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~ ~d~ PERTAINING TO
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u.. Stoil: ~RE FOR THE ELDERLY PROGRAM SPENDING AUTHORITY FOR 2000~01
MEMORANDUM OF AGREEMENT
BETWEEN
THE ALLIANCE FOR AGING, INC.
AND
MONROE COUNTY BOARD OF COMMISSIONERS
CLERL,.r, .~ n'
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This Memorandum of Agreement outlines the Home Care for the Elderly Subsidy Payment spending
authority for Monroe County Board of Commissioners, hereinafter referred to as the "Provider", for 2000-01 and
details the responsibilities and the expectations associated with this authority.
1. The Alliance For Aging has determined the total amount of Home Care for the Elderly subsidy payments
available to each Lead Agency within Planning and Service Area (PSA) 11 based on each county's proportion
of the clients enrolled in the Home Care for the Elderly Program as of June 1, 2000.
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2. The 1 S99-00 Home Care for the Elderly Subsidy Payment spending authority for the Provider is $62,944.00.
Under no circumstances must the Provider exceed the allocated spending authority limits. To that
effect, the Provider agrees to do the following:
a. The Provider will establish, house and maintain a client voucher file for each client enrolled in the HCE
Program. Client voucher files shall be intended to establish a proper audit trail of services authorized
and provided to clients enrolled in the HCE program.
b. Client voucher files will contain a separate service payment/utilization record (DOEA Form 133)
for each month that the client is enrolled in the HCE program. DOEA Form 133 establishes a
payment trail, by client, of services authorized for payment. It further serves as the instrument for data
entry of service utilization information in the Client Information, Registration and Tracking System
(CIRTS).
c. All items/services purchased by a caregiver in support of a client shall require prior authorization from
the case manager who shall so indicate in the client care plan/case record. A receipt, signed by the
caregiver, must be presented to the case manager and attached to DOEA Form 133 in order to
authorize payment. Receipts for all authorized items/services must be present in the client voucher
file in support of all caregiver reimbursements.
d. For services provided by vendors, including the Lead Agency, case managers will be responsible for
indicating the Provider ID/Location Code and Service Type on DOEA Form 133. Service payment
amount information shall be entered on DOEA Form 133 by the Lead Agency utilizing vendor invoices
which clearly indicate the client served, services received, date of service and payment information.
Prior authorization by the case manager is required before a service is received. The authorization for
the client to receive these services shall be the case manager's entry into the client care plan/case
record as well as the case manager's entry on DOEA Form 133 to indicate Provider ID/Location,
Service Code and payment information.
e. The Provider will enter all data for HCE Basic and Special Subsidies in CIRTS by the 15th of each
month for payments incurred between the 16th of the previous month and the 15th of the current
month.
MEMORANDUM OF AGREEMENT
Monroe County Board of Commissioners
& The Alliance For Aging
Page Two
f. The Provider will run a CIRTS Monthly Utilization Report. The Provider will verify, correct and certify
the Monthly Utilization Report and submit this report to the Alliance by the 20th of the month in which
the report is generated. The Alliance may also require a Request for Payment and Receipt and
Expenditure Report to accompany this report.
g. Caregivers who are determined eligible for the HCE Basic Subsidy after the 15th of a month, will be
processed by the Provider to begin eligibility for the HCE Basic Subsidy in the first day of the following
month.
h. The Provider is responsible for continued monitoring of all vendors with which it holds agreements for
the provision of services to be reimbursed as Special Subsidies. Said agreements must be approved
by the Alliance, outline the vendor's responsibility to carefully follow clients' care plans/service
authorizations and adhere to spending limits.
3. The Alliance agrees to do the following:
a. The Alliance will verify and process the CIRTS data prior to payment for HCE Basic and Special
Subsidies.
b. Provided the monthly report is received from the Case Management agency by the due date, the
Alliance will process Basic and Special, Subsidy checks to caregivers by the third of the month
following the month services are rendered.
c. The Alliance will supply the Provider with a list of the amount paid each month to each caregiver, the
date the payment was made and the check number.
This Memorandum of Agreement will be in effect for the period July 1, 2000 through June 30, 2001 or until
otherwise revised or terminated.
PROVIDER: MONROE COUNTY BOARD
OF COMMISSIONERS
ALLIANCE FOR AGING, INC.
BOARD PRESIDENT OR
AUTHORIZED DESIGNEE
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NAME: Sl"i..../c.V ;=;.~c."..cv...
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TITLE: rv1 AL-/ fJE-..
DATE: 7/'-itf[,
FEDERAL ID NUMBER:
PROVIDER FISCAL YEAR ENDING DATE:
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NAME: MARTY RA
TITLE: PRESIDENT
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