06/17/1993 Agreement COIN.
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13 annp otfjage
BRANCH OFFICE CLERK OF THE CIRCUIT COURT BRANCH OFFICE
3117 OVERSEAS HIGHWAY MONROE COUNTY 88820 OVERSEAS HIGHWAY
MARATHON, FLORIDA 33050 500 WHITEHEAD STREET PLANTATION KEY, FLORIDA 33070
TEL. (305) 289 -6027 KEY WEST, FLORIDA 33040 TEL. (305) 852 -7145
TEL. (305) 292 -3550
MEMORANDUM
TO: Peter Horton, Director
Division of Community Services
FROM: Ruth Ann Jantzen, Deputy Clerk 4 •
DATE: July 23, 1993
On June 16, 1993, the Board of County Commissioners authorized execution of a 1993-
1994 Community Care for Disabled Adults Grant and Contract KG -178, between the
State of Florida, Department of Health and Rehabilitative Services and Monroe
County /In Home Services.
Enclosed for return to the appropriate contact is a duplicate original of the subject
contract.
If you should have a question on the above, please contact me.
Enclosure
cc: County Attorney
Finance
County Administrator, w/o document
Risk Management, w/o document
File
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' 7/1/93 Contract No. 11G - 1 7 8
STATE OF FLORID
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
STANDARD CONTRACT
THIS CONTRACT is entered into between the State of Florida, Department of Health and Rehabilitative Services,
hereinafter referred to as the "department ", and Monroe County In -Home Services
, hereinafter referred to as the "provider ".
THE PARTIES AGREE:
I. THE PROVIDER AGREES: 4. To provide a financial and compliance audit to the
department as specified in Attachment T and
A.To provide services according to the conditions specified to ensure that all related party transactions are
in Attachment(s) I disclosed to the auditor. Additional audit requirements
are specified in Attachment 1, Special Provisions,
B.Federal Laws and Regulations Section D
1. If this contract contains federal funds, the provider
shall comply with the provisions of 45 CFR, Part 74, 5. To Include these aforementioned audit and record
and /or 45 CFR, Part 92, and other applicable keeping requirements in all approved subcontracts and
regulations as specified in Attachment N/A assignments.
2. If this contract contains federal funds and is over D. Retention of Records
$100,000, the provider shall comply with all applicable 1. To retain all client records, financial records,
standards, orders, or regulations issued under Section supporting documents, statistical records, and any
306 of the Clean Air Act, as amended (42 U.S.C. other documents (including electronic storage media)
1857(h) et seq.), Section 508 of the Clean Water Act, pertinent to this contract for a period of five (5) years
as amended (33 U.S.C. 1368 et seq.), Executive Order after termination of this contract, or if an audit has
11738, and Environmental Protection Agency been initiated and audit findings have not been
regulations (40 CFR Part 15). The provider shall report resolved at the end of five (5) years, the records shall
any violations of the above to the department. be retained until resolution of the audit findings.
3. If this contract contains federal funding in excess of 2. Persons duly authorized by the department and federal
$100,000, the provider must, prior to contract auditors, pursuant to 45 CFR, Part 92.36(i)(10), shall
execution, complete the Certification Regarding have full access to and the right to examine any of said
Lobbying form, Attachment If a Disclosure records and documents during said retention period or
of Lobbying Activities form, tan and Form LLL, Is as long as records are retained, whichever is later.
required, it may be obtained from the contract E. Monitoring
manager. All disclosure forms as required by the 1. To provide reports as specified in Attachment
Certification Regarding Lobbying form must be I . These reports will be used for monitoring
completed and returned to the contract manager. progress or performance of the contractual services as
C.Audits and Records specified in Attachment T
1. To maintain books, records, and documents (including
electronic storage media) in accordance with generally 2. To permit persons duly authorized by the department
accepted accounting procedures and practices which to inspect any records, papers, documents, facilities,
sufficiently and properly reflect all revenues and goods and services of the provider which are r levant
expenditures of funds provided by the department to this contract, and /or Interview any client§ and
under this contract. employees of the provider to be assured-of sati ctory •
performance of the terms and conditions -aajyt this
2. To assure that these records shall be subject at all contract. Following such inspection the department:
reasonable times to inspection, review, or audit by will deliver to the provider a list of its comments with
state personnel and other personnel duly authorized regard to the manner in which said go¢t# or services
are being provided. The provider will rectify aI
by the department, as well as by federal personnel. all
deficiencies provided by the department withid the
3. To maintain and file with the department such specified period of time set forth in the commkrjts or
progress, fiscal and inventory reports as specified in provide the department with a reasanabll and
Attachment I , and other reports as the acceptable Justification for not correcting the - noted
department may require within the period of this shortcomings. The providers failure to correct or
justify within a reasonable time as specified by the
contract. Such reporting requirements must be
reasonable given the scope and purpose of this department may result In the withholding of payments,
contract. being deemed in breach or default, or termination of
this contract.
