Backup Documents 11/18/2014 Item #16D 2 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 1 6 0 2
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office I 'flails D
1. Peggy Hager Community and Human "-t
Services
2. County Attorney Office County Attorney Office (3, 11120114-
3.
,12OI14-3. BCC Office Board of County `
Commissioners \l\Z,\\�z
4. Minutes and Records Clerk of Court's Office
On (24IL 313M
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the
addressees above,may need to contact staff for additional or missing information.
Name of Primary Staff Lisa Carr Phone Number 239-252-2339
Contact/ Department --
Agenda Date Item was November 18,2014 Agenda Item Number C1:6-.13-.4" j, p ZApproved by the BCC7)
Type of Document First Amendment to Agreement 12-5944 Number of Original 3
Attached Child Advocacy For Mandated Services Documents Attached
PO number or account n/a
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column, whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature? ORIGINAL LNC
2. Does the document need to be sent to another agency for additional signatures? If yes, / -L
N
C `` j
provide the Contact Information(Name; Agency;Address;Phone)on an attached sheet. /"
4
3. Original document has been signed/initialed for legal sufficiency. (All documents to be LNC
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's I,DI��/n
Office and all other parties except the BCC Chairman and the Clerk to the Board tC
5. The Chairman's signature line date has been entered as the date of BCC approval of the LNC Le-
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's LNC
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip LDie"—
should be provided to the County Attorney Office at the time the item is input into SIRE.
Some documents are time sensitive and require forwarding to Tallahassee within a certain !"/
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on 11/18/14 and all changes made during LNC
the meeting have been incorporated in the attached document. The County
Attorney's Office has reviewed the changes,if applicable.
9. Initials of attorney verifying that the attached document is the version approved by the N
BCC,all changes directed by the BCC have been made,and the document is ready for the
Chairman's signature.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
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MEMORANDUM
Date: November 24, 2014
To: Lisa Carr, Grants Coordinator
Housing, Human & Veteran Services
From: Teresa Cannon, Deputy Clerk
Minutes & Records Department
Re: First Amendment to the Agreement#12-5944 — Child Advocacy
for Mandated Services
Attached are two originals of the amendment document referenced above,
(Item #16D2) approved by the Board of County Commissioners on November 18, 2014.
The third original will be held in the Minutes and Record's Department for the
Board's Official Record.
If you have any questions, please feel free to contact me at 252-8411.
Thank you
Attachment
1602
FIRST AMENDMENT TO AGREEMENT 12-5944
CHILD ADVOCACY FOR MANDATED SERVICES
Fti be
r,Amendment, is entered into this , day of ��1c,\�'i f,)
i\ C'1'-, 2014, by and
between the Collier County Child Advocacy Council, Inc. d/b/a Children's Advocacy Center of Collier
County (hereinafter referred to as the "CCCAC") a not-for-profit Corporation, under agreement with the
State of Florida, Department of Children and Families, providing coordination of the Child Protection
Team of Collier County (hereinafter referred to as "CPT") authorized to do business in the State of
Florida and Collier County, Florida, herein after to be referred to as "COUNTY," collectively stated as
the"Parties."
WHEREAS, on September 25, 2012, the County entered into an agreement with CCCAC to
provide initial forensic physical examination and medical consultation services for allegedly abused and
neglected children who are residents of Collier County pursuant to Section 39.304(5), Florida Statutes or
conduct a medical records review in cases where such a review can serve in place of an initial forensic
physical examination(hereinafter referred to as the "Agreement"); and
WHEREAS, the Parties desire to amend the Agreement by modifying the language in paragraph
2, Scope of Work and paragraph 3, Compensation.
NOW, THEREFORE, in consideration of foregoing Recitals, and other good and valuable
consideration, the receipt and sufficiency of which is hereby mutually acknowledged, the Parties agree to
amend the Agreement as follows:
1. Amend paragraph 2, Scope of Work as follows:
SCOPE OF WORK: The CCCAC will provide the following services in accordance with
Florida Statute § 39.304(5),Attachment A:
A. Provide initial forensic physical medieal examination and medical consultation
mien services for abused or neglected children who are residents of Collier County pursuant
to Section § 39.304(5) Chapter 39, Florida Statutes, or conduct a medical records review in cases
where such a review can serve in place of an initial forensic physical examination.
B. Possess, maintain and keep current any and all necessary license(s) required by governmental
authorities.
