Okaloosa County BOCC — September 16, 2014 — Annual Health Dept Contract

CONTRACT BETWEEN OKALOOSA COUNTY BOARD OF COUNTY COMMISSIONERS AND STATE OF FLORIDA DEPARTMENT OF HEALTH FOR OPERATION OF THE OKALOOSA COUNTY HEALTH DEPARTMENT CONTRACT YEAR 2014-2015 This agreement (“Agreement’) is made and entered into between the State of Florida, Department of Health (“State”) and the Okaloosa County Board of County Commissioners (“County”), through their undersigned authorities, effective October 1, 2014. 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. Okaloosa 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, 2014, through September 30, 2015, 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 shail provide those services as set forth on Part Ill of Attachment II hereof, in order to maintain the following three levels of service pursuant to Section 154.01(2), Florida Statutes, as defined below: a. “Environmental health services” are those services which are organized and operated to protect the health of the general public by monitoring and regulating activities in the environment which may contribute to the occurrence or transmission of disease. Environmental health services shall be supported by available federal, state and local 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 ll of Attachment II hereof. This funding will be used as shown in Part | of Attachment II. i. The State's appropriated responsibility (direct contribution excluding any state fees, Medicaid contributions or any other funds not listed on the Schedule C) as provided in Attachment II, Part Il is an amount not to exceed $ 3,485,328 (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 Il, Part Il is an amount not to exceed $601,661 (amount listed under the “Board of County Commissioners Annual Appropriations section of the revenue attachment). b. Overall expenditures will not exceed available funding or budget authority, whichever is less, (either current year or from surplus trust funds) in any service category. Unless requested otherwise, any surplus at the end of the term of this Agreement in the County Health Department Trust Fund that is attributed to the CHD shall be carried forward to the next contract period. c. Either party may establish service fees as allowed by law to fund activities of the CHD. Where applicable, such fees shall be automatically adjusted to at least the Medicaid fee schedule. d. Either party may increase or decrease funding of this Agreement during the term hereof by notifying the other party in.writing of the amount and purpose for the change in funding. If the State initiates the increase/decrease, the CHD will revise the Attachment II and send a copy of the revised pages to the County and the Department of Health, 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 I] 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 who payments shall be made is: County Health Department Trust Fund Okaloosa County 221 Hospital Dr NE Fort Walton Beach, FL 32548 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, 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; fii. 