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' 7/1/93
F. Indemnification coverage may be provided by a self - insurance
If the provider is a state agency or subdivision as defined program established and operating under the laws of
in section 768.28, Florida Statutes, only No. 2 below is the State of Florida. The department reserves the right
applicable. Other than state agencies or subdivisions to require additional insurance as specified in
refer only to No. 1. Attachment 1 where appropriate.
1. The provider agrees to be Ilable for all claims, suits, 2. If the provider is a state agency or subdivision as
judgments, or damages, including court costs and defined by section 768.28, Florida Statutes, the
attorney's fees, arising out of the negligent or provider shall fumish the department, upon request,
intentional acts or omissions of the provider, and its written_ verification of liability protection in accordance
agents, subcontractors, and employees, in the course with section 768.28, Florida Statutes. Nothing herein
of the operation of this contract. Further, the provider shall be construed to extend any party's liability
agrees to indemnify the department against all claims, beyond that provided in section 768.28, Florida
suits, judgments, or damages, including court costs Statutes.
and attorney's fees, arising out of the negligent or
. intentional acts or omissions of the provider, and its H.Safeguarding Information
agents, subcontractors, and employees, in the course Not to use or disclose any information concerning a
of the operation of this contract. Also, the provider recipient of services under this contract for any purpose
agrees to defend the department, upon receiving not in conformity with the state regulations and federal
timely written notification from the department, against regulations (45 CFR, Part 205.50), except upon written
all claims, suits, judgments, or damages, including consent of the recipient, or his responsible parent or
costs and attorney's fees, arising out of the negligent guardian when authorized by law.
or intentional acts or omissions of the provider and its
agents, subcontractors, and employees, in the course I. Client Information
of the operation of this contract. Where the provider To submit management, program, and client identifiable
and the department commit joint negligent acts, the data, as specified by the department in Attachment
provider shall not be liable for nor have any obligation I
to defend the department with respect to that part of
the joint negligent act committed by the department. J. Assignments and Subcontracts
In no event shall the provider be liable for or have any 1. To neither assign the responsibility of this contract to
obligation to defend the department against such another party nor subcontract for any of the work
claims, suits, judgements, or damages, including costs contemplated under this contract without prior written
and attorney's fees, arising out of the sole negligent approval of the department. No such approval by the
acts of the department. department of any assignment or subcontract shall be
deemed in any event or in any manner to provide for
2. Any provider who is a state agency or subdivision, as the incurrence of any obligation of the department in
defined in section 768.28, Florida Statutes, agrees to addition to the total dollar amount agreed upon in this
be fully responsible for its negligent acts or omissions contract. All such assignments or subcontracts shall
or intentional tortious acts which result in claims or be subject to the conditions of this contract (except
suits against the department, and agrees to be liable Section I, Paragraph 0.1.) and to any conditions of
for any damages proximately caused by said acts or approval that the department shall deem necessary.
omissions. Nothing herein is intended to serve as a
waiver of sovereign immunity by any provider to which 2. Unless otherwise stated in the contract between the
sovereign immunity applies. Nothing herein shall be provider and subcontractor, payments made by the
construed as consent by a state agency or subdivision provider to the subcontractor must be within seven (7)
of the State of Florida to be sued by third parties in any working days after receipt of full or partial payments •
matter arising out of any contract. The provider agrees from the department In accordance with section
that it is an independent contractor of the department 287.0585, Florida Statutes. Failure to pay within seven
and not an agent or employee. (7) working days will result in a penalty charged
against the provider and paid to the subcontractor in
G.Insurance the amount of one -half of one (1) percent of the
1. To provide adequate liability insurance coverage on a amount due, per day from the expiration of the period
comprehensive basis and to hold such liability allowed herein for payment. Such penalty shall be In
insurance at all times during the existence of this addition to actual
payments owed and shall not exceed
contract. The provider accepts full responsibility for fifteen (15) percent of the outstanding balance due.
