Item C04
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date:
8-19-2009
Division: _County Administrator
Bulk Item: Yes X
No
Department: Social Services/In-Home Services_
Staff Contact PersonlPhone #: Sheryl GrahamlX451 0
AGENDA ITEM WORDING: Approval of the of the Home and Community Based Case
Management Referral Agreement between the Florida Department of Children & Families and the
Monroe County Board of County Commissioners (Social Services/In-Home Services Program) for
State Fiscal Year (SFY) July 1, 2009 to June 30, 2010.
ITEM BACKGROUND: Approval of the Home and Community Based Waiver Case Management
Referral Agreement will enable Monroe County In-Home Services to continue providing services to
Monroe County's disabled adult population under the Home and Community Based ServicesIMedicaid
Waiver program.
PREVIOUS RELEVANT BOCC ACTION: Prior approval granted to the Home and Community
Based Case Management Referral Agreement (7-1-08 to 6-30-09) on 10-15-08.
CONTRACT/AGREEMENT CHANGES: none
STAFF RECOMMENDATIONS: Approval
TOTAL COST: Approx.$13,000.00_INDIRECT COST: _-O-_BUDGETED: Yes -XNo_
COST TO COUNTY: $0 (No Cash Match Required) SOURCE OF FUNDS: CCDA State
Medicaid- Waiver Funds
REVENUE PRODUCING: Ye~#.,NO Ul:)uNT PER MONTH Year
APPROVED BY: County At X "i1Y11 rurchasing ~Risk Management _X_
Not Required_
DOCUMENTATION:
Included X
DISPOSITION:
AGENDA ITEM #
Revised 1/09
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
CONTRACT SUMMARY
Contract # Home and Community
Based Case Management Referral
Agreement 09-10
Effective Date: 7/1/2009
Expiration Date: 06/3012010
Contract PurposelDescription: Approval of Home and Community Based Waiver Case Management Referral
Agreement between the Florida Department of Children & Families and the Monroe County Board of County
Commissioners (Social Services/In-Home Services Program) for State Fiscal Year (SFY) July 1,2009 to June 30,
2010.
Contract with: Florida Department of Children &
Families
Contract Manager:
Sheryl Graham
(Name)
4510
(Ext.)
Community Services/Stop 1
(Department/Stop #)
For BOCC meeting on 8/19/09
Agenda Deadline:
08/04/09
CONTRACT COSTS
Total Dollar Value of Contract: approx. $13,000,00
Budgeted? Yes X No Account Codes:
Grant: appro x , $ 13,000.00
County Match: $-0-
Current Year Portion: $
125 - 6153709 -
Estimated Ongoing Costs: $
(Not included in dollar value above)
/yr
ADDITIONAL COSTS
For:
(eg, Maintenance, utilities, ianitorial, salaries, etc)
Risk ManaflJent
O~B.lPu~a<}i~g
'1-17-0~
'":llnleq
') \ \~\ b'
Yes
Date Out
CONTRACT REVIEW
Date In
Changes
Nee~~
Yes ~
'1WJE
Division Director
Yes
County Attorney
Yes
Comments:
OMB Form Revised 2/27/01 MCP #2
! HlHid,~ O~'IJ<lnmclll of
i Cllildfo:n & Fal'tu/i......
ADULT SERVICES
HOME AND COMMUNITY BASED WAIVER
CASE MANAGEMENT REFERRAL AGREEMENT
This Referral Agreement made this I st day of July, 2009, between the Florida Department of
Children and Families' (DCF) Circuit 11 Program Office, and Monroe Co. In-Home Services
hereinafter referred to as "case management agency", details the responsibilities and the expectations
associated with the Medicaid Waiver for State Fiscal Year (SFY) 2009-20 10. The case management
agency is a Medicaid Waiver case management agency. This Referral Agreement is in effect from
the date of signature, through SFY 2009-2010 for as long as the Medicaid waiver case management
agency remains enrolled with the State of Florida's Medicaid fiscal agent. Case management agency
noncompliance, nonperformance, or unacceptable performance under this agreement may require a
corrective action plan addressing the problems identified by state agency Quality Assurance
Reviews. Failure of case management agencies to adhere to the Department of Children and Families'
. guidance on eligibility and referral for services may result in recoupment of program funds or case
management agency dis-enrollment as a Medicaid Waiver program case management agency.
