06/20/2007 Contract
DANNYL. KOLHAGE
CLERK OF THE CIRCUIT COURT
DATE:
June 25, 2007
TO:
Dotti Albury, Administrative Assistant
Monroe County In-Home Services Program
Pamela G. Han~
Deputy Clerk
FROM:
At the June 20, 2007, Board of County Commissioner's meeting the Board granted
approval and authorized execution of the following:
Contract KG060 - Community Care for Disabled Adults (CCDA) Contract between the
State of Florida, Department of Children & Families and the Monroe County Board of County
CommissionerslMonroe County In-Home Services. This Contract is for Fiscal Year July I, 2007
through June 30, 2008.
Alzheimer's Disease Initiative (ADI) Contract KZ797 between Alliance for Aging, Inc.
(Area Agency on Aging) and the Monroe County Board of County Commissioners (Community
Services/In-Home Services) for Fiscal Year 7/1107 to 6/30/08.
Home Care for the Elderly (HCE) Case Management Contract KH772 between the
Alliance for Aging, Inc. and the Monroe County Board of County Commissioners (Monroe
County Social Services/In-Home Services Program) for Fiscal Year July 1,2007 through June 30,
2008.
/Community Care for the Elderly (CCE) Contract KC771 between the Alliance for Aging,
Inc. (Area Agency on Aging) and the Monroe County Board of County Commissioners
(Community Services/In-Home Services) for Fiscal Year 7/1107 to 6/30/08.
Enclosed are four duplicate originals of the above-mentioned, executed on behalf of
Monroe County, for your handling. Please be sure to return the fully executed "Monroe County
Clerk's Office Original" and the "Monroe County Finance Department's Original" as soon as
possible. Should you have any questions please do not hesitate to contact this office.
cc: County Attorney
Finan,ge w/o documents
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CONTRACT NUMBER KC 771
Page 1
COMMUNITY CARE FOR THE ELDERLY CONTRACT
2007-2008
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.
PA429, and its successor, incorporated herein by reference.
I. Recipient Agrees:
A. Services to be Provided:
1. The recipient's service provider application for state fiscal year 2007, 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 operating in Planning and Service Areas 7 and 9. 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 will be provided in a manner consistent with and described in the
recipient's service provider application for state fiscal year 2007 and the Department of
Elder Affairs 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 $582.837.00. subject to the availability of
funds.
Obligation to Pay:
The Alliance's performance and obligation to pay under this contract is contingent upon
an annual appropriation by the Legislature.
B. 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
pursuant to this contract are in the state grants and aids appropriations.
III. Recipient and Alliance Mutually Agree:
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CONTRACT NUMBER KC 771
Page 2
A. Effective Date:
1. This contract shall begin on July 1, 2007 or on the date the contract has been
signed by both parties, whichever is earlier.
2. Delivery of services shall end on June 30, 2008.
IN WITNESS WHEREOF, the parties hereto have caused this agreement to be executed by
their undersigned officials as duly authorized.
PROVIDER
SIGNED BY:
ALLIANCE FOR AGING, INC.
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SIGNED
NAME:
Mario DiGennaro
NAME:
President & CEO
TITLE:
Mayor/Chairman
TITLE:
DATE:
June 20, 2007
DATE:
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CONTRACT NUMBER KC 771
Page 3
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 for state fiscal year 2007, 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 operating in Planning and Service Areas 7 and 9, 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 scheduled to begin operation in the Miami-Dade County area.
B. Manner of Service Provision:
The services to be provided are those described in the recipient's service provider
application for state fiscal year 2007. All CCE services will be provided in a manner
consistent with the conditions set down in the Department of Elder Affairs Home
Community Based Services Handbook dated 01/03 and by the Alliance as determined
by its Board of Directors. 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 rate reimbursement for
approved services. The recipient must ensure fixed 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 771
Page 4
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
req uest.
