Item C15 BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: 9-18-2013 Division:—County Administrator.
Bulk Item: Yes _X_ No Department: Social Services/-TrN 44rn<-
Staff Contact Person/Phone#: Sheryl Graham/X45 10
AGENDA ITEM WORDING: Aged and Disabled Adult Medicaid Waiver(ADA-MW) Referral
Agreement between the Alliance for Aging Inc. and the Monroe County Board of County
Commissioners(Social Services/In-Home, Services)for Case Management
ITEM BACKGROUND: Approval of the of the Aged and Disabled Adult M/W Referral Agreement
will enable Monroe County In-Home Services to continue providing Case Management services to
Monroe County's elderly population under the Aging and Disabled(ADA) Medicaid Waiver program.
PREVIOUS RELEVANT BOCC ACTION: Prior approval granted to Aged and Disabled Adult
Medicaid Waiver Referral Agreement on April 19,2006.
CONTRACT/AGREEMENT CHANGES: none
STAFF RECOMMENDATIONS: Approval
TOTAL COST: approx.. $45,000.00 INDIRECT COST: _-0--BUDGETED: Yes X No
COST TO COUNTY: $-0- SOURCE OF FUNDS:
REVENUE PRODUCING: Yes No X AMOUNT PER MONTH Year
APPROVED BY: County A,; t MMB/Purchg�ing X Risk Management!7
DOCUMENTATION: Included X Not Required
DISPOSITION: AGENDA ITEM#
Revised 1/09
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
CONTRACT SUMMARY
Contract with: Alliance for Aging, Inc. Contract
Effective Date: September 18,2013
Expiration Date: June 30,2014
Contract Purpose/Description: Approval of the Renewal of the Aged and Disabled Adult Medicaid Waiver
(ADA-MW)Referral Agreement between the Alliance for Aging,Inc. and the Monroe County Board of County
Commissioners(Social Services/In-Home Services)for Case Management
Contract Manager: Sheryl Graham 4510 Social Services/Stop 1
(Name) (Ext.) (Department/Stop#)
For BOCC meeting on 9/18/2013 Agenda Deadline: 9/3/2013
CONTRACT COSTS
Total Dollar Value of Contract: Approx. $45,000.00 Current Year Portion: $
Budgeted?Yes X No 0 Account Codes: J - -
Grant: Approx. $45,000.00(Fiscal
Year)
County Match: $-0-
ADDITIONAL COSTS
Estimated Ongoing Costs: $ /yr For:
(Not included in dollar value above) {e .Maintenance,utilities,janitorial,salaries,etc)
CONTRACT REVIEW
Changes Date Out
Date In Needed evi
Division Director Yes 0 No 0
Risk Management yes❑ No
O.M.B./Purchaging Yes❑ No _
County Attorney Yes❑ Now
Comments:
OMB Form Revised 2/27/01 MCP#2
HOME AND COMMUNITY BASED SERVICES AUG 0 9 3
AGED ANC? DISABLED ADULT(ADA) MEDICAID WAIVER
y__A?4�_�
CASE'MANAGEMENT REFERRAL'AGREEMENT B
This Referral Agreement between the Alliance for Aging. Inc., the area agency on aging (AAA) for
planning and service area (PSA) 11 and _Monroe County In-Home
Services , a case management agency, shall begin on January 1, 2013 or on
the date the agreement has been signed by both parties, whichever is later. This referral agreement is in
effect for a period of time that is equal to the Medicaid waiver provider's enrollment period with the State
of Florida's Medicaid fiscal agent and is contingent upon an annual appropriation by the Legislature. The
purpose of this agreement is to enable eligible elderly participants to receive case management services
from qualified providers with oversight of the quality of care by the Medicaid Waiver Specialist employed
by the AAA. These services are authorized in order that the participant may remain in the least
restrictive setting and avoid or delay premature nursing home placement. Services and care are to be
furnished in a way that fosters the independence of each participant to facilitate aging in place. All
parties agree that routines of care provision and service delivery must be consumer-driven to the
maximum extent possible. All parties agree to and will treat each participant with dignity and respect.
1. Objectives
A. To maintain a climate of cooperation and consultation with and between agencies, in order to
achieve maximum efficiency and effectiveness.
B. To participate together by means of shared information in the development and expansion of
services.
