Item C07
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: 7-15-2009 Division: _County Administrator
Bulk Item: Yes X No - Department: Social Services/In-Home Services_
--
Staff Contact Person/Phone #: Sheryl GrahamlX45I 0
AGENDA ITEM WORDING: Approval of Amendment 001 to the Community Care for the Elderly
(CCE) Contract KC-971 between the Alliance for Aging, Inc. (Area Agency on Aging) and the Monroe
County Board of Commissioners (Social Services/In-Home Services) for fiscal year 7/1/09 to 6/30110.
ITEM BACKGROUND: Approval of Amendment 001 to the CCE Contract will d~crease the amount
under contract by $8,824.00 from $503,344.00 to $494,520.00. This is due to the reason that the initial
contract was submitted prior to the amounts being finalized by the AAA in order to make the 09-10
contract year.
PREVIOUS RELEVANT BOCC ACTION: Prior approval granted for the eCE Contract #KC-971
on 6-17-09.
CONTRACT/AGREEMENT CHANGES: Decreasing the amount under contract by $8,824.00 for a
contract total of$494,520.00
ST AFF RECOMMENDATIONS: Approval
TOT AL COST: $494,520.00 INDIRECT COST: -0- BUDGETED: Yes X No
COST TO COUNTY: Inkind (Space) Match of $22,201.00 SOURCE OF FUNDS: Grants
No Cash Match is Required- an Inkind(Space) Match of $22,201.00 and co-Payment Match of
$22,305.00 will be used for the $44,506.00 Total Match Commitment.
REVENUE PRODUCING: Yes-X- No - AMOUNT PER MONTH approx.$2,500.00
1:- Year approx. $30,000.00
APPROVED BY: County Arty X OMB/Purchasing ~Risk Management _X_
DOCUMENT A TION: 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 Amendment
001 to contract # KC-
971
Effective Date: July 1, 2009
Expiration Date: June 30, 2010
Contract Purpose/Description: Approval of Amendment 001 to the CCE Contract will decrease the amount
under contract by $8,824.00 from $503,344.00 to $494,520.00
Contract Manager: Sheryl Graham 4510 Social Services/Stop I
(Name) (Ext. ) (Department/Stop #)
For BOCC meeting on 7/15/2009 Agenda Deadline: 6/30/2009
CONTRACT COSTS
Total Dollar Value of Contract: $494,520.00 Current Year Portion: $
Budgeted? Yes X No Account Codes: 125 -6153809 - - -
- -
Grant:$494,520.00 (Fiscal Year) - - - -
County Match: (Required) Inkind Match of $22,201.00 and - - - -
Client Co-Pay Match of$22,305.00 will be used for the
$44,506.00 Total Match Commitment
- - - -
ADDITIONAL COSTS
Estimated Ongoing Costs: $ /yr For:
(Not included in dollar value above) (eg, Maintenance, utilities, ianitorial, salaries, etc)
CONTRACT REVIEW
Changes Date Out
Dat0 Ne~ ~
Division Director ~);() 6 T Yes No
Risk Mana~ment ~ ' J- q 6t Yes Q ~
(%f \J ~~ I ~"1 ~
. .B./Purcha ing ~ io Yes 6/zQ/uy
tt l'l \ oC\ Yes G''!
County Attorney -"
Comments:
OMB Form Revised 2/27/01 MCP #2
Amendment 001 CONTRACT KC 971 Page 1
THIS AMENDMENT, entered into between the Alliance for Aging, Inc. hereinafter referred
to as the "Alliance", and Monroe County Board of Commissioners.
The purpose of this amendment is to decrease the amount under contract by $ 8,824
from $503,344 to $ 494,520.
The provider must adjust the Unit Cost Methodology to take this decrease in funding into
account.
METHOD OF PAYMENT:
1. This amendment shall begin on July 1, 2009 or the date it has been signed by both parties,
whichever is earlier.
All provisions in the contract and any attachments thereto in conflict with this amendment
shall be and are hereby changed to conform with this amendment.
All provisions not in conflict with this amendment are still in effect and are to be performed at
the level specified in the contract are hereby amended to conform with this amendment.
This amendment and all its attachments are hereby made a part of the contract. This
amendment and all its attachments are hereby made a part of the contract.
IN WITNESS WHEREOF, the parties hereto have caused this 1-page amendment to be executed
by their undersigned officials as duly authorized.