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 To Be Provided Unit Rate Maximum Maximum
Units Dollars
Case Management 53.06 1,799 $95,464
Homemaker 31.37 3,624 $213,689
Personal care 38.10 6,037 $250,016
Respite (in home) 24.26 852 $23,668
F. 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, Fiorida
Administrative Code promulgated for administration of Sections 430.201 through
430.207, Florida Statutes, and the Department of Elder Affairs Home and
Community Based Services Handbook dated 01/03.
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.
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CONTRACT NUMBER KC 771
Page 5
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
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 determined 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 intermediate 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
el) 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.
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 determined
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
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CONTRACT NUMBER KC 771
Page 6
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:
a) The recipient must identify, through the consumer assessment, potential
Medicaid eligibie 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 determination 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
determination 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 form 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 information for planning and
negotiating unit rates.
6
CONTRACT KC 671
COMMUNITY CARE FOR THE ELDERLY PROGRAM
Report
Number
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Leqend:
Note # 1:
Note # 2:
Page 7
ATTACHMENT II
CONTRACT REPORT CALENDAR
Based On
July Advance * .............................................................
August Advance ** .... ......... ....... ..,........ ..... ............... .....
July Expenditure Report ............. .......... ............ ...... ........
August Expenditure Report .............................................
September Expenditure Report.. ............ .................. ........
October Expenditure Report ......................... ..... .......... ....
November Expenditure Report .........................................
December Expenditure Report ..... ... ....................... ...... ....
January Expenditure Report ............................................
February Expenditure Report...........................................
March Expenditure Report ............................. ......... .........
April Expenditure Report ..... ............... ..... ............. ...........
May Expenditure Report / July Advanced Reconciliation ** ....
June Expenditure Report / August Advanced Reconciliation **
Final Expenditure and Closeout Report
*
Advance based on projected cash need.
**
Submit To The
Alliance
On This Date
July 1
July 1
August 15
September 15
October 15
November 15
December 15
January 15
February 15
March 15
April 15
May 15
June 15
July 15
July 20
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.
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.
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 KC 671
Page 8
EXHIBIT A
CCE/HCE REFERRAL PROTOCOL
Issue:
Referral/Activation in the Community and Home Care for the Elderly Programs.
Policy:
Referrals will be made based on availability of funds.
Purpose:
To ensure funding is spent expeditiously and consumers are given a choice of case
management agencies, to the extent possible.
Procedure:
I. Roles and Responsibilities
A. Alliance for Aging
1. Fiscal/Administration Department
a. Monitors overall program and Lead Agency specific spending levels
on a monthly basis to ensure the lead agencies are operating within
the funding allocations
b. Recommends potential cases for activation based on projected
funding available by Lead Agency.
c. Notifies Contract Management of availability of funds by Lead Agency.
2. Contract Management
a. Uses the information from the Administration Department to select
consumers from the waiting list for activation.
b. Notifies the Elder Helpline.
c. Monitors compliance with service standards and outcome measures.
d. Reviews care plans and files per the File Review Policies and
Procedures.
e. Reviews data in CIRTS.
3. Elder Helpline: conducts screening and assessment to place consumers on
the waiting lists as appropriate, works with Adult Protective Services to
respond to high risk referrals, offers consumers choice of case management
agency, makes appropriate referrals.
B. Case Management Agency
1. Accepts referrals from the Elder Helpline.
2. Refers inquiries from consumers interested in services to the Elder Helpline
for screening and assessment and placement on the waiting list.
3. Completes comprehensive assessments on new consumers and annual
reassessment on existing consumers and develops care plans and reviews
care plans semi-annually.
4. Authorizes service delivery and enters data into CIRTS.
5. Bills in CIRTS accordingly.
6. Monitors care plans in an effort to keep costs down while sustaining the
individuals in the community.
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CONTRACT KC 671
Page 9
II. Wait Listing New Consumers
A. Elder Helpline conducts intake and completes a Telephone Screen on all consumers.
1. APS non-high risk referrals will be prioritized for services as per the
Memorandum of Understanding. APS High Risk Referrals are not waitlisted.
