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<br />PERFORMANCE MEASURES: <br /> <br />The following performance measures will be used to assess, in part, PERFORMING AGENCY'S <br />effectiveness in providing the services described in this contract Attachment, without waiving <br />the enforceability of any of the other terms of the contract. <br /> <br />PERFORMING AGENCY shall report on: <br /> <br />. Screening, referral and PHC eligibility services (PHC-200) <br />. Client intake - new and recertitied clients (PHC-200) <br />. Number ofPHC eligible clients receiving medical services (pHC-200) <br />. Clients served by month (PHC-200) <br />. Cost and type of services provided (PHC-200) <br />. Client demographic data (PHC-300) (annual) <br /> <br />ELIGIBILITY: <br /> <br />All individuals considered for PHC eligibility must be screened ani'determined eligible using a <br />TDH or PHC program approved screening tool as updated in the spring of each year when <br />federal poverty levels and eligibility determination forms are revised. <br /> <br />CO-PA Y: <br /> <br />PERFORl'vlING AGENCY may assess co-pay from clients provided services by RECEIVING <br />AGENCY under this Attaclunent. A co-pay assessment may not exceed 25% of the amount <br />RECEIVING AGENCY pays PERFORMING AGENCY for the provision of a given service. A <br />client shall not be denied services due to inability to pay. Local Health Departments shall <br />comply with RECEIVING AGENCY fee collection policies detailed in 25 TAC ~ 1.91. <br /> <br />PERFOR:L\1ING AGENCY shall make reasonable efforts to investigate and apply for all other <br />sources of third party funding available to or identified by the patient before submitting claims <br />for allowable costs to RECEIVING AGENCY Program. <br /> <br />PERFORMING AGENCY shall provide services to clients who live or who receive services in <br />the following county (ies)/area: Lamar. <br /> <br />SECTION II. SPECIAL PROVISIONS: <br /> <br />General Provisions, Reports Article, is revised to include the following: <br /> <br />PERFORMING AGENCY shall submit monthly reports within 30 days following the <br />end of the month. RECEIVING AGENCY Program requires comprehensive reports that <br />allow the Program to assess the volume and quality of services being provided. <br /> <br />A TT ACHMENT - Page 2 <br />