PROVIDER:
Monroe County Board of ALLIANCE FOR AGING, INC.
Commissioners.
SIGNED BY: SIGNED BY:
George Neugent Max B. Rothman, JD, LL.M.
NAME: NAME:
Mayor President & CEO
TITLE: TITLE:
July 15, 2009
DATE: DATE:
D
CONTRACT NUMBER KC 971 Page 1
COMMUNITY CARE FOR THE ELDERL Y CONTRACT
2009-2010
THIS CONTRACT is entered into between the Alliance for Aging, Inc., hereinafter referred to
as the "Alliance", and Monroe County, hereinafter referred to as the "recipient". This contract
is subject to all provisions contained in the MASTER AGREEMENT executed between the
Alliance and the recipient, Agreement No., and its successor, incorporated herein by reference.
Attachment I, II, III, IV, V and VI are integral to this Agreement
The parties agree:
I. Recipient Agrees:
A. Services to be provided:
To plan, develop, and accomplish the services delineated, or otherwise cause
the planning, development, and accomplishment of such services and activities,
under the conditions specified and in the manner prescribed in Attachment I of
this aareement and included in the Service Provider Application (SPA)
submitted in response to the March 2008 CCE/Lead Aaency RFP. The recipient
will not be allowed to provide services that are not included in the SPA
submitted in response to the March 2008 CCE/Lead Agency RFP and included
related Unit Cost Methodology submitted as an integral part of the RFP
application. In the event of the conflict between the Service Provider Application
and this contract, the contract controls. Additionally, the recipient is subject to
the Referral Protocol included in Attachment IV and ARC Outsourced Functions
Policies and Procedures outlined in Attachment V
B. Final Request for Payment:
1. The recipient must submit the final request for payment to the Alliance no
later than July 15, 2010; if the recipient fails to do so, all right to
payment is forfeited, and the Alliance will not honor any requests
submitted after the aforesaid time period.
2. If the contract is terminated prior to the contract end date of July 1, 2010,
then the recipient must submit the final request for payment to the Alliance
no more than 45 days after the contract is terminated, but no later than July
15,2010. If the recipient fails to do so, all right to payment is forfeited,
and the Alliance will not honor any requests submitted after the
aforesaid time period.
C. Additional Reporting Requirements
1. If the Alliance has sanctioned the recipient, while the sanctions are in effect
the recipient shall provide to the Alliance, on a monthly basis, the recipient's
financial statements that reflect the current, un-audited revenues and the
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CONTRACT NUMBER KC 971 Page 2
recipient's cash position as well as any other financial and/or programmatic
documentation that may be requested by the Alliance.
2. If the recipient is required to prepare a corrective action plan or respond to
a Fiscal and/or Programmatic Monitoring, supporting documentation as
requested by the Alliance shall be provided within the time frame stipulated
by the Alliance.
3. If the recipient has requested transfers of funds between programs,
supporting documentation shall be provided.
4. The recipient is to provide explanations to any program surplus/deficit
and/or program spend-out plans as requested by the Alliance for Aging
within the time period requested by the Alliance.
5. The recipient is responsible to report the units of services in CIRTS on a
monthly basis. The recipient is ultimately responsible to ensure that sub-
providers report units of service in CIRTS as well. The recipient is aware
and accepts that all units of service not reported after a maximum of ninety
(90) days after the date of service will not be honored and paid by the
Alliance. These units will be considered forfeited.
The recipient acknowledges that failure to meet the requirements set forth in
the 2008 CCE/Lead Agency RFP and in this agreement as well as in the
Master Agreement may result in delay or termination of payment and/or in
sanctions and other enforcement actions as established in the Master
Agreement, including termination of contract.
II. The Alliance Agrees:
A. Contract Amount
To pay for services according to the conditions of Attachment I in an amount not to
exceed! 503,344 for the State Fiscal Year 2009-2010, subject to the availability of
funds. Recipient must not exceed their quarterly allocations and spending authority
as reflected in Attachment III. Failure of the recipient to remain within allocated
authorized spending authority amounts may result in the Alliance enforcing sanctions
as set forth in the Enforcement Clause, Section III, 8, of the Master Agreement. The
Alliance reserves the right to adjust the CCE quarterly allocations and spending
authority for each lead agency based on availability of funds or as deemed
necessary.
B. Obligation to Pay
The Alliance's performance and obligation to pay under this contract is contingent
upon an annual appropriation by the Legislature.
