Okaloosa County BOCC — August 5, 2014 — FWBMC Baker Act CSU MOA (FY 2015) — reading text

MEMORANDUM OF AGREEMENT Florida Mental Health (Baker Act) Emergency Services for Intervention, Assessment and Stabilization Treatment Services for Okaloosa County with Fort Walton Beach Medical Center This agreement (“Agreement”) is entered into on this day of 2014, by and between Fort Walton Beach Medical Center, hereinafter referred to as “Provider”, and Okaloosa County, hereinafter referred to as “Contractor” or “County.” For and in consideration of the mutual undertaking, agreements and annual funding set forth in Exhibit A attached hereto, the Provider and Contractor agree as follows: |. The Provider agrees: a. To determine eligibility for individuals seeking emergency stabilization services brought to the attention of Fort Walton Beach Medical Center which are reimbursable under the Florida Mental Health Act (Baker Act) (hereinafter, “Client” or “Clients”). To provide crisis stabilization services of Clients in the Crisis Stabilization Unit (CSU) at Fort Walton Beach Medical Center and determine eligibility for appropriate admissions for Okaloosa County residents. To provide services to Clients to receive reimbursement pursuant to this agreement; to ensure compliance with all the applicable administrative rules and regulations of the Department of Children and Families (hereinafter called “Department”). To inform all Clients as to their eligibility status and their rights to a fair hearing regarding their eligibility pursuant to Department regulations. To encourage Clients to contribute toward the cost of their care. To comply with all provisions of the Florida Mental Health Act (Baker Act), Chapter 394, Part 1, Florida Statutes, Florida Administrative Codes, 65E-2, 65E-5, 65E-12, 65E- 13 and 65E-14, and Department rules and regulations, guidelines, and instructions for compensation for provision of services. To provide services in the same manner and with the same availability as services are rendered to other patients of Provider. Provider shail not discriminate against any Client in the provision of services hereunder, whether on the basis of the Client's age, gender, race, color, religion, origin, sexual orientation, disability, health status, source of payment, utilization of medical or mental health services or supplies or other unlawful basis including, without limitation, the existence of a grievance by the Client against Provider. Provider agrees to provide medical services to Clients in accordance with the prevailing practices and standards of the profession and the community. h. To comply with Florida pharmaceutical rules and regulations as specified in Chapter 465, Florida Statutes. i. To comply with all Departmental licensing standards, applicable accrediting standards and Agency for Health Care Administration (AHCA) standards and criteria established by the Department and made known to the Provider. j. To submit an invoice within ten (10) business days of the beginning of each month for that month’s service provision. The invoice submitted each month shall be equal to one twelfth (1/12) of the agreed upon contract amount for Provider’s services set forth in Exhibit A. To submit a monthly Client census report within fifteen (15) business days of the Provider’s financial month end close procedure. To submit a quarter Client census report within fifteen (15) business days of the end of each quarter. The contents of the Client census reports will be agreed upon between Ernie Padgett, County Administrator for Okaloosa County, or his designee, and Mitch Mongell, Chief Executive Officer, Fort Walton Beach Medical Center, or his designee. The invoice and reports will be submitted to the address in Notice, Section 4 of this Agreement. k. To retain all financial records, supporting documents, statistical records, client records and any other documents pertinent to this agreement for a period of five years after final payment, or if an audit has been initiated during the period and the findings have not been resolved at the end of the five years, the records shall be retained until resolution of the audit findings. 1. Not to transfer its responsibility under this agreement. m. To maintain one (1) million/three (3) million liability insurance coverage at all times during the life of this agreement and provide a copy to the County Purchasing Department for file. n. To act as an independent contractor and not as an employee of the County and to hold the County harmless from al! claims, suites, judgments or damages arising from the Provider’s negligent acts during the operation of this agreement. o. To be liable for and indemnify, defend, and hold the County harmless from all claims, suits, judgments or damages arising from the Provider’s negligent acts during the operation of this agreement. 2. The Contractor agrees: a. To submit payment to Provider at the address in Section 4 within thirty (30) days after receipt of monthly billings from the Provider. 2 b. To consider requests from Provider for adjustment to reimbursement for services submitted by April 1 of each year. All adjustments will be subject to Board of Commissioners approval. To act as an independent entity and not as an employer of the Provider and to hold the Provider harmless from all claims, suits, judgments or damages arising from the County’s negligent acts during the operation of this agreement to the extent of the waiver of sovereign immunity specified in Section 768.28(5), Florida Statutes. To be liable for and indemnify, defend, and hold the Provider harmless from all claims, suits judgments or damages arising from the County’s negligent acts during the operation of this agreement to the extent of the waiver of sovereign immunity specified in Section 768.28(5), Florida Statutes. 3, The Contractor and Provider mutually agree that: a. Except as provided in Section 3.(d)., this agreement shall become effective on October 1, 2014, and shall continue in effect indefinitely unless changes are required by state statute. Exhibit A (Budget) will be replaced annually with current and mutually approved budget figures. Any alterations, variations, modifications, or waivers of provisions of this agreement shall only be valid when they have been reduced to writing, duly signed by both the Provider and the Contractor and attached to this agreement. Services provided under the terms of this agreement apply only to eligible clients who reside in Okaloosa County. This agreement, or part of this agreement, may be terminated by either party, at any time, with or without cause, upon no less than ninety (90) days notice, in writing to the other party. Said notice shall be delivered in accordance with Section 4. This agreement contains all terms and conditions agreed upon by the parties. No other agreement, or otherwise, regarding the subject matter of this agreement shall be deemed to exist or to bind any of the parties hereto. 4. Notice: When any notice, demand or request is required or permitted hereunder, that notice, demand or request shall be either hand-delivered or sent by United States Mail, registered or certified, postage prepaid, or delivered via overnight courier to the addresses below or to any other address that either party may specify by notice to the other party. Notice of a change of address shall be effective when received by the other party. A notice shall be deemed received upon hand delivery, three days after posting in United States Mail or one day after dispatch by overnight courier. To County: Dino J. Villani, Director Okaloosa County Public Safety 90 College Boulevard East Niceville, FL 32578 To Provider: Fort Walton Beach Medical Center Attn: Mitch Mongel!, CEO 1000 Mar-Walt Drive Ft. Walton Beach, FL 32547 ATTEST/WITNESS: FORT WALTON BEACH MEDICAL CENTER / ‘ — By: MOM ‘Witness Signature ‘ Mitch Mongell, Chief Executive Officer JerPay Ss A foore, Cve Date: Hiclry ATTEST: OKALOOSA COUNTY by and through its BOARD OF COUNTY COMMISSIONERS By: By: Gary Stanford Charles K. Windes, Jr., Chairman Deputy Clerk of Circuit Court MEMORANDUM OF AGREEMENT Florida Mental Health (Baker Act) Emergency Services for Intervention, Assessment and Stabilization Treatment Services for Okaloosa County with Fort Walton Beach Medical Center EXHIBIT ‘A’ Public Safety Emergency Services for: FY 2015 Stabilization Services for Okaloosa County Current funding not to exceed: $266,738.04 Baker Act In-Patient Services: For Crisis Stabilization Unit (CSU) to ensure Public Safety $266,738.04 SUBTOTAL $266,738.04 TOTAL ANNUAL BOARD OF COUNTY COMMISSIONER $266,738.04 FUNDS 3.1 Match from State of Florida