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 Okaloosa County. e. That any surplus/deficit funds, including fees or accrued interest, remaining in the County Health Department Trust Fund account at the end of the contract year shall be credited/debited to the state or county, as appropriate, based on the funds contributed by each and the expenditures incurred by each. Expenditures will be charged to the program accounts by state and county based on the ratio of planned expenditures in the core contract and funding from all sources is credited to the program accounts by state and county. The equity share of any surplus/deficit funds accruing to the state and county is determined each month and at contract year-end. Surplus funds may be applied toward the funding requirements of each participating governmental entity in the following year. However, in each such case, all surplus funds, including fees and accrued interest, shall remain in the trust fund until accounted for in a manner which clearly illustrates the amount which has been credited to each participating governmental entity. The planned use of surplus funds shall be reflected in Attachment II, Part | 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. |. The CHD shall abide by all State policies and procedures, which by this reference are incorporated herein as standards to be followed by the CHD, except as otherwise permitted for some purchases using county procedures pursuant to paragraph 6.b. hereof. m. The CHD shall establish a system through which applicants for services and current clients may present grievances over denial, modification or termination of services. The 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 | 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. 0. 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, 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: i, March 1, 2015 for the report period October 1, 2014 through December 31, 2014; ii. June 1, 2015 for the report period October 1, 2014 through March 31, 2015; fii. ° September 1, 2015 for the report period October 1, 2014 through June 30, 2015; and Iv. December 1, 2015 for the report period October 1, 2014 through September 30, 2015. 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 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, 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 Agreement are as follows: For the State: For the County: Laura T. Green Gary Stanford Name Name Business Manager Finance Director Title Title 221 Hospital Dr NE 101 E James Lee Blvd Fort Walton Beach, FL 32548 Crestview, FL 32536 Address Address (850) 833-9233 (850) 689-5639 Telephone Telephone lf 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. In WITNESS THEREOF, the parties hereto have caused this 19 page agreement to be executed by their undersigned officials as duly authorized effective the 1° day of October, 2014. BOARD OF COUNTY COMMISSIONERS FOR OKALOOSA COUNTY SIGNED BY: NAME: Charles K. Windes, Jr. TITLE: Chairman DATE: ATTESTED TO: SIGNED BY: NAME: Gary Stanford TITLE: Finance Director DATE: STATE OF FLORIDA DEPARTMENT OF HEALTH SIGNED BY: NAME: John H. Armstrong, MD, FACS TITLE: Surgeon General/Secretary of Health DATE: SIGNED BY:_ \ooe CO) Nee ve. NAME: Karen A. Chapman, MD, MPH TITLE:__CHD Director DATE: a LK (4 ATTACHMENT | OKALOOSA 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 Sexually Transmitted Disease Program Dental Health Special Supplemental Nutrition Program for Women, Infants and Children (including the WIC Breastfeeding Peer Counseling Program) Healthy Start/ Improved Pregnancy Outcome Family Planning Immunization Requirement Requirements as specified in F.A.C. 64D-3, F.S. 381 and F.S. 384. Periodic financial and programmatic reports as specified by the program office. Service documentation and monthly financial reports as specified in DHM 150-24* and ail federal, state and county requirements detailed in program manuais and published procedures. Requirements as specified in the 2007 Healthy Start Standards and Guidelines and as specified by the Healthy Start Coalitions in contract with each county health department. Requirements as specified in Public Law 91-572, 42 U.S.C. 300, ef 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. 