Assurances and Agreement Sample Contracts

FHWA SUBRECIPIENT
Assurances and Agreement • September 19th, 2023

All recipients of federal funds must comply with Title VI of the Civil Rights Act of 1964 and other Nondiscrimination statutes that afford legal protections. The Wisconsin Department of Transportation (WisDOT) is a recipient of Federal Highway Administration (FHWA) financial assistance and committed to ensuring nondiscrimination in all WisDOT programs and activities as demonstrated in our signed assurances and Title VI Implementation Plan. Because WisDOT directly or indirectly extends FHWA funds to you, your organization is an FHWA Subrecipient that is required to provide the same Title VI commitment, assurances and plan.

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Practitioner AGREEMENT FORM
Assurances and Agreement • June 24th, 2016

The New York State Department of Health AIDS Institute has established five programs for HIV Uninsured Care (ADAP, ADAP Plus, the HIV Home Care Program, and the ADAP Plus Insurance Continuation Program). The mission of these programs is to provide access to medical services and care for all New York State residents with or at risk of acquiring HIV. The programs employ a dual approach to carry out their mission. First, the programs empower the individual to seek and access care by providing an "Enrollment Card", which allows the individual to choose a provider and receive care/drugs without cost. Second, the programs supply a stable and timely funding stream to health care providers, enabling them to use the revenues to develop program capacity to meet the needs of uninsured and underinsured HIV and HIV at risk populations.

NEW YORK STATE DEPARTMENT OF HEALTH
Assurances and Agreement • September 25th, 2007

To assist uninsured or underinsured persons with HIV, obtain necessary medical care and treatments, the AIDS Institute/New York State Department of Health has implemented a reimbursement pool that pays for ambulatory care services.

AGREEMENT FORM
Assurances and Agreement • August 10th, 2009

The New York State Department of Health, AIDS Institute, in cooperation with the HIV planning councils of New York City, Long Island, Lower Hudson Regions and Dutchess County has implemented a program to provide reimbursement to qualified primary care providers who provide services to uninsured persons with Human Immunodeficiency Virus (HIV).

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