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06/15/2011 ContractDANNY L. KOLHA GE CLERK OF THE CIRCUIT COURT DA TE: June 20, 2011 TO: Sheryl Graham, Director Social Services Department ATTN: Dotty Albury In -Home Services Program FROM: Pamela G. Hanc ck .C. At the June 15, 2011, Board of County Commissioner's meeting the Board granted approval and authorized execution of the following: Item C3 Amendment #0002 to the Community Care for Disabled Adults (CCDA) Contract #KG -065 (7/1/10- 6/30/11) between the Florida Department of Children & Families and the Monroe County Board of County Commissioners (Social Services /In -Home Services). Item C6 Community Care for Disabled Adults (CCDA) Contract #KG -066 (7/1/11- 6/30/12) between the Florida Department of Children & Families and the Monroe County Board of County Commissioners (Social Services /In -Home Services). Item C41 Community Care for the Elderly (CCE) Contract KC -1171 between the :Alliance for Aging, Inc. (Area Agency on Aging) and the Monroe County Board of Commissioners (Social Services /In -Home Services) for fiscal year 7/1/11 to 12/31/11. Item C42 Home Care for the Elderly (HCE) Contract KH -1172 between the Alliance for / Aging, Inc. (Area Agency on Aging) and the Monroe County Board of County Commissioners (Social Services /In -Home Services) for fiscal year 7/1/11 to 12/31/11. Item C43 Amendment #003 to the Community Care for the Elderly (CCE) Contract KC -1071 between the Alliance for Aging, Inc. (Area Agency on Aging) and the Monroe County Board of Commissioners (Social Services /In -Home Services) for fiscal year 7/1/10 to 6/30/2011. Enclosed are four duplicate originals of each of the above - mentioned, executed on behalf of Monroe County, for your handling. Please be sure to return the Clerk's Original as well as Finance's Copy as soon as possible. Should you have any questions, please do not hesitate to contact our office. cc: County Attorney Finance File./ Clerk's Original T i Contract Number KH 1172 Page 1 HOME CARE FOR THE ELDERLY CONTRACT 2011 -2012 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 "provider." THIS CONTRACT IS SUBJECT TO FURTHER MODIFICATION IN ORDER TO INCORPORATE CERTAIN PASS - THROUGH LANGUAGE REQUIRED BY THE STATE OF FLORIDA DEPARTMENT OF ELDER AFFAIRS. ALL SUBSEQUENT MODIFICATIONS WILL BE MADE THROUGH AMENDMENTS TO THIS CONTRACT. Attachment I, II, III, IV, V, VI, VII, VIII and IX are integral to this Agreement I. Recipient Agrees: A. Services to be Provided: 1. The recipient's service provider application for state fiscal year 2011, 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 HCE, 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 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 2011 and the 2010 Department of Elder Affairs Client Home And Community Based Services Handbook. 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. 11. The Alliance Agrees: A. Contract Amount: To pay for Case Management and Case Aide services in an amount not to exceed $6,347, subject to the availability of funds. As a matter of reference, the Alliance projects to process and pay the basic subsidy to qualified caregivers participating in the HCE program of approximately $16,628. At the time of execution of this contract, no funds are projected to be available for Special Subsidy including, Specialized Medical Equipment and Supplies — Vendor (SCSV) and Specialized Medical Equipment and Supplies- Consumer reimbursement (SCSM). The Alliance will notify the recipient when funds become available for the provision of these services. T Contract Number KH 1172 Page 2 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. Program Title Year Funding Source CSFA# Fund Amounts Home Care for the 2011 General Revenue 65001 $6,347 Elderl TOTAL FUNDS CONTAINED IN THIS CONTRACT: $6,W t� _ N III. Recipient and Alliance Mutually Agree: - A. Effective Date: 1. This contract shall begin on July1, 2011 or on the date the contract has been signed by both parties, whichever is later. 2. Delivery of services shall end on December 31, 2011. This contract shall end on January 15, 2012. IN WITNESS WHEREOF, the parties hereto have caused this agreement to be executed by their undersigned officials as duly authorized. PROVIDER: SIGNED BY: NAME: TITLE: 0 Mo roe County Board of Co my Commissioners Carruthers 6 - 15 - 2011 - -I r=i - T1 ,J rn CD cD ALLIANCE FOR AGING, INC. SIGNED BY: A2� NAME: Max B. Rothm , JD, LL.M. TITLE: President & CEO DATE: 2-,o AS j — P.Ei1 - Auu T cou ATTORNEY, 2 Contract Number KH 1172 Page 3 ATTACHMENT I HOME CARE FOR THE ELDERLY PROGRAM I. STATEMENT OF PURPOSE The Home Care for the Elderly (HCE) Program encourages the provision of care in family - type living arrangements in private homes on a not for profit basis as an alternative to nursing home or other institutional care. II. SERVICES TO BE PROVIDED A. Services: 1. The recipient's July 2011 application, 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 HCE, 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 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. B. Manner of Service Provision: The services will be provided in a manner consistent with and described in the recipient's July 2011 application and the 2010 Department of Elder Affairs Home and Community -Based Services Handbook. In the event the handbook 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 that 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 106H and 105H. 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. B. Invoices must be submitted no later than 90 days after the end of the month on which the expense was incurred, except that invoices can not be submitted after close out 9 Contract Number KH 1172 Page 4 report date (usually July 15th.) Invoices submitted late will not paid. Exceptions to this rule are at the discretion of the Alliance, on a case by case basis; such exceptions must be requested prior to the expiration of the invoicing deadline. In making a determination of the exception the Alliance will consider whether the disruption to the billing cycle was beyond the control of the provider, the frequency with which such exceptions are requested by the provider, and whether the Alliance can request reimbursement at a late date from DOEA. C. 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 request. D. The recipient may request a monthly advance for service costs 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 nine 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 December 2011 reports. All advance payments are subject to the availability of funds. E. 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 at the end of the first quarter of the contract period. F. Contingent upon the recipient's ability to maintain program expenditures within the assigned quarterly allocations and the availability of funds, the Alliance shall make payment to the provider for provision of services at the rate(s) stated below: SERVICE TO BE UNIT MAXIMUM MAXIMUM PROVIDED RATE UNITS DOLLARS Case Management $47.86 132 $6,347 G. 