C. Source of Funds
The costs of services paid under any other contract or from any other source are not
eligible for reimbursement under this contract. The funds awarded to the recipient
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itI.t....
CONTRACT NUMBER KC 971 Page 3
pursuant to this contract are in the state grants and aids appropriations and consists
of the following:
Program Title Year Funding Source CSFA# Fund Amounts
Community Care 2009 General RevenuefTobacco 65010 $503,344
for the Elderlv Settlement Trust Funds
TOTAL FUNDS CONTAINED IN THIS CONTRACT: $503,344
III. Recipient and Alliance Mutually Agree:
A. Effective Date:
1. This contract shall begin on July 1, 2009 or on the date the contract has been
signed by both parties, whichever is later.
2. Delivery of services shall end on June 30, 2010. This contract shall end on July
15,2010. See Attachment I, Section III.F.
B. Termination, Suspension, and/or Enforcement:
The causes and remedies for termination or suspension of this contract shall follow the
same procedures as outlined in Section III. B. and Section III.C. of the Master
Agreement.
C. Recipient Responsibility:
Notwithstanding anything to the contrary in the Master Agreement. the recipient
maintains responsibility for the performance of all sub recipients and vendors in
accordance with all applicable federal and state laws.
D. Notice, Contact, and Payee Information:
1. The name. address. and telephone number of the contract manager for the Alliance
for this contract is:
Max B. Rothman, JD, LL.M.
President and CEO
9500 South Dadeland Boulevard, Suite 400
Miami, Florida 33156
(305) 670-6500, Ext. 224
2. The name, address, and telephone number of the representative of the recipient
responsible for administration of the program under this contact is:
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CONTRACT NUMBER KC 971 Page 4
3. In the event different representatives are designated by either party after execution
of this contract, notice of the name and address of the new representative will be
rendered in writing to the other party and said notification attached to originals of
this contract.
4. The name (recipient name as shown on page 1 of this contract) and mailing
address of the official payee to whom the payment shall be made: (Fill in contact
information) .
E. Renegotiation or Modification
1. Modifications or changes to the funding in this contract and corresponding
services related to the increase or decrease, may be made in the form of a
written Contract Amendment signed by the Alliance's President and CEO. The
Board President or its Designee of the Recipient shall sign the Notice of Award
Increase/Decrease and return it to the Alliance within fourteen (14) days or
sooner if requested by the Alliance. By signing Notice of Award
Increase/Decrease, the Board President or its Designee of the Recipient
acknowledges the receipt of and agreement with the terms contained in the
Notice.
2. Upon Receipt of a Notice of Award Increase/Decrease, the recipient shall update
affected information in budget summaries, deliverable schedules, or any other
applicable financial information contained in this contract. The parties shall then
incorporate such changes into a contract amendment. This shall be done within
ten working days of receipt of such notice.
IN WITNESS THEREOF, the parties hereto have caused this 17-page contract (including
Attachment I-III) to be executed by their undersigned officials as duly authorized.
RECIPIENT:
MONROE COUNTY ALLIANCE FOR AGING, INC.
BOARD PRESIDENT OR AUTHORIZED DESIGNEE
SIGNED BY: SIGNED BY:
NAME: George Neugent NAME: Max B. Rothman, JD, LL.M.
TITLE: Mayor TITLE: President and CEO
DATE: 6-17-09 DATE:
4
__"_" c,<.~____ -' ,..-.---'--.
CONTRACT NUMBER KC 971 Page 5
ATTACHMENT I
COMMUNITY CARE FOR THE ELDERLY PROGRAM
I. STATEMENT OF PURPOSE
The Community Care for the Elderly (CCE) Program provides community-based services
organized in a continuum of care to assist aged 60+ elders at risk of nursing home
placement to live in the least restrictive environment suitable to their needs.
II. SERVICES TO BE PROVIDED
A. Services:
1. The recipient's service provider application submitted in response to the 2008 CCE
/Lead Agency RFP and any revisions thereto approved by the Alliance and located
in the Contract Manager's file are incorporated by reference in this contract between
the Alliance and the recipient, and prescribe the services to be rendered by the
recipient.
