERVICES (210)
1.45
207
2,561
37,711
29,461
37,711
27,702
87,585
45,000
132,585
TOBACCO PREVENTION (212)
3.54
0
8,463
63,192
54,651
63,192
63,168
244,203
0
244,203
WIC (21W1)
35.30
11,941
91,697
538,325
488,778
538,325
538,136
2,103,564
0
2,103,564
WIC BREASTFEEDING PEER COUNSELING (21W2)
1.21
0
1,645
13,840
11,860
13,840
13,836
53,376
0
53,376
FAMILY PLANNING (223)
2.51
1,748
1,966
59,131
80,670
99,131
89,107
328,039
0
328,039
IMPROVED PREGNANCY OUTCOME (225)
5.43
1,079
6,982
157,441
134,915
157,441
157,381
206,489
400,689
607,178
HEALTHY START PRENATAL (227)
9.71
1,532
8,384
150,660
131,958
150,660
155,597
190,796
398,079
588,875
COMPREHENSIVE CHILD HEALTH (229)
2.64
275
791
44,836
39,852
44,836
44,823
0
174,347
174,347
HEALTHY START INFANT (23 1)
5.04
729
4,518
61,718
55,741
61,718
66,689
245,866
0
245,866
SCHOOL HEALTH (234)
6.73
0
284,934
151,262
76,773
96,262
91,222
317,855
97,664
415,519
COMPREHENSIVE ADULT HEALTH (237)
1.09
812
1,878
111,575
87,042
111,575
101,534
201,608
210,118
411,726
COMMUNITY HEALTH DEVELOPMENT (238)
1.81
0
184
32,252
27,637
32,252
32,239
124,380
0
124,380
DENTAL HEALTH (240)
14.96
5,035
8,955
326,256
276,722
326,256
321,136
7,853
1,242,517
1,250,370
PRIMARY CARE SUBTOTAL
91.42
23,358
422,958
1,748,199
1,496,060
1,733,199
1,702,570
4,111,614
2,568,414
6,680,028
C. ENVIRONMENTAL HEALTH:
Water and Onsite Sewage Programs
COASTAL BEACH MONITORING (347)
0.15
391
391
6,798
5,825
6,798
6,795
26,216
0
26,216
LIMITED USE PUBLIC WATER SYSTEMS (357)
0.19
193
1,030
3,422
3,489
3,722
3,720
5,275
9,078
14,353
PUBLIC WATER SYSTEM (358)
0.00
0
0
24
21
24
24
47
46
93
PRIVATE WATER SYSTEM (359)
0.01
0
14
119
102
119
118
0
458
458
INDIVIDUAL SEWAGE DISP. (361)
6.71
1,632
4,089
116,012
104,413
121,012
115,967
221,757
235,647
457,404
Group Total
7.06
2,216
5,524
126,375
113,850
131,675
126,624
253,295
245,229
498,524
Facility Programs
FOOD HYGIENE (348)
1.29
227
1,027
21,020
20,512
23,520
21,011
86,063
0
86,063
BODY PIERCING FACILITIES SERVICES (349)
0.03
2
3
618
530
618
619
2,385
0
2,385
GROUP CARE FACILITY (35 1)
0.65
195
316
10,400
8,912
10,400
10,397
0
40,109
40,109
MIGRANT LABOR CAMP (352)
2.58
257
1,763
46,027
42,441
49,027
48,009
129,245
56,259
185,504
Version: 4
Page 1 of 2
C. ENVIRONMENTAL HEALTH:
Facility Programs
HOUSING,PUBLIC BLDG SAFETY,SANITATION (353)
0.00
0
0
12
11
12
13
24
24
48
MOBILE HOME AND PARKS SERVICES (354)
0.35
89
358
3,904
6,059
6,904
5,903
22,770
0
22,770
SWIMMING POOLS/BATHING(360)
3.29
1,676
19,104
69,692
59,720
69,692
69,664
130,160
138,608
268,768
BIOMEDICAL WASTE SERVICES (364)
1.07
852
915
21,704
19,599
21,704
21,697
84,704
0
84,704
TANNING FACILITY SERVICES (369)
0.00
17
47
1,047
1,847
2,097
1,748
6,647
92
6,739
Group Total
9.26
3,315
23,533
174,424
159,631
183,974
179,061
461,998
235,092
697,090
Groundwater Contamination
STORAGE TANK COMPLIANCE (355)
0.00
0
0
0
0
0
0
0
0
0
SUPER ACT SERVICE (356)
0.03
28
38
1,557
1,334
1,557
1,556
6,004
0
6,004
Group Total
0.03
28
38
1,557
1,334
1,557
1,556
6,004
0
6,004
Community Hygiene
TATTOO FACILITIES SERVICES
0.27
0
41
4,702
4,030
4,702
4,701
18,135
0
18,135
COMMUNITY ENVIR. HEALTH (345)
0.00
0
0
0
0
0
0
0
0
0
INJURY 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)
0.01
4
11
208
179
208
209
406
398
804
RABIES SURVEILLANCE/CONTROL SERVICES (366)
0.00
0
0
0
0
0
0
0
0
0
ARBOVIRUS SURVEILLANCE (367)
0.00
0
0
0
0
0
0
0
0
0
RODENT /ARTHROPOD CONTROL (368)
0.00
0
0
28
24
28
27
54
53
107
WATER POLLUTION (370)
0.00
0
0
0
0
0
0
0
0
0
INDOOR AIR (371)
0.00
0
0
0
0
0
0
0
0
0
RADIOLOGICAL HEALTH (372)
0.00
0
0
58
50
58
59
114
111
225
TOXIC SUBSTANCES (373)
0.00
0
0
0
0
0
0
0
0
0
Group Total
0.28
4
52
4,996
4,283
4,996
4,996
18,709
562
19,271
ENVIRONMENTAL HEALTH SUBTOTAL
16.63
5,563
29,147
307,352
279,098
322,202
312,237
740,006
480,883
1,220,889
D. NON- OPERATIONAL COSTS:
NON - OPERATIONAL COSTS (599)
0.00
0
0
1,800
335
200
3,350
5,685
0
5,685
ENVIRONMENTAL HEALTH SURCHARGE (399)
0.00
0
0
3,000
3,000
13,500
24,000
43,500
0
43,500
MEDICAID BUYBACK (611)
0.00
0
0
5,533
5,532
5,532
5,532
0
22,129
22,129
NON - OPERATIONAL COSTS SUBTOTAL
0.00
0
0
10,333
8,867
19,232
32,882
49,185
22,129
71,314
TOTAL CONTRACT
170.47
55,312
527,735
3,217,631
