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SFY2009 10/15/2008DANNYL. KOLHAGE CLERK OF THE CIRCUIT COURT DATE: October 28, 2008 TO: Community Services ATTN: Dotti Albury, In -Home Services Program • y� FROM: Isabel C. DeSantis Deputy Clerk r�_' At the October 15, 2008 BOCC Meeting, the Board granted approval and authorized execution of the following: The 2008-2009 Nutrition Services Incentive Program (NSIP) Contract US-951 between Monroe County Nutrition Program and the Alliance for Aging. The Renewal of the Home and Community Based Case Management Referral Agreement between Monroe County (Monroe County In -Home Services Program) and the Florida Department of Children & Families (DCF) for State Fiscal Year July 1, 2008 to June 30, 2009. Enclosed are four duplicate originals executed by Monroe County of the above -mentioned for your handling. Please be sure that the sets stamped Monroe County Clerk's Office Original and Monroe County Finance Department's Original are returned to my office as quickly as possible. Should you have any questions, please do not hesitate to contact me. Thank you. cc: County Attorney Finance File \ MCl1lE'3e c.",,.,,,vro, n ';'''-'''J \-.':1:"". s Office Oriaiual ADULT SERVICES HOME AND COMMUNITY BASED WAIVER CASE MANAGEMENT REFERRAL AGREEMENT This Referral Agreement made this I st day of July, 2008, between the Florida Department of Children and Families' (DCF) Circuit 16 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) 2008-2009. The case management agency is a Medicaid 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 must be consumer-driven to the maximum extent possible. All partieos 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 technical 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 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 I responsible for the direct provision of those services to consumers served under the waiver program, and the Department being responsible for management and oversight of the waiver 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 district 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. 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 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 district 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 nan1e, Social Security ID 2 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 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 DCI' 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. 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 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, 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: 1. Client's name; 2. Client's address (with directions if not easily accessible); 3. Pertinent information regarding client's health or disabilities and living situation; and, 3 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. 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. 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 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. If required by 45 CFR Parts 160, 162, and 164, the following provisions 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 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 4 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 with 45 C.P.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.P.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.P.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 ofform. 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 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: 5 Service A. Case Management 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, 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 wi.tness whereof, the parties have caused this 6 page agreement to be executed by their undersigned officials as duly authorized. r- II) e :r::: a:::: Florida Departtnent of Children and Families Circuit 16 Program Office ~fL;/&;;1f ?~ (;11-,0.4 le'/2r2ADA?_ print name ' . 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