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 10. 11. 12. ATTACHMENT | (Continued) Environmental Health HIV/AIDS Program School Health Services Tuberculosis General Communicable Disease Control Refugee Health Program levels as documented in Florida. SHOTS and supported by CHD Guidebook policies and technical assistance guidance. Requirements as specified in Environmental Health Programs Manual 150-4* and DHP 50-21* 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. 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. Requirements as specified in the Fiorida Schoo! 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. Tuberculosis Program Requirements as specified in F.A.C. 64D-3 and F.S. 392. Carry out surveillance for reportable communicable and other acute diseases, detect outbreaks, respond to individual cases of reportable diseases, investigate outbreaks, and carry out communication and quality assurance functions, as specified in F.A.C. 64D-3, F.S. 381, F.S. 384 and the CHD Epidemiology Guide to Surveillance and Investigations. Programmatic and financial requirements as specified by the program office. *or the subsequent replacement if adopted during the contract period. ATTACHMENT II OKALOOSA COUNTY HEALTH DEPARTMENT PART i. PLANNED USE OF COUNTY HEALTH DEPARTMENT TRUST FUND BALANCES Estimated Staite Estimated County Share of CHD Trust Share of CHD Trust Fund Balance Fund Balance . Total 1. CHD Trust Fund Ending Balance 09/30/14 133,654 855,641 989 295 2. Drawdown for Contract Year October 1, 2014 to September 30, 2015 35,824 172,471 208,295 3. Special Capital Project use for Contract Year October 1, 2014 to September 30, 2014 - - - 4. Balance Reserved for Contingency Fund October 1, 2014 to September 30, 2015 97,830 683,170 781,000 Special Capital Projects are new construction or renovation projects and new furniture or equipment associated with these projects, and mobile health vans. 1. GENERAL REVENUE - STATE 015040 015040 015040 015040 015040 015040 015050 AIDS PATIENT CARE AIDS PREVENTION & SURVEILLANCE - GENERAL REVENUE CHD - TB COMMUNITY PROGRAM DENTAL SPECIAL INITIATIVE PROJECTS FAMILY PLANNING GENERAL REVENUE SCHOOL HEALTH SERVICES - GENERAL REVENUE CHD GENERAL REVENUE NON-CATEGORICAL GENERAL REVENUE TOTAL 2. NON GENERAL REVENUE - STATE 015010 015010 STATE UNDERGROUND PETROLEUM RESPONSE ACT TOBACCO STATE AND COMMUNITY INTERVENTIONS NON GENERAL REVENUE TOTAL 3. FEDERAL FUNDS - STATE 007000 007000 007000 007000 007000 007000 007000 007000 007000 007000 007000 007000 007000 015075 AIDS DRUG ASSISTANCE PROGRAM ADMIN BIOTERRORISM HOSPITAL PREPAREDNESS WIC BREASTFEEDING PEER COUNSELING PROG COASTAL BEACH WATER QUALITY MONITORING COMPREHENSIVE COMMUNITY CARDIO - PHBG FAMILY PLANNING TITLE X - GRANT IMMUNIZATION ACTION PLAN INJURY SURVEILLANCE & PREVENTION GRANT MCH SPECIAL PRJICT UNPLANNED PREGNANCY MCH SPECIAL PROJECTS DENTAL PHP PUBLIC HEALTH PREPAREDNESS BASE ALLOC TEENAGE PREGNANCY PREVENTION REPLICATION WIC PROGRAM ADMINISTRATION INSPECTIONS OF SUMMER FEEDING PROGRAM - DOE FEDERAL FUNDS TOTAL 4, FEES ASSESSED BY STATE OR FEDERAL RULES - STATE 001020 001092 001206 001206 001206 001206 001206 001206 001206 001206 CHD STATEWIDE ENVIRONMENTAL FEES CHD STATEWIDE ENVIRONMENTAL FEES ON SITE SEWAGE DISPOSAL PERMIT FEES SANITATION CERTIFICATES (FOOD INSPECTION) SEPTIC TANK RESEARCH SURCHARGE PUBLIC SWIMMING POOL PERMIT FEES-10% HQ TRANSFER DRINKING WATER PROGRAM OPERATIONS TANNING FACILITIES ONSITE SEWAGE TRAINING CENTER MOBILE HOME & RV PARK FEES FEES ASSESSED BY STATE OR FEDERAL RULES