C. To promote programs and activities designed to prevent the premature institutionalization of elders
and disabled adults.
D. All parties recognize that the consumer retains the right to assume risk, tempered only by the
individual's ability to assume responsibility for that risk.
E. All parties recognize that the consumer retains the right to choose which enrolled case
management agency he/she will receive services from.
F. The parties of this agreement will provide technical assistance and consultation to each other on
matters pertaining to actual service delivery and share appropriate assessment information and
care plans so duplication will not occur.
G. To establish an effective working relationship between the case management agency that is
responsible for the development of care plans and authorization of services available under the
waiver, the service provider that is responsible for the direct provision of those services to
consumers served under the waiver program, and the AAA that is responsible for management
and oversight of the waiver program.
11. Under this Agreement, the Area Agency on Aging agrees to the following:
A. To facilitate the enrollment of providers with the Medicaid Fiscal Agent.
B. To ensure the case management agency is an active Medicaid Waiver provider prior to serving
any consumer under the Aged and Disabled Adult(ADA) Medicaid Waiver Program.
C. To provide technical assistance and training to the case management agencies.
D. To complete a new referral agreement signed by all parties when unit rate changes are approved.
E. To assist the Department in conducting monitoring and other related management/administrative
functions for compliance with state and federal laws and rules governing waiver program
operations.
F. To report any adverse incident reports to the Department within 48 hours of the incident being
notified to the AAA.by the case management agency.
G. To develop and maintain written policies and procedures, as necessary, to ensure necessary
performance standards.
H. To assist the ADRC (Aging and Disability Resource Center) in maintaining the Applicant (APPL)
on the waitlist for Medicaid Home and Community Based Waiver Service Programs.
I
1. Assist the Department in reporting follow-up for substantiated reports of abuse, neglect, and
exploitation within 10 working days of receipt of the information.
J. To review and correct the CIRTS (Client Information and Registration Tracking System) exception
reports monthly and provide the Department with a summary of the resolutions, as requested.
III. Under this Agreement, the Case Management Agency agrees to the following:
A. Assign qualified case managers as contained in the ADA Medicaid Waiver to provide case
management services under the Medicaid Nome and Community Based Waiver for Aged and
Disabled Adults; Provider rates shall not exceed the approved negotiated rates that are at or
below the service provider's contracted'rates.
B. Develop and implement the Plan of Care specifically outlining the service(s) to be delivered that
must be signed by the consumer.
C. Adhere to the federal waiver requirements and policies and procedures outliners in the
following manuals published by the Agency for Health Care Administration: the Florida Medicaid
Aged and Disabled Adult Waiver Services Coverage and Limitations Handbook, Aged and
Disabled Adult Waiver Procedure Codes and Fee Schedule, Aged and Disabled Adult Waiver
Incontinence Fee Schedule and Quality Standards, Florida Medicaid Provider General Handbook,
and Department of Elder Affairs Programs and Services Handbook including any and all
attachments or updates
D. Refer consumers to any qualified Service Providers as selected by the consumer.
E. Issue written service authorizations to the service provider with at least 24 hours notice. The
referral will contain at a minimum:
1. Name
2. Address(with directions if not easily accessible)
3. Pertinent information regarding consumer's health or disabilities and living situation
4. Detailed service description including frequency, duration and specific tasks to be
performed.
F. Evaluate quality of services and service documentation by the service provider.
G. Accept financial responsibility for service claims found to be out of compliance if the non
compliance was the result of a`failure by the case management agency to update, renew, or
terminate the service authorization:
H. Monitor service providers for adherence to authorized care plans, authorized
reimbursement rates, and to ensure that the service provider is billing only for services authorized
in the care plan.
1. Develop and implement a policy to ensure that its employees, board members, and
management, will avoid any conflict of interest or the appearance of a conflict of interest
when disbursing or using the funds described in this agreement or when contracting with
another entity which will be paid by the funds described in this agreement. A conflict of
interest includes, but is not limited to, receiving, or agreeing to receive, a direct or indirect benefit,
or anything of value from a service provider,'consumer,'vendor, or any person wishing to benefit
from the use or disbursement of funds. To avoid a conflict of interest, the case management
agency must ensure that all individuals make a disclosure to the AAA of any relationship which
may be a conflict of interest, within thirty (30) days of an individual's original appointment or
placement on a board, or if the individual
is serving as an incumbent, within thirty(30)days of the commencement of the agreement.