identifying and determining the type(s) and extent of
liability insurance necessary to provide reasonable K. Financial Reports
financial protections for the provider and the clients to To provide financial reports to the department as
be served under this contract. Upon the execution of specified In Attachment I
this contract, the provider shall furnish the department
written verification supporting both the determination
and existence of such insurance coverage. Such
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7/1/93
L Return of Funds procedures set forth in subsections 946.515(2) and (4),
1. To return to the department any overpayments due to Florida Statutes. For purposes of this contract, the
unearned funds or funds disallowed pursuant to the person, firm, or other business entity carrying out the
terms of this contract that were disbursed to the provisions of this contract shall be deemed to be
provider by the department. The provider shall return substituted for the department insofar as dealings with
any overpayment to the department within forty (40) PRIDE. This clause Is not applicable to any
calendar days after either discovery by the provider, or subcontractors, unless otherwise required by law. An
notification by the department, of the overpayment. In abbreviated list of products /services available from
the event that the provider or its independent auditor PRIDE may be obtained by contacting PRIDE's
discovers an overpayment has been made, the Tallahassee branch office at (904) 487 -3774 or
provider shall repay said overpayment within forty (40) SunCom 277 -3774.
calendar days without prior notification from the
department. In the event that the department first 2. Procurement of Products or Materials with
discovers an overpayment has been made, the Recycled Content
department will notify the provider by letter of such a Additionally, It Is expressly understood and agreed that
finding. Should repayment not be made in a timely any products or materials which are the subject of, or
manner, the department will charge interest of one (1) are required to carry out this contract shall be
percent per month compounded on the outstanding procured in accordance with the provisions of
balance after forty (40) calendar days after the date of section 403.7065, Florida Statutes.
notification or discovery.
P. Civil Rights Requirements
2. For state universities, should repayment not be made 1. Provider Assurance
within forty (40) calendar days after the date of The provider assures that ft will comply with:
notification, the department will notify the State a. Title VI of the Civil Rights Act of 1964, as amended,
Comptroller's Office who will then enact a transfer of 42 U.S.C. 2000d et seq., which prohibits
the amounts owed from the state university's account discrimination on the basis of race, color, or national
to the account of HRS. origin.
M. Incident Reporting b. Section 504 of the Rehabilitation Act of 1973, as
1. Client Risk Prevention amended, 29 U.S.C. 794, which prohibits
If services to clients will be provided under this discrimination on the basis of handicap.
contract, the provider and any subcontractors shall, in
accordance with the client risk prevention system, c. Title IX of the Education Amendments of 1972, as
report those reportable situations listed In amended, 20 U.S.C. 1681 et seq., which prohibits
HRSR 215-6, Paragraph 5, in the manner prescribed In discrimination on the basis of sex.
HRSR 215-6 or district operating procedures.
d. The Age Discrimination Act of 1975, as amended, 42 g
2. Abuse, Neglect and Exploitation Reporting
In compliance with Chapter 415, Florida Statutes, an U.S.C. 6101 et seq., which prohibits discrimination
of the on the basis of age.
employee
provider who knows, or has
reasonable cause to suspect, that a child, aged person e. Section 654 of the Omnibus Budget Reconciliation
or disabled adult is or has been abused, neglected, or
exploited, shall immediately report such knowledge or Act 1981, as amended, 42 U.S.C. 9849, which
suspicion to the central abuse registry and tracking prohibits discrimination on the basis of race, creed,
actor, national origin, sex, handicap, political
system of the department on the single statewide toll-
free telephone number (1- 800- 96ABUSE). affiliation or beliefs.
f. The Americans with Disabilities Act of 1990, P.L 101 -
N.Tra nsportation Disadvantaged
If clients are to be transported under this contract, the. which prohibits discrimination on the basis of
provider will comply with the provisions of Chapter 427, disability and requires reasonable accommodation
Florida Statutes, and Rule Chapter 41 -2, Florida for persons with disabilities.