... The purpose of this agreement is to enable eligible disabled adult participants to receive case
management services from qualified case management agencies with oversight of the quality of care
by the Florida Department of Children and Families' Circuit I I Program Office and the Medicaid
Waiver Specialist employed by the Department of Elder Affairs (DOEA). These services are
authorized in order that the participant may remain in the least restrictive setting and avoid or delay
nursing home placement. Services and care are to be furnished in a way that fosters the
independence of each participant and facilitates an increased functional capacity, 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 disabled adults.
D, To provide teclmical assistance to and consultation between agencies on matters
pertaining to actual service delivery and share appropriate assessment information and
care plans to avoid duplication,
E. To establish an effective working relationship between the case management agency, the
service case management agency, and the [<,Iorida Department of Children and Farnilies; the
case management agency being responsible for the development of care plans and
authorization of services avai lable under the waiver, the case management agency being
responsible for the direct provision of those services to consumers served under the waiver
program, and the Department being responsihle for management and oversight of the waiver
1
, ...
program.
II. Under this Agreement, the Circuit (Regional) Program Office agrees to the following:
A. To provide technical assistance and training to the case management agency,
B. To provide or to assist the Medicaid Waiver Specialist in providing annual on site
monitoring of the case management agency and, when applicable, conduct the same
monitoring of circuit DCF staff performing case management activities, using the
approved DOEA Medicaid waiver programmatic monitoring tool.
C. To monitor and project case management agency expenditures.
D. To conduct telephone screenings on all new referrals requesting services through the
ADA-HCBS Medicaid waiver within the timeframes set forth in the Adult Services Wait
List Policy guidelines, and using the Adult Services Screening for Consideration for
Community-Based Programs; CF-AA1 022.
E, To accept all Budget Entity Team referrals for face-to face assessments,
F, To complete all initial face-to-face assessments on all pre-screened individuals referred
by the Budget Entity Team for service consideration and program application, using the
Adult Services Client Assessment, CF-AA 3019.
G. To maintain an accurate and current active waiver case list.
H. To notify, on a timely basis, the Adult Services Central Office budget stafT of all waiver
service terminations, service increase requests and atypical monthly expenditure trends
with regards to the terms of this Agreement.
III. Under this Agreement, the Case Management Agency agrees to the following:
A. Adhere to the Department of Children and Families' guidance on eligibility and referral flJ[
services, as established through the Aged and Disabled Adult (ADA) Waiver Handbook
policy and the ADA Waiver format 1915(c),
B. Assign qualified case managers in accordance with the Aged and Disabled Adult
Medicaid Waiver Handbook to provide case management under the Medicaid Home and
Community Based Waiver for Aged and Disabled Adults.
C. Explain to each individual requesting consideration for ADA-HCBS Medicaid waiver
services that the Medicaid waiver program maintains a centralized Waiting List on which
the individual will be placed according to his or her score received through the Adult
Services Screening for Consideration for Community Based Services.
D. Supply all new disabled adult referrals (individuals requesting Aged and Disabled Adult
Home and Community Based Waiver services) with the name of a DCF Adult Services
counselor and the phone number to the nearest DCF Adult Services unit for the individual
to pursue service consideration and program screening,
E. Maintain and permit circuit access to:
1. A current and accurate log of all Medicaid waiver claims, activities and payments by
individual consumer;
2. A listing of each Medicaid waiver consumer served by full name, Social Security ID
and Medicaid ID;
3. Current (within one year) Consumer Care Plans indicating present authorized
service(s) and cost analysis by service on each waiver consumer serviced through this
2
contract; and,
4. Cunent log of consumer terminations of service (if applicable) with cost analysis of
the terminated consumer's unexpended care plan budget dak of termination and
reason for tenl1ination.
F, Develop and imdement the Plan of Care, ',vhich must be signed by the COnSiJmer, that
sDecificallyoutlInes:
1. Cj le consumer's health conditions ard tremments;
2, Challenges and impediments to the consumds daily living functionality identified by
the assessmeLt and to be addressed with the Plan of Care;
3. Service(s) authorized;
4. The frequency and intensity of the arranged service interventions;
5, Service gaps;
6. Expected outcomes to be achieved;
7. Cost analysis. by service, of those service units authorized for consumer delivery;
and,
8. The fom1al and informal support persons (agencies) responsible for delivering both
the DCF funded services authorized by the case manager and all other non-DCF
funded services,
G, Re-evaluate the Plan of Care at least every six months.