2. Consumers may not be enrolled in a Department of Elder Affairs state general
revenue funded program, including CCE, who are also enrolled in a Medicaid
capitated long-term care health plan or program. These programs include the Frail
Elder Program operated by United Health Care, the Channeling Program operated
by Miami Jewish Home and Hospital for the Aged, the Long Term Care Community
Diversion Program and the Program of All Inclusive Care for the Elderly (PACE)
program.
B. Manner of Service Provision:
The services to be provided are those described in the recipient's service provider
application submitted in response to the 2008 CCE /Lead Agency RFP and as
described in this contract. All CCE services will be provided in a manner consistent
with the conditions set down in the Department of Elder Affairs January 2003, Draft
Home and Community-Based Services Handbook and by the Alliance. In the event
either the handbook or the service provisions established by the Alliance is revised,
such revision will automatically be incorporated into the contract and the recipient will
be given a copy of the revisions.
III. METHOD OF PAYMENT
A. The method of payment in this contract is based on a fixed unit rate for approved
services. The recipient must ensure fixed unit rates include only those costs which are
in accordance with all applicable state and federal statutes and regulations and are
based on audited historical costs in instances where an independent audit is required.
All requests for payment and expenditure reports submitted to support requests for
payment shall be on DOEA forms 106C and 105C. Duplication or replication of both
forms via data processing equipment is permissible, provided all data elements are in
the same format as included on department forms.
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CONTRACT NUMBER KC 971 Page 6
B. The recipient shall maintain documentation to support payment requests which shall be
available to the Comptroller, the Department of Elder Affairs, or the Alliance upon
request.
C. The recipient may request a monthly advance for service costs for each of the first two
months of the contract period, based on anticipated cash needs. Detailed
documentation justifying cash needs for advances must be submitted with the signed
contract, approved by the Alliance, and maintained in the contract manager's file. All
payment requests for the third through the twelfth months shall be based on the
submission of monthly actual expenditure reports beginning with the first month of the
contract. The schedule for submission of advance requests is ATTACHMENT II to this
contract. Reconciliation and recouping of advances made under this contract are to be
completed by the time the final payment is made. All advance payments are subject to
the availability of funds.
D. Advance funds may be temporarily invested by the recipient in an insured interest
bearing account. All interest earned on contract fund advances must be returned to the
Alliance within thirty (30) days of the end of the first quarter of the contract period.
E. The Alliance shall make payment to the provider for provision of services up to a
maximum number of units of service and at the rate(s) stated below:
Service Maximum Maximum
Service to be Provided Unit Units of Dollars
Rate Service
Adult Day Care $16.17 TBD TBD
Case Management $52.57 TBD TBD
Chore $33.75 TBD TBD
Homemaker $22.76 TBD TBD
Housing Improvement $35.32 TBD TBD
Material Aid $376.73 TBD TBD
Intake $53.17 TBD TBD
Personal Care $34.89 TBD TBD
In Home Respite $23.59 TBD TBD
Total $503,344
F. Additional Reporting Conditions:
1. The recipient agrees to implement the distribution of funds as detailed in the service
provider application and the Budget Summary, ATTACHMENT III to this contract.
Any changes in the total amounts of the funds identified on the Budget Summary
form require a contract amendment.
2. The recipient is to offer services based on clients' service plans and will not be
restricted to providing the services as projected. Additional budget
revisions/contract amendments will be required to move funding among these
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CONTRACT NUMBER KC 971 Page 7
services. Any changes in the total amount of the funds under contract require a
formal contract amendment.
3. The Alliance reserves the right to adjust the total quarterly award as well as the
contracted unit rate to reflect recipient costs and utilization rates based on actual
consumers enrolled in the program.
4. This contract is for services provided beginning July 1, 2009 through June 30, 2010,
however, the contract is in effect through July 15, 2010 in order to provide for
maximization of resources and to allow for greater flexibility to pay for the services
rendered by June 30, 2009. Services provided after June 30, 2009 cannot be
reimbursed under this contract.
5. The recipient shall submit a draft closeout report by July 15, 2010.
6. The final expenditure report and request for payment will be due to the Alliance no
later than July 15, 2010. No expenditure reports or requests for payment will be
accepted after July 15, 2009.
G. Any payment due by the Alliance under the terms of this contract may be withheld
pending the receipt and approval by the Alliance of complete and accurate financial and
programmatic reports due from the recipient and any adjustments thereto, including any
disallowance not resolved as outlined in Section I.T. of the Master Agreement.