Administrative Code. The provider shall submit to the
department the reports required pursuant to Volume 10, g• All regulations, guidelines, and standards as are now
Chapter 27, HRS Accounting Procedures Manual. or may be lawfully adopted under the above
statutes.
O.Purchasing
1. PRIDE The provider agrees that compliance with this
It is expressly understood and agreed that any articles assurance constitutes a condition of continued
which are the subject of, or are required to carry out receipt of or benefit from funds provided through
this contract shall be purchased from Prison this contract, and that It is binding upon the
Rehabilitative Industries and Diversified Enterprises, provider, its successors, transferees, and assignees
Inc. (PRIDE) identified under Chapter 946, Florida for the period during which services are provided.
Statutes, in the same manner and under the The provider further assures that all contractors,
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7/1/93
subcontractors, subgrantees, or others with whom it funds, including any funds obtained through this
arranges to provide services or benefits to contract, it shall, in publicizing, advertising or describing
participants or employees In connection with any of the sponsorship of the program, state: 'Sponsored by
its programs and activities are not discriminating
against those participants or employees in violation N/A
of the above statutes, regulations, guidelines, and
standards. PROVIDER
2. Compliance Questionnaire and the State of Florida, Department of Health and
Rehabilitative Services'. If the sponsorship reference is in
In accordance with HRSM 220 -2, the provider agrees
w
to complete the Civil Rights Compliance Questionnaire, of material, the words 'State of Florida, Department
of Health and Rehabilitative Services shall appear in the
HRS Forms 946 A and B, if services are provided to
clients and if 15 or more people are employed. same size letters or type as the name of the organization.
t].Requirements of Section 287.058, Florida Statutes T . Discounted Invoices
1. To submit bills for fees or other compensation for to allow voices which N/A
are a percent discount on selected
services or expenses in sufficient detail for a proper In paid In less s than days. The
pre -audit and post -audit thereof. provider must clearly mark any Invoice wit t e discount
if it is to be allowed. The provider may submit Invoices
2. Where applicable, to submit bills for any travel with or without the negotiated discount terms. The
expenses in accordance with section 112.061, Florida department shall comply with Invoice offered.
215.422(4),
Statutes. The department may, when specified Florida Statutes, if a discounted Irnoice is offered.
i� y, pecffied in
Attachment , establish rates lower than the U. Final Invoice
maxim provided in section 112.061, Florida The provider must submit the final invoice for payment to
the department no more than A� days after the
contract ends or Is terminated; it t provider fails to do
3. To provide units of deliverables, Including reports, so, all right to payment Is forfeited and the department
findings, and drafts as specified in will not honor any requests submitted after the aforesaid
Attachment I , to be received and time period. Any payment due under the terms of this
accepted by the contract manager prior to payment. contract may be withheld until all reports due from the
provider and necessary adjustments thereto have been
4. To comply with the criteria and final date by which approved by the department.
such criteria must be met for completion of this
contract as specified In Section III, Paragraph A.2. of V. Use Of Funds For Lobbying Prohibited
this contract. To comply with the provisions of section 216.347, Florida
Statutes, which prohibits the expenditure of contract
5. To allow public access to all documents, papers, funds for the purpose of lobbying the Legislature or a
letters, or other materials subject to the provisions of state agency.
Chapter 119, Florida Statutes, and made or received
by the provider in conjunction with this contract. It is II. THE DEPARTMENT AGREES:
expressly understood that substantial evidence of the
provider's refusal to comply with this provision shall A. Contract Amoun
constitute a breach of contract. To pay for contracted services according to the
conditions of Attachment I In an amount not to exceed
R. Withholdings and Other Benefits $ 121,_821 , subject to the availability of
1. The provider is responsible for Social Security and funds. e State of Florida's performance and obligation
Income Tax withholdings. to pay under this contract Is contingent upon an annual
appropriation by the Legislature. The costs of services
2. The provider is not entitled to state retirement or leave paid under any other contract or from any other source
are not eligible for reimbursement under this
benefits except where the provider is a state agency. ement uner s contract. •
3. Unless Justified by the provider and agreed to by the B. Contract Payment
department in Attachment I, Section ,the Pursuant to section 215.422, Florida Statutes, the
su voucher authorizing payment of an invoice submitted to
department will not furnish services of
port (e.g., the department shall be filed with the State Comptroller
office space, office supplies, telephone service, not later than twenty (20) days from the latter of the date
secretarial, or clerical support) normally available to a proper Invoice Is received or receipt, inspection and
career service employees. approval of the goods or services, except that in the case
S. Sponsorship of a bona fide dispute the voucher shall contain a
If statement of the dispute and authorize payment only in
As required by section 286.25, Florida Statutes,
the amount not disputed. The date on which an invoice is
provider is a nongovernmental organization which
sponsors a program financed wholly or in part by state deemed received is the date on which a proper invoice is
first received at the place designated by the department.