J. To submit voided and/or adjusted claims no later than 45 days after either party has identified the
error. The provider's refusal to adjust or void erroneous claims may result in termination of this
agreement and/or referral to the Department, and will be referred to the Agency for Health Care
Administration for appropriate action.
K. Adhere to requirements contained in the Health Insurance Portability and Accountability Act
(HIPPA , as applicable, and to maintain the waiver participant's confidentiality.
L. To submit claim data for billing to the Medicaid fiscal agent after delivery of services has been
accomplished. All services should be billed within 60 days after services have been provided or
document reasons for delayed submission of claims. Such documentation shall be available for
review by the area agency on aging or by the Department, upon request.
2
M. To submit claims for billing to the Medicaid fiscal agent at the agency's contracted rate, as per
page 4 of this agreement.
N. To report adverse incidents that affect the health, safety&welfare of a client to the AAA within 48
hours of its occurrence using the required reporting template as provided by the AAA. Adverse
incidents may include injuries such as death, brain or spinal damage, permanent disfigurement,
fracture or dislocation of bones or joints, and conditions requiring medical attention to which the
client has not given informed consent, any condition that requires the transfer of the client within
or outside an ALF or consumer's residence to a unit providing a more acute level of care due to
the adverse incident not related to the client's condition prior to the incident, abuse, neglect or
exploitation, resident elopement or an event that is reported to law enforcement(does not include
Baker Act transport or deaths by natural causes).
0. To report any adverse incidents involving abuse, neglect, and exploitation to the Department of
Children & Families (DCF).
P. Participate in training arranged by the AAA, the Department, Department of Children and
Families and/or Agency for Health Care Administration, as required.
Q. To review and correct any CIRT (Client Information and Registration Tracking System) exception
reports submitted by the AAA monthly by the stipulated time frame.
R. Comply with any additional ADA Medicaid Waiver case management related requests for
information from the Department regarding implementation of the Statewide Medicaid Managed
Care Program (SMMCLTC).
S. To submit written follow up of how the critical incidents as reported by the Department were
addressed within 5 days of receiving the report from the AAA. Weekly reports/updates must be
provided by the case management agency until the issue is resolved.
T. To provide care plans and other documents for upload in a format specified by the Department
prior to the transition period to SMMCLTC. Additional requirements must be met as follows:
1. To ensure coordination of care for consumers transitioning to SMMCLTC.
2. To share and pass records and information including current care plans, service
authorizations, and optional 701 B assessments, as requested, by AHCA and/or the
Department pursuant to the method and time frames requested by AHCA and/or the
Department.
3. Failure to comply with the terms of this agreement may result in Medicaid payments being
recouped or withheld for non-compliant case management providers.
U. Notify the AAA of any change of ownership action at least 90 days prior to the effective date of
closing. Medicaid Waiver provider numbers are non-transferable.
V. The AAA may impose Department-approved sanctions for non-compliance with items of this
agreement.
IV. Under this agreement, the following services will be delivered by the Service provider in
accordance with the plan of care or service authorization:
Service Unit Rate County/Region Served
A. Case Management_$45.00 an hour Monroe
B.
C.
D.
E.
V. Termination
In the event this agreement is terminated, the case management agency agrees to submit, at the time
notice of intent to terminate is delivered, a plan that identifies procedures to ensure services to
consumers will not be interrupted or suspended by the termination.
3
A. Termination at Will
This agreement may be terminated by either party upon no less than thirty (30) calendar days
notice, without cause, unless a lesser time is mutually agreed upon by both parties, in writing.
Said notice shall be delivered by certified mail, return receipt requested, or in person with proof of
delivery.
B. Termination Because of Lack of Funds
In the event funds to finance this agreement become unavailable, the area agency may terminate
this agreement upon no less than twenty-four(24) hours notice in writing to the other party. Said
notice shall be delivered by certified mail, return receipt requested, or in person with proof of
delivery. The area agency shall be the final authority as to the availability of funds.
C. Termination for Breach
Unless a breach is waived by the area agency in writing, or the parties fail to cure the breach
within the time specified by the area agency, the area agency may, by written notice to the
parties, terminate the agreement upon no less than twenty-four (24) hours notice. Said notice
shall be delivered by certified mail, return receipt requested, or in person with proof of delivery.