C. Maintain adequate fiscal accounting procedures in accordance with generally accepted
accounting principles auditing standards. Maintain all financial records, documentation, and
reports relating to funds paid under this Agreement.
D. Maintain books, records, documents and other evidence and accounting procedures and
practices that fully and properly reflect all direct costs of any nature expended in the performance
of the Agreement.
First Amendment to Agreement 12-5944 Child Advocacy for Mandated Services
Collier County Child Advocacy Council, Inc. Inc.d/b/a
Children's Advocacy Center of Collier County
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D€. Allow inspection, review or audit of these records by County personnel upon reasonable
notice, subject to the confidentiality requirements of Chapter 39, Florida Statutes. CCCAC will
provide the County with the privacy, security and audit protocol agreement forms from the
Department of Health (DH) and the Department of Children and Families (DCF) and the County
will execute said forms.
EF. Retain all books, records and other documents relative to this Agreement for three (3) years
after final payment.
G. CCCAC shall receive reimbursement for those medical services pursuant to Section
39.304(5), Florida Statutes in accordance with Paragraph 3, Compensation, of this Agreement.
Section 39.304(5), Florida Statutes. Reimbursement shall only be sought for those services
authorized pursuant to Section 39.304, Florida Statutes and shall not be sought for an initial
forensic examination. The CCCAC shall also provide a copy of said notice to Collier County
with certification by the case coordinator that said notice was given. The copy provided to
Collier County shall have all confidential information redacted from the copy provided to Collier
County. When circumstances do not permit the CCCAC to give said notice to the parents, legal
guardian or legal custodian, CCCAC shall send, by regula _. . • .' , .- •. ' - •_ .. -. ,
legal guardian or legal custodian.
1. Circumstances which would be deemed to not permit the CCCAC to give said notice include
those instances when a parent, legal guardian or 1 egal custodian is not present, or when
personnel and the parents, legal guardian or legal custodian.
giving said notice to the parents, legal guardian or legal custodian. When CCCAC sends the
notice to the parents, legal guardian or legal custodian by regular U.S. Mail, CCCAC shall
provide a copy of said notice to Collier County with a certification by the case coordinator
that states such notice was mailed. The copy provided to Collier County shall have all
confidential information redacted from the copy provided to Collier County.
3. Families with medical insurance will be afforded the opportunity to file a claim with their
insurance company through receipt of a statement of expenses that will be provided by the
CCCAC. These families will be expected to submit all insurance payments they receive to the
County for reimbursement of related medical expenses.
OH. The CCCAC shall pay from its own account for the initial forensic physical medical
examination and medical consultation costs to the providers of medical diagnosis and evaluation
services for each child abuse or neglect case and seek reimbursement from the County in
accordance with the Compensation section of this agreement. There shall be a monthly invoice
which shall reference a CPT case number for each examination and evaluation, and which shall
provide an indication of whether each case is Medicaid eligible, denied, or pending Medicaid
eligibility determination.
I-IT. The CCCAC shall maintain Medicaid provider status from Florida Department of Health
(DOH) and shall bill Medicaid for all investigation costs of the initial forensic physical medical
First Amendment to Agreement 12-5944 Child Advocacy for Mandated Services
Collier County Child Advocacy Council, Inc. Inc.d/b/a
Children's Advocacy Center of Collier County
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examination and medical consultation evaluation services for each Medicaid eligible child abuse
or neglect case. The County shall not be required to pay for any costs for the initial forensic
physical medical examination and medical consultation evaluation in Medicaid eligible cases.
The CCCAC shall obtain from Medicaid a denial form for all cases found not to be Medicaid
eligible, and shall submit same to the County at the time of billing_ pursuant to paragraph H,
above. Each denial form shall refer to a case number that corresponds to the number on the initial
forensic physical medical examination and/or medical consultation invoice.
J. The CCCAC shall also use its best efforts to seek reimbursement from appropriate state
agencies for all sexual abuse examinations billed during the term of this Agreement. If payment is
denied by said agencies, the CCCAC shall obtain from said state agencies a denial notification,
which shall also refer to a case number that corresponds to the number on the examination
invoice and promptly provide it to the County.
IK. Before execution of this Agreement, the CCCAC shall furnish the County with copies of its
current contracts between the CPT and its medical provider(s), and copies of its contracts with
DCF relating to the CPT. Any amendments or new agreements executed during the term of this
agreement between CPT and its medical provider(s) or DCF shall be immediately forwarded to
the County.