H. Mmimally reassess the client annually or more often if significant changes in the clienl's
situation warrant, with the Adult Services Client Assessment Instrument and amend the
Plan of Care accordingly. Make the required changes to authorized services and/or
service case management agencies as needed.
1. Adhere to the policies and procedures as outlined in the following manuals published by
the Agency for Health Care Administration: Aged and Disabled Adult Waiver Guidelines
and the Medicaid Case management agency Reimbursement Handbook (Non-
Institutional 081), including any and all attachments or updates.
J. Provide to the Agency for Health Care Administration, by the 15th of each month, a
completed Case management agency Monthly Report Form, CF-AA 1119, which is a
detailed expenditure repc)li showing the number of clients served, defined units and type
of services provided, cost of each service unit, number of units of service provided,
totaled monthly cost of services delivered, and a year to date total cost of services
delivered. This report will also include the number of active clients at the beginning of
the month, t~ le number added and deleted during the month, and the final count at the end
of the month.
K. Refer clients to the qualified direct service case management agency as selected hy the client,
whenever reasonable and possible:.
L. Issue written service authorizations to subcontracted service case management agencies
with at least 24 hours notice. The authorization will contain at a minimum:
1. Client's name;
2. Client's adrlress (with directions ifnot easily accessible);
3. Pertinent information regarding client's health or disabilities and living situation; and,
4. Detailed service description including frequency, duration and specific tasks to be
performed.
M, Evaluate quality of services and service documentation by the subcontracted service case
management agency,
3
l'<. Hold the Department of Children and Families hannkss from fil13ncial responsibility for
.3ervice cJalms'ound out of comr:;liance if they are the result of a failure by the case
managflnent agency to updak, rene\v, or teminat..: a client C:.ire pL:m or service
authorization,
O. Perform semi-annual administrative monitoring of :';llbcontracted senrice case
management agencies for adherence to illlthorizedcare pLms and authori::>:ecl
reimbursement rates.
P. Develop and implement a policy to ensure that its employees, board members, (me!
mancli:!:ement 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 COIhlict 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 case management agency, 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 case management
agency staff, volunteers, and board members bound by this service agreement make a
disclosure to the undersigned case management agency of any relationship which may be
a conflict of interest, within thirty (30) days of original appointment or placement on a
board, or if the individual is serving as an incumbent, within thirty (30) days ofth~
commencement of the COIll ract.
Q. Follow-up with the undersigned on all billing errors identified by the Agency for Health
Care Administration and/or the Circuit DCF office to ensure that all void or adjustment
claims are submitted no later than 45 days after each billing error has been identified by
either party. Any case management agency error not adjusted or voided within 45 days
may be adjusted or voided by the Agency for Health Care Administration or Florida
Department of Children and Families' Circuit Program Office. The case management
agency's refusal to adjust or void erroneous claims will result in termination of this
agreement.
R. Ifrequired by45 CFRParts 160,162, and 164, the f{)llowingprovisions shall apply [45
CFR 164.504(e)(2)(ii)]:
(a) The case management agency hereby agrees not to use or disclose protected
health information (PHI) except as permitted or required by this Agreement, state
or federal law,
(b) The case management agency agrees to use appropriate safeguards to prevent LIse
or disclosure of PHI other than as provided for by this Agreement or applicable
law,
(c) The case management agency agrees to report to the department any use or
disclosure of the information not provided for by this Agreement or applicable
law.
(d) The case management agency hereby assures the department that if any PHI
received from the department, or received by the case management agency on the
4
department's bchalt~ is furnished to case managemellt agency's subcontractors or
agents in the performance of tasks requireJ by this Agreemenl, that those
subcontractors or agents must first have agreed to the same restrictions :md
conditions that apply to the case managenlcnt agency with respect to such
information,
(f') The case management agency agrees to make PHI avaihble in. accordance with 45
C,F,R. 164.524,
(t) The case management agency agre.:s to make PHI available for amendment and to
incorporate any amendments to PHI in accordance with 45 C.F,R. 164.526,
(g) The case management agency agrees to make available the information rtluired
to provide an accounting of disclosures in accordance with 45 C.F.R. 164.528.