TOTAL 100,000 20,920 40,033 7,075 47,880 177,240 1,228,822 1,621,970 4,500 154,172 158,672 16,477 26,899 9,117 13,267 20,724 84,286 27,900 5,000 22,556 38,200 132,443 67,517 841,548 1,108 1,307,037 124,331 134,688 8,820 2,443 1,155 6,752 63 475 1,420 1,141 281,288 (> > ) oo oO oco0.cUCmUDCUCUCcOCUCcUOUUCUC OUCDUCOOUCCOCOUC OCUCUOUcCOOUlUCO mo o coc 7F OF cFlCUCUUCOOUCUCOUUCOOUCUCUCOD 100,000 20,920 40,033 7,075 47,880 177,240 1,228,822 1,621,970 4,500 154,172 158,672 16,477 26,899 9,117 13,267 20,724 84,286 27,900 5,000 22,556 38,200 132,443 67,517 841,548 1,108 1,307,037 124,331 184,688 8,820 2,443 1,155 6,752 68 475 1,420 4,141 281,288 (oo <> <> > = > >) o co co op oOmUmcUDUCUODUUCUCOCUCUKOUCOUCOUUCUOCUODCUMDCUCO oo C90 Oo fF C90 2G 900 : 89 100,000 20,920 40,033 7,075 47,880 177,240 1,228,822 1,621,970 4,500 154,172 158,672 16,477 26,899 9,117 13,267 20,724 84,286 27,900 5,000 22,556 38,200 132,443 67,517 841,548 1,103 1,807,037 124,331 134,688 8,820 2,443 1,155 6,752 63 475 1,420 1,141 281,288 Page 1 of 3 5. OTHER CASH CONTRIBUTIONS - STATE: 090001 DRAW DOWN FROM PUBLIC HEALTH UNIT OTHER CASH CONTRIBUTION TOTAL 6. MEDICAID - STATE/COUNTY: 001059 001059 001059 001082 001083 001089 LOW INCOME POOL AHCA PRIMARY CARE LOW INCOME POOL ALLOCATION MNGD BY DOH LOW INCOME POOL AHCA PRIMARY CARE CHD CLINIC FEES CHD CLINIC FEES CHD CLINIC FEES MEDICAID TOTAL 7, ALLOCABLE REVENUE - STATE: 018000 038000 CHDTF UNRESTRICTED CASH RESERVE CHDTF UNRESTRICTED CASH RESERVE ALLOCABLE REVENUE TOTAL 8. OTHER STATE CONTRIBUTIONS NOT IN CHD TRUST FUND - STATE ADAP PHARMACY DRUG PROGRAM STD WIC PROGRAM BUREAU OF PUBLIC HEALTH LABORATORIES IMMUNIZATIONS OTHER STATE CONTRIBUTIONS TOTAL 9, DIRECT LOCAL CONTRIBUTIONS - BCC/TAXK DISTRICT 008034 CHD LOCAL REVENUE & EXPENDITURES DIRECT COUNTY CONTRIBUTIONS TOTAL 10, FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION - COUNTY 001077 001094 001114 001115 001117 CHD CLINIC FEES CHD STATEWIDE ENVIRONMENTAL FEES VITAL STATISTICS CERTIFIED RECORDS VITAL STATISTICS CERTIFIED RECORDS VITAL STATISTICS CERTIFIED RECORDS FEES AUTHORIZED BY COUNTY TOTAL 11, OTHER CASH AND LOCAL CONTRIBUTIONS - COUNTY 001009 001029 001090 004010 005041 CHD CLINIC FEES CHD CLINIC FEES CHD CLINIC FEES CHD CLINIC FEES CHD LOCAL REVENUE & EXPENDITURES 1,800 25 1,825 oo 0.0UCUMNUlCMDODlUCOUCOO oo oO 8 CO fF o9o0CUDmUmUCUODOUCOD 496,003 700,000 555,412 5,784 112,134 3,810 1,873,143 i=) i=) oo 90lUOlUCOUUCOUUCUCUCOFU 601,661 601,661 111,446 160,538 46,656 126,288 3,888 438,816 65 158,776 15,216 35 4,900 496,003 700,000 555,412 5,784 112,134 3,810 1,873,143 1,800 25 1,825 oo o00CUCMRMWmlClCUCUCUOUCOUCUCOU 601,661 601,661 111,446 150,538 46,656 126,288 3,888 438,816 65 758,776 15,216 35 4,900 oocUmUcmUOmUmUCOTWUCOUCUOOUCUCUCOD 542,207 81,814 0 3,349,198 48,887 616,542 4,638,648 oO °o0UUmUDWUlUCUCONMUUCOUCUCOUD oO Oo fo 30 8 496,003 700,000 555,412 5,784 112,134 3,810 1,873,143 1,800 25 1,825 542,207 81,814 0 3,349,198 48,887 616,542 4,638,648 601,661 601,661 111,446 150,538 46,656 126,288 3,888 438,816 65 758,776 15,216 35 4,900 Page 2 of 3 007010 RYAN WHITE TITLE HI - DIRECT TO CHD 007010 RYAN WHITE TITLE III - DIRECT TO CHD - 2005-2006 011000 CHD CLINIC FEES 011001 HEALTHY START DATA MANAGEMENT 090002 DRAW DOWN FROM PUBLIC HEALTH UNIT OTHER CASH AND LOCAL CONTRIBUTIONS TOTAL 12, ALLOCABLE REVENUE - COUNTY 018000 CHDTF UNRESTRICTED CASH RESERVE 038000 CHDTF UNRESTRICTED CASH RESERVE COUNTY ALLOCABLE REVENUE TOTAL 13. BUILDINGS - COUNTY ANNUAL RENTAL EQUIVALENT VALUE JANITORIAL SERVICES UTILITIES BUILDING MAINTENANCE GROUNDS MAINTENANCE INSURANCE OTHER (Specify) OTHER (Specify) BUILDINGS 