10/03/1978 AgreementAGREINEN I' FOR BAKLIZ ACT
MATCHING FUNDS
TIT I S AGREEMENT, Made this _ 3 day of October
1978, by and between the BOARD OF COUNTY COMMISSIONERS OF MONROE
COUNTY, FLORIDA, hereinafter referred to as "BOARD", and the - -
DADE-MONROE MENTAL IWALTII BOARD, INC., District XI, herei-nafter F
referred to as
For and in consideration of the mutual covenants made herein,
t
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 (IIRS 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 '36-&e-&-. during the period beginning
October 1, 1978, and ending September 30, 1979.
(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
normally available to the District and to make an annual report to
the Board on the expenditure of (:aunty funds for the above speci-
fied purposes.
This agreement sha11 terminae at 11:59 t
_ P•m,, September 30, --
1979, and the Board shall not be liable under the terms of this
agreement for arty liability incurred after the time of termination;
however, the Board shal_1 be liable fur Outstanding costs incurred
prior to the termination of this agreement provided the District
i
submits to the Board the reclu.ired Summary Record of Bills Paid
within three (3) weeks Of -the date Of termination of this a r � g Be-
ment, provided however th (W at the maximum p of reimbursement specified
above is nut 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
f
Health Board, Inc.
IN WITNESS WHERE01, 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 Commis
sioners,_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 �_
day of
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A
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BOARD OF COUNTY COMMISSIONERS
MONROE COUNTY, FLORIDA Attest:
By: VL B
Y(
Chairman e k/-
Board of County Commissioners
(SEAL)
w DADE-MONROE MENTAL HEALTH
BOARD, INC., DISTRICT XI
President
(SEAL)
By
e cSr t A�ar