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7/1/93
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Invoices which have to be returned to a vendor because notice In writing to the provider. Said notice shall be
of vendor preparation errors will result in a delay in the delivered by certified mail, retum receipt requested, or
payment. The invoice payment requirements do not start in person with proof of delivery. The department shall
until a properly completed Invoice, as defined In Rule be the final authority as to the availability of funds.
Chapter 3A -24, Florida Administrative Code, is provided
to the department. Approval and inspection of goods or 3. Termination for Breach
services shall take no longer than five (5) working days Unless the provider's breach Is waived by the
unless the bid specifications, purchase order or contract department In writing, the department may, by written
specifies otherwise. Such approval is for the purpose of notice to the provider, terminate this contract upon no
authorizing payments and does not constitute a final less than twenty - four (24) hours notice. Said notice -
approval of services purchased under this contract. A shall be delivered by certified mall, retum receipt
payment Is deemed to be Issued on the first working day requested, or in person with proof of delivery. If
that payment is available for delivery or mailing to the applicable, the department may employ the default
provider. If a warrant in payment of an invoice is not provisions In Chapter 13A- 1.006(4), Florida
issued within forty (40) days, or thirty -five (35) days for Administrative Code. Waiver of breach of any
health care providers as defined in Rule Chapter 3A -24, provisions of this contract shall not be deemed to be a
Florida Administrative Code, after the receipt of the waiver of any other breach and shall not be construed
invoice and receipt, inspection, and approval of the to be a modification of the terms of this contract. The
goods and services, the department shall pay to the provisions herein do not limit the department's right to
provider, in addition to the amount of the invoice, interest remedies at law or to damages.
at a rate of one (1) percent per month calculated on a
daily basis on the unpaid balance from the expiration of C.Notice and Contact
such forty (40) day period, or thirty -five (35) day period 1. The name, address and telephone number of the
for health care providers as defined In Rule contract manager for the department for this contract
Chapter 3A -24, Florida Administrative Code, until such Is:
time that the warrant Is issued to the provider. The Barbara Adkison
temporary unavailability of funds to make a timely
payment due for goods or services does not relieve the 1320 S . Dixie Hwy, 3rd floor
department from this obligation to pay Interest penalties. Cora 1 Gables. FL 33146
C.Vendor Ombudsman
A Vendor Ombudsman has been established within the
Department of Banking and Finance. The duties of this 2. The name, address and telephone number of the
individual include acting as an advocate for vendors who representative of the provider responsible for
may be experiencing problems In obtaining timely administration of the program under this contract Is: . ,
payment(s) from a state agency. The Vendor Gwen Rodriguez
Ombudsman may be contacted at (904) 488 - 2924 or by
calling the State Comptroller's Hotline, 1-800-848-3792.
1315 Whitehead St.
Key West, FL 33040
III. THE PROVIDER AND DEPARTMENT MUTUALLY Tel: 292 -3515
AGREE:
F
A. Effective Date 3. In the event that different representatives are
designated by either party after execution of this _ - =
1. This contract shall begin on July 1 , 19 9 3 .
or on the date on which the contract has been sig contract notice of the name and address of the new
by both parties, whichever is later. i�% ] representatN e will be rendered In writing to the other