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. REPORTING: The provider need to provide the Alliance with an expenditure plan by July 15 or two weeks after contract has been signed, a monthly update due on the 21 of each following month. The expenditure plan and updates must follow the format provided by the Alliance. 4 Contract Number KH 1172 Page 5 V. SPECIAL PROVISIONS A. State Laws and Regulations: 1. The recipient agrees to comply with applicable parts of Rule Chapter 581-1-1, Florida Administrative Code promulgated for administration of Sections 430.601 through 430.608, Florida Statutes, and the 2010 Department of Elder Affairs Home and Community Based Services Handbook. 2. 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. 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. 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 d) 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. 2. Priority Criteria for Other Assessed Individuals: The assessment and provision of services should always consider the most cost effective means of service delivery. Functional impairment shall be determined through the department's consumer assessment form administered to each applicant. The most frail individuals not prioritized in groups one, two or three above, regardless of referral source, will receive services to the extent funding is available. C. Consumer Information, Registration and Tracking System (CIRTS): 1. The recipient will ensure the collection and maintenance of Home Care for the Elderly (HCE) subsidies and case management information on a monthly basis from the Consumer Information, Registration and Tracking System (CIRTS). Maintenance includes valid exports and backups of all data and systems according to department standards. 9 Contract Number KH 1172 Page 6 2. The recipient must ensure all data for HCE subsidies are entered in the CIRTS by the 15th of each month. HCE subsidy data entered into the CIRTS by the 15th of the month will be for payments incurred between the 16th of the previous month and the 15th of the current month. Case management data entered into the CIRTS by the 15th of the month will be for units of service provided during the previous month from the 16th and up to and including the 15th of the current month or case management units of service may be entered according to the recipient schedule, in aggregate on the 31 st or daily, weekly or monthly. 3. The recipient will ensure data entry for HCE subsidies will cease on the 15th of the month and the CIRTS Monthly Service Utilization Report, by consumer and by worker identification is run. 4. The recipient will ensure the Monthly Utilization Report, by consumer and by worker identification is verified, corrected, certified no later than the 20th of the month in which the report is generated. 5. The recipient will ensure caregivers determined eligible for the HCE basic subsidy after the 15th of a month, will be processed to begin eligibility for the HCE basic subsidy on the 1 st day of the next month. 6. The Alliance will reconcile and verify the CIRTS data prior to payment for HCE basic and special subsidies and case management. 8. The Alliance will reconcile and verify the CIRTS data prior to payment for HCE basic and special subsidies and case management. N. Contract Number KH 1172 Page 7 ATTACHMENT II HOME CARE FOR THE ELDERLY PROGRAM CONTRACT REPORT CALENDAR Report Number Based On 1 July Advance * .......................... ............................... 2 August Advance * ......................... ............................... 3 July Expenditure Report ... 1 /12 advance Reconciliation ....... 4 August Expenditure Report ...1/12 advance Reconciliation ... 5 September Expenditure Report ...1/12 advance Reconciliation 6 October Expenditure Report ...1/12 advance Reconciliation .... 7 November Expenditure Report ... 1 /12 advance Reconciliation . 8 December Expenditure Report ...1 /12 advance Reconciliation Legend * 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 Note # 1 : 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. 7 Contract Number KH 1172 ATTACHMENT III Page 8 REFERRAL PROTOCOL Issue: Screening, Triage, and Referral for Activation under the Community Care for the Elderly /Home Care for the Elderly Programs and for the Aging & Disabled Adults and the Assisted Living for the Elderly Medicaid Waivers. Policy: Referrals will be based on availability of funds, in accordance with prioritization requirements. Purpose: To ensure funding is spent expeditiously and consumers are referred into programs for appropriate services. Procedure for Monroe County: Roles and Responsibilities A. Alliance for Aging / Aging Resource Center ➢ Monitors overall program and Lead Agency specific spending levels on a monthly basis to ensure the Lead Agency is operating within the funding allocation. ➢ Determines the number of cases for activation based on projected funding available. ➢ Screens consumers to link with appropriate resources and prioritize for DOEA- funded programs and services. ➢ Recommends potential cases for activation based upon projected funding available by Lead Agency. ➢ Selects consumers from the waiting list based on their prioritization score. ➢ Refers consumers from the waiting list to the Lead Agency in Monroe County for activation, based on availability of funds. ➢ Monitors compliance with service standards and outcome measures. ➢ Reviews care plans and files per the File Review Policies and Procedures. ➢ Reviews data in CIRTS. B. Case Management Agency ➢ Accepts referrals from the Aging Resource Center. ➢ Refers inquiries from consumers interested in services to the ARC for Information and Referral to community resources, Screening, Triage, and Long -Term Care Options Counseling, as appropriate. ➢ Through outsourcing, the functions of Screening and Intake may also be completed by the Lead Agency. ➢ Completes comprehensive assessments on new consumers and annual reassessment on existing consumers and develops care plans and reviews care plans semi - annually. ➢ Authorizes service delivery and enters data into CIRTS. ➢ Screens consumers for Medicaid Waiver eligibility. ➢ Bills in CIRTS and Medicaid as appropriate. ➢ Monitors care plans in an effort to keep costs down while sustaining the individuals in the community. Management of the Assessed Prioritized Consumer List (APCL). A. Referrals to the ARC are routed to the Information and Referral Specialists or Intake Unit staff depending on the type of referral. Clients are provided information on community resources and programs available including private pay options. Persons are directed to those resources most 0 Contract Number KH 1172 Page 9 capable of meeting the need they have expressed to ARC staff. Cases presenting strong identifiers that indicate the consumer might benefit from publicly funded long term care services are screened, entered into CIRTS, triaged and provided options counseling. Through outsourcing, the functions of Screening and Intake may also be performed by the Lead Agency. DOEA prioritization requirements will be adhered to by both entities, as follows: 1. APS High Risk Referrals (See section B) 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 APCL. ARC staff will contact the client on a monthly basis to determine if there has been a change in the client's situation. 