Item C08
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: 7-14-2009 . Division: _County Administrator
Bulk Item: Yes X No - Department: Social Services/In-Home Services_
--
Staff Contact Person/Phone #: Sheryl GrahamlX451 0
AGENDA ITEM WORDING: Approval of Amendment 001 to the Home Care for the Elderly (HCE)
Contract KH-972 between the Alliance for Aging, Inc. (Area Agency on Aging) and the Monroe
County Board of County Commissioners (Social Services/In-Home Services) for fiscal year 7/1/09 to
6/30/1 O.
ITEM BACKGROUND: Approval of Amendment 001 to the HCE eontract will decrease the amount
under contract by $1,391.00 from $12,112.00 to $10,721.00. 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 Home Care for the
Elderly (HCE) Grant Contract #KH972 on 6-17-09.
CONTRACT/AGREEMENT CHANGES: Decreasing the amount under contract by $1,391.00 for a
contract total of$1O,721.00.
ST AFF RECOMMENDATIONS: Approval
TOTAL COST: $10,721.00 INDIRECT COST: _-O-_BUDGETED: Yes JLNo -
COST TO COUNTY: $0 (No Cash Match Required) SOURCE OF FUNDS: Grant
REVENUE PRODUCING: Yes X No - AMOUNT PER MONTH $50.00 Year $600.00
72-
APPROVED BY: County Atty 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 HCE Contract #
KH -972
Effective Date: July 1, 2009
Expiration Date: June 30, 2010
Contract PurposelDescription: Approval of Amendment 001 to the Home Care for the Elderly (HCE)
Contract#KH-972 will decrease the amount under contract by $1,391.00 from $12,112.00 to $10,721.00
Contract Manager: Sheryl Graham 4510 Social Services/Stop 1
(Name) (Ext. ) (Department/Stop #)
For BOCC meeting on 7/15/2009 Agenda Deadline: 6/30/2009
CONTRACT COSTS
Total Dollar Value of Contract: $10,721.00 Current Year Portion: $
Budgeted? Yes X No Account Codes: 125 -6153609 - - -
- -
Grant:$l 0,721.00 (Fiscal Year) - - - -
County Match: $0 (No Cash Match required) - - - -
- - - -
ADDITIONAL COSTS
Estimated Ongoing Costs: $ /yr For:
(Nollncluded in dollar value above) (eg. Maintenance, utilities, ianitorial, salaries, etc)
CONTRACT REVIEW
Changes Date Out
~~ N~ ~
Division Director &. vO 07 Yes '. No .
Risk Mana~ment ~- Ctt ~if1 Yes No toeA 9-D7
A ~ .'0- Ct( 30 100f
O. .B.IPurchlsing Yes ~
County Attorney \, \~~ \\> t.\ Yes No
Comments:
OMB Form Revised 2/27/01 MCP #2
Amendment 001 CONTRACT KH 997 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 $ 1,391
from $12,112 to $10,721.
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:
Contract Number KH 972 Page 1
HOME CARE FOR THE ELDERLY CONTRACT
2009-2010
THIS AGREEMENT is entered into between the Alliance for Aging, Inc., hereinafter referred to as
the "Alliance," and Monroe County Board of Commissioners, hereinafter referred to as the
"recipient." This agreement is subject to all provisions contained in the MASTER AGREEMENT
executed between the Alliance and the Recipient, Agreement No. PA829, and its successor,
incorporated herein by reference. Attachment I, II, III, IV and V are integral to this Agreement.
I. Recipient Agrees:
A. Services to be Provided:
1. 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 AQency 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 and ARC Outsourced Functions included in Attachment
III and ARC Outsourced Functions Policies and Procedures outlined in Attachment IV
2 Consumers may not be enrolled in a Department of Elder Affairs' state general revenue
funded program, including HCE, who are also enrolled in a Medicaid capitated long tenn
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 scheduled to begin operation in the Miami-
Dade County area.
B. Manner of Service Provision:
The services willlSe provided in a manner consistent with and described in the recipient's service
provider application for state fiscal year 2009 and the Department of Elder Affairs Client Home
And Community Based Services Handbook dated 01/03 In the event the manual is revised,
such revision will automatically be incorporated into the contract and the recipient will be given a
copy of the revisions.