In witness whereof, the parties have caused this 4 page agreement to be executed by their undersigned
officials as duly authorized.
Area Agency on Aging Case Management Agency
signature signature
Max'B. Rothman JI) LL.M. George Neu-gent
print name print name
President/CEO Mayor
title title
9-1`8-2013
date date _�'�Z
C
Signature
Raman Gastesi
County Administrator
14 Aunust 2013
F
UNTY AT REV'
AST /r
SSISTAT CCU
Date
4
Graham-Sheryl
From: Idarmis Perez <Perezi@AllianceForAging.org>
Sent: Friday,August 09,2013 2:08 PM
To: Albury=Dotti;Graham-Sheryl
Cc: Idarmis Perez;Jill Rosenkranz
Subject: FW:ADA-MW Case Management Referral Agreement I
Attachments: ADA CM RA-2013.doc
Hi,
Since this agreement is due on 8/23/13, it may be good to have this one signed, as well and ratified in the
same way that the ADA service provider agreement will be done during September.
Please let me know if you have any;questions. Thank you.
Idarmis Perez
Medicaid Waiver Specialist
Alliance for Aging
760 NW 107 Ave.,Ste.214
Miami,FL 33172
Telephone#:305-670-6500,ext.278
Fax#:305-222-4111
Email:oerezi@aliianceforaging.org
From: Idarmis Perez
Sent:Friday,August 09,2013 2:03 PM
To:dcuetara@firstclualityhomecare.com;gengracio@firstgualityhomecare.com;Tatiana Pita;Carlos Martinez;
VGarcia@myMiamiJewish.org;P-engracio@firstgualitvhomecare.com MONEY2@miamidade.gov;
ECLERMO@miamidade.gov;Albury-Dotti@monroecounty-fl.gov•Graham-Shervl@monroecounty-fl.gov;Wilkes-
Kim@monroecounty-fLgov;Nursingsouthnsc@cs.com
Cc: Idarmis Perez;Jill Rosenkranz
Subject:ADA- MW Case Management Referral Agreement
Hi Everyone,
Attached is the new ADA—MW Case Management Referral Agreement. This revised agreement includes new
responsibilities as an ADA- MW Case Management Agency, as well as the Alliance's responsibilities.
Please complete page 3 using the services and rates you are currently authorized to provide (this would only
apply to case management and case aide services). If the information indicated on this page is different from
what is currently authorized on file, the services and rates will be changed to reflect your current information.
1
Please read and sign agreement on page 4. Please return the original agreement by mail to the Alliance by
August 23,2013, An executed copy will be returned to you once the agreement is signed by the Alliance's
President/CEO. The agreement is effective the date executed by the Alliance.
Please contact us if you have any questions. Thank you in advance for your cooperation.
Idarmis Perez
Medicaid Waiver Specialist
Alliance for Aging
760 NW 107 Ave.,Ste.214
Miami,FL 33172
Telephone#:305-670-6500,ext.278
Fax#:305-222-4111
Email:perezi@allianceforaging.org
2
HOME AND COMMUNITY BASED SERVICES
AGED AND DISABLED ADULT(ADA) MEDICAID WAIVER
CASE MANAGEMENT REFERRAL AGREEMENT
This Referral Agreement between the Alliance for`Aging. Inc. the area agency on aging (AAA) for
planning and service area (PSA) 11 andS&ViLn-
, a ease management agency, shall begin on July 1, 2004 or on the date`the agreement has been signed
by both parties,whichever is later. This referral agreement is in effect for a period of time that is equal to
the Medicaid waiver provider's enrollment period with the State of Florida's Medicaid fiscal agent and is
contingent upon an annual appropriation by the Legislature. The purpose of this agreement is to enable
eligible elderly participants to receive case management services from qualified providers with oversight
of the quality of care by the Medicaid Waiver Specialist employed by the AAA. These services are
authorized in order that the participant may remain in the least restrictive setting and avoid or delay
premature nursing home placement. Services and care are to be furnished in a way that fosters the
independence of each participant to facilitate aging in place. All parties agree that routines of care
provision and service delivery must be consumer-driven to the maximum extent possible. All parties
agree to and will treat each participant with dignity and respect.
1. Objectives
A. To maintain a climate of cooperation and consultation with and between agencies, in order to
achieve maximum efficiency and effectiveness.
