10/23/1979 AgreementAGREEMENT FOR BAKER ACT
MATCHING FUNDS
THIS AGREEMENT, Made this 23rd day of October
1979, by and between the BOARD OF COUNTY COMMISSIONERS OF
MONROE COUNTY, FLORIDA, hereinfater 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 per cent (250) 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 pro-
cedures. This cost is not to exceed a total reimbursement
of Thirty Thousand Dollars ($30,000.00) during the period
beginning October 1, 1979 and ending September 30, 1980.
(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 reimburse-
ment pruposes in order to comply with regulations safe-
guarding the patient's right to confidentiality. Copies of
individual client bills are kept on file in the District's
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 normally available to the District and to
make an annual report to the Board on the expenditure of
County funds for the above specified purposes.
Page 1 of 2 Pages
This agreement shall terminate at 11:59 p.m., September 30,
19BO, and the Board shall not be liable under the terms of this
agreement for any liability incurred after the time of termina-
tion; 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
agreement, 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 termi-
nation.
County warrants or check 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 23rd day of October , 1979.
Atts`�
lerk
Attest:
Clerk
BOARD OF C UNTY COMMISSIONERS OF
MONROE C TY, RIDA
By
C airman
(Seal)
DADE-MONROE MENTAL HEALTH BOARD, INC.,
Di XI
By 4
Press ent
APPROVED AS TO FORM
AND tf�, fAt SUFttC Y.
ArrornWs Office
(Seal)
Page 2 of 2 Pages