II. The Alliance Agrees:
A. Contract Amount:
To pay for services in an amount not to exceed $12.112.00, subject to the availability of funds.
Obligation to Pay:
The Alliance's perfonnance and obligation to pay under this contract is contingent upon an annual
appropriation by the Legislature.
B. Source of Funds:
1
Contract Number KH 972 Page 2
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 pursuant to this contract
are in the state grants and aids appropriations.
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 earlier.
2. Delivery of services shall end on June 30, 2010.
IN WITNESS WHEREOF, the parties hereto have caused this agreement to be executed by their
undersigned officials as duly authorized.
PROVIDER:
Monroe County Board of ALLIANCE FOR AGING, INC.
Commissioners
SIGNED BY: SIGNED BY:
Max B. Rothman, JD, LL.M.
NAME: George Neugent NAME:
Mayor President & CEO
TITLE: TITLE:
DATE: 6-17-09 DATE:
2
Contract Number KH 972 Page 3
ATTACHMENT I
HOME CARE FOR THE ELDERLY PROGRAM
I. STATEMENT OF PURPOSE
The Home Care for the Elderly (HCE) Program encourages the provision of care in family-type living
arrangements in private homes on a not for profit basis as an alternative to nursing home or other
institutional care.
II. SERVICES TO BE PROVIDED
A. Services:
1. The recipient's July 2009 application 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 HCE, 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 any other areas that
may participate in the Long Term Care Community Diversion Program through expansion
and the Program of All Inclusive Care for the Elderly (PACE) program.
B. Manner of Service Provision:
The services will be provided in a manner consistent with and described in the recipient's July
2009 application and the Department of Elder Affairs Home and Community-Based Services
Handbook dated 01/03. In the event the handbook 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 rate reimbursement for approved
services. The recipient must ensure fixed rates include only those costs that 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 106H
and 10SH. 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.
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 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 nine 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 May & June 2009
reports. All advance payments are subject to the availability of funds.
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Contract Number KH 972 Page 4
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 at the
end of the first quarter of the contract period.
E. Contingent upon the recipient's ability to maintain program expenditures within the
assigned quarterly allocations and the availability of funds, the Alliance shall make
payment to the provider for provision of services at the rate{s) stated below:
SERVICE TO BE PROVIDED UNIT MAXIMUM MAXIMUM
RATE UNITS DOLLARS
Case Management $47.86 253 $12,112
F. Any payment due by the Alliance under the tenns 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 58H-1, Florida
Administrative Code promulgated for administration of Sections 430.601 through 430.608,
Florida Statutes, and the Department of Elder Affairs Home and Community Based Services
Handbook dated 01/03.
2. 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. 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.
2. Priority Criteria for Other Assessed Individuals:
The assessment and provision of services should always consider the most cost effective means
of service delivery. Functional impainnent shall be determined through the department's
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CONTRACT KH 972 Page 5
consumer assessment form administered to each applicant. The most frail individuals
not prioritized in groups one, two or three above, regardless of referral source, will receive
services to the extent funding is available.
C. Consumer Infoonation, Registration and Tracking System (CIRTS):
1. The recipient will ensure the collection and maintenance of Home Care for the Elderly (HCE)
subsidies and case management information on a monthly basis from the Consumer
Information, Registration and Tracking System (CIRTS). Maintenance includes valid exports
and backups of all data and systems according to department standards.
2. The recipient must ensure all data for HCE subsidies are entered in the CIRTS by the 15th of
each month. HCE subsidy data entered into the CIRTS by the 15th of the month will be for
payments incurred between the 16th of the previous month and the 15th of the current month.
Case management data entered into the CIRTS by the 15th of the month will be for units of
service provided during the previous month from the 16th and up to and including the 15th of the
current month or case management units of service may be entered according to the recipient
schedule, in aggregate on the 31st or daily, weekly or monthly.
3. The recipient will ensure data entry for HCE subsidies will cease on the 15th of the month and
the CIRTS Monthly Service Utilization Report, by consumer and by worker identification is run.
4. The recipient will ensure the Monthly Utilization Report, by consumer and by worker
identification is verified, corrected, certified no later than the 20th of the month in which the
report is generated.
5. The recipient will ensure caregivers determined eligible for the HCE basic subsidy after the 15th
of a month, will be processed to begin eligibility for the HCE basic subsidy on the 1 st day of the
next month.
