10/30/1980 AgreementAGREEMENT 1,107, DAI,LR ACT
MATr'11-11NG FUNDS
THIS AGREEMENT, Made this 30th day of October, 1980, 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 per cent (250) of total District expenditures for Baker
Act hospital, 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 pro-
cedures. This cost is not to exceed a total reimbursement of
Thirty Thousand Dollars ($30,000.00) during the period beginning
October 1, 1980 and ending September 30, 1981.
(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 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'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.
This agreement shall terminate at 11:59 p.m., September 30,
1981, an' 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
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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
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 30th day of October , 1980.
Attest:
G
erk
Attest:
BOARD OF COUNTY COMMISSIONERS OF
MONROE COUNTY, FLORIDA
(4— ;.>,P"
Chairman
(Seal)
DADE-MONROE MENTAL HEALTH BOARD, INC.
Di ct XI
By i �eA�
President
(Seal)
APPROVED AS TO FORM
Secretary AIMDto" SUycF/CIEIVCY.
BY
A�ey'� ONice
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