06/09/1999 Agreement
REFERRAL AGREEMENT
This Referral Agreement, made this 6th day of April 1999, shall be in effect for the period of
May 30, 1999 to May 30, 2000 between Monroe County Board of County Commissioners/Monroe
County In-Home Services, the Case Management Agency, and HOME CARE MEDICAL
SERVICES, 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 d~bl~
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To maintain a climate of cooperation and consultation with and be~ 'M
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To participate together by means of shared information in the development of
services,
adults who are at risk of premature institutionalization,
I.
Objectives
1.
2,
3, To promote programs and activities designed to prevent premature
institutionalization of elders and disabled adults.
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
occur.
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 Based 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:
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.
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. Specialized Medical Equipment
V. Under this Agreement, the Case Management Agency is not bound to only refer to
the Service Provider Agency.
CASE MANAGEMENT AGENCY
HOME CARE MEDICAL SERVICES
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Anthony Cataldi
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Mayor
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ATTEST: DANNY L KOLHAGE CLERK
BY