(h) The case management agency agrees to make its internal practices, books and
records relating to the use and disclosure of PHI received from the department or
created or received by the case management agency on behalf of the department
available for purposes of determining thp. case manager's complianc~ with these
assurances,
(i) The case management agency agrees [hat at the termination of this Agreement, if
feasible and where not inconsistent with other provisions of this Agreement
concerning record retention, it will return or destroy all PHI received from the
department or received by the case management agency on behalf of the
department, that the case management agency still maintains regardless of form.
If not feasible, the protections of this Agreement are hereby extended to that PHf
which may then be used only for such purposes as make the return or destruction
infeasible.
U) A violation or breach of any of these assurances shall constitute a material breach
of this Agreement.
S. Adhere to the Adult Services' Preliminary In-house Procedures for transferring a
Medicaid waiver consumer and the consumer's budget from one circuit to another at the
consumer's request.
IV. Termination
In the event this agreement is terminated, the case management agency agrees to subrnit, 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
5
This agreement rmy be terminated by either party upc n no less than thirty (30) calendar days
notice, \vithout cause. unless a lesser time is mutually agreed upon by bOth parties. in \' riting,
Said notice shall be delivered hy certified mail. return receipt requested, or in person \\;1[h
proof of delivery.
3, Termination for Breach
Unless a breach is waived by the Florida Department ofChildr;n and Families in writing or
the parties fail to cure the breach within the time specified by the Florida Departnent of
Children and Families, the Florida Department of Children and Families may, by written
notice' to the parties, terminate the agreement upon no less than twenty-four (24) hours notice.
SaidlOtice shal1 be delivered by certified mail, return receipt requested, or in person \"lith
proof of delivery.
In witness whereof, the parties have caused this 6 page agreement to be executed by their
undersigned officials as duly authorized.
Florida Department of Children
and Families Circuit 11
Program Office
Monroe Co, In-Home Services
S ignalUre
Signature
George Neugent
Print Name
Print Name
Mayor
Title
Title
8-19-09
Date
Date
I~! ~q
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i\\'I~>l~ .~
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6
';If'lrd<2C('~rT'I<!'f'\'t<)/
Ollldren & Famllifl
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ADULT SERVICES
HOJ\lE AND CONL\lUNITY BASED \V AIVER
CASE NIANAGE~IENT REFERRAL AGREE~lENT
This Referral Agreement made this 1st day of July, 2008, betvveen the Florida Department of
Children and Families' (DCF) Circuit 16 Program Office, and '\Ionroe County In-Home Services.,
hereinafter referred to as "case management agency", details the responsibilities and the expectations
associated with the \fedicaid Waiver for State Fiscal Year (SFY) 2008-2009. The case management
agency is a ~fedicaid Waiver case management agency. This Referral Agreement is in effect from
the date of signature, through SFY 2008-2009 for as long as the Medicaid waiver case management
agency remains enrolled with the State of Florida's Medicaid fiscal agent. Case management agency
noncompliance, nonperformance, or unacceptable performance under this agreement may require a
corrective action plan addressing the problems identified by state agency Quality Assurance
Reviews. Failure of case management agencies to adhere to the Department of Children and
Families' guidance on eligibility and referral for services may result in recoupment of program
funds or case management agency dis-enrollment as a Medicaid Waiver program case management
agency,
The purpose of this agreement is to enable eligible disabled adult participants to receive case
management services from qualified case management agencies with oversight of the quality of care
by the Florida Department of Children and Families' Circuit 16 Program Office and the Medicaid
Waiver Specialist employed by the Department of Elder Affairs (DOEA). These services are
authorized in order that the participant may remain in the least restrictive setting and avoid or delay
nursing home placement. Services and care are to be furnished in a way that fosters the independence
of each participant and facilitates an increased functional capacity. All parties agree that routines of
care provision and service delivery mu~t 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 bet\:veen 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 disabled adults.
0, To provide technical assistance to and consultation between agencies on matters
pertaining to actual service deli" ery and share appropriate assessment information and
care plans to avoid duplication.
E, To establish an effective working relationship between the case management agency, the
service case management agency, and the Florida Department of Children and Families; the
,.:ase management agency being responsible for the developmem of care plans and
luthorization of services available under the waiver, the case management agency being
'.
responSiblcl the direct provision of those services l_~~umers served under the waiver
program, and the Department being responsible for management and oversight of the
waIver program.
II.
('nder this Agreement, the Circuit (Regional) Program Office agrees to the following:
A, To provide technical assistance and training to the case management agency.
