10/12/1976 AgreementAGREEMENT FOR BAKER ACT
MATCHING FUNDS
THIS AGREEMENT, Made this 12 day of
October
1976, by and between the BOARD OF COUNTY COMMISSIONERS OF MONROE
COUNTY, FLORIDA, hereinafter referred to as "Board", and FLORIDA KEYS
MENTAL HEALTH BOARD, INC., District #23, hereinafter referred to as
"District";
For and in consideration of the mutual covenants made herein,
the parties hereby agree as follows:
(1) The Board agrees to reimburse the District twenty-
five (25) per cent of total District expenditures for Baker Act hos-
pital and physician services, as billed to the District on state
approved Baker Act Billing Forms (DMH BA97) for clients qualifying
for such services under applicable state and federal regulations and
eligibility determination procedures and the Board also agrees to
reimburse the District one hundred (100) percent of total District
expenditures for transportation costs, incurred by eligible clients,
who are transported from the contracted Baker Act in -patient facili-
ties to South Florida State Hospital, as billed to the District on
the Transportation Billing Form MHDB-I-BA. This cost is not to exceed
a total reimbursement of $15,000.00 during the period beginning
October 1, 1976, and ending September 30, 1977.
(2) The District agrees to provide to the Board on a
regular basis a copy of the Summary Record of Bills Paid (DMH-BA-99a)
from which reimbursement due the District can be calculated; however,
copies of individual client bills will not be available for inspection
by the Board for reimbursement purposes in order to comply with regu-
lations safeguarding the patient's right to confidentiality. Copies
of individual client bills are kept on file in the District business
office and will be made available under controlled conditions to
qualified auditors for audit purposes. The District further agrees
to provide to the Board any Baker Act statistical data normally avail-
able to the District and to make an annual report to the Board on
the expenditure of County funds for the above specified purposes.
(6
-2-
This agreement shall terminate at 11:59 P.M., September 30,
1977, 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 sub-
mits to the Board the required Summary Record of Bills Paid within
three (3) weeks of the date of termination of this agreement, pro-
vided however that the maximum of reimbursement specified above is
not exceeded. This agreement may also be terminated by either party
upon thirty (30) days written notice delivered by certified mail to
the party receiving notice of termination.
County warrants or checks written for reimbursement to the
District shall be made payable to the Florida Keys 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 FLORIDA KEYS
MENTAL HEALTH BOARD, INC., District #23, has caused these presents to
be signed in its name by its President and Secretary of the Board,
all as of the 12 day of
Attest:
Clerk
Attest:
October
. A. D . 1976.
BOARD OF COUNTY COMMISSIONERS OF
MONROE gPUNTY, FLORIDA
By
girman, Board of County Com-
ssioners - Pro Tem
(Seal)
FLORIDA KEYS MENTAL HEALTH BOARD,
District 423
By
t
(Seal)
C.
SecretaryiV