We at Mentor Network are looking for master’s level clinicians that are interested in providing in home services to children and families. We were wondering if you would be able to post this in your department for graduate students to see.
All resumes may be submitted directly to me at this e-mail, in person or by mail to the address below, or faxed to the fax number listed below.
Thank you for your time and consideration in this matter.
Wendy Silva, LMHC
Ft Myers MENTOR
Supporting Individuals. Enhancing Lives. Strengthening Relationships
13420 Parker Commons Blvd, Ste 106
Fort Myers, FL 33912
Phone: (239) 466-2000 Ext 18
Fax: (239) 466-0640
This Consulting Agreement (“Agreement”) is made by and between Florida MENTOR (the “Company”) and ____________________________________________, a consultant retained by the Company as an independent contractor (“Consultant”).
The Company and Consultant agree as follows:
1. Term of the Agreement: This Agreement shall commence at 8:00 AM on ____________, 201__, and shall terminate at 5:00 PM on _______________, 201__, unless terminated earlier by either party, for any or no reason, upon thirty (30) days written notice.
2. Services to be Performed: Consultant agrees to perform those consulting services for the Florida MENTOR , Ft Myers Outpatient program, as may be requested by the Company. Exhibit “A” to this Agreement contains a description of the general services to be provided by Consultant to the Company under this Agreement. Consultant will at all times, and notwithstanding any term or provision of this Agreement, have complete and sole discretion for the manner in which the services provided under this Agreement will be performed. The Company will have the sole discretion to determine whether the work performed by Consultant is satisfactory to the Company and in compliance with the quality, safety and other standards established by the Company.
3. Qualifications of Consultant: Consultant represents that he/she has the qualifications and skills necessary to perform the services under this Agreement in a competent, professional manner, without the advice, direction, or supervision of the Company. Consultant will provide the Company with all documents requested by the Company to establish Consultant’s qualifications and appropriate credentials and licenses for the services to be performed under this Agreement. Exhibit “B” to this Agreement sets forth the specific education, certification, licensure and insurance requirements that Consultant must establish and maintain in order to provide the services requested by the Company under this Agreement.
4. Compensation: Consultant will be compensated for all consulting services requested by the Company and performed by Consultant at following rates: (See Exhibit A).
5. Status as Independent Contractor: Consultant is an independent contractor and not an employee or agent of the Company.
6. Control of Work: In the performance of its consulting services, Consultant at all times has exclusive control over the manner, method and details of all services performed by Consultant without supervision by the Company. Consultant will not direct, manage, supervise or control any employees of the Company.
7. Non-Exclusivity of Services: During the term of this Agreement, Consultant shall be free to perform consulting services for persons, businesses or governmental entities other than the Company; provided, however, that in no instance shall Consultant use or disclose any confidential information or trade secrets of the Company or its affiliates, clients or consumers other than in the performance of consulting services on behalf of the Company.
8. Taxes: Consistent with Consultant’s status as an independent contractor, the Company shall withhold no federal, state or local income, social security, Medicare, Medicaid, or other payroll taxes from compensation paid to Consultant under this Agreement. Consultant will obtain the necessary taxpayer identification number from the Internal Revenue Service (“IRS”) and provide that number to the Company. The Company will provide an IRS Form 1099 for amounts paid to the Consultant for services performed during the tax year. Consultant is at all times responsible for paying when due all federal, state and local income taxes, including estimated and self-employment taxes, incurred as a result of the compensation paid by the Company to Consultant for services under this Agreement. Consultant agrees to indemnify the Company for any claims, costs, losses, fees, penalties, interest, or damages suffered by the Company as a result of Consultant’s failure to comply with this provision.
9. Consultant Certification and Affirmative Obligations: The Consultant certifies that s/he is not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from transacting business by or with a Federal, state or local governmental department or agency. Throughout the term of this agreement, including any extensions or automatic renewals thereof, the Consultant shall immediately disclose to the Company his/her placement on the excluded individuals list maintained by the Office of Inspector General (“OIG”). Such disclosure shall be made by written notice in accordance with paragraph 16 of this agreement.
10. Benefits: By executing this Agreement, Consultant agrees that he/she is only entitled to that compensation as set forth in paragraph 4 of this Agreement, and no other payments, benefits, or other compensation of any kind, including worker’s compensation and unemployment insurance benefits.
11. Indemnification: Consultant shall indemnify, defend and hold harmless the Company, and all of its employees, officers, agents, and assigns, from any and all claims, demands, losses, costs, expenses, obligations, liabilities, damages, and deficiencies including interest, penalties, attorney’s fees, liquidated damages, and costs that the Company may incur as a result of any negligence, active or passive fault, or breach by Consultant.