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 CONTRIBUTIONS TOTAL GRAND TOTAL CHD PROGRAM oococUCmODUUlCUCUODUUCUCOUCCOUUCUNDOUCUCUCOCOUCO oo.o0o006€C06UC~;hMNmC—C~Cw 3,406,616 206,534 69,616 5,726 3,940 172,471 1,237,279 1,800 25 1,825 oo 00 73 030 Oo G&G & o co 0 030 C3 & 4,152,724 206,534 69,616 5,726 3,940 172,471 1,237,279 1,800 25 1,825 o oc co fC fF fC FO fF > > a > 7,559,340 oo foc fF 9 82 440,412 74,000 0 0 0 0 0 0 514,412 a > — >) 5,153,060 206,534 69,616 5,726 3,940 172,471 1,237,279 1,800 25 1,825 440,412 74,000 © > > <> 514,412 oolUObUmUCOUCUCOUCUCUCOD 12,712,400 Page 3 of 3 A. COMMUNICABLE DISEASE CONTROL: IMMUNIZATION (101) SEXUALLY TRANS. DIS. (102) HIV/AIDS PREVENTION (03A1) HIV/AIDS SURVEILLANCE (03A2) HIV/AIDS PATIENT CARE (08A3) ADAP (03A4) TUBERCULOSIS (104) COMM. DIS. SURV. (106) HEPATITIS (109) PREPAREDNESS AND RESPONSE (116) REFUGEE HEALTH (118) VITAL RECORDS (180) COMMUNICABLE DISEASE SUBTOTAL B. PRIMARY CARE: CHRONIC DISEASE PREVENTION PRO (210) WIC (21W1) TOBACCO USE INTERVENTION (212) WIC BREASTFEEDING PEER COUNSELING (21W2) FAMILY PLANNING (228) IMPROVED PREGNANCY OUTCOME (225) HEALTHY START PRENATAL (227) COMPREHENSIVE CHILD HEALTH (229) HEALTHY START CHILD (231) SCHOOL HEALTH (234) COMPREHENSIVE ADULT HEALTH (237) COMMUNITY HEALTH DEVELOPMENT (238) DENTAL HEALTH (240) PRIMARY CARE SUBTOTAL C. ENVIRONMENTAL HEALTH: Water and Onsite Sewage Programs COSTAL BEACH MONITORING (347) LIMITED USE PUBLIC WATER SYSTEMS (357) PUBLIC WATER SYSTEM (358) PRIVATE WATER SYSTEM (859) ONSITE SEWAGE TREATMENT & DISPOSAL (861) Group Total Facility Programs TATTOO FACILITY SERVICES (344) 0.00 0,43 0.55 3.26 4.79 0.00 30.32 0.00 4,200 1,854 123 242 97 18 8,483 15,017 195 6,571 3,794 40 352 1,970 2,400 15,322 631 672 1,205 5,034 8,011 136 3,240 547 140 798 101 0 18,334 31,341 34 51,456 366 4,716 7,478 0 108 438 0 216,941 5,884 1,147 5,704 294,272 565 18 1,684 2,267 52,085 129,518 7,384 0 134,176 5,434 18,552 43,546 0 86,396 0 33,080 505,171 7,594 269,987 49,245 10,768 203,336 0 1,749 6,905 0 80,251 340,073 73,936 217,006 1,260,850 6,773 1,762 60,616 69,151 44,632 110,987 6,327 0 114,979 4,657 11,613 37,815 0 74,0384 0 28,347 432,891 6,508 231,358 42,199 9,228 174,243 0 1,489 5,917 0 68,769 291,416 63,358 185,958 1,080,453 5,804 1,510 0 0 51,943 59,257 52,085 129,518 1,384 0 134,176 5,434 13,552 43,546 0 86,396 0 33,080 505,171 7,694 269,987 49,245 10,768 208,336 0 1,749 6,905 0 80,251 340,073 73,936 217,006 1,260,850 6,773 1,762 0 0 60,616 69,151 52,064 129,469 7,381 0 134,124 §,433 13,545 43,528 0 86,362 0 33,066 504,972 7,592 269,883 49,227 10,765 203,258 0 1,747 6,901 0 80,219 339,942 73,908 216,923 1,260,365 6,772 1,762 0 0 60,593 69,127 60,074 282,053 28,476 0 199,776 20,958 40,033 93,419 0 199,211 0 0 924,000 29,288 1,041,215 189,916 41,529 154,722 0 0 0 0 309,490 0 135,896 157,034 2,059,090 26,122 567 0 0 184,378 211,067 140,792 217,439 0 0 317,679 0 12,229 74,516 0 188,977 0 127,573 1,024,205 0 0 629,451 0 6,744 26,628 0 0 1,811,504 149,242 679,859 2,803,428 6,229 0 0 49,390 55,619 200,866 499,492 28,476 0 517,455 20,958 52,262 167,935 0 333,188 0 127,573 1,948,205 29,288 1,041,215 189,916 41,529 184,173 0 6,744 26,628 0 309,490 1,811,504 285,138 836,893 4,862,518 26,122 6,796 0 0 233,768 266,686 Page 1 of 2 FOOD HYGIENE (348) 1.45 122 526 24,153 20,697 24,153 24,143 73,054 20,092 93,146 BODY PIERCING FACILITIES SERVICES (349) 0.00 0 0 0 0 0 0 0 0 0 GROUP CARE FACILITY (351) 0.29 105 171 4,600 3,942 4,600 4,597 0 17,739 17,739 MIGRANT LABOR CAMP (852) 0.00 0 0 0 0 0 0 0 0 0 HOUSING & PUB, BLDG. (358) 0.00 0 0 0 0 0 0 0 0 0 MOBILE HOME AND PARK (354) 0.39 108 298 6,347 5,439 6,347 6,344 12,543 11,934 24,477 