IV. SPECIAL PROVISIONS
A. State Laws and Regulations:
1. The recipient agrees to comply with applicable parts of Rule Chapter 58C-1, Florida
Administrative Code promulgated for administration of Sections 430.201 through
430.207, Florida Statutes, and the Department of Elder Affairs January 2003, Draft
Home and Community-Based Services Handbook.
3. The recipient agrees to comply with the provisions of Sections 97.021 and 97.058,
Florida Statutes, and all rules related thereto in the Florida Administrative Code.
B. Assessment and Prioritization for Service Delivery for New Consumers:
The following are the criteria to prioritize new consumers for service delivery. It is not
the intent of the Department of Elder Affairs to remove existing clients from any
program in order to serve new clients being assessed and prioritized for service
delivery.
1. Abuse, Neglect and Exploitation:
The recipient will ensure that pursuant to Section 430.205(5), Florida Statute, those
elderly persons who are determined by adult protective services to be victims of
abuse, neglect, or exploitation who are in need of immediate services to prevent
further harm and are referred by adult protective services, will be given primary
consideration for receiving Community Care for the Elderly Services. As used in
this subsection, "primary consideration" means that an assessment and services
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CONTRACT NUMBER KC 971 Page 8
must commence within 72 hours after referral to the department or as established in
accordance with department contracts by local protocols developed between
department service recipients and adult protective services.
2. Priority Criteria for Individuals in Nursing Homes in Receivership
The recipient will ensure that pursuant to Section 400.126 (12), Florida Statute.
those elderly persons detennined through a CARES assessment to be a resident
who could be cared for in a less restrictive setting or who do not meet the criteria for
skilled or intennediate care in a nursing home, will be referred for such care, as
appropriate for the resident. Residents referred pursuant to this subsection shall be
given primary consideration for receiving services under the Community Care for
the Elderly program in a manner as persons classified to receive such services
pursuant to Section 430.205, Florida Statute.
3. Priority Criteria for Service Delivery:
a) Individuals in nursing homes under Medicaid who could be transferred to the
community;
b) Individuals in nursing homes, whose Medicare coverage is exhausted and
may be diverted to the community;
c) Individuals in nursing homes which are closing and can be discharged to the
community; or
d) Individuals whose mental or physical health condition has deteriorated to the
degree self care is not possible, there is no capable caregiver and
institutional placement will occur within 72 hours.
e) For the purpose of transitioning individuals receiving Community Care for
Disabled Adults (CCDA) and Home Care for Disabled Adults (HCDA)
services through the Department of Children and Families (DCF) Adult
Services to community-based services provided through the department,
when services are not currently available, area agency on aging staff and
lead agency case managers shall ensure that "Aging Out" individuals are
prioritized for services only after Adult Protective Services (PAS) High Risk
and Imminent Risk individuals.
4. Priority Criteria for Service Delivery for Other Assessed Individuals:
The assessment and provision of services should always consider the most cost
effective means of service delivery. Service priority for individuals not included in
groups one, two or three above, regardless of referral source, shall be detennined
through the department's client assessment form administered to each applicant, to
the extent funding is available. First priority will be given to applicants at the higher
levels of frailty and risk of nursing home placement. For individuals assessed at the
same priority and risk of nursing home placement, priority will be given to applicants
with the lesser ability to pay for services.
5. Referrals for Medicaid Waiver Services:
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CONTRACT NUMBER KC 971 Page 9
a) The recipient must identify, through the consumer assessment, potential
Medicaid eligible CCE consumers and refer these individuals for Medicaid
Waiver services.
b) Individuals who have been identified as being potentially Medicaid Waiver
eligible are required to apply for Medicaid Waiver services in order to receive
CCE services and can only receive CCE services while the Medicaid Waiver
eligibility detennination is pending. If the consumer is found ineligible for
Medicaid Waiver services for any reason other than failure to provide
required documentation, they may continue to receive CCE services.
c) Individuals who have been identified as being potentially Medicaid Waiver
eligible must be advised of their responsibility to apply for Medicaid Waiver
services as a condition of receiving CCE services while the eligibility
detennination is being processed.
C. Co-payment Collections:
1. The recipient will establish annual co-payment goals. The Alliance has the option to
withhold a portion of the recipient's Request for Payment if goals are not met
according to the Department of Elder Affairs co-payment guidelines.
2. Co-payments include only the amounts assessed consumers or the amounts
consumers opt to contribute in lieu of an assessed co-payment. The contribution
must be equal to or greater than the assessed co-payment.
