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07/01/99Contract Number KG997
ALZHEIMERS DISEASE INITIATIVE
STANDARD CONTRACT
THIS CONTRACT is entered into between the Alliance for Aging, Inc., hereinafter referred to as the
"Alliance", and the Monroe County Board of Commissioners, hereinafter referred to as the "provider". This
contract is subject to all provisions contained in the MASTER AGREEMENT executed between the Alliance
and the Provider, Agreement No. PA29. and its successor, incorporated herein by referen~. \.0.."
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To plan, develop, and accomplish the services delineated, or otherwise?:ca~ ~ ~ing,
development, and accomplishment of such services and activities, under the conditions specifi~ and in
the manner prescribed in Attachmentl.. of this agreement.
B. Requirements of Section 287.058, Florida Statutes:
These requirements are herein incorporated by reference.
C. Final Request for Payment
1. The provider must submit the final request for payment to the Alliance no more than 45 days after
the contract ends or is terminated; if the provider fails to do so, all right to payment is forfeited,
and the Alliance will not honor any requests submitted after the aforesaid time period. Any
payment due under the terms of this contract may be withheld until all reports due from the
provider, and necessary adjustments thereto, have been approved by the Alliance.
2. A final receipt and expenditure report as a closeout report will be forwarded to the Alliance within
sixty (60) days after the contract ends or is terminated. All monies which have been paid to the
provider which have not been used to retire outstanding obligations of the contract being closed out
must be refunded to the Alliance along with the final receipt and expenditure report.
.11. The Alliance Agrees:
Contract Amount
To pay for contracted services according to the conditions of AttachmentL in an amount not to exceed $_
31.693.50, subject to the availability of funds. The Alliance's performance and obligation to pay under this
contract is contingent upon an annual appropriation by the Legislature. The costs of services paid under any
other contract or from any other source are not eligible for reimbursement under this contract. The schedule
of funds awarded to the provider pursuant to this contract is in state grants and aids appropriations and
consists of the following:
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07/01/99Contract Number KG997
Program Title Year Funding Source CFDA# Fund Amounts
Alzheimer's 1999 General Revenue N/A $31,693.50
Disease Initiative
TOTAL FUNDS CONTAINED IN THIS CONTRACT: $31,693.50
III. Provider and Alliance Mutually Agree:
A. Effective Date:
1. This contract shall begin on Julv 1. 1999 or on the date the contract has been signed by both parties,
whichever is later.
2. . This contract shall end on December 31. 1999.
B. Termination and Suspension
The causes and remedies for termination or suspension ofthis contract shall follow the same procedures
as outlined in Section III. B. And Section III. C. of the Master Agreement.
C. Notice, Contact, and Payee Information:
1. The name, address, and telephone number of the contract manager for the Alliance for this contract
IS:
John L. Stokesberrv
Alliance for Aging, Inc.
9500 S. Dadeland Boulevard, Suite 400
Miami, Florida 33156
305-670-6500
2. The name, address, and telephone number of the representative of the provider responsible for
administration of the program under this contract is:
Louis LaTorre
5100 College Road - Wing III
Key West, FL 33040
(305) 292-4420
. 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.
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07/01/99Contract Number KG997
4. The name (provider name as shown on page 1 of this contract) and mailing address of the official
payee to whom the payment shall be made:
Monroe County Board of Commissioners
5100 College Road - Wing III
Key West, FL 33040
IN WITNESS THEREOF, the parties hereto have caused this --L page contract to be executed by their
undersigned officials as duly authorized.
PROVIDER: MONROE COUNTY BOARD
OF COMMISSIONERS
ALLIANCE FOR AGING, INC.
BOARD PRESIDENT OR
AUTHORlZED DESIGNEE
SIGNED \ ,...... -, "':-... ,'1\ ., 4 ,_ ~\\~_~........~
BY: '.1.J-"~I.....NI..~'"''.'''''''-'-''''' \ . ~,
SIGNED
B~~G'r\~ ~~~Ov-I
NAME: LL) i \ h.. \ VYoj ~ ~ C'k. 1::tcu-- U ..Q J-
TITLE: _MCllA~
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DATE: 'l-~j~(~('i
NAME: RAMONA FRlSCHMAN, EdD
TITLE: BOARD PRESIDENT
DATE: ~I
FEDERAL ID NUMBER: 59-6000749
PROVIDER FISCAL YEAR END DATE: September 30
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ATT~ST: DANNY L KOLHAGE
fl I ClERK
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BY ...., C . ,0l~ .
DEPUTY CLERK ~<C j
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07/01/99Contract Number KG997
ATTACHMENT I
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
I. STATEMENT OF PURPOSE
Alzheimer's Disease Initiative Program is focused on caring for persons 18 + with memory disorders.
II. SERVICES TO BE PROVIDED
A. Services:
The approved Service Provider Application of Monroe County Board of Commissioners for
Alzheimer's Disease Initiative funds for July 1, 1999 to December 31, 1999, 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 provider, and prescribe the services to be rendered by the
provider.
B. Manner of Service Provision:
Respite services will be provided in a manner consistent with and described in the Service Provider
Application for the Alzheimer's Disease Initiative funds for July 1, 1999 to December 31, 1999 of the_
Monroe County Board of Commissioners and the Department of Elder Affairs Client Services Manual.
In the event the manual is revised, the contract will incorporate any such revision and the provider will
be given a copy of the revision.
III. METHOD OF PAYMENT
A. this is a fixed rate - advance funding contract. All requests for payment and expenditure reports
submitted to support requests for payment shall be on DOEA forms 106Z and 105Z. 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 provider may request a monthly advance 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
maintained in the contract managers 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 A TT ACHMENT 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.