They are immediately referred for service to a Lead Agency on a rotation
basis. APS cases are served for a maximum of 30 calendar days or less
as appropriate.
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 assessed priority consumer list. Elder
Helpline staff will contact the client on a monthly basis to determine if there
has been a change in the client's situation. Elder Helpline staff will offer
choice of case management agency as per #3 below.
3. Community Care and Home Care for the Elderly waiting list consumers will
be given fact sheets on the Lead Agencies and a choice form so that they
may select a case management agency of their choice prior to activation in
the program once funding becomes available within the agency the client
selects. The client has 30 calendar days from the date the choice form was
mailed to make a choice. If the form is not returned within one month, the
Elder Helpline will call the client to determine if the client is still interested and
to verify the mailing address. The information package and the choice form
will be mailed a second and final time. The client will have two weeks to
return the signed choice form. If the form is not returned, the client will be
terminated from the waiting list.
4. All other referrals will be waitlisted and prioritized, during which time the Elder
Helpline will research other community resources.
B. Appropriate HIPAA forms are sent to the client.
III. Opening New Cases
A. Regular CCE and HCE Clients
1. The Fiscal/Administration 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 spending authority as reflected
under Attachment III. In addition, the department will do cost projections, and
share the information with the Surplus/Deficit review committee to determine
slot availability. Contract Management will be notified when funding is
available and the number of new cases to be activated by Lead Agency.
2. Contract Management will run the Prioritized Risk Report to identify the
consumers to be opened. The information will be entered in the Excel
Referral Spreadsheet on the network and the Elder Helpline will be notified
accordingly.
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CONTRACT KC 671 Page 10
3. Based on available funding for each Lead Agency, the Elder
Helpline will call consumers from the each Lead Agency's waiting list to
inform them they are ready to be opened for services. If the client is no
longer interested in receiving services the next client on the list will be
contacted.
4. If the lead agency cannot activate the client due to the fact that it has
exhausted its quarterly spending authority, the client will be given the choice
of selecting an alternate case management agency that does have available
funding. The client will be mailed fact sheets on the available Lead Agencies
and a coded choice form which will need to be returned to the Elder Helpline
within one week.
a. Written Choice: If the form is returned, the written choice is
documented in the Excel Referral Spreadsheet and the client CIRTS
status will be changed from APCL to TAAS. The Activation Referral
Form will then be sent to the Lead Agency selected by the consumer
b. Verbal Choice: If the form is not returned within the week, the Elder
Helpline will call the client to obtain a verbal choice.
i. The verbal choice is documented in the Excel Referral
spreadsheet and the client's CIRTS status will be changed
from APCL to TAAS. The Activation Referral Form will then
be sent to the Lead Agency selected by the client. A
choice form indicating the verbal choice will be sent to the
Lead Agency. The Lead Agency will have that form signed
by the client and returned to the Elder Helpline along with the
Activation Referral form indicating when services started.
The Client Choice form and the Activation Referral form
are to be returned to the Elder Helpline within two (2)
weeks of receipt.
Ii. If the written form is returned after the verbal choice was made
and it is different from the verbal choice, the verbal choice will
be honored. The client will be notified of the referral based on
the verbal choice and informed that they can change agencies
if they are still interested, after six (6) months.
B. APS High Risk Referral:
1. During work hours, the Elder Helpline will check in CIRTS by Social Security
Number, client name and then other identifying information as needed, to see
if the person is in CIRTS.
a. If the person is already in CIRTS being served by a Lead Agency, the
referral will be made to that Lead Agency.
b. If the CIRTS query shows the person is not being served by a specific
Lead Agency, the referral will be made to the Lead Agency slated to
receive a referral on a rotation basis.
