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02/10/1999 REFERRAL AGREEMENT This Referral Agreement, made this /D day of (=ci 199?, shall be in effect for the period of 12/1/98 to 11/31/99 between Monroe County Board of County Commissioners /Monroe County In -Home Services, the Case Management Agency, and STAFF BUILDERS, INC., the Service Provider Agency. The purpose of this agreement is to promote the development of a coordinated service delivery system to meet the needs of the aged or disabled ad is who aF ° v risk of premature institutionalization. t -� c)r, — O I. Objectives r c7 1. To maintain a climate of cooperation and consultation with and betwee agencies, in order to achieve maximum efficiency and effectivene�'s. to v 2. To participate together by means of shared information in the development of services. 3. To promote programs and activities designed to prevent premature institutionalization of elders and disabled adults. Cle 4. The parties of the Agreement will provide technical assistance and consultation to each other on matters pertaining to actual service delivery and share appropriate assessment information and care plans so duplication may not occu 5. Both parties of the Agreement may terminate upon no less than thirty days notice without cause; the Case Management Agency may terminate upon no less than twenty -four hours notice due to lack of funds; and unless waived by the Case Management Agency, the Agreement may be terminated for breach upon no less than twenty -four hour notice. All termination notices must be delivered by certified mail, return receipt requested, or in person with proof of delivery. II. Under this agreement, the Service Provider Agency agrees to the following: 1. To accept referrals for the Aged /Disabled Home and Community Bases Service (HCBS) Medicaid Waiver from only the Case Management Agency. • 2. To provide quality service(s) specified in Section IV for the waiver participant which is subject to quality monitoring and /or observation by the Case Management Agency. 3. To adequately and sufficiently furnish the appropriate staff to meet the needs of the waiver participant. Staffing requirements must be based on the amount and type of services provided to waiver recipients as authorized in their respective care plans, in accordance with the recipient service needs and documented in recipient assessments. 4. To provide services for HCBS /MW Clients in only the following geographical areas: All of Monroe County (Key Largo to Key West). 5. To provide services for HCBS /MW Clients at the rate of $See Section IV per hour. In addition, if the hourly rate changes, the Service Provider understands that it is the Service Provider's responsibility to inform (in writing) both the Medicaid Waiver Specialist and the Lead Agency. 6. To provide only those services specifically outlined in the Plan of Care or service authorization submitted by the Case Management Agency. 7. To bill Medicaid the usual and customary rate for each service. 8. To attach documentation regarding provider qualifications to this agreement; and to provide, as requested, any information regarding Medicaid Waiver billing, payment, or waiver participant information, to the Case Management Agency or Area Agency on Aging. Provider rate increases /decreases must be forwarded to the Case Management Agency and Area Agency on Aging along with justification for any increase. If additional services are added to this agreement, an amendment must prepared by the Case management Agency listing the service(s). The necessary documentation regarding provider qualifications for the additional services will be signed, attached to the agreement and forwarded to the Area Agency on Aging and the Case Management Agency. 9. To maintain the waiver participant's confidentiality. 10. To immediately report any changes in the waiver participant's condition to the Case Management Agency. 11. To maintain enrolled provider status by renewing applicable licensure, certification, contract, and /or referral agreements. 12. Each party agrees to indemnify the other against all claims, suits, judgments, or damages, including court costs and attorney's fees, arising out of the negligent or intentional acts or omissions of the opposite party, and its agents, subcontractors, and employees, in the course of the operation of this contract. 13. Nothing herein is intended to serve as a waiver of sovereign immunity by any provider to which sovereign immunity applies. Nothing herein shall be construed as consent by a state agency or subdivision of the State of Florida to be sued by third parties in any matter arising out of any contract. 14. Nothing herein shall be construed to extend any party's liability beyond that provided in section 768.28, Florida Statutes. 15. To accept referrals for and provide service to participants in all areas of Monroe County. III. Under this Agreement, the Case Management Agency agrees to the following: (11, 1. To provide the Service Provider Agency with any pertinent information and history on the referred waiver participant. 2. To provide the Service Provider Agency with a copy of the Plan of Care or a service authorization form specifically outlining the service(s) to be delivered. 41610 3. To be available to the Service Provider Agency for discussing the referred case. 4. To immediately report any changes in the waiver participant's condition to the Service Provider Agency. IV. Under the agreement, the following service will be delivered by the Service Provider Agency: 1. Companionship - $5.25 per Unit of Service 2. Homemaker - $4.50 per Unit of Service 3. Escort - $5.25 per Unit of Service 4. Personal Care - $5.00 per Unit of Service 5. Respite Care - $4.50 per Unit of Service 6. Counseling - $15.00 per Unit of Service 7. Physical (PT) Therapy - $10.00 per Unit of Service 8. Occupational (OT) Therapy - $10.00 per Unit of Service Coe 9. Speech Therapy - $10.00 per Unit of Service I S , \ 10. Caregiver Training /Support (Individual) Caregiver Training /Support Group - $2.00 ,,0.: - ,� per Unit of Service t \ \\\W ' Under this Agreement, the Case Management Agency is not bound to only refer to 1 �� the Service Provider Agency. if `' CASE MANAGEMENT AGENCY SERVICE PROVIDER AGENCY STAFF BUILDERS, INC. 1 1 • w A . A g 11 signature signature b G Gull At. /min a gsr ✓t 51( II � SG tis well print name print name • vu�/% � MAYOR C,I `'�`'"ti 1� < title title .,1 - /0- 99 °115 k7 date date Le APPROVED AS TO F +R / RpNiGQa to be Provided hereunder will AND L SUFFIC ' Y / �� 44 s t . )ndered by the Staff l Inc. wholly -owned subsidiary .. /. �/ ' NN U TON SANDRA J. PARSHALL � w ' 1.. DATE r 7 Senior Vice President 1 "9 local li nsed ent . National Health Care Operations 4 /\/ /\ / \ A,. / \ \ / \ -•/ / \/\ ,� - t 9 C) M �--• �G : 1 : Cr] N i .cg 0 c. E.v ~�C !:„.:_:: . ... ,:::. :7..:: y a r 0 ,,. ,., c .•._.y. 0 � ,.' „ . are = e / 91 eilli '''''‘■ . :; . - E. 1 1 0 EU- ._ i..:., .:.. 9 • t1 h ! � c o owy r ,• , _ A O a c y M"'� '° 6 ot • Pa te; wow �, z til > © .. . '. : ,<'. g 21 , emil ,Pb CV › tv pi . .. , . : ....•. 0..0 C) :.fr --..• .• '.. : i §1 till i 4 Ow ..., , � � ...-. 2 . • n : Z ,• . ,. . a cy P.1 r x B a, Z Cl oplk l'll -_ - . : y 1.� / • ....• 1 O. 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