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SFY2003 10/16/2002 eleltl of De eircol coon Danny L. Kolhage Office (305) 292-8550 Fax (305) 295-3663 Memnrandum To: Louis LaTorre, Director Social Services Attn: Trish Barker, Bayshore Manor Isabel C. DeSantis, , .l; Deputy Clerk ~ From: Date: Wednesday, October 30, 2002 At the BOCC meeting of October 16, 2002, the Board granted approval and authorized execution ofthe Home and Community Based Waiver Referral Agreement between the Alliance for Aging, Inc. and the Monroe County to enable respite clients to remain in the Aged and Disabled Adult (ADA) Waiver Program. Under this program, clients are referred to Bayshore Manor for daytime facility respite. Attached hereto are four (4) fully-executed duplicate originals ofthe subject document for your handling. Please be sure that both the Clerk's and Finance Orie-inals are returned to this office as quickly as possible. Should you have any questions, please do not hesitate to contact this office. cc: Finance, w /0 doc. County Attorney File V '..~~~ nuv- - c~ .or._. '.~ .....",. ~_ ~. - ~,':'"'I~'-:i'~f-""<:' :"'c ~~-,., .i.\,.,*"~"",,,...J ,_,,;~~y 1B5:::~"...,QQ ~" 'it'" '~.:-.~. ." ~"".it.o-......... ~4-- HOME AND COMMUNITY BASED WAIVER REFERRAL AGREEMENT This Referral Agreement, made this 1st day of July, 2002 between Alliance for Aging, the Area Agency on Aging for Planning and Service Area.1.l and Bavshore Manor, the Service Provider. This Referral Agreement is in effect for a period of time that is equal to the Medicaid waiver provider's enrollment period with the State of Florida's Medicaid fiscal agent. One purpose of this agreement is to promote the development of a coordinated service delivery system to meet the needs of the aged or disabled adults who are at risk of premature institutionalization. Another purpose of this agreement is to enable eligible elderly participants to receive Home and Community Based Waiver Services from qualified providers with oversight of the quality of care by the Medicaid Waiver Specialist employed by the Area Agency on Aging. These services are authorized in order that the participant may remain in the least restrictive setting and avoid or delay premature nursing home placement. Services and care are to be furnished in a way that fosters the independence of each participant to facilitate aging in place. 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 elders and disabled adults. D. To require the parties of this Agreement to provide technical assistance and consultation to each other on matters pertaining to actual service delivery and share appropriate assessment information and care plans so duplication may not occur. E. To establish an effective working relationship between the case management agency that is responsible for the development of care plans and authorization of services available under the waiver, the service provider that is responsible for the direct provision of those services to consumers served under the waiver program, and the Area Agency on Aging that is responsible for management and oversight of the waiver program. II. Under this Agreement, the Service provider agrees to the following: A. To accept referrals for the 1915c Home and Community Based Service (HCBS) Medicaid Waiver from the enrolled case management agency. B. To provide quality service(s) to the waiver participant as specified in Section IV. Provision of service(s) is subject to quality monitoring and/or observation by the case management agency and/or the Area Agency on Aging and/or the Department of Elder Affairs. C. To provide only those services specifically outlined in the Plan of Care and authorized by the enrolled case management agency. D. To attach documentation regarding the service provider's qualifications to this agreement; and to provide, as requested, any information regarding Medicaid Waiver billing, payment, or waiver participant information, to the case management agency or Area Agency on Aging. Provider rate increases/decreases must be forwarded to the Area Agency on Aging along with justification for any increase. If additional services are to be added to this agreement, a written request to do so must be received by the Area Agency on Aging and an amendment must be prepared by the Area Agency on Aging listing the added service(s). The necessary documentation regarding provider qualifications for the additional services must be attached to the agreement. E. To maintain the waiver participant's confidentiality according to 42 CFR 431.301. F. To immediately report any changes in the waiver participant's condition to the case management agency. G. To maintain enrolled provider status by renewing applicable licensure, certification, contract, and/or referral agreements and by maintaining all provider qualifications as contained in the Aged and Disabled Adult Medicaid Waiver under which services are provided. H. To include its name and other appropriate information on a list of all enrolled providers which will be shown to consumer during development of an individualized plan of care, understanding that the consumer reserves the right at all times to a choice of enrolled providers. 1. To immediately notify the case management agency of staffing shortfalls which will negatively impact provision of service to Medicaid Waiver consumers. J. To submit claim data for billing to the Medicaid fiscal agent after delivery of services has been accomplished. All services should be billed within 60 days after services have been provided or document reasons for delayed submission of claims. Such documentation shall be available for review by the area agency on agency or by the Department of Elder Affairs, upon request. K. To submit claims for billing to the Medicaid fiscal agent at the agency's usual and customary rate. It is a violation of federal regulation to bill Medicaid more than the agency's usual and customary rate. L. To submit void or adjustment claims no later than 45 days after the error has been identified by either party. Any error not adjusted or voided within 45 days may be adjusted or voided by the Area Agency on Aging. The provider's refusal to adjust or void erroneous claims will result in termination of this agreement. M. To 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. 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 provider, consumer, vendor, or any person wishing to benefit from the use or disbursement of funds. To avoid a conflict of interest, the service provider must ensure that all individuals make a disclosure to the Area Agency on Aging of any relationship which may be a conflict of interest, within thirty (30) days of an individual's 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. N. To adhere to the policies and procedures as outlined in the following manuals published by the Agency for Health Care Administration: the Aged/Disabled Adult Waiver Guidelines and the Medicaid Provider Reimbursement Handbook (Non- Institutional 081), including any and all attachments or updates. III. Under this Agreement, the Area Agency on Aging agrees to the following: A. To facilitate the enrollment of providers with the Medicaid Fiscal Agent. B. To provide technical assistance and training to Service Providers. C. To notify the case management agency within 48 hours of any approved service provider rate adjustment. D. To regularly monitor the Service Providers in accordance with requirements specified by the Department of Elder Affairs. IV. Under this agreement, the following services will be delivered by the Service provider in accordance with the plan of care or service authorization: Facility Based Respite A. B. C. D. E. $2,50 County/Region Served Monroe County Service Unit Rate V. Termination In the event this agreement is terminated, the case management agency and the service provider agree 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 any 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 Because of Lack of Funds In the event funds to finance this agreement become unavailable, the area agency may terminate this agreement upon no less than twenty-four (24) hours notice in writing to the other party. Said notice shall be delivered by certified mail, return receipt requested, or in person with proof of delivery. The area agency shall be the final authority as to the availability of funds. C. Termination for Breach Unless a breach is waived by the area agency in writing, or the parties fail to cure the breach within the time specified by the area agency, the area agency 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 _ page agreement to be executed by their undersigned officials as duly authorized. Area Agency on Aging . J-:6:;:; ~ /- signature signature c.,~a...f" \C!..~ "~CY'\ "''j II M c. (.0 Y print name )rtU4n W J SJ/-rj pnnt name pr" ( e...G ~ title title 1J1~Jo,- dale date o cr.:: o U LJ_! 0::: 0:::: o 1..1... o W --l 1..1... :.... a N x: 0.. lr> I co W u- ......, <= C'':; c-l LLJ <( CJ ~ <t. :x:t)>= ',:::! I- ~~a:~ .uo -_.: .U . ~..... ;~. ::'j w ~~u~ .::( z ;;::;J 0 ;r: N\ o..~ 0 (' \0/1 ~I C~ ~ I'IPT>.