3. Co-payments collected in the CCE program can be used as part of the local match.
D. Match:
The recipient will assure a match requirement of at least 10 percent of the cost for all
Community Care for the Elderly services. The match will be made in the fonn of cash
and/or in kind resources. At the end of the contract period, all Community Care for the
Elderly funds expended must be properly matched.
E. Service Cost Reports:
The recipient will submit semi-annual service cost reports which reflect actual costs of
providing each service by program. This report provides infonnation for planning and
negotiating unit rates.
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CONTRACT NUMBER KC 971 Page 10
ATTACHMENT II
COMMUNITY CARE FOR THE ELDERLY PROGRAM
CONTRACT REPORT CALENDAR
Report Submit To The
Number Based On Alliance
On This Date
1 July Expenditure Report August 15
2 August Expenditure Report September 15
3 September Expenditure Report October 15
4 October Expenditure Report ... .. . .. . ... . .. . .. .. . . .. .. . . .. . . . ... . . . . . . .. November 15
5 November Expenditure Report ... ... ... ... ... .., ... ... ... ... ... ... ..... December 15
6 December Expenditure Report ... ... ... ... ." ... ... ... .. . ... ... ... ... .. January 15
7 January Expenditure Report ... ... ... ... ... ... ... ... ... ... ... ... .,. ..... February 15
8 February Expenditure Report ...... ... ... ... ... ...... ... ... ... ... ... ... . March 15
9 March Expenditure Report............................................... April 15
10 April Expenditure Report '" ... . . . . .. . .. .. . . . . .. . .. . . .. . .. . . . ... .. . . .. .. . . May 15
11 May Expenditure Report / July Advanced Reconciliation ** ..... June 15
12 June Expenditure Report / August Advanced Reconciliation ** July 15
13 Final Expenditure and Request for Payment Report... ... .. . ... .. July 15,2010
14 Closeout Report ... ... ... ... ... ... ... ... ... ... ... ... ... ... .,. ... ... ... ... .,. July 15, 2010
LeQend: ** Submission of expenditure reports mayor may not generate a payment
request. If final expenditure report reflects funds due back to the Alliance,
payment is to accompany the report.
Note # 1: The last two months of the recipient's fiscal reports covering actual
expenditures should reflect an adjustment repaying advances for the first two
months of the contract.
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CONTRACT NUMBER KC 971 Page 11
ATTACHMENT III
COMMUNITY CARE FOR THE ELDERLY PROGRAM
BUDGET SUMMARY
Case
Quarter Dates Management CCE Services TOTAL
First N/A
Second N/A
Third N/A
Fourth N/A
Total
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CONTRACT NUMBER KC 971 Page 12
ATTACHMENT IV
REFERRAL PROTOCOL
Issue: Screening, Triage, and Referral for Activation under the Community Care for the
Elderly/Home Care for the Elderly Programs and for the Aging & Disabled Adults
and the Assisted Living for the Elderly Medicaid Waivers.
Policy: Referrals will be based on availability of funds, in accordance with prioritization
requirements.
Purpose: To ensure funding is spent expeditiously and consumers are referred into
programs for appropriate services.
Procedure for Monroe County:
I. Roles and Responsibilities
A. Alliance for Aging / Aging Resource Center
~ Monitors overall program and Lead Agency specific spending levels on a
monthly basis to ensure the Lead Agency is operating within the funding
allocation.
~ Determines the number of cases for activation based on projected funding
available.
~ Screens consumers to link with appropriate resources and prioritize for
DOEA-funded programs and services.
~ Recommends potential cases for activation based upon projected funding
available by Lead Agency.
~ Selects consumers from the waiting list based on their prioritization score.
~ Refers consumers from the waiting list to the Lead Agency in Monroe
County for activation, based on availability of funds.
~ Monitors compliance with service standards and outcome measures.
~ Reviews care plans and files per the File Review Policies and Procedures.
~ Reviews data in CIRTS.
B. Case Management Agency
~ Accepts referrals from the Aging Resource Center.
~ Refers inquiries from consumers interested in services to the ARC for
Information and Referral to community resources, Screening, Triage, and
Long- Term Care Options Counseling, as appropriate.
~ Through outsourcing, the functions of Screening and Intake may also be
completed by the Lead Agency.