2,769,566
3,231,380
3,144,016
7,243,057
5,119,536
12,362,593
Version: 4 Page 2 of 2
ATTACHMENT III 1609
COLLIER COUNTY HEALTH DEPARTMENT
CIVIL RIGHTS CERTIFICATE
The applicant provides this assurance in consideration of and for the purpose of obtaining federal grants, loans,
contracts (except contracts of insurance or guaranty), property, discounts, or other federal financial assistance to
programs or activities receiving or benefiting from federal financial assistance. The provider agrees to complete
the Civil Rights Compliance Questionnaire, DH Forms 946 A and B (or the subsequent replacement if adopted
during the contract period), if so requested by the department.
The applicant assures that it will comply with:
Title VI of the Civil Rights Act of 1964, as amended, 42 U.S.C., 2000 Et seq., which prohibits
discrimination on the basis of race, color or national origin in programs and activities receiving or
benefiting from federal financial assistance.
2. Section 504 of the Rehabilitation Act of 1973, as amended, 29 U.S.C. 794, which prohibits discrimination
on the basis of handicap in programs and activities receiving or benefiting from federal financial
assistance.
3. Title IX of the Education Amendments of 1972, as amended, 20 U.S.C. 1681 et seq., which prohibits
discrimination on the basis of sex in education programs and activities receiving or benefiting from
federal financial assistance.
4. The Age Discrimination Act of 1975, as amended, 42 U.S.C. 6101 et seq., which prohibits discrimination
on the basis of age in programs or activities receiving or benefiting from federal financial assistance.
5. The Omnibus Budget Reconciliation Act of 1981, P.L. 97 -35, which prohibits discrimination on the basis
of sex and religion in programs and activities receiving or benefiting from federal financial assistance.
6. All regulations, guidelines and standards lawfully adopted under the above statutes. The applicant agrees
that compliance with this assurance constitutes a condition of continued receipt of or benefit from federal
financial assistance, and that it is binding upon the applicant, its successors, transferees, and assignees
for the period during which such assistance is provided. The applicant further assures that all contracts,
subcontractors, subgrantees or others with whom it arranges to provide services or benefits to
participants or employees in connection with any of its programs and activities are not discriminating
against those participants or employees in violation of the above statutes, regulations, guidelines, and
standards. In the event of failure to comply, the applicant understands that the grantor may, at its
discretion, seek a court order requiring compliance with the terms of this assurance or seek other
appropriate judicial or administrative relief, to include assistance being terminated and further assistance
being denied.
22
1609
ATTACHMENT IV
COLLIER COUNTY HEALTH DEPARTMENT
FACILITIES UTILIZED BY THE COUNTY HEALTH DEPARTMENT
Facility
Description
Collier County Health
Department & Public
Services Building H
Immokalee Satellite
Golden Gate WIC Office
CCHD Annex
Location
3339 E. Tamiami Trail
Building H, Naples
419 North First Street
Immokalee
Owned By
Collier County
Collier County
4945 Golden Gate Parkway Benderson
Unit 102, Naples Development
3205 Beck Blvd Florida Department
Naples of Environmental
Protection
23
1609
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
2011 -2012 $ $ $ _
2012 -2013 $ $ $ _
2013 -2014 $ 0 $ 0 $ 0
2014 -2015 $ $ $ _
2015 -2016 $ $ $ _
PROJECT TOTAL $ 0 $ 0 $ 0
SPECIAL PROJECT CONSTRUCTION /RENOVATION PLAN
PROJECT NAME:
LOCATION/ ADDRESS:
PROJECT TYPE:
NEW BUILDING
ROOFING
RENOVATION
PLANNING STUDY
NEW ADDITION
OTHER
SQUARE FOOTAGE:
PROJECT SUMMARY: Describe scope of work in reasonable detail.
ESTIMATED PROJECT INFORMATION:
START DATE (initial expenditure of funds) :
COMPLETION DATE:
DESIGN FEES:
$
CONSTRUCTION COSTS:
$
FURNITURE /EQUIPMENT
$
TOTAL PROJECT COST:
$ -
COST PER SQ FOOT:
$ #DIV /01
Special Capital Projects are new construction or renovation projects and new furniture or equipment
associated with these projects and mobile health vans.
24