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State of North Carolina Program ID 9: Division of Social Servi.ces Lead Agency: Contract Application Page 2 of 3 Fl. FiscaL Provisions I A. Method of Reimbursement 1.® Reimbursement will be made in accordance with the current budget approved by the Department and on file with both parties. The amount of reimbursement will be based on allowable expenditures made in behalf of eligible clients, determined in accordance with acceptable cost al-location methods. The Provider will report all expenditures made under the terms of the contract. 2.0 Reimbursement will be made at a unit cost rate of $ per unit of service delivered to eligible clients for an estimated number of units. The Provider will report the units of service delivered to eligible clients on a monthly basis; and will document total expenditures made under the terms of the contract to the Lead Agency within thirty days after the termination of this contract, or as instructed by the Lead Agency. Reimbursement which exceeds actual allowable cost will be adjusted to actual allowable cost. 3.0 Reimbursement will be made at a fixed rate of $ per unit of service de- livered to eligible clients for an estimated number of units, with reim- bursement based on the actual number of units of service delivered, whether over or under the estimated number of units. The Provider will report the units of .service delivered to eligible clients. The Provider will submit the reimbursement reports monthly in accordance with policy set forth in County Letter BSA-1-79 on Form DSS-1571 to the Department by the fifth working day of the month following the month in which the services were delivered. Reimbursement will be made to the Provider by the Department on a monthly basis. The unit of service is B. Limitations For Purchase Contracts only l.[] Reimbursement for the costs of services delivered to Title XX eligible clients may not exceed twice the total amount expended for categorically related Title XX clients 2.[] The Provider agrees to pay the Department/Division up to $ Monitoring Fee as payment in full for the administration of the contract. Reimbursement to the Provider will be reduced by 1.25 percent of the gross allowable cost each month. 3.[] The Provider agrees to pay the Department up to $ Certification Fee as payment in full for the determination and certification of client eligibility. Reimbursement will be reduced by 1.25 percent of the gross allowable cost each month. C. Fees for Service l.E]No fees will be charged to individuals determined to be eligible by the Department. 1.~ ibe Depl 'Linen nn the r'_ovider of _!mount of t:e i:ee _arged to to be ri: eligible cIi_ents an of any subsequent ch an~5es on Form HS-1360. No other fees may be c harged to ~ `i.e_nC. Fees will b- :epo_ted on corm DSS -..571. The Pr,.wider wiii esra'-sl±sh a -.)!an with th- cl_i_ent for collecting the fee on at 1~as. = eon;ll. he-i fees are p.i-, within eys of the d;_ , the nd send ;p: ,f _he bil n :ile )epartment_