~ Completes comprehensive assessments on new consumers and annual
reassessment on existing consumers and develops care plans and
reviews care plans semi-annually.
~ Authorizes service delivery and enters data into CIRTS.
~ Screens consumers for Medicaid Waiver eligibility.
~ Bills in CIRTS and Medicaid as appropriate,
~ Monitors care plans in an effort to keep costs down while sustaining the
individuals in the community.
II. Management of the Assessed Prioritized Consumer List (APCL).
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CONTRACT NUMBER KC 971 Page 13
A. Referrals to the ARC are routed to the Information and Referral Specialists or
Intake Unit staff depending on the type of referral. Clients are provided information
on community resources and programs available including private pay options.
Persons are directed to those resources most capable of meeting the need they
have expressed to ARC staff. Cases presenting strong identifiers that indicate the
consumer might benefit from publicly funded long term care services are
screened, entered into CIRTS, triaged and provided options counseling. Through
outsourcing, the functions of Screening and Intake may also be performed by the
Lead Agency. DOEA prioritization requirements will be adhered to by both entities,
as follows:
1. APS High Risk Referrals (See section B)
2. Imminent Risk cases will be prioritized for activation after APS High Risk
Referrals have been served. If budgetary constraints prevent opening new
cases, clients will be placed on the APCL. ARC staff will contact the client
on a monthly basis to determine if there has been a change in the client's
situation.
3. All other CARES referrals will be screened and prioritized in accordance
with DOEA requirements.
4. Aging Out consumers will be referred by DCF for prioritization and/or
activation in the corresponding aged program managed by the Alliance, as
appropriate (See section IV).
5. Consumers applying for the Community Care for the Elderly (CCE) and/or
Home Care for the Elderly (HCE) programs will be contacted and screened
using the statewide assessment form developed by the Department of
Elder Affairs for this purpose (Form 701A). If a consumer is being served
through a DOEA-funded agency which enters their annual assessment into
CIRTS, the Priority Score generated by that assessment will determine
their ranking on the APCL.
6. Consumers referred for inclusion under the Assisted Living for the Elderly
(ALE) Medicaid Waiver APCL will be interviewed and screened using the
701A form.
7. Consumers referred for inclusion under the Aging and Disabled Adult
(ADA) Medicaid Waiver APCL will be contacted and screened following the
same procedure as the one described under Section 5. Individuals who
appear as potentially eligible for other types of public assistance will be
referred to the Economic Self-Sufficiency Unit at the Department of
Children and Families.
8. All other referrals will be waitlisted and prioritized, during which time other
community resources will be researched, including private pay/fee for
services providers. Consumers on the waiting lists will be reassessed
according to Department requirements (NOI #062906-1-I-OVCS
6/29/2006).
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CONTRACT NUMBER KC 971 Page 14
B. HIPAA forms will be sent to the consumer as appropriate.
III. Opening New Cases
A. CCE/ADAlALE/HCE Clients
1. The Fiscal Department will monitor Lead Agency specific spending levels
on a monthly basis to ensure each Lead Agency is operating within its
quarterly funding allocation and/or spending authority. In addition, the
department will do cost projections, and share the information with the
Surplus/Deficit review committee to determine slot availability. The ARC
and the Quality Assurance Department will be notified when funding is
available and the number of new cases to be activated by Lead Agency.
2. Upon notification from the Vice President for Finance of funding
availability, the Aging Resource Center Intake Unit Supervisor will run the
Prioritized Risk Report to identify the consumers on the APCL to be
opened.
3. Based on available funding, the ARC Intake Unit Supervisor will refer wait
listed clients to the Lead Agency for activation, in accordance with
prioritization requirements. The Lead Agency will update the wait list
enrollment using the appropriate code to terminate from the APCL.
B. APS Referrals
1. APS Low and Intermediate Risk referrals will be screened and prioritized
for services as per the DOEA/APS Memorandum of Understanding. Low
and Intermediate Risk referrals are also offered information and referral to
additional community resources, including private pay as appropriate.
2. APS High Risk Referrals are not waitlisted. They are immediately referred
for service from DCF in Monroe County to the Lead Agency. ARTT
referrals will be forwarded directly the Lead Agency. APS cases are to be
served for a maximum of 31 calendar days. If additional time is justified,
the case management agency will staff the case with the Alliance to obtain
the extension needed.