12. Insurance: Consultant agrees to maintain, throughout the term of this Agreement, professional liability insurance in the amounts of One Million Dollars ($1,000,000) per occurrence and Three Million Dollars ($3,000,000) in the annual aggregate, and to provide evidence of such insurance to the Company upon request.
13. Assignments Prohibited: This Agreement is an agreement for personal services of Consultant who is an independent contractor as contemplated under the laws of the State of Florida and all applicable laws of the United States of America. Therefore, neither this Agreement, nor any right or obligation of Consultant may be transferred, assigned, or encumbered by Consultant without the Company’s prior written consent, which consent may be withheld for any or no reason. Any purported transfer, assignment or encumbrance without that consent will be void and of no force or effect.
14. Waiver: No delay or failure by either party to exercise any right under this Agreement, and no partial or single exercise of that right, will constitute a waiver of that or any other right, unless otherwise expressly provided herein.
15. Modification: No modification or waiver of any provision of this Agreement will be effective unless the same is in writing and signed by the parties and then such modification or waiver will be effective only in the specific instance and for the purpose for which it was given.
16. Notices: Any notice required to be given under the terms of this Agreement to a party will be in writing and sent via the United States Postal Service, postage prepaid, and addressed to the addresses under such party’s signature below.
17. Forum Selection, Venue, and Choice of Law: The parties expressly agree that the laws of the State of Florida will govern the validity, construction, interpretation, effect, and enforcement of this Agreement. Each party hereby irrevocably and unconditionally consents and submits to the personal jurisdiction of the state and Federal courts located in that state with respect to any action relative to this Agreement and the parties hereby waive any objection to personal jurisdiction of, venue at, and service of process of any of the aforementioned Federal or state courts.
18. Partial Invalidity: In case any one or more of the provisions contained in this Agreement should be invalid, illegal, or unenforceable in any respect, the validity, legality, and enforceability of the remaining provisions contained herein will not in any way be affected or impaired thereby.
19. Entire Agreement: This Agreement contains the entire understanding between the parties with respect to the subject matter hereof. There are no representations or promises other than those expressly set forth herein. The parties acknowledge that they are relying fully upon the contents of this Agreement and not upon any other promises, representations or warranties, expressed or implied, not contained herein concerning the subject matter hereof to induce them to execute this Agreement. The headings contained in this Agreement are for convenience only and are not intended to modify of affect the meaning of any provision of this Agreement.
The Company and Consultant agree that during the term of this Agreement, Consultant shall perform the following services for the Company and its clients:
Service: Your Pay (45% of Medicaid Rates)
Individual Therapy (Medicaid): $33.00/hr ($8.25/unit-15 min)
Individual Therapy (TBOS): $28.80/hr ($7.20/unit- 15 min)
Treatment Plans $43.65
Treatment Plan Reviews $21.83
Bio-Psychological (Licensed only) $21.60
Monthly Summaries $ 3.75 flat rate for first summary
Any pre-approved mandatory / staffing / trainings $ 15.00 hour
Supervision (first two months every week) $ 15.00 hour
After two months supervision will be scheduled only as needed
a. Obtain and file all required Florida MENTOR Consent forms signed by legal guardian
b. Provide face to face counseling of clients in home, school, or other appropriate locations
c. Maintain up to date files/records
d. Complete a Bio-psycho-social and Treatment Plan within thirty (30) days of admit
e. Complete Treatment Plan reviews a minimum of every ninety (90) days from signed Treatment Plan date
f. Complete progress notes following all face to face sessions with clients
g. Complete any required MENTOR documentation
h. Complete any required documentation for Authorizations for treatment
i. Complete a detailed invoice for payment listing all services rendered
j. Meet with CS Supervisor as scheduled
The following is a listing of the specific education, certification, licensure, insurance and other requirements that Consultant must establish and maintain in order to provide the services requested by the Company under this Agreement:
Minimum Master’s Degree from an accredited university or college with a major in Counseling, Social Work, Psychology, Rehabilitation, Special Education or a human services field. Minimum of two (2) years professional experience in providing services to persons with behavioral illness
For completion of Biopsychosocial assessments, you must have one of the current unrestricted Florida licenses: ARNP, MD, LFMT, LCSW, LMHC
See Paragraph 12 above. _________________________________________________________ ____________________________________________________________________________________________________________________________________________________________