03/18/2009 Agreement DANNY L. KOLHA GE
CLERK OF THE CIRCUIT COURT
DATE: April 2, 2009
TO: Community Services
ATTN: Dotti Albury
In -Home Services Program
FROM: Pamela G. Hance ' 1
Deputy Clerk �%
At the March 18, 2009, Board of County Commissioners' meeting the Board granted
approval and authorized execution of the following:
Home and Community Based Services Assisted Living for the Frail Elderly (ALE)
Medicaid Waiver Case Management Referral Agreement between the Alliance for Aging, Inc.
(Area Agency on Aging for Miami -Dade and Monroe Counties) and the Monroe County Board
of County Commissioners (Monroe County In -Home Services Program for Fiscal Year March,
2009 through June, 2010. Enclosed are four duplicate originals, executed on behalf of Monroe
County. d /t 2 � J ry , t.. G eu!a�
Amendment 002 to the Community Care for the Elderly (CCE) Contract #KC871
between the Alliance for Aging, Inc. (Area Agency on Aging for Miami -Dade and Monroe
Counties) and the Monroe County Board of County Commissioners (Social Services /In -Home
Services) for Fiscal Year July 1, 2008 to June 30, 2009. Enclosed are three duplicate originals,
executed on behalf of Monroe County.
Amendment 003 to the Community Care for the Elderly (CCE) Contract #KC871
between the Alliance for Aging, Inc. (Area Agency on Aging for Miami -Dade and Monroe
Counties) and the Monroe County Board of County Commissioners (Social Services /In -Home
Services) for Fiscal July 1, 2008 to June 30, 2009. Enclosed are three duplicate originals,
executed on behalf of Monroe County.
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 our office.
cc: County Attorney
Finance w/o document
File,"
n~k)m"e CC'~ ae~'g cm~e O;r!g;,~nI
HOME AND COMMUNITY BASED SERVICES
ASSISTED LIVING FOR THE FRAil ELDERLY (ALE) MEDICAID WAIVER
CASE MANAGEMENT REFERRAL AGREEMENT
This Referral Agreement between the Alliance for A in Inc., the area agency on aging (AM) for
Planning and Service Area (PSA) 11 and ,a case management agency,
shall begin on July 1, 2004 or on the date the agreement has been signe by both parties, whichever is
later. 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 and is contingent upon an
annual appropriation by the Legislature. The purpose of this agreement is to enable eligible elderly
participants to receive case management services from qualified providers with oversight of the quality of
care by the Medicaid Waiver Specialist employed by the AM. 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. The parties of this Agreement will 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 Assisted Living Facility that is responsible for the direct provision of those services to
consumers served under the waiver program, and the AM that is responsible for management
and oversight of the waiver program.
II. 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 the case management agencies.
C. To provide on site monitoring of the case management agency at least semi-annually.
D. Monitor and project Provider expenditures to assure spending is maintained within spending
authority.
E. To regularly participate in mandated core training for ALF administrators if requested by the
trainer contracted by the Department of Elder Affairs to conduct such trainings.
III. Under this Agreement, the Case Management Agency agrees to the following:
A. Assign qualified case managers who have successfully completed core training to provide case
management under the ALE Medicaid Waiver and meet the minimum qualifications as contained
in the ALE Medicaid Waiver. Case managers must complete such training within six months of
being assigned to the ALE Medicaid Waiver.
B. Develop and implement the Plan of Care specifically outlining the service(s) to be delivered which
must be signed by the resident, ALF administrator or representative of the ALF's nursing staff,
and the Case Manager and provided to the ALF for their files.
C. Be available to the ALF for case staffing of the referred case and provide narratives describing
the contents of such staffing for the case record.
D. Provide on site case management activities with the resident and the ALF staff monthly and note
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the resident's progress and receipt of services as evidenced by the facility Service Activity Plan
and resident log entries; changes in the residents Activities of Daily Living, Instrumental
Activities of Daily Living; and certify continuing participation in the program based on the
observations. A case file must be maintained at the case management agency describing the
case management activities.
E. Review the Care Plan quarterly with the resident, his/her family if applicable, and the ALF facility
s ta ff.
F. Provide the assisted living facility with a copy of the Comprehensive Resident Assessment, any
subsequent reassessments and Plans of Care.
G. Adhere to the policies and procedures as outlined in the following manuals published by the
Agency for Health Care Administration: Assisted Living Medicaid Waiver Guidelines and the
Medicaid Provider Reimbursement Handbook (Non-Institutional 081), including any and all
attachments or updates.
H. Provide to the AM a monthly summary of Assisted Living Case Management expenditures billed
and accrued.
I. Provide consumers with a list of all qualified Service providers.
J. 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
provider, 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
individuals make a disclosure to the AM 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
agreement.
K. To submit void or adjustment claims no later than 45 days after the error has been identified by
either party. The provider's refusal to adjust or void erroneous claims may result in termination of
this agreement and/or referral to the department, and will be referred by department to the
Agency for Health Care Administration for appropriate action.
IV. 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 that 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 Because of Lack of Funds
In the event funds to finance this agreement become unavailable, the AM 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 AM 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 AM, the AM 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.
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In witness whereof, the parties have caused this ~ page agreement to be executed by their undersigned
officials as duly authorized.
Max B. Rothman, JO, ~
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President/CEO
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M~ynr
title
3-18-09
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