�• 1 9t � party and se notification attached to originals of this
2. This contract shall end on June 30 199:- / , contract.
D.Ren or Modification
B.Termination 3 1. Modifications of provisions of this contract shall only
1. Termination at Will / cc be valid when they have been reduced to writing and
This contract may be terminated by
ither'.:
Y - rty upon duly signed. The parties agree to renegotiate this
no less than thirty unless a rty (30) calendar s notice, without contract If federal and /or state revisions of any
mutually g upon by applicable laws, or regulations make changes in this
both parties. Said notice shall be delivered by certified contract necessa
mail. return receipt requested, or in person with proof ry
of delivery. 2. The rate of
payment and the total dollar amount may_ - •
2. Termination Because of Lack of Funds be adjusted retroactively to reflect price level increases
In the event funds to finance this contract become and changes in the rate of payment when these have
unavailable, the department may terminate the been established through the appropriations process
contract upon no Tess than twenty-four (24) hours and e subsequently identified in the department's
Aerating budget.
5
/1 /y3
Contract No. P(G -1 ? p,
E. Name, Mailing and Street Address of Payee F. All Terms and Conditions Included
1. The name (provider name as shown on page 1 of this This contract and Its attachments as referenced,
contract) and mailing address of the official payee to ( Attachments I. II
whom the payment shall be made: Exhibits A, B, C, D
Monroe County In -Home Services
1315 Whitehead Street
Key West, FL 33040 contain all the terms and conditions agreed upon by the
parties.
2. The name of the contact person and street address
where financial and administrative records are
maintained:
Gwen Rodrik,uez
1315 Whitehead Street
Key West, FL 33040
IN WITNESS THEREOF, the parties hereto have caused this 020 page contract to be executed by their undersigned
officials as duly authorized.
PROVIDER STATE OF FLORIDA, DEPARTMENT OF
MONROE COUNTY IN - HOME SERVICES HEALTH AND REHABIUTATIVE SERVICES
SIGNED BY: 1/� SIGNE Y:
NAME: J. ck London NA Anita M. Bock
TITLE: Mayor
TITLE: Deputy District Administrator .
DATE: to// 7/ 9 3 DATE: ‘%
FEDERAL ID NUMBER (or SS Number for an Individual):
VF596000749029
STATE AGENCY 29 DIGIT SAMAS CODE:
PROVIDER FISCAL YEAR ENDING DATE:
September 30, 1993
•
1 CONTRACT IS NOT VAUD UNTIL SIGNED AND DATEQ BY
BOTH PARTIES
APPROVED ASTOFO -M ATTEST: DANNY L. KOLHAGE, CLERK
- o [EGAL SUFFIP CY A
e .416 7. BY .621./.40,10.4Apid
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ALornd 's •
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07/01/93 Community Care for Disabled
Adults
Aging and Adult Services
Fixed Price
ATTACHMENT I
A. Services to be Provided.
The services to be provided are identified in Section C.2.
of this attachment. The applicable service definitions and
standards are found in HRSM 140 -8. The performance standard,
Exhibit A , will be used during monitoring and quality
assurance visits if the provider determines client eligibility
for services.
B. Manner of Service Provision.
1. The provider will maintain a current record on each
individual in the program including current documentation of
eligibility for: services; identifying information about the
recipient and established need to receive the services; service
delivery data; and all other forms or records necessary for
program operation and reporting as determined necessary by the
department.
2. If the services are not provided in the client's home,
the provider will maintain their facilities in which the services
are provided so that at all times the facilities conform to the
standards required by state and local fire and health
authorities, whichever are more stringent.
3. The provider will maintain sufficient staff, facilities
and equipment to deliver the agreed upon services or will notify
the department whenever they are unable or are going to be unable
to provide the required quality or quantity of services.
C. Method of Payment.
1. The department shall make payment to the provider for a
total dollar amount not to exceed $121,821 , subject to the
availability of funds.
2. The department shall make payment to the provider for
'provision of services up to a maximum number of units of service
and at the rate(s) stated below:
Services to be
Provided Units of Service Unit Rate Maximum Units
Case Management One -Hour $34.79 1000
Home Delivered
Meals One -meal $4.46 6024
Homemaker One -Hour $20.70 906
Personal Care One -Hour $21.39 1360
Respite One -Hour $16.87 730.25
( 9 j • GA08
07/01/93 Community Care for Disabled
Adults
3. Rates listed in paragraph C -2 are the department's 90%
share of the gross cost per unit of service. If the contract is
for Adult Day Health Care or Medicaid waiver service(s) for
Medicaid waiver eligible recipients, then no match is required.