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07/01/99Contract Number KG997
c. Advance funds may be temporarily invested by the provider 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.
D. Any payment due by the Alliance under the terms of this contract may be withheld pending the receipt
and approval by the Alliance of all financial and programmatic reports due from the provider and any
adjustments thereto.
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 to be
Provided
Respite
Unit of
Service
1 client hour
Unit
Rate
$20.661017
Maximum
Units
1534
Maximum
Dollars
$31,694
IV. SPECIAL PROVISIONS
A. Program Income
Program Income earned may be spent in the same year as earned. Any program income funds not spent
may be carried forward into the next fiscal year. Any prior year program income carried forward must
be spent in the following year.
B. State Laws and Regulations
The provider agrees to comply with applicable parts of Rule 58D-l, Florida Administrative Code
promulgated for administration of Sections 430.501 through 430.504, Florida Statutes, and the
Department of Elder Affairs Client Services Manual.
C. Research and Statistics and Reports
The provider agrees to respond to requests for research information and statistical data concerning its
clients based on information requirements of the Memory Disorder Clinics, Brain Bank and
Alzheimer's Disease Research Database. Model Day Cares must develop and report on innovative
, therapies and interventions which can be shared with other Alzheimer's Disease Initiative health and
social services personnel via training. Reports will include the hypothesis, data collection items,
research methods, timeline for completion, and plan for dissemination of findings. Model Day Care
programs must report all training activities provided to health care and social service personnel and
caregivers, as well as serve as a natural laboratory for service related applied research by Memory
. Disorder Clinics.
D. Comprehensive Assessment Review and Evaluation for Long Term Care Services (CARES) Program
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07/01/99Contract Number KG997
Those persons who are functionally assessed by the Comprehensive Assessment Review and
Evaluation for Long Term Care Services (CARES) Program to be at imminent risk of nursing home
placement and referred to the Alzheimer's Disease Initiative Program will have services started
immediately. The provider must shelter an adequate portion of funds to serve these CARES referrals.
E. Co-payment Collections
1. The Alliance will hold back 3 percent (3%) of the provider contract amount from the Requests/or
Payment within the first five months of the contract year: The amount of funds so held back shall
be released to a provider upon collection by the provider, by November 15, of 25 percent (25%) of
the total co-payments projected for collection by the provider for the contract year.
2. Within three business days of November 15, the Alliance will determine if the provider collected,
on or before November 15,25 percent (25%) of their total projected annual co-payments. The
Alliance will release to each such provider all funds so held back from such provider. The Alliance
will reallocate all funds held back from the providers if provider fails, by November 15, to collect
25 percent (25%) of their total projected annual co-payments. All such funds held back will be
distributed pro rata only to providers who have collected, by March 15, 50 percent (50%) of their
total annual projected co-payments.
3. The Alliance will certify to the Department, that funds held back pursuant to this clause have not
been distributed to the provider if the provider failed to meet its co-payment collection projections
by November 15. Upon failure of the Alliance to so certify by April 1, the Department will
reallocate such funds among the PSA's for distribution to providers who have collected at least 50
percent (50%) of their projected annual co-payments on or before March 15.
4. Co-payments include only the amounts assessed clients or the amounts clients opt to contribute in
lieu of an assessed co-payment. The contribution must be equal to or greater than the assessed
co-payment.
5. In the event this contract is extended to twelve (12) months, ending June 30, this section will be
amended to reflect the usual 5% holdback over seven months with the requirement for the provider
to have collected 50% by March 15.
F. ' Outcome Achievement
1. The Alliance will assign the provider legislatively approved outcome measures.
2. The Alliance will track outcome achievement on a monthly basis. Technical assistance will be
provided to the provider when achievement levels drop 1 % or more from the assigned outcome
measures. Corrective action will be required specifying actions the provider will take to bring
achievement levels up to assigned amount if achievement drops 2% or more.
07/01/99Contract Number KG997
3. The.Alliance will monitor implementation of provider strategies toward achieving outcomes as
described in the Service Provider Application for Monroe County Social Services.
G. Care Plans
Care plans will be costed out for each client. Projected costs will be provided to fiscal officers to
manage resources and compare to actual expenditures for the provider.
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
ATTACHMENT II
CONTRACT REPORT CALENDAR
ADVANCE BASrS CONTRACT
Report
Number Month
1 July
2 August
3 September
4 October
5 November
6 December
7 January
8 February
9 March
10 April
11 May
12 June
13 July
14 Aug.
15 **
16 **
Submit to
Alliance
On This
Based On Date
Advance* July 1
Advance* July 1
July Expenditure Report August 10
August Expenditure Report September 10
September Expenditure Report October 10
October Expenditure Report November 10
November Expenditure Report December 10
December Expenditure Report January 10
January Expenditure Report February 10
February Expenditure Report March 10
March Expenditure Report April 10
April Expenditure Report May 10
Adv. Recon.** May Expenditure Report June 10
Adv. Recon.** June Expenditure Report July 10
Final Request for Payment August 15
Closeout Report August 29
Legend.: *
**
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 Alliance 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 DOEA is
dependent on the accuracy of the expenditure report.
Note # 2: A final request for payment may be submitted to the Alliance
by the provider up to 45 days after the contract has ended.
Note'# 3: The last two months of the provider'S fiscal reports covering
actual expenditures should reflect an adjustment repaying advances for
the first two months of the contract.
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PSA XI
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07/01/99Contract Number KG997
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
BUDGET SUMMARY
AGENCY: Monroe County Board of Commissioners
1. Respite
2. Model Day Care
3. Total
$ 31.693.50
o
$ 3 L693 .50
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Amendment
ATTACHMENT III