Jb. The CCCAC shall act as an independent entity and not as an agent of the County in operating
the aforementioned service.
2. Amend paragraph 3, Compensation as follows:
COMPENSATION. The County shall reimburse the CPT at the fixed rate of three hundred fifty
dollars ($350.00) per examination for initial forensic physical medical examination and
administrative costs. evaluation, plus actual x ray and laboratory costs incurred in all non
Medicaid eligible cases. The County shall also reimburse the CPT at the fixed rate of one hundred
twenty five dollars ($125.00) for a medical consultation, where such a medical consultation can
serve in place of an initial forensic physical examination;, Hhowever, the County shall in no
instance be required to pay for both an initial forensic physical examination and a medical
consultation. A medical consultation may be provided when a medical physical evaluation has
already been performed by a non-CPT medical provider. A medical consultation involves
situations where the child protective investigator(or court) requests CPT to assist with a medical
opinion. A medical consultation must result in a typed report that references all the pertinent
history, examination findings and laboratory/imaging studies used to reach the medical
conclusions. The CPT medical record must include copies of the relevant records and reports
used to arrive at the medical opinion.
3.1 Medicaid is primary payer on all non Crimes Victim's Services initial forensic physical
examinations or medical consultations. The Medicaid portal is to be used to document Medicaid
eligibility. If a child is denied or found not to have Medicaid via the Medicaid portal, the denial
or ineligible finding is to be printed and presented with the invoice to the County. If any non
Medicaid eligible case involves sexual abuse, the CCCAC shall seek payment from appropriate
state agencies prior to seeking reimbursement from the County. If appropriate state agencies do
not pay for sexual abuse examinations within thirty (30) days from the submission of the invoice
First Amendment to Agreement 12-5944 Child Advocacy for Mandated Services
Collier County Child Advocacy Council, Inc. Inc.d/b/a
Children's Advocacy Center of Collier County
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to that agency by the CCCAC, then CCCAC shall invoice the County, and said invoices shall be
paid by the County in accordance with Chapter 218, Florida Statutes, also known as the "Local
Government Prompt Payment Act" after receipt of a written request for reimbursement and a
copy of statement(s) provided the County pursuant to the provisions of Section 2, Paragraph H&
I-above.
3.2 Crimes Victim's Services is to be billed for all situations covered under 2011 Florida Statutes
§ 960.28, see Attachment B. If denied, the invoice will include documentation of denial. The
County will be billed at the time denial is received by CCCAC. If reimbursement from Crimes
Victim's Services State agencies is received by the CCCAC at any time after the County has paid
CPT invoices, CCCAC shall then reimburse the County for any Crimes Victim's Services state
agency monies se received. Said reimbursement shall reference the case number for which the
reimbursement is being provided.
3.3 There shall be a monthly invoice which shall reference an invoice number, invoice date, a
CPT case number for each initial forensic physical examination and/or medical consultation.
will also incur similar additional expenses in seeking reimbursement in sexual abuse cases.
Because the County will benefit from these expenses incurred by CPT to obtain Medicaid
payment or reimbursement from Crime Victims' Services, County agrees to pay the sum of fifty
dollars ($50.00) to CPT for reimbursement of CPT's administrative costs in each Medicaid
eligible case and ach sexual abuse case for which Crime Victims' Services reimbursement is
obtained, if authorized by Medicaid or Crime Victims' Services.
3.4 County shall Reimburse CCCAC for postage charges for statements sent to parents, guardians
or legal custodians pursuant to the provisions of Section 2, Paragraph G, above.
3.45- Monthly payments will be made upon receipt of a proper invoice and in compliance with
Chapter 218 Florida Statutes, otherwise known as the "Local Government Prompt Payment Act."
Collier County reserves the right to withhold and/or reduce an appropriate amount of any
payments for work not performed or for unsatisfactory performance of CCCAC requirements.
The County shall pay the CCCAC for the performance of this Agreement.
3.56- Payments will be made for services furnished, delivered, and accepted, upon receipt and
approval of invoices submitted on the date of services or within six (6) months after completion
of contract. Any untimely submission of invoices beyond the specified deadline period is subject
to non-payment under the legal doctrine of"laches" as untimely submitted. Time shall be deemed
of the essence with respect to the timely submission of invoices under this agreement.
