01/12/1982 AgreementAGREEMENT FOR BAKER ACT
MATCHING FUNDS
THIS AGREEMENT, made this 12th day of January
1982, by and between the BOARD OF COUNTY COMMISSIONERS OF MONROE
COUNTY, FLORIDA, hereinafter referred to as "BOARD", and the DADE-
MONROE MENTAL HEALTH BOARD, INC., District XI, hereinafter refer-
red to as "DISTRICT",
For and in consideration of the mutual covenants made here-
in, the parties hereby agree as follows:
(1) The Board agrees to reimburse the District twenty-five
percent (25%) of total District expenditures for Baker Act hos-
pital, physician, and crisis stabilization services, as billed
to the District on state approved Baker Act Billing Forms (HRS 346)
for clients qualifying for such services under applicable state
and federal regulations and eligibility determination procedures.
This cost is not to exceed a total reimbursement of Thirty -Eight
Thousand Two Hundred Eighty Dollars ($38,280) during the period
beginning October 1, 1981 and ending September 30, 1982.
(2) The District agrees to provide to the Board on a
regular basis a copy of the Baker Act Summary Billing Form from
which reimbursement due the District can be calculated; however,
copies of individual client bills will not be available for in-
spections by the Board for reimbursement purposes in order to
comply with regulations safeguarding the patient's right to con-
fidentiality. Copies of individual client bills are kept on file
in the District's business office and will be made available under
controlled condition to qualified auditors for audit purposes.
The District further agrees to provide the Board any Baker Act
statistical data normally available to the District and to make an
annual report to the Board of the expenditure of County funds for
the above specified purposes.
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This agreement shall terminate at 11:59 P.M., September 30,
1982, and the Board shall not be liable under the terms of this
agreement for any liability incurred after the time of termination;
however, the Board shall be liable for outstanding costs incurred
prior to the termination of this agreement provided the District
submits to the Board the required Baker Act Summary Billing Form
within three (3) weeks of the date of termination of this agree-
ment, provided, however, that the maximum of reimbursement
specified above is not exceeded. This agreement may also be ter-
minated by either party upon thirty (30) days written notice de-
livered by certified mail to the party receiving notice of ter-
mination.
County warrants or checks written for reimbursement to the
District shall be made payable to the Dade -Monroe Mental Health
Board, Inc.
IN WITNESS WHEREOF, the BOARD OF COUNTY COMMISSIONERS OF
MONROE COUNTY, FLORIDA, has caused these presents to be signed
in its name by its Chairman, Board of County Commissioners, and
the Clerk of the Board of County Commissioners, and the Dade -
Monroe Mental Health Board, Inc., District XI, has caused these
presents to be signed in tis name by its President and Secretary
of the Board all as of the 17_+►, day of ZAyuo"y , 1982.
(SEAL)
Attest:
C e
(SEAL)
Att
:Secretary
BOARD OF COUNTY COMMISSIONERS
OF MONRO COUNTY, FLORIDA
By
ayo C airman
DADE-MONROE MENTAL HEALTH BOARD, INC.
District XI
Bye
President
APPf WV
At AttwnZW6
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