B. To participate together by means of shared information in the development and expansion of
services.
C. To promote programs and activities designed to prevent' the premature institutionalization of
elders and disabled adults.
D. The parties of this agreement will provide technical assistance and consultation to each other on
matters pertaining to actual service delivery and share appropriate assessment information and
care plans so duplication may not occur.
E. To establish an effective working relationship between the case management agency that is
responsible for the development of care plans and authorization of services available under the
waiver, the service provider that is responsible for the direct,provision of those services to
consumers served under the waiver program,'and the AAA that is responsible for management
and oversight of the waiver program.
11. Under this Agreement,the Area Agency on Aging agrees to the following:
A. To facilitate the enrollment of providers with the Medicaid Fiscal Argent,
B. To ensure the case management agency is an active Medicaid provider prior to serving any
consumer under the Aged and Disabled Adult (ADA) Medicaid Waiver and Assisted Living for
Frail Elderly(ALE) Medicaid Waiver Programs and any other Medicaid Waiver program that may
be approved by the Centers for Medicaid and Medicare Services (CMS) and implemented in the
State of Florida.
C. To provide technical assistance and training to the case management agencies.
D. To provide on site monitoring of the case management agency at least semi-annually.
E. To monitor and project Provider expenditures to assure spending is maintained within
spending authority.
F. To complete a new referral agreement signed by all parties when unit rate changes are approved.
111. Under this Agreement the Case Management Agency agrees to the following:
A. Assign qualified case managers as contained in the ADA Medicaid Waiver to provide case
management services under the Medicaid Home and Community Eased Waiver for Aged and
Disabled Adults. Provider rates shall not exceed the approved negotiated rates that are at or
below the service provider's contracted rates.
B. Develop and implement the Plan of Care specifically outlining the service(s) to be delivered that
i
must be signed by the consumer.
C. Adhere to the federal waiver requirements and policies and procedures outlined in the
following manuals,published by the Agency for Health Care Administration: Aged and
Disabled Adult Waiver Guidelines and the Medicaid Provider Reimbursement Handbook
(Non-Institutional 081). including any and all attachments or updates.
D. Provide to the AAA a monthly summary of Aged and Disabled Adult Medicaid Waiver
expenditures billed and accrued.
E. Refer consumers to any qualified Service Provider as selected by the consumer.
F. Issue written service authorizations to the service provider with at least 24 hours notice. The
referral will contain at a minimum.
1.Name
2.Address(with directions if not easily accessible)
3. Pertinent information regarding consumer's health or disabilities and living situation
4. Detailed service description including frequency, duration and specific tasks to be
performed.
G. Evaluate quality of services and service documentation by the service provider.
H. Accept financial responsibility for service claims found to be out of compliance if the non
compliance was the result of a failure by the case management agency to update, renew, or
terminate the service authorization.
1. To forward a monthly expenditure tracking report to the area agency no later than the date agreed
upon by both parties.
J. Monitor service providers for adherence to authorized care plans, authorized
reimbursement rates, and to ensure that the service provider is billing only for services authorized
in the care plan.
K. Develop and implement a,policy to ensure that its employees, board members, and
management, will avoid any conflict of interest or the appearance of a conflict of interest
when disbursing or using the funds described in this agreement or when contracting with
another entity which will be paid by the funds described In this agreement.A conflict of
interest includes,but is not limited to, receiving, or agreeing to receive, a direct or indirect benefit,
or anything of value from a service provider, consumer, vendor,or any person wishing to benefit
from the use or disbursement of funds. To avoid a conflict of interest, the case management
agency must ensure that all individuals make a disclosure to the AAA of any relationship which
may be a conflict of interest, within thirty (30) days of an Individual's original appointment or
placement on a board, or if the individual
is serving as an incumbent,within thirty(30)days of the commencement of the agreement.
L. To submit void or adjustment claims no later than 45 days after either party has identified the
error. The provider's refusal to adjust or void erroneous claims may result in termination of this
agreement and/or referral to the department, and will be referred to the Agency for Health Care
Administration for appropriate action.
M. The AAA may impose department-approved sanctions for non-compliance with items of this
agreement.
IV. Under this agreement, the following services will be delivered by the Service provider in
accordance with the plan of care or service authorization:
Service Unit Rate County/Region Served'
A. Case Management $45.00/hr Monroe
B.