3. All other CARES referrals will be screened and prioritized in accordance with DOEA requirements. 4. Aging Out consumers will be referred by DCF for prioritization and/or activation in the corresponding aged program managed by the Alliance, as appropriate (See section IV). 5. Consumers applying for the Community Care for the Elderly (CCE) and /or Home Care for the Elderly (HCE) programs will be contacted and screened using the statewide assessment form developed by the Department of Elder Affairs for this purpose (Form 701A). If a consumer is being served through a DOEA- funded agency which enters their annual assessment into CIRTS, the Priority Score generated by that assessment will determine their ranking on the APCL. 6. Consumers referred for inclusion under the Assisted Living for the Elderly (ALE) Medicaid Waiver APCL will be interviewed and screened using the 701A form. 7. Consumers referred for inclusion under the Aging and Disabled Adult (ADA) Medicaid Waiver APCL will be contacted and screened following the same procedure as the one described under Section 5. Individuals who appear as potentially eligible for other types of public assistance will be referred to the Economic Self - Sufficiency Unit at the Department of Children and Families. 8. All other referrals will be waitlisted and prioritized, during which time other community resources will be researched, including private pay /fee for services providers. Consumers on the waiting lists will be reassessed according to Department requirements (NOI #062906- 1- 1 -OVCS 6/29/2006). B. HIPAA forms will be sent to the consumer as appropriate. III. Opening New Cases A. CCE /ADA/ALE /HCE Clients The Fiscal 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 /or spending authority. In addition, the department will do cost projections, and share the information with the Surplus /Deficit review committee to determine slot availability. The ARC and the Quality Assurance Department will be notified when funding is available and the number of new cases to be activated by Lead Agency. D Contract Number KH 1172 Page 10 2. Upon notification from the Vice President for Finance of funding availability, the Aging Resource Center Intake Unit Supervisor will run the Prioritized Risk Report to identify the consumers on the APCL to be opened. 3. Based on available funding, the ARC Intake Unit Supervisor will refer wait listed clients to the Lead Agency for activation, in accordance with prioritization requirements. The Lead Agency will update the wait list enrollment using the appropriate code to terminate from the APCL. B. APS Referrals 1. APS Low and Intermediate Risk referrals will be screened and prioritized for services as per the DOEA/APS Memorandum of Understanding. Low and Intermediate Risk referrals are also offered information and referral to additional community resources, including private pay as appropriate. 2. APS High Risk Referrals are not waitlisted. They are immediately referred for service from DCF in Monroe County to the Lead Agency. ARTT referrals will be forwarded directly the Lead Agency. APS cases are to be served for a maximum of 31 calendar days. If additional time is justified, the case management agency will staff the case with the Alliance to obtain the extension needed. 3. Upon receipt of the APS referral, the Lead Agency will coordinate services to begin within the 72 hour period mandated by statute. A comprehensive assessment will be done within 72 hours of the referral. Services required under the care plan will remain in place for a maximum of 31 days, unless an extension has been granted. 4. The Lead Agency will enter ACTV enrollment under their provider number in CIRTS. In addition, service codes will be entered by service date for all services provided. If a service(s) is not provided as required under the care plan, an NDP code will need to be entered in CIRTS and the case notes under the client file should document the reason for non - delivery of such service(s). IV. Aging Out Consumers: A. All "Aging Out" consumers will be referred by DCF for activation in the corresponding aged program managed by the Alliance. B. Consumers active in the CCDA and HCDA programs that are turning 60 and are eligible for CCE and /or HCE will be opened in the corresponding aged program managed by the Alliance if funding is available. If funding is available, these consumers will be made active. If funding is not available, they will be waitlisted for these programs but will be given priority for activation once funding is available. C. Consumers active in the ADA Medicaid Waiver, upon turning age 60, will continue to be eligible for and receive ADA Medicaid waiver services. Note: These ARC policies and procedures are subject to change. Any modifications will be done through a contract amendment. 10 Contract Number KH 1172 Page 11 ATTACHMENT IV CERTIFICATION REGARDING LOBBYING CERTIFICATION FOR CONTRACTS, GRANTS, LOANS AND AGREEMENTS The undersigned certifies, to the best of his or her knowledge and belief, that: (1)No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any state or federal agency, a member of congress, an officer or employee of congress, an employee of a member of congress, or an officer or employee of the state legislator, in connection with the awarding of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement. (2)If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a member of congress, an officer or employee of congress, or an employee of a member of congress in connection with this federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form -LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. (3)The undersigned shall require that the language of this certification be included in the award documents for all sub - awards at all tiers (including subcontracts, sub - grants, and contracts under grants, loans and cooperative agreements) and that all subproviders shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000.00 and not more than $100,000.00 for each such failure. Signature Date Name of Authorized Individual Application or Agreement Number Name and Address of Organization 11 Contract Number KH 1172 Page 12 ATTACHMENT V FINANCIAL AND COMPLIANCE AUDIT The administration of resources awarded by the Alliance of Elder Affairs to the provider may be subject to audits and /or monitoring by the Alliance of Elder Affairs, as described in this section. MONITORING In addition to reviews of audits conducted in accordance with OMB Circular A -133, as revised, and Section 215.97, F.S., (see "AUDITS" below), monitoring procedures may include, but not be limited to, on -site visits by the Alliance staff, limited scope audits as defined by OMB Circular A -133, as revised, and /or other procedures. By entering into this agreement, the provider agrees to comply and cooperate with any monitoring procedures /processes deemed appropriate by the Alliance for Aging. In the event the Alliance for Aging determines that a limited scope audit of the provider is appropriate, the provider agrees to comply with any additional instructions provided by the Alliance to the provider regarding such audit. The provider further agrees to comply and cooperate with any inspections, reviews, investigations, or audits deemed necessary by any level of government. AUDITS PART I: FEDERALLY FUNDED This part is applicable if the provider is a State or local government or a non -profit organization as defined in OMB Circular A -133, as revised. In the event that the provider expends $500,000.00 or more in Federal awards during its fiscal year, the provider must have a single or program - specific audit conducted in accordance with the provisions of OMB Circular A- 133, as revised. EXHIBIT 1 to this agreement indicates Federal resources awarded through the Alliance of Elder Affairs by this agreement. In determining the Federal awards expended in its fiscal year, the provider shall consider all sources of Federal awards, including Federal resources received from the Alliance of Elder Affairs. The determination of amounts of Federal awards expended should be in accordance with the guidelines established by OMB Circular A -133, as revised. An audit of the provider conducted by the Auditor General in accordance with the provisions of OMB Circular A -133, as revised, will meet the requirements of this part. In connection with the audit requirements addressed in Part 1, paragraph 1, the provider shall fulfill the requirements relative to auditee responsibilities as provided in Subpart C of OMB Circular A -133, as revised. If the provider expends less than $500,000.00 in Federal awards in its fiscal year, an audit conducted in accordance with the provisions of OMB Circular A -133, as revised, is not required. In the event that the provider expends less than $500,000.00 in Federal awards in its fiscal year and elects to have an audit conducted in accordance with the provisions of OMB Circular A -133, as revised, the cost of the audit must be paid from non- Federal resources (i.e., the cost of such audit must be paid from provider resources obtained from other than Federal entities.) An audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal year. Compliance findings related to agreements with the Alliance of Elder Affairs shall be based on the agreement's requirements, including any rules, regulations, or statutes referenced in the agreement. The financial statements shall disclose whether or not the matching requirement was met for each applicable agreement. All questioned costs and liabilities due to the Alliance of Elder Affairs shall be fully disclosed in the audit report with reference to the Alliance of Elder Affairs agreement involved. If not otherwise disclosed as required by Section .310(b)(2) of OMB Circular A -133, as revised, the schedule of expenditures of Federal awards shall identify expenditures by agreement number for each agreement with the Alliance of Elder Affairs in effect during the 12 Contract Number KH 1172 Page 13 audit period. Financial reporting packages required under this part must be submitted within the earlier of 30 days after receipt of the audit report or 9 months after the end of the provider's fiscal year end. As an Alliance requirement the Statement of Functional Expenses need to be part of the Financial and Compliance Audit Report. PART II: STATE FUNDED This part is applicable if the provider is a nonstate entity as defined by Section 215.97(2), Florida Statutes. In the event that the provider expends a total amount of state financial assistance equal to or in excess of $500,000.00 in any fiscal year of such provider (for fiscal years ending September 30, 2004 or thereafter), the provider must have a State single or project - specific audit for such fiscal year in accordance with Section 215.97, Florida Statutes; applicable rules of the Alliance of Financial Services; and Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and for - profit organizations), Rules of the Auditor General. EXHIBIT I to this agreement indicates state financial assistance awarded through the Alliance of Elder Affairs by this agreement. In determining the state financial assistance expended in its fiscal year, the provider shall consider all sources of state financial assistance, including state financial assistance received from the Alliance of Elder Affairs, other state agencies, and other nonstate entities. State financial assistance does not include Federal direct or pass- through awards and resources received by a nonstate entity for Federal program matching requirements. In connection with the audit requirements addressed in Part II, paragraph 1, the provider shall ensure that the audit complies with the requirements of Section 215.97(8), Florida Statutes. This includes submission of a financial reporting package as defined by Section 215.97(2), Florida Statutes, and Chapter 10.550 (local governmental entities) or 10.650 (nonprofit and for - profit organizations), Rules of the Auditor General. If the provider expends less than $500,000.00 in state financial assistance in its fiscal year (for fiscal years ending September 30, 2004 or thereafter), an audit conducted in accordance with the provisions of Section 215.97, Florida Statutes, is not required. In the event that the provider expends less than $500,000.00 in state financial assistance in its fiscal year and elects to have an audit conducted in accordance with the provisions of Section 215.97, Florida Statutes, the cost of the audit must be paid from the nonstate entity's resources (i.e., the cost of such an audit must be paid from the provider resources obtained from other than State entities). An audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal year. Compliance findings related to agreements with the Alliance of Elder Affairs shall be based on the agreement's requirements, including any applicable rules, regulations, or statutes. The financial statements shall disclose whether or not the matching requirement was met for each applicable agreement. All questioned costs and liabilities due to the Alliance of Elder Affairs shall be fully disclosed in the audit report with reference to the Alliance of Elder Affairs agreement involved. If not otherwise disclosed as required by Rule 691 - 5.003, Fla. Admin. Code, the schedule of expenditures of state financial assistance shall identify expenditures by agreement number for each agreement with the Alliance of Elder Affairs in effect during