2. DCF should notify the Elder Helpline if there is someone else in the home
who may be receiving services. This person will aiso be checked in CIRTS
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CONTRACT KC 671 Page 11
and if that person is receiving services from a Lead Agency, then
the new referral will be made to that Lead Agency to avoid having more than
one Lead Agency in the home.
3. Staff is on-call after hours using a beeper. The staff person on call will have
the list of Lead Agencies, their on-call information and the rotation status and
will make referrals accordingly.
a. The next business day, the Elder Helpline will check CIRTS to see if
that person is being served by another Lead Agency.
b. In the event the person is being served by another Lead Agency, the
Lead Agency that was contacted while on-call will be asked to
terminate their involvement and a referral will be made to the existing
Lead Agency.
4. The Lead Agency must return the Referral Form indicating the service start
date to the Elder Helpline within two (2) weeks of receiving the faxed referral.
If the Referral Form is not returned during that time, the Elder Helpline will
follow up with the case management agency and notify Contract
Management.
5. The Lead Agency will enter ACTV enrollment under their provider number in
CIRTS.
6. The Elder Helpline will send copies of the Referral Forms to CARES for
clients originating from them.
IV. Clients Changing Case Management Agencies
A. Frequency of Changes
Consumers will be allowed to change case management agencies at the time of the
six (6) month care plan review and at their annual re-assessment. Consumers will
need to request a change of case management agency by the 1 a'h of the month in
order for the change to be in effect by the 21st of the month. If the request is made
after the 10th of the month, the change will take effect by the 21 ,t of the following
month.
B. Process for Changing
1. Requests to change case management agency must come from the client or
their personal representative to the Elder Helpline who will offer choice.
Requests made by the case management agency will not be honored and will
be followed up on with the client by the Elder Helpline.
2. When consumers call the Elder Helpline to change case management
agency, the reason for the change will be asked, if the consumer spoke with
their case management agency about their concerns and if they would like to
speak with someone else at that agency.
3. If the consumer does not want to speak with the case management agency
and still wants to change, the Elder Helpline will offer the consumer the
choice of agencies, sending them a fact sheet on each agency (unless they
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CONTRACT KC 671 Page 12
already know who they want to change to) and a form to sign
indicating their choice (a verbal choice will be accepted and followed up with
a written form). The consumer will need to return the form by said date and
the Elder Helpline will then make the referral using the Transfer Form.
4. If the consumer chooses to call the agency, nothing will be done until the
consumer calls the Elder Helpline back requesting a change, at which time,
the Elder Helpline will offer the consumer the choice of agencies, sending
them a fact sheet on each agency and a form to sign indicating their choice.
The consumer will need to return the form by said date and the Elder Helpline
will then make the referral using the Transfer Form.
5. The Elder Helpline will send the Transfer Form to the selected Lead Agency
and current Lead Agency. The new Lead Agency will fax a copy of the
Transfer Form back to the Elder Helpline within two (2) weeks of referral
indicating that necessary documentation was received from the current Lead
Agency and the service start up date.
6. If the Elder Helpline does not receive the Transfer Form back from the new
Lead Agency within 2 weeks from the fax date, it will follow up with the new
Lead Agency and notify Contract Management.
7. The new Lead Agency will place a copy of the form in the consumer file.
8. The Elder Helpline will give a copy of the completed transfer form to MIS to
change owner provider.
9. The old Lead Agency will terminate enrollment in CIRTS as of the 20'h of the
month when the transfer is to take place. The new Lead Agency will activate
enrollment in CIRTS as of the 21" of the month when the transfer is to take
place.
10. Each Lead Agency will need to notify its respective vendors of the termination
and/or activation of services for the transferred client as appropriate.
11. The Elder Helpline will send copies of the Transfer Form to CARES for
consumers originating from them.
13. Consumers who are active in the HCDA program and who turn 60 will be
eligible for service under the HCE program if funding permits. Requests to
open the consumer in the HCE program need to be made to the Elder
Helpline. If funding is not available, these consumers will be waitlisted but
will be given priority for opening.
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