C.
D.
E.
2
a a
V.Termination
In the event this agreement is terminated, the case management agency agrees to submit, at the
time notice of intent to terminate is delivered, a plan which identifies procedures to ensure
services to consumers will not be interrupted or suspended by the termination.
A. Termination at Will
This agreement may be terminated by any party upon no less than thirty(30)calendar days
notice,without cause, unless a lesser time is mutually agreed upon by both parties,in writing.
Said notice shall be delivered by certified mail, return receipt requested, or in person with
proof of delivery.
B. Termination Because of Lack of Funds
In the event funds to finance this agreement become unavailable, the area agency may
terminate this agreement upon no less than twenty-four(24)hours notice in writing to the
other party. Said notice shall be delivered by certified mail, return receipt requested, or in
person with proof of delivery. The area agency shall be the final authority as to the
availability of funds.
C. Termination for Breach
Unless a breach is waived by the area agency in writing, or the parties fall to cure the breach
within the time specified by the area agency, the area agency may, by written notice to the
parties, terminate the agreement upon no less than twenty-four(24)hours notice. Said
notice shall be delivered by certified mail, return receipt requested, or in person with proof of
delivery.
VI. Agreement
Not withstanding the effective date as determined in the First Paragraph of this agreement, this
contract is retroactive to July 1, 2004.
In witness whereof,the parties have caused this 3 page agreement to be executed by their
undersigned officials as duly authorized.
Area Agency on Aging' Service P o der
ignature J--- signature
Steven Weisberg, M.S. Charles "S nny" McCoy_
Print name Print name
President/CEO Mayer
Title Title
5�� )1�, � Zoos
Date Date
L QUWX
MONROE COUN "
EY
A PROVED AS TO FORM:
SUS M. GRIMSLE
ASSISTA COUNTY ATTORNEY
3
of
F
Alliance for Aging, Inc.
Area Agency on Aging ji)r
Miami-Dade and Monroe Conntias
Winston H.Lonsdale Max B.Rothman,JD. LL.M.
Chain President and CEO
TO: Kim Wilkes
Monroe County In Home Services
FROM: Idarmis Perez, Medicaid Waiver Specialist
DATE: August 22,2013
REF: Home and Community Based Services (HCBS)—
ADA(Aged and Disabled Adults)—
MW(Medicaid Waive
Referral Agreement
As we discussed today, enclosed are the 6 original copies of the Case
Management Referral Agreements for Monroe County.
Please refer to my email sent today regarding the deadline date by which
all agreements should be returned to the Alliance.
If you have any questions, please do not hesitate to contact me at
(305)670-6500, ext. 278
Thank you very much.
-01
alliance for Aging Inc.
76O Nib 107 Ave.,Ste.214
Miami,FL 33172
HOARD OF COUNTY COMIVftISSIONERS
�^ Monroe
George Neugent,District 2
County of Monroe Mayor Pro Tern,Heather CwrWx rs,Dis wt 3
Florida�e Danny L.Kolhage,District I
Ile Keys David Rice,District 4
Sylvia J.Murphy,District 5
In Home services Program
GAIO Buildng
1100 Simonton Street
Room 1-189
Key West,R-33040
(305)292-4583
(305)292-4417 FAX
Affiance for Aging,Inc.
Idarmis Perez,Mermaid Waiver Specialist
760 NW 107d Avenue
Suite 214
barn ,FL 33172
8/14/2013
Dear Idarmis:
Enclosed are six(6),original copies of the ADA-MW Case Management Referral Agreement. This
document has been approved by our County Attorney,and has been signed by the County
Administrator.
Please have Mr. Max Rothman execute them on the Alliance's behalf as soon as possible, as we
need them back to us immediately so that we can get it on the next BOCC Agenda, for the Mayor
to ratify. When Mr. Rothman signs the above mentioned document please send back five(5)
executed original copies to Sheryl Graham's attention.'
Since our County Administrator has already signed the agreement,after Mr. Rothman signs it will
be official. Once on the agenda and the Mayor ratifies it, we will send you the final copies via Fed
Ex to your attention.
Thank you.
Sincerely;
Dotti Albury, Coordinator,Monroe County In-Home Services Program
Cc: Sheryl Graham, Director, Monroe County Social Services