To provide the H.P.C with a copy of its annual financial and compliance audit (this is a requirement only if the provider expends or obligates $500,000 or more in federal funds annually from all federal sources). To acknowledge the source of funding through this contract originates from CFDA #84.181 on the Provider Checklist (attachment 1). To provide evidence of workers compensation coverage or completed Workers Compensation Exemption Form (attachment 2) and return it with this contract. To utilize the U.S. Department of Homeland Security’s E-Verify system to verify the Employment eligibility of all persons employed during the contract term by the provider to perform employment duties within Florida, or to provide a completed United States Internal Revenue Service Form I-9 (Employment Eligibility Verification) attachment 4, for each new provider to H.P.C. who will verify employment eligibility using the E-verify system, within 3 days of receipt of the signed contract. To acknowledge receipt of their Vendor/Sub-recipient relationship under the DOH Early Steps contract on the Provider Checklist (attachment 1). To acknowledge review of the PHOG on the Provider Checklist (attachment 1). . This document delineates the delivery standards, procedures, and requirements for the State of Florida Early Steps Program. It is the Provider’s responsibility to read said Guidelines. To acknowledge review of the appropriate Medicaid provider handbooks on the Provider Checklist (attachment 1). A copy of the current provider Medicaid Early Intervention Services Handbook is housed at the Health Planning Council of Southwest Florida, 8961 Daniels Center Drive, Suite 401, Fort Myers, FL 33912 telephone 239-433-6700, and is available on-line at . It is the Provider’s responsibility to read said Guidelines. On request all Providers will make available to H.P.C. the documentation of completion of all (1) Mandatory State of Florida Early Steps Orientation Modules within Ninety (90) days after Modules have been offered by the State Program Office (2) Completion of annual HIPAA training, (3) the attendance of twelve (12) hours of early intervention related continuing education per year. To agree to carry with you your Medicaid Acceptance letter when on the premises of any licensed childcare center to comply with the Department of Children and Families (DCF) licensing regulations.
To provide the H.P.C with a copy of its annual financial and compliance audit (this is a requirement only if the provider expends or obligates $500,000 or more in federal funds annually from all federal sources). To acknowledge the source of funding through this contract originates from CFDA #84.181 on the Provider Checklist (attachment 1). To provide evidence of workers compensation coverage or completed Workers Compensation Exemption Form (attachment 2) and return it with this contract. To utilize the U.S. Department of Homeland Security’s E-Verify system to verify the Employment eligibility of all persons employed during the contract term by the provider to perform employment duties within Florida, or to provide a completed United States Internal Revenue Service Form I-9 (Employment Eligibility Verification) attachment 4, for each new provider to H.P.C. who will verify employment eligibility using the E-verify system, within 3 days of receipt of the signed contract. To acknowledge receipt of their Vendor/Sub-recipient relationship under the DOH Early Steps contract on the Provider Checklist (attachment 1). To acknowledge review of the PHOG on the Provider Checklist (attachment 1). . This document delineates the delivery standards, procedures, and requirements for the State of Florida Early Steps Program. It is the Provider’s responsibility to read said Guidelines. To acknowledge review of the appropriate Medicaid provider handbooks on the Provider Checklist (attachment 1). A copy of the current provider Medicaid Early Intervention Services Handbook is housed at the Health Planning Council of Southwest Florida, 8961 Daniels Center Drive, Suite 401, Fort Myers, FL 33912 telephone 239-433-6700, and is available on-line at . It is the Provider’s responsibility to read said Guidelines. On request all Providers will make available to H.P.C. the documentation of completion of all (1) Mandatory State of Florida Early Steps Orientation Modules within Ninety (90) days after Modules have been offered by the State Program Office (2) Completion of annual HIPAA training, (3) the attendance of twelve (12) hours of early intervention related continuing education per year. To agree to carry with you your Medicaid Acceptance letter when on the premises of any licensed childcare center to comply with the Department of Children and Families (DCF) licensing regulations.
2013-14_Provider_Contract.docx