6. The Alliance will reconcile and verify the CIRTS data prior to payment for HCE basic and special
subsidies and case management.
7. The Alliance will reconcile and verify the CIRTS data prior to payment for HCE basic and special
subsidies and case management.
5
CONTRACT KH 972 Page 6
ATTACHMENT II
HOME CARE FOR THE ELDERLY PROGRAM
CONTRACT REPORT CALENDAR
Report Submit To
Number Based On The Alliance
On This Date
1 July Advance * ............................................................. July 1
2 August Advance ** ... '" ... ... ... ... ....,... ... ... ... ... ... ... ... ... ... ... July 1
3 July Expenditure Report ............... ............ ...................... August 15
4 August Expenditure Report ... ............ ......... ......... ............ September 15
5 September Expenditure Report ........................................ October 15
6 October Expenditure Report ... ... ... ......... .................. ... ..... November 15
7 November Expenditure Report ............ ...... ...... ...... ...... ... .. December 15
8 December Expenditure Report ... ... ... ... ... ... ... ... ... ... ... ... ..... January 15
9 January Expenditure Report ......... ............ ....................... February 15
10 February Expenditure Report...... ...... ... ... ... ... ... '" ...... ... .... March 15
11 March Expenditure Report ... ... ...... ... ...... ... ... ...... ... ... ... ..... April 15
12 April Expenditure Report ................................................. May 15
13 May Expenditure Report ... ... ... ... ... ...... ... ... ... ... ... ...... ... .... June 15
14 June Expenditure Report ............ ...... ... ...... ... ...... ... ... ... .... July 15
15 Final Expenditure and Closeout Report July 15
Leqend * Advance based on projected cash need.
** Submission of expenditure reports mayor may not generate a payment request. If final
expenditure report reflects funds due back to the department, payment is to accompany
the report.
Note # 1 : Report #1 for Advance Basis Contracts cannot be submitted to the Alliance prior to July
1 or until the contract with the Alliance has been executed. Actual submission of the
vouchers to the Department of Elder Affairs is dependent on the accuracy of the
expenditure report.
Note # 2: The last two months of the recipient's fiscal reports covering actual expenditures should
reflect an adjustment repaying advances for the two months of the contract.
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CONTRACT KH 972 Page 7
ATTACHMENT III
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.
y Determines the number of cases for activation based on projected funding available.
y Screens consumers to link with appropriate resources and prioritize for DOEA-funded
programs and services.
y Recommends potential cases for activation based upon projected funding available
by lead Agency.
y Selects consumers from the waiting list based on their prioritization score.
y Refers consumers from the waiting list to the lead Agency in Monroe County for
activation, based on availability of funds.
y Monitors compliance with service standards and outcome measures.
y 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 Infonnation
and Referral to community resources, Screening, Triage, and Long-Tenn Care
Options Counseling, as appropriate.
y Through outsourcing, the functions of Screening and Intake may also be completed
by the Lead Agency.
y Completes comprehensive assessments on new consumers and annual
reassessment on existing consumers and develops care plans and reviews care
plans semi-annually.
y Authorizes service delivery and enters data into CIRTS.
y Screens consumers for Medicaid Waiver eligibility.
y Bills in CIRTS and Medicaid as appropriate.
y 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).
A. Referrals to the ARC are routed to the Infonnation and Referral Specialists or Intake Unit staff
depending on the type of referral. Clients are provided infonnation on community resources
and programs available induding 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 benefrt from publicly funded
long tenn care services are screened, entered into CIRTS, triaged and provided options
counseling. Through outsourcing, the functions of Screening and Intake may also be
perfonned by the Lead Agency. DOEA prioritization requirements will be adhered to by both
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CONTRACT KH 972 Page 8
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).
B. HIPAA fonns will be sent to the consumer as appropriate.
III. Opening New Cases
A. CCE/ADA/ALE/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
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CONTRACT KH 972 Page 9
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 DOEAJAPS 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 fOlwarded
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:
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 turning 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 KH 972 Page 10
ATTACHMENT IV
Aging Resource Center Outsourced Functions
A. Perform ARC outsourced functions in accordance with policies and procedures developed by the
Alliance for Aging. (ATTACHMENT V)
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.
10