the audit period. Financial reporting packages required under this part must be submitted within 45 days after delivery of the audit report, but no later than 12 months after the provider's fiscal year end for local governmental entities. Non - profit or for - profit organizations are required to be submitted within 45 days after delivery of the audit report, but no later than 9 months after the provider's fiscal year end. Notwithstanding the applicability of this portion, the Alliance of Elder Affairs retains all right and obligation to monitor and oversee the performance of this agreement as outlined throughout this document and pursuant to law. 13 Contract Number KH 1172 Page 14 As an Alliance requirement the Statement of Functional Expenses need to be part of the Financial and Compliance Audit Report. PART III: REPORT SUBMISSION Copies of reporting packages for audits conducted in accordance with OMB Circular A -133, as revised, and required by PART I of this agreement shall be submitted, when required by Section .320 (d), OMB Circular A -133, as revised, by or on behalf of the provider directly to each of the following: The Alliance for Aging, Inc. at the following address: Alliance for Aging, Inc. Attn: Carlos Lahitte 760 NW 107' Ave. Suite 214 Miami, FL 33172 -3155 14 Contract Number KH 1172 Page 15 ATTACHMENT V IT11.11� 1 PART I: AUDIT RELATIONSHIP DETERMINATION Providers who receive state or federal resources may or may not be subject to the audit requirements of OMB Circular A -133, as revised, and /or Section 215.97, Fla. Stat. Providers who are determined to be recipients or subrecipients of federal awards and /or state financial assistance may be subject to the audit requirements if the audit threshold requirements set forth in Part I and /or Part II of Exhibit 1 are met. Providers who have been determined to be vendors are not subject to the audit requirements of OMB Circular A -133, as revised, and /or Section 215.97, Fla. Stat. Regardless of whether the audit requirements are met, providers who have been determined to be recipients or subrecipients of Federal awards and /or state financial assistance, must comply with applicable programmatic and fiscal compliance requirements. In accordance with Sec. 210 of OMB Circular A -133 and /or Rule 691 - 5.006, FAC, provider has been determined to be: Vendor or exempt entity and not subject to OMB Circular A -133 and /or Section 215.97, F.S. X Recipient /subrecipient subject to OMB Circular A -133 and /or Section 215.97, F.S. NOTE: If a provider is determined to be a recipient /subrecipient of federal and or state financial assistance and has been approved by the Alliance to subcontract, they must comply with Section 215.97(7), F.S., and Rule 69I- .006(2), FAC [state financial assistance] and Section _ .400 OMB Circular A -133 [federal awards]. PART II: FISCAL COMPLIANCE REQUIREMENTS FEDERAL AWARDS OR STATE MATCHING FUNDS ON FEDERAL AWARDS. Providers who receive Federal awards or state matching funds on Federal awards and who are determined to be a subrecipient, must comply with the following fiscal laws, rules and regulations: STATES, LOCAL GOVERNMENTS AND INDIAN TRIBES MUST FOLLOW: 2 CFR Part 225 Cost Principles for State, Local and Indian Tribal Governments (Formerly OMB Circular A -87)* OMB Circular A -102 — Administrative Requirements OMB Circular A -133 — Audit Requirements Reference Guide for State Expenditures Other fiscal requirements set forth in program laws, rules and regulations NON - PROFIT ORGANIZATIONS MUST FOLLOW: 2 CFR Part 230 Cost Principles for Non -Profit Organizations (Formerly OMB Circular A -122 - Cost Principles)* 2 CFR Part 215 Administrative Requirements (Formerly OMB Circular A -110 - Administrative Requirements) Requirements) OMB Circular A -133 - Audit Requirements Reference Guide for State Expenditures Other fiscal requirements set forth in program laws, rules and regulations EDUCATIONAL INSTITUTIONS (EVEN IF A PART OF A STATE OR LOCAL GOVERNMENT) MUST FOLLOW: 2 CFR Part 220 Cost Principles for Educational Institutions OMB (Formerly Circular A -21- Cost Principles)* 15 Contract Number KH 1172 Page 16 2 CFR Part 215 Administrative Requirements (Formerly OMB Circular A -110 - Administrative Requirements) OMB Circular A -133 — Audit Requirements Reference Guide for State Expenditures Other fiscal requirements set forth in program laws, rules and regulations *Some Federal programs may be exempted from compliance with the Cost Principles Circulars as noted in the OMB Circular A -133 Compliance Supplement, Appendix 1. STATE FINANCIAL ASSISTANCE. Providers who receive state financial assistance and who are determined to be a recipient /subrecipient, must comply with the following fiscal laws, rules and regulations: Section 215.97, Fla. Stat. Chapter 691 -5, Fla. Admin. Code State Projects Compliance Supplement Reference Guide for State Expenditures Other fiscal requirements set forth in program laws, rules and regulations 16 Contract Number KH 1172 Page 17 ATTACHMENT VI CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE FOR AGREEMENTS, GRANTS, LOANS AND COOPERATIVE AGREEMENTS The undersigned, an authorized representative of the provider named in the contract or agreement to which this form is an attachment, hereby certifies that: (1)The provider and any sub - providers of services under this contract have financial management systems capable of providing certain information, including: (1) accurate, current, and complete disclosure of the financial results of each grant - funded project or program in accordance with the prescribed reporting requirements; (2) the source and application of funds for all agreement supported activities; and (3) the comparison of outlays with budgeted amounts for each award. The inability to process information in accordance with these requirements could result in a return of grant funds that have not been accounted for properly. (2)Management Information Systems used by the provider, sub - provider(s), or any outside entity on which the provider is dependent for data that is to be reported, transmitted or calculated, have been assessed and verified to be capable of processing data accurately, including year -date dependent data. For those systems identified to be non - compliant, provider(s) will take immediate action to assure data integrity. (3)If this contract includes the provision of hardware, software, firmware, microcode or imbedded chip technology, the undersigned warrants that these products are capable of processing year -date dependent data accurately. All versions of these products offered by the provider (represented by the undersigned) and purchased by the State will be verified for accuracy and integrity of data prior to transfer. In the event of any decrease in functionality related to time and date related codes and internal subroutines that impede the hardware or software programs from operating properly, the provider agrees to immediately make required