07-L(1) Health Contract - Laserfiche WebLink

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PERFORMING AGENCY. RECEIVING AGENCY personnel may, from time to time, provide technical assistance and training to PERFORMING AGENCY. PERFORMING AGENCY shall cooperate with RECEIVING AGENCY staff to attain the goals of unified community health assessment, policy development, coordinated services, and quality assurance and to prevent unnecessary duplication of services. PERFORMANCE MEASURES The following performance measure(s) will be used to assess, in part, the PERFORMING AGENCY'S effectiveness in providing the services described in this contract Attachment, without waiving the enforceability of any of the other terms of the contract. At least 25% of the total amount of this Attachment shall be for services provided to Title V eligible individuals ages one (1) through twenty-one (21) by PERFORMING AGENCY. PERFORMING AGENCY shall provide services to clients who receive services in the following county(ies)/area: Lamar. SECTION II. SPECIAL PROVISIONS: General Provisions, Terms and Conditions of Payment Article; is revised to include: PERFORMING AGENCY'S contract amount under this Attachment is a ceiling against which it may bill, on a fee-for-service basis, for the provision of allowable services to Title V eligible clients. Only allowable services provided to Title V eligible clients may be billed against this ceiling. The current schedule of allowable services and rates, as well as Title V eligibility requirements, may be modified at the sole discretion of RECEIVING AGENCY with thirty (30) days written notice to PERFORMING AGENCY. The notice will provide PERFORMING AGENCY with an opportunity to terminate this Attachment should the modification include a reduction in rates. PERFORMING AGENCY shall have thirty (30) days from receipt of this notice to exercise the option for termination. If the PERFORMING AGENCY does not exercise the option during the thirty (30) day time period, PERFORMING AGENCY shali be deemed to have waived the option. A Request for "Advance or Reimbursement", Form 270 (TDH Form GC-10), is due no later than ninety (90) days after the end of the Attachment term. This report shall be marked "Final". BILLING REOUIREMENTS PERFORMING AGENCY shall bill RECEIVING AGENCY on a monthly basis for allowable services provided to Title V eligible clients. Bills for all allowable services shall be submitted as aggregate activity reports with a TDH Monthly Reimbursement Request and shall not refer to or identify individual clients. PERFORMING AGENCY shall bill within thirty (30) days after the end of the month which services were provided or within sixty (60) days in cases of potentially Medicaid eligible individuals who are ATTACHVIENT - Page 2