SFY2008 08/15/2007DANNYL. KOLHAGE
CLERK OF THE CIRCUIT COURT
DATE: August 27, 2007
TO: Dotti Albury, Administrative Assistant
Monroe County In -Home Services Program
FROM: Pamela G. Han c
Deputy Clerk
At the August 15, 2007, Board of County Commissioner's meeting the Board granted
approval of the Adult Services Home and Community Based Waiver Case Management Referral
Agreement between the Florida Department of Children and Families (DCF) District 11 Program
Office and the Monroe County Board of County Commissioners (Social Services/ln-Home
Services) for State Fiscal Year 2007 - 2008.
Enclosed is a duplicate original of the above -mentioned for your handling. Should you
have any questions please do not hesitate to contact this office.
cc: County Attorney
Finance
File✓
ADULT SERVICES
HOME AND COMMUNITY BASED WAIVER
CASE MANAGEMENT REFERRAL AGREEMENT
This Referral Agreement made this 1st day of July, 2007, between the Florida Department of Children
and Families' (DCF) District I I Program Office, and Monroe County 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) 2007-2008. The case management agency is a Medicaid
Waiver case management agency. This Referral Agreement is in effect from the date of signature, through
SFY 2007-2008 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' District II 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.
I. 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 technical assistance to and consultation between agencies on matters
pertaining to actuaI 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 Florida Department of Children and Families; the
case management agency being responsible for the development of care plans and
authorization of services available under the waiver, the case management agency being
responsible for the direct provision of those services to consumers served under the waiver
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program, and the Department being responsible for management and oversight of the waiver
program.
II. Under this Agreement, the District (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 district DCF staff performing case management activities, using the
approved DOEA Medicaid waiver progrannnatic 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.
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 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 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 ofa 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 district access to:
I. 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 ill
and Medicaid ill;
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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
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:
I. 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.
L 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 report showing the number of c1ient~ 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, the 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 by 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:
I. Client's name;
2. Client's address (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
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performed.
M. Evaluate quality of services and service documentation by the subcontracted service case
management agency.
N. 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. Perlorm 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 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 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. Ifrequired by 45 CFR Parts 160, 162, and 164, the following provisions shall apply [45
CFR 164.504(e)(2)(ii)}:
(a) The case m3n'l8ement 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 m3n'l8ement agency agrees to use appropriate safeguards to prevent use
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
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law.
Cd) 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 with 45
C.F.R. 164.524.
({) 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.
(j) 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 district to another at the consumer's
request.
IV. The following services will be delivered by the case management agency in accordance with
the plan of care or service authorization:
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Service
A. Case Management under COC
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, return 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 District I I
Program Office
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MONROE COUNTY ATTORNEY
A ROVED AS TO FORM:
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YNTHIA L. ALL
ASSISTANT COUNTY ATTORNEY
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