corrections to restore hardware and software programs to the same level of functionality as warranted herein, at no charge to the State, and without interruption to the ongoing business of the state, time being of the essence. (4) The provider and any sub - provider(s) of services under this contract warrant their policies and procedures include a disaster plan to provide for service delivery to continue in case of an emergency including emergencies arising from data integrity compliance issues. The provider shall require that the language of this certification be included in all subagreements, subgrants, and other agreements and that all sub - providers shall certify compliance accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by OMB Circulars A -102 and 2 CFR Part 215 (formerly OMB Circular A -1 10). Name and Address of Provider Signature Title Date Name of Authorized Signer (Revised June 2008) 17 W Contract Number KH 1172 Page 18 ATTACHMENT VII CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION FOR LOWER TIER COVERED TRANSACTIONS (1)The prospective provider certifies, by signing this certification, neither it nor its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal Alliance or agency. (2)Where the prospective provider is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this certification. Signature Date Title Agency/ Organization (Certification signature should be same as Contract signature.) Instructions for Certification 1.The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction," "person," "primary covered transaction," and 'voluntarily excluded," as used herein, have the meanings set out in the sections of rules implementing Executive Order 12549. (2 CFR 180.5- 180.1020, as supplemented by 2 CFR 376.10- 376.995). You may contact the Contract Manager for assistance in obtaining a copy of those regulations. 2.This certification is a material representation of facts upon which reliance was placed when the parties entered into this transaction. If it is later determined that the provider knowingly rendered an erroneous certification, in addition to other remedies available to the federal government, the Alliance may pursue available remedies, including suspension and /or debarment. 3.The provider will provide immediate written notice to the Contract Manager if at any time the provider learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. The provider may decide the method and frequency by which it determines the eligibility of its principals. Each participant to a lower tier covered transaction may, but is not required to, check the Excluded Parties List System (EPLS). 4.The provider will include a "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transaction" in all its lower tier covered transactions and in all solicitations for lower tier covered transactions. 5.The provider agrees that it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, determined ineligible or voluntarily excluded from participation, unless otherwise authorized by the federal government. 6.If the provider knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the federal government, the Alliance may pursue available remedies, including suspension, and /or debarment. .The provider may rely upon a certification of a prospective participant hi a lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. (Revised June 2008) Contract Number KH 1172 Page 19 ASSURANCES —NON- CONSTRUCTION PROGRAMS ATTACHMENT VIII Public reporting burden for this collection of information is estimated to average 45 minutes per response including time for reviewing instructions searching existing data sources gathering and maintaining the data needed and completing anc reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget. Paperwork Reduction Project (034 -0043), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET, SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. Note: Certain of these assurances may not be applicable to your project or program. If you have questions please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified. l .Has the legal authority to apply for Federal assistance, and the institutional, managerial and financial capability (including funds sufficient to pay the non - Federal share of project cost) to ensure proper planning, management, and completion of the project described in this application. 2.Will give the awarding agency, the Comptroller General of the United States, and if appropriate, the State, through any authorized representative, access to and the right to examine all records, books, papers, or documents related to the award; and will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives. 3.Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest, or personal gain. 4.Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency. 5.Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C.. 4728 -4763) relating to prescribed standards for merit systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPM's Standards for a Merit System of Personnel Administration (5 C.F.R. 900, Subpart F). 6.Will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88 -352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C.. 1681 -1683, and 1685- 1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C.794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C.. 6101 - 6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92 -255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91 -616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g). 523 and 527 of the Public Health Service Act of 1912 (42 U.S.C.. 290 dd -3 and 290 ee 3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C.. 3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination provisions in the specific statute(s) under which application for Federal assistance is being made; and (j) the requirements of any other nondiscrimination statute(s) which may apply to the application. 7.Will comply, or has already complied, with the requirements of Titles II and III of the uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91 -646) which provide for fair and equitable treatment of persons displaced or whose property is acquired as a result of Federal or federally assisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of Federal participation in purchases. 8.Will comply, as applicable, with the provisions of the Hatch Act (5 U.S.C.. 1501 -1508 and 7324 - 7328), which limit the political activities of employees whose principal employment activities are funded in whole or in part with Federal funds. 9.Will comply, as applicable, with the provisions of the Davis -Bacon Act (40 U.S.C..276a to 276a -7), the Copeland Act (40 U.S.C. 276c and 18 U.S.C. 874) and the Contract Work Hours and Safety Standards Act (40 U.S.C. 327 -333), 19 Contract Number KH 1172 Page 20 regarding labor standards for federally assisted construction subagreements. 10.Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93 -234) which requires recipients in a special flood hazard area to participate in the program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000.00 or more. 11.Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91 -190) and Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved State management program developed under the Coastal Zone Management Act of 1972 (16 U.S.C..1451 et seq.); (f) conformity of Federal actions to State (Clear Air) Implementation Plans under Section 176(c) of the Clear Air Act of 1955, as amended (42 U.S.C..7401 et seq.); (g) protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as amended, (P.L. 93 -523); and (h) protection of endangered species under the Endangered Species Act of 1973, as amended, (P.L. 93 -205). 12 Will comply with the Wild and Scenic Rivers Act of 1968 components of the national wild and scenic rivers system. (16 U.S.C..1721 et seq.) related to protecting components or potential 13.Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as amended (16 U.S.C..470), EO 11593 (identification and protection of historic properties), and the Archaeological and Historic Preservation Act of 1974 (16 U.S.C..469a -1 et seq.). 14.Will comply with P.L. 93 -348 regarding the protection of human subjects involved in research, development, and related activities supported by this award of assistance. 15.Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89 -544, as amended, 7 U.S.C..2131 et seq.) pertaining to the care, handling, and treatment of warm blooded animals held for research, teaching, or other activities supported by this award of assistance. 16.Will comply with the Lead -Based Paint Poisoning Prevention Act (42 U.S.C..4801 et seq.), which prohibits the use of lead- based paint in construction or rehabilitation of residence structures. 17.Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act Amendments of 1996 and OMB Circular No. A -133, Audits of States, Local Governments, and Non -Profit Organizations. 18.Will comply with all applicable requirements of all other Federal laws, executive orders, regulations and policies governing this program. SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL TITLE APMCANT ORGANIZATION DATE SUBMITTED 01 Contract Number KH 1172 Page 21 ATTACHMENT IX STATE OF FLORIDA ALLIANCE OF ELDER AFFAIRS CIVIL RIGHTS COMPLIANCE CHECKLIST Program /Facility Name County Provider Address Completed By City, State, Zip Code Date ]Telephone 3. STAFF CURRENTLY EMPLOYED. Effective date: PART I. READ THE ATTACHED INSTRUCTIONS FOR ILLUSTRATIVE INFORMATION WHICH WILL HELP YOU IN THE COMPLETION OF THIS FORM. 1. Briefly describe the geographic area served by the program facility and the type of service provided: 2. POPULATION OF AREA SERVED. Source of data: Total# I % White I % Black I % Hispanic I % Other I % Female 3. STAFF CURRENTLY EMPLOYED. Effective date: Total# % White I % Black I % Hispanic % Other % Female % Disabled 4. CLIENTS CURRENTLY ENROLLED OR REGISTERED Effective date: Total# % White % Black I % Hispanic % Other % Female % Disabled % Over 40 5. ADVISORY OR GOVERNING BOARD, IF APPLICABLE. Total # % White % Black % Hispanic % Other % Female % Disabled PART IL USE A SEPARATE SHEET OF PAPER FOR ANY Da'LANATIONS REQUIRING MORE SPACE. 6. Is an Assurance of Compliance on file with the Alliance? If NA or NO explain NA YES NO 7. Compare the staff composition to the population. Is staff representative of the population? If NA or NO, explain. NA YES NO 8. Compare the client composition to the population. Are race and sex characteristics representative of the Population? If NA or NO, explain. NA YES NO 21 9. Are eligibility requirements for services applied to clients and applicants wit] reizara to race, co ova i own ongm, sex, age, re pion or disabilltv r It NA or NA YES NO 10. Are all benefits, services and facilities available to applicants and participants in an equally effective manner regardless of race, sex, color, age, national origin, religion or disability? It NA or NO, explain. NA YES NO 11. For in- patient services are room assignments made without regard to race, color, national origin or disability? If NA or PTO, explain. NA YES NO 12. Is the program/ facility accessible to non - English speaking clients? If NA or NO, explain. NA YES NO 13. Are employees applic eplam�n ants and participants informed of their protection against xation� If yes, how? Verbal • Written • Poster • If NA or NO, explain. • 14. Give the number and current status of any discrimination complaints regarding services or employment filed against the program / facility. 22 i + 15. Is the pro�ggrram /facility physically accessible to mobility, hearing, and sight - unpaired individuals? If NA or NO, explain. NA YES NO PART III. THE FOLLOWING QUESTIONS APPLY TO PROGRAMS AND FACILITIES WITH 15 OR MORE EMPLOYEES YES NO 16. Has a self- evaluation been conducted to identify any barriers to serving disabled individuals, and to make any necessary modifications? If NO, explain. • • 17. Is there and established grievance procedure that incorporates due process in the resolution of complaints? If NO, explain. • • YES NO 18. Has a person been designated to coordinate Section 504 compliance activities? If YES NO NO, explain. ❑ ❑ 19. Do recruitment and notification materials advise applicants, em loyees and participants of nondiscrimination on the basis of disability? If NO, explain. • KENO 20. Are auxiliary aids available to assure accessibility of services to hearing and sight impaired individuals? If NO, explain. 23 • r Y > YES NO • • PART IV. FOR PROGRAMS OR FACILITIES WITH 50 OR MORE EMPLOYEES AND FEDERAL CONTRACTS OF $50,000 OR MORE. 21. Do you have a written affirmative action plan? If NO, explain. US tin DOEA USE ONLY Reviewed By Incompliance: YES NO* Program Office *Notice of Corrective Action Sent Date Telephone Response Due On -Site n Desk Review n Response Received DOEA Form 101 -A, Revised May 2008 Page 2 of 2 ATTACHMENT IX Contract Number KH 1172 Page 24 INSTRUCTIONS FOR THE CIVIL RIGHTS COMPLIANCE CHECKLIST l .Describe the geographic service area such as a district, county, city or other locality. If the program/ facility serves a specific target population such as adolescents, describe the target population. Also, define the type of service provided. 2.Enter the percent of the population served by race and sex. The population served includes persons in the geographical area for which services are provided such as a city, county or other regional area. Population statistics can be obtained from local chambers of commerce, libraries, or any publication from the 1980 Census containing Florida population statistics. Include the source of your population statistics. ( "Other" races include Asian/Pacific Islanders and American Indian/Alaskan Natives.) 3.Enter the total number of full-time staff and their percent by race, sex and disability. Include the effective date of your summary. 