POOLS/BATHING PLACES (360) 2.50 404 1,316 38,191 32,727 38,191 38,177 76,068 71,218 147,286 BIOMEDICAL WASTE SERVICES (364) 0.00 0 0 0 0 0 0 0 0 0 TANNING FACILITY SERVICES (368) 0.06 14 33 1,049 899 1,049 1,049 2,609 1,437 4,046 Group Total 4.69 758 2,844 74,340 63,704 74,340 74,310 164,274 122,420 286,694 Groundwater Contamination STORAGE TANK COMPLIANCE SERVICES (355) 0.00 0 0 0 0 0 0 0 0 0 SUPER ACT SERVICES (356) 0.13 29 39 2,377 2,037 2,377 2,377 4,500 4,668 9,168 Group Total 0.13 28 39 2,377 2,037 2,377 2,377 4,500 4,668 9,168 Community Hygiene COMMUNITY ENVIR. HEALTH (845) 0.00 0 0 162 139 162 163 0 626 626 INJURY PREVENTION (846) 0.00 0 0 1,297 1,111 1,297 1,295 5,000 0 5,000 LEAD MONITORING SERVICES (350) 0.00 0 0 o 0 0 0 Q 0 0 PUBLIC SEWAGE (362) 0.00 0 0 0 0 0 0 0 0 0 SOLID WASTE DISPOSAL SERVICE (363) 0.00 0 0 0 0 0 0 0 0 0 SANITARY NUISANCE (365) 0.33 69 178 5,531 4,740 5,531 5,529 0 21,331 21,331 RABIES SURVEILLANCE (366) 1.97 520 1,306 31,227 26,759 31,227 31,214 0 120,427 120,427 ARBORVIRUS SURVEIL. (367) 0.00 0 0 0 0 0 0 a 0. 0 RODENT/ARTHROPOD CONTROL (368) 0.00 0 0 0 0 0 0 0 0 0 WATER POLLUTION (870) 0.00 0 0 0 0 0 0 0 0 0 INDOOR AIR (871) 0.00 0 0 0 0 0 0 0 0 0 RADIOLOGICAL HEALTH (372) 0.00 0 0 0 0 0 0 0 0 0 TOXIC SUBSTANCES (373) 0.00 0 0 0 0 0 0 0 0 0 Group Total 2.30 589 1,484 38,217 32,749 38,217 38,201 5,000 142,884 147,384 ENVIRONMENTAL HEALTH SUBTOTAL 11.10 2,576 6,134 184,085 157,747 184,085 184,015 384,841 325,091 708,932 D. NON-OPERATIONAL COSTS: SPECIAL CONTRACTS (599) 0.00 0 0 0 i) 0 0 0 0 0 ENVIRONMENTAL HEALTH SURCHARGE (399) 0.00 0 0 5,774 4,948 5,774 5,773 22,269 0 22,269 MEDICAID BUYBACK (611) 0.00 0 0 4,257 3,648 4,257 4,254 16,416 0 16,416 NON-OPERATIONAL COSTS SUBTOTAL 0.00 0 0 10,031 8,596 10,031 10,027 38,685 0 38,685 TOTAL CONTRACT 114,35 32,915 331,747 1,960,137 —-:1,679,687 1,960,137 1,959,879 3,406,616 4,152,724 7,559,340 Page 2 of 2 ATTACHMENT Ill OKALOOSA COUNTY HEALTH DEPARTMENT CIVIL RIGHTS CERTIFICATE The applicant provides this assurance in consideration of and for the purpose of obtaining federal grants, loans, contracts (except contracts of insurance or guaranty), property, discounts, or other federal financial assistance to programs or activities receiving or benefiting from federal financial assistance. The provider agrees to complete the Civil Rights Compliance Questionnaire, DH Forms 946 A and B (or the subsequent replacement if adopted during the contract period), if so requested by the department. The applicant assures that it will comply with: 1. Title VI of the Civil Rights Act of 1964, as amended, 42 U.S.C., 2000 Et seqg., which prohibits discrimination on the basis of race, color or national origin in programs and activities receiving or benefiting from federal financial assistance. Section 504 of the Rehabilitation Act of 1973, as amended, 29 U.S.C. 794, which prohibits discrimination on the basis of handicap in programs and activities receiving or benefiting from federal financial assistance. Title IX of the Education Amendments of 1972, as amended, 20 U.S.C. 1681 et seq., which prohibits discrimination on the basis of sex in education programs and activities receiving or benefiting from federal financial assistance. 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. 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. 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 IV OKALOOSA COUNTY HEALTH DEPARTMENT FACILITIES UTILIZED BY THE COUNTY HEALTH DEPARTMENT Facility Description Location Owned By Okaloosa CHD 221 Hospital Dr NE Okaloosa County Fort Walton Beach, Fl 32548 810 E. James Lee Blvd Okaloosa County Crestview, FL 32536