3. Add Attachment A, Florida Statute § 39.304(5)
4. Add Attachment B, Florida Statute § 960.28
5. All other terms and conditions of the Agreement remain in full force and effect. This
Amendment merges any prior written and oral understanding and agreements, if any, between the
parties with respect to the matters set forth herein.
First Amendment to Agreement 12-5944 Child Advocacy for Mandated Services
Collier County Child Advocacy Council, Inc. Inc. d/b/a
Children's Advocacy Center of Collier County
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6.
IN WITNESS WHEREOF,the Parties have executed this Amendment, on the date and year first above
written.
COLLIER COUNTY CHILD ADVOCACY BOARD OF COUNTY COMMISSIONERS
COUNCIL, INC. OF COLL,`R COU0' Y,FLORIDA
By:
An I i`
oracqueliriffith Stephens, M.A •M HENNING, CHAI�r AN
/6 / y I\o\)eM.tfae r I , X 14
Date Date
ATTEST: Approved for form and legality:
DWIGHT E. BROCK,CLERK
Jennifer A. Belped' `OC
Assistant County Attorney �
Attest as to Chairman'Z.2 .)*L.4 jr,_1/4.' , ..elo6i.itaiii. cS _______ 4:: '
DEPUTY CLERK
sinn'?t wwe only.
1,trn#... I (0D
' Agenda 1 1 ii gip/
Dato
First Amendment to Agreement 12-5944 Child Advocacy for Mandated Services
Collier County Child Advocacy Council, Inc. Inc.d/b/a ' F .c 11 dj t w
Children's Advocacy Center of Collier County
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ATTACHMENT A
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Florida Statute § 39.304(5)
(5) The county in which the child is a resident shall bear the initial costs of the examination of
the allegedly abused, abandoned, or neglected child; however, the parents or legal custodian of
the child shall be required to reimburse the county for the costs of such examination, other than
an initial forensic physical examination as provided in s. 960.28, and to reimburse the
department for the cost of the photographs taken pursuant to this section. A medical provider
may not bill a child victim, directly or indirectly, for the cost of an initial forensic physical
examination.
First Amendment to Agreement 12-5944 Child Advocacy for Mandated Services
Collier County Child Advocacy Council, Inc. Inc.d/b/a
Children's Advocacy Center of Collier County
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ATTACHMENT B
Florida Statute § 960.28 Payment for victims' initial forensic physical examinations.
(1) A medical provider who performs an initial forensic physical examination may not bill a
victim or the victim's parent or guardian if the victim is a minor directly or indirectly for that
examination.
(2) The Crime Victims' Services Office of the department shall pay for medical expenses
connected with an initial forensic physical examination of a victim of sexual battery as defined in
chapter 794 or a lewd or lascivious offense as defined in chapter 800. Such payment shall be
made regardless of whether the victim is covered by health or disability insurance and whether
the victim participates in the criminal justice system or cooperates with law enforcement. The
payment shall be made only out of moneys allocated to the Crime Victims' Services Office for
the purposes of this section, and the payment may not exceed $500 with respect to any violation.
The department shall develop and maintain separate protocols for the initial forensic physical
examination of adults and children. Payment under this section is limited to medical expenses
connected with the initial forensic physical examination, and payment may be made to a medical
provider using an examiner qualified under part I of chapter 464, excluding s. 464.003(16);
chapter 458; or chapter 459. Payment made to the medical provider by the department shall be
considered by the provider as payment in full for the initial forensic physical examination
associated with the collection of evidence. The victim may not be required to pay, directly or
indirectly, the cost of an initial forensic physical examination performed in accordance with this
section.
(3) The department may allow, deny, controvert, or litigate claims made against it under this
section.
(4) Information received or maintained by the department identifying an alleged victim who
seeks payment of medical expenses under this section is confidential and exempt from the
provisions of s. 119.07(1).
(5) A defendant or juvenile offender who pleads guilty or nolo contendere to, or is convicted
of or adjudicated delinquent for, a violation of chapter 794 or chapter 800 shall be ordered by the
court to make restitution to the Crimes Compensation Trust Fund in an amount equal to the
compensation paid to the medical provider by the Crime Victims' Services Office for the cost of
the initial forensic physical examination. The order may be enforced by the department in the
same manner as a judgment in a civil action.
First Amendment to Agreement 12-5944 Child Advocacy for Mandated Services
Collier County Child Advocacy Council, Inc. Inc. d/b/a
Children's Advocacy Center of Collier County
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