11/15/1977 AgreementAGREEMENT FOR BAKER ACT
MATCHING FUNDS
THIS AGREEMENT, Made this 15th day of November
1977, 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
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 hospital
and physician 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 $15,000.00 during the period beginning
October 11, 1977, and ending September 30, 1978.
(2) The District agrees to provide to the Board on a regular
basis a copy of the Summary Record of Bills Paid (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
regulations 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 the Board any Baker Act statistical data
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normally available to the District and to make an annual report to
the Board on the expenditure of County funds for the above speci-
fied purposes.
This agreement shall terminate at 11:59 p.m., September 30,
1978, 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 Summary Record of Bills Paid
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 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 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 its name by its President and Secretary of the
Board, all as of the 15th day of November A.D. 1977.
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BOARD OF COUNTY COMMISSIONERS
MONROE COUNTY, FLORIDA
By:4hairmall
-
Board of County Commissioners
(SEAL)
DADE-MONROE MENTAL HEALTH
BOARD, INC., DISTRICT XI
By�
President
(SEAL)
Attest:
C1
Attest:
F
eer tary
HEREBY CERTIFY that this document
has been reviewed for le a! suffi-
ciency and that the same meents with
my approval.
By
Attorney's Office