3. Upon receipt of the APS referral, the Lead Agency will coordinate services
to begin within the 72 hour period mandated by statute. A comprehensive
assessment will be done within 14 working days of the referral. Services
required under the care plan will remain in place for a maximum of 31
days, unless an extension has been granted.
4. The Lead Agency will enter ACTV enrollment under their provider number
in CIRTS. In addition, service codes will be entered by service date for all
services provided. If a service(s) is not provided as required under the
care plan, an NDP code will need to be entered in CIRTS and the case
notes under the client file should document the reason for non-delivery of
such service(s).
IV. Aging Out Consumers:
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CONTRACT NUMBER KC 971 Page 15
A. All "Aging Out" consumers will be referred by DCF for activation in the
corresponding aged program managed by the Alliance.
B. Consumers active in the CCDA and HCDA programs that are tuming 60 and are
eligible for CCE and/or HCE will be opened in the corresponding aged program
managed by the Alliance if funding is available. If funding is available, these
consumers will be made active. If funding is not available, they will be waitlisted
for these programs but will be given priority for activation once funding is
available.
C. Consumers active in the ADA Medicaid Waiver, upon turning age 60, will continue
to be eligible for and receive ADA Medicaid waiver services.
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CONTRACT NUMBER KC 971 Page 16
ATTACHMENT V
Aging Resource Center Outsourced Funtions
A. Perform ARC outsourced functions in accordance with policies and procedures
developed by the Alliance for Aging. (ATTACHMENT VI)
B. Maintain wait lists in CIRTS in accordance with DOEA requirements.
C. Report number of client contacts to the Aging Resource Center
D. Adhere to prioritization policy as set forth by the Department of Elder Affairs
E. Update the agency Disaster Plan to incorporate ARC outsourced functions.
F. Ensure against conflicts of interest and inappropriate self-referrals by referring
consumers in need of options counseling or long-term care services beyond the
provider's scope of services to the Aging Resource Center.
G. Ensure that services provided are in the clients' best interest, are the most cost
effective, of high quality, and are responsive and appropriate to the assessed needs.
The Assessed Priority Consumer List (APCL) is maintained when services funded by the
department are not available. Through outsourcing, the function of Screening may also be
completed by the Lead Agency for the Community Care for the Elderly, Home Care for the
Elderly, Aging and Disabled Adults, and the Assisted Living for the Elderly Medicaid Waivers.
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CONTRACT NUMBER KC 971 Page 17
ATTACHMENT VI
Policy and Procedure for Outsourced function - Screening
Objective: To ensure that a comprehensive list of clients in need of services is
maintained in CIRTS by appropriate funding source and that the ARC is thereby able to
effectively gauge the level of elder service need in Miami-Dade and Monroe Counties.
Policy: To obtain necessary information from clients in order to assist in
determining level of need and eligibility for DOEA funded services
Procedure:
ARC Contracted Providers will collect information from callers and conduct a 701A assessment.
Alternatively, if a 701B assessment already exists or is provided from another source (Le.
CARES) the information from the 7018 can be utilized.
Based on the information provided via the 701A(B) assessment, the ARC Contracted Provider will make a
determination as to the services that the caller is in need of receiving.
The ARC Contracted Provider will determine the appropriate funding source(s) that provides the needed
services.
If the caller is in need of a service(s) that is not provided by the ARC Contracted Provider, the ARC
Contracted Provider will refer caller to the ARC Elder Helpline utilizing the ARC Referral
Form and/or to an ARC Contracted Provider that provides the needed service.
The caller will be provided with general information regarding the ARC as well as the ARC Elder Helpline
contact number.
The caller will be informed of the services and funding sources that they are being placed on the wait list
for in CIRTS.
ARC Contracted Provider will create a client record in aRTS (if there is no existing record) and enter the
services needed for the caller by funding source and service. [If there is an existing
record in CIRTS, the appropriate fields will be updated].
If the ARC Contracted Provider determines that the caller may qualify for more than one funding sourcef
ARC Contracted Provider is encouraged to enter the appropriate information under
multiple funding sources. [If there is an existing client record in CIRTS, the client record
in CIRTS will be updated with appropriate information].
ARC Contracted Provider will inform caller that they will receive a follow-up call (or home visit in
case of active client) to check on their status based on DOEA Wait List Reassessment Standards
and encourage caller to contact the ARC Elder Helpline with any questions.
Note: These ARC policies and procedures are subject to change. Any
modifications will be done through a contract amendment.
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