B. To provide or to assist the Yledicaid Waiver Specialist in providing annual on site
monitoring of the case management agency and, when applicable, conduct the same
monitoring of district DCF staff performing case management activities, using the
approved DOEA yledicaid waiver programmatic monitoring tool.
C. To monitor and project case management agency expenditures.
D. To conduct telephone screenings on all new referrals requesting services through the
ADA-HCBS Medicaid waiver within the timeframes set forth in the Adult Services \Vait
List Policy guidelines, and using the Adult Services Screening for Consideration for
Community-Based Programs.
E. To accept all Budget Entity Team referrals for face-to face assessments.
F. To complete all initial face-to-face assessments on all pre-screened individuals referred
by the Budget Entity Team for service consideration and program application, using the
Adult Services Client Assessment, CF-AA 3019.
G. To maintain an accurate and current active waiver case list.
H. To notifY, on a timely basis, the Adult Services Central Office budget staff of all waiver
service terminations, service increase requests and atypical monthly expenditure trends
with regards to the terms oftrus Agreement.
III. Under this Agreement, the Case Management Agency agrees to the following:
A. Adhere to the Department of Children and Families I guidance on eligibility and referral for
services, as established through the Aged and Disabled Adult (ADA) Waiver Handbook
policy and the ADA Waiver format 1915(c).
B, Assign qualified case managers in accordance with the Aged and Disabled Adult
:Medicaid Waiver Handbook to provide case management under the Medicaid Home and
Community Based Waiver for Aged and Disabled Adults.
C, Explain to each individual requesting consideration for ADA-HCBS Medicaid waiver
services that the Medicaid waiver program maintains a centralized Waiting List on which
the individual will be placed according to his or her score received through the Adult
Services Screening for Consideration for Community Based Services.
D, Supply all new disabled adult referrals (individuals requesting Aged and Disabled Adult
Home and Community Based Waiver services) with the name of a DCF Adult SeIY'ices
counselor and the phone number to the nearest DCF Adult Services unit for the individual
to pursue service consideration and program screening,
E. .'v[aintain and permit district access to:
1, A current and accurate log of all .'vfedicaid waiver claims, activities and payments by
individual conswner;
2, A. listing of each .'vfedicaid 'xaiwr consumer served by full name, Social Security ID
'1
'.
'. )~
J
~
and Medicaid ID;
3. Current (vvithin one year) Consumer Care Plans indicating present authorized
service(s) and cost analysis by service on each waiver consumer serviced through this
contract; and,
4. Current log of consumer terminations of service (if applicable) with cost analysis of
the terminated consumer's unexpended care plan budget, date of termination and
reason for termination.
F, Develop and implement the Plan of Care, which must be signed by the consumer, that
specifically outlines:
1, The consumer's health conditions and treatments;
2. Challenges and impediments to the consumer's daily living functionality identified by
the assessment and to be addressed with the Plan of Care;
3. Service(s) authorized;
4, The frequency and intensity of the arranged service interventions;
5. Service gaps;
6, Expected outcomes to be achieved;
7. Cost analysis, by service, of those service units authorized for consumer delivery; and,
8. The formal and informal support persons (agencies) responsible for delivering both
the DCF funded services authorized by the case manager and all other non-DCF
funded services.
G. Reevaluate the Plan of Care at least every six months.
H. Minimally reassess the client annually or more often if significant changes in the client's
situation warrant, with the Adult Services Client Assessment Instrument and amend the
Plan of Care accordingly. Make the required changes to authorized services and/or
service case management agencies as needed.
1. Adhere to the policies and procedures as outlined in the following manuals published by
the Agency for Health Care Administration: Aged and Disabled Adult Waiver Guidelines
and the Medicaid Case management agency Reimbursement Handbook (Non-Institutional
081), including any and all attachments or updates.
1. Provide to the Agency for Health Care Administration, by the 15th of each month, a
completed Case management agency Monthly Report Form, CF-AA 1119, which is a
detailed expenditure report showing the number of clients served, defined units and type
of services provided, cost of each service unit, number of units of service provided,
totaled monthly cost of services delivered, and a year to date total cost of services
delivered. This report \vill also include the number of active clients at the beginning of
the month, the number added and deleted during the month, and the tinal count at the end
of the month.