4.Enter the total number of clients who are enrolled, registered or currently served by the program or facility, and list their percent by race, sex and disability. Include the date that enrollment was counted. 5.Enter the total number of advisory board members and their percent by race, sex, and disability. If there is no advisory or governing board, leave this section blank. 6.Each recipient of federal financial assistance must have on file an assurance that the program will be conducted in compliance with all nondiscriminatory provisions as required in 45 CFR 80. This is usually a standard part of the contract language for DOEA recipients and their sub - grantees, 45 CFR 80.4 (a). 7.1s the race, sex, and national origin of the staff reflective of the general population? For example, if 10% of the population is Hispanic, is there a comparable percentage of Hispanic staff? 24 CONTRACT KH 1172 Page 25 8.Where there is a significant variation between the race, sex or ethnic composition of the clients and their availability in the population, the program /facility has the responsibility to determine the reasons for such variation and take whatever action may be necessary to correct any discrimination. Some legitimate disparities may exist when programs are sanctioned to serve target populations such as elderly or disabled persons, 45 CFR 80.3 (b) (6). 9. Do eligibility requirements unlawfully exclude persons in protected groups from the provision of services or employment? Evidence of such may be indicated in staff and client representation (Questions 3 and 4) and also through on -site record analysis of persons who applied but were denied services or employment, 45 CFR 80.3 (a) and45CFR80.1 (b) (2). l O.Participants or clients must be provided services such as medical, nursing and dental care, laboratory services, physical and recreational therapies, counseling and social services without regard to race, sex, color, national origin, religion, age or disability. Courtesy titles, appointment scheduling and accuracy of record keeping must be applied uniformly and without regard to race, sex, color, national origin, religion, age or disability. Entrances, waiting rooms, reception areas, restrooms and other facilities must also be equally available to all clients, 45 CFR 80.3 (b). 11.For in- patient services, residents must be assigned to rooms, wards, etc., without regard to race, color, national origin or disability. Also, residents must not be asked whether they are willing to share accommodations with persons of a different race, color, national origin, or disability, 45 CFR 80.3 (a). 12.The program /facility and all services must be accessible to participants and applicants, including those persons who may not speak English. In geographic areas where a significant population of non- English speaking people live, program accessibility may include the employment of bilingual staff. In other areas, it is sufficient to have a policy or plan for service, such as a current list of names and telephone numbers of bilingual individuals who will assist in the provision of services, 45 CFR 80.3 (a). 13.Programs /facilities must make information regarding the nondiscriminatory provisions of Title VI available to their participants, beneficiaries or any other interested parties. This should include information on their right to file a complaint of discrimination with either the Florida Alliance of Elder Affairs or the U.S. Alliance of HHS. The information may be supplied verbally or in writing to every individual, or may be supplied through the use of an equal opportunity policy poster displayed in a public area of the facility, 45 CFR 80.6 (d). 14.Report number of discrimination complaints filed against the program/ facility. Indicate the basis, e.g., race, color, creed, sex, age, national origin, disability, retaliation; the issues involved, e.g., services or employment, placement, termination, etc. Indicate the civil rights law or policy alleged to have been violated along with the name and address of the local, state or federal agency with whom the complaint has been filed. Indicate the current status, e.g., settled, no reasonable cause found, failure to conciliate, failure to cooperate, under review, etc. 15.The program/ facility must be physically accessible to disabled individuals. Physical accessibility includes designated parking areas, curb cuts or level approaches, ramps and adequate widths to entrances. The lobby, public telephone, restroom facilities, water fountains, information and admissions offices should be accessible. Door widths and traffic areas of administrative offices, cafeterias, restrooms, recreation areas, counters and serving lines should be observed for accessibility. Elevators should be observed for door width, and Braille or raised numbers. Switches and controls for light, heat, ventilation, fire alarms, and other essentials should be 25 f� / . CONTRACT KH 1172 Page 26 installed at an appropriate height for mobility impaired individuals. 16.Section 504 of the Rehabilitation Act of 1973 requires that a recipient of federal financial assistance conduct a self- evaluation to identify any accessibility barriers. Self- evaluation is a four step process: -With the assistance of a disabled individual/ organization, evaluate current practices and policies which do not comply with Section 504. -Modify policies and practices that do not meet Section 504 requirements. -Take remedial steps to eliminate any discrimination that has been identified. -Maintain self- evaluation on file. (This checklist may be used to satisfy this requirement if these four steps have been followed.), 45 CFR 84.6. 17.Programs or facilities that employ 15 or more persons must adopt grievance procedures that incorporate appropriate due process standards and provide for the prompt and equitable resolution of complaints alleging any action prohibited by Section 504.45 CFR 84.7 (b). 18.Programs or facilities that employ 15 or more persons must designate at least one person to coordinate efforts to comply with Section 504.45 CFR 84.7 (a). 19.Continuing steps must be taken to notify employees and the public of the program/ facility's policy of nondiscrimination on the basis of disability. This includes recruitment material, notices for hearings, newspaper ads, and other appropriate written communication, 45 CFR 84.8 (a). 20.Programs /facilities that employ 15 or more persons must provide appropriate auxiliary aids to persons with impaired sensory, manual or speaking skills where necessary. Auxiliary aids may include, but are not limited to, interpreters for hearing impaired individuals, taped or Braille materials, or any alternative resources that can be used to provide equally effective services, (45 CFR 84.52 (d). 21.Programs /facilities with 50 or more employees and $50,000 in federal contracts must develop, implement and maintain a written affirmative action compliance program in accordance with Executive Order 11246.41 CFR 60 and Title VI of the Civil Rights Act of 1964, as amended.