K. Refer clients to the qualitied direct service case management agency as selected by the client,
'.'Yhenever reasonable and possible,
L. Issue \\Titten service authorizations to subcontracted service case management agencies
with at least 24 hours notice, [he authorization will contain at a minimum:
1, Client's name;
2, Client's address (with directions ifnot easily accessible);
3. Pertinent information regarding client's health or disabilitieslr:d living situatIOn; 3.nd,
3
I
~)
4, Detailed service description including frequency, duration and specific tasks to be
performed.
~1. Evaluate quality of services and service documentation by the subcontracted service case
management agency.
X Hold the Department of Children and Families harmless from financial responsibility for
service claims found out of compliance if they are the result of a failure by the case
management agency to update, renew, or terminate a client care plan or service
authorization.
O. Perform semi-annual administrative monitoring of subcontracted service case
management agencies for adherence to authorized care plans and authorized
reimbursement rates.
P. Develop and implement a policy to ensure that its employees, board members, and
management \\<111 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 case management agency, 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 case management
agency staff, volunteers, and board members bound by this service agreement make a
disclosure to the undersigned case management agency of any relationship which may be
a conflict of interest, within thirty (30) days of 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 contract.
Q. Follow-up with the undersigned on all billing errors identified by the Agency for Health
Care Administration and/or the district DCF office to ensure that all void or adjustment
claims are submitted no later than 45 days after each billing error has been identified by
either party. Any case management agency error not adjusted or voided within 45 days
may be adjusted or voided by the Agency for Health Care Administration or Florida
Department of Children and Families' District Program Office. The case management
agency's refusal to adjust or void erroneous claims will result in termination of this
agreement.
R. If required by 45 CFR Parts 160, 162, and 164, the following provisions shall apply [45
CFR 1 64.504(e)(2)(ii)]:
(a) The case management agency hereby agrees not to use or disclose protected
health information (PHI) except as permitted or required by this Agreement, state
or federal law,
Ib) The case management agency agrees to use appropriate safeguards to prevent use
or disclosure of PHI other than as provided for by this Agreement or applicable
law.
Ie) The case management agency agrees to report to the department any use or
-+
;
j)
disclosure of the information not provided for by this Agreement or applicable
law.
(d) The case management agency hereby assures the department that if any PHI
received from the department, or received by the case management agency on the
department's behalf, is furnished to case management agency's subcontractors or
agents in the performance of tasks required by this Agreement, that those
subcontractors or agents must first have agreed to the same restrictions and
conditions that apply to the case management agency with respect to such
information.
(e) The case management agency agrees to make PHI available in accordance \vith 45
C,F.R. 164.524.
(f) The case management agency agrees to make PHI available for amendment and to
incorporate any amendments to PHI in accordance with 45 C.F.R. 164.526.
(g) The case management agency agrees to make available the information required
to provide an accounting of disclosures in accordance with 45 C.F.R. 164.528.
(h) The case management agency agrees to make its internal practices, books and
records relating to the use and disclosure of PHI received from the department or
created or received by the case management agency on behalf of the department
available for purposes of determining the case manager's compliance with these
assurances.
(i) The case management agency agrees that at the termination of this Agreement, if
feasible and where not inconsistent with other provisions of this Agreement
concerning record retention, it will return or destroy all PHI received from the
department or received by the case management agency on behalf of the
department, that the case management agency still maintains regardless of form.
If not feasible, the protections of this Agreement are hereby extended to that PHI
which may then be used only for such purposes as make the return or destruction
infeasible.
U) A violation or breach of any of these assurances shall constitute a material breach
of this Agreement.
S, Adhere to the Adult Services' Preliminary In-house Procedures for transferring a \,[edicaid
waiver consumer and the consumer's budget from one district to another at the consumer's
req uest.
IV, The following services will be delivered by the case management agency in accordance '.vith
'he plan of care or service authorization:
.:;
}
,.:')....'"
--.-.-."
"
Service
A. Case ylanagement under CDC
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 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, rerum receipt requested, or in
person with proof of delivery.
B. Termination for Breach
Unless a breach is waived by the Florida Department of Children and Families in writing or
the parties fail to cure the breach within the time specified by the Florida Department of
Children and Families, the Florida Department of Children and Families 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 6 page agreement to be executed by their
undersigned officials as duly authorized.
Florida Department of Children
and Families Circuit 16
Program Office
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title
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Mario Di Gennaro
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10-15-08
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