4. The provider shall submit to the contract manager an
original and 3 copies of invoices, Exhibit R for payment on a
monthly basis. The due date for these invoices is the 10th day
of the month following the month being reported.
a. The provider agrees to identify Medicaid waiver
eligible clients and direct bill the Medicaid fiscal agent for
services rendered to these clients. Provider further agrees to
furnish the contract manager with a copy of the remittance
voucher from the Medicaid fiscal agent on a monthly basis.
b. Provider agrees to accept the Medicaid
reimbursement as payment in full and not bill a Medicaid
recipient or the department for the cost of the service or any
portion of the cost of the service. The provider agrees to abide
by the provisions of the Medicaid Aged /Disabled Waiver Handbook.
5. The provider expressly understands that any payment due
under the terms of this contract may be withheld pending the re-
ceipt and approval of the department of all financial and program
reports due from the provider as a part of this contract and any
adjustments thereto. -
6. A final report will be made to the department within
sixty (60) days after the contract ends or is terminated, on a
form provided by the department, identifying total units of
service and total payment received. In the event of an over-
payment resulting from revised units of service for the contract
period being reported, these monies must be returned to the
department with the final report.
D. Special Provisions.
1. State Laws and Regulations
a. The provider will comply with the applicable
provisions of Chapter 409, Chapter 410 and Section 20.19(2)(b)2f,
Florida Statutes.
b. The provider will comply with the applicable
provisions of Chapter 10A -16, Florida Administrative Code.
c. The provider will comply with the applicable
provisions of HRSM 140 -8, CCDA Program Manual and any other
applicable guidelines or criteria established by the department.
d. The provider, if offering Adult Day Care Services
or Adult Day Health Care Services, shall be licensed unless
otherwise exempted under Chapter 400, Part IV, Florida Statutes.
( ] GA08
• • 07/01/93 Community Care for Disabled
Adults •
2. Client Information
a. The provider of case management services agrees to
submit to the department management program data including client
identifiable data in accordance with instructions provided by the
department.
b. The provider must maintain records documenting the
clients, by name or unique identifier, to whom services are pro-
vided, the number of units provided and the dates of service
provision. This must track to each invoice for payment.
Requests for payment which cannot be supported with supporting
documentation will be returned to the provider upon inspection by •
the department.
•
3. Service Reports
The provider agrees to submit to the contract manager a
monthly summary report and six, nine and twelve months cumulative
summary reports as described in Chapter 5, HRSM 140 -8.
4. Expenses
Receipts are required for all expenses incurred, (e.g.,
office supplies, printing, long distance telephone calls, etc.).
Receipts are required for all expenses of this nature.
5. Subcontracts
a. Departmental approval of the provider's
application shall constitute approval of the provider sub-
contracts if the subcontracts follow the service and funding
information as identified in the approved provider application.
b. The provider will provide technical assistance to
all subcontractors, as necessary.
c. The provider agrees to conduct monitoring of
subcontract agencies. Copies of reports of such monitoring
visits will be submitted to the department and other appropriate
agents in a format and within the time frames approved by the
department.
6. Suspension
a. The department may, for reasonable cause, •
temporarily suspend the use of funds by a provider pending cor-
rective action, or pending a decision to terminate the award.
b. The department may prohibit the provider from
receiving further payments and may prohibit the provider from in-
curring additional obligations of funds. The suspension may
apply to only part, or all of the provider's operation.
GA08
•
07/01/93 Community Care for Disabled
Adults
c. To suspend operations of the provider, the
department will notify the provider in writing by Certified Mail
of: the action to be taken; the reason(s) for such action; and
the conditions of the suspension. The notification will also:
indicate what corrective action(s) are necessary to remove the
suspension; indicate the provider's right to an administrative
hearing; and provide the provider with the appropriate time
period to request an administrative hearing- before the effective
date of the suspension (unless provider's actions warrant an
immediate suspension).
7. Copyrights Clause
Where activities supported by this contract produce
original writing, sound recordings, pictorial reproductions,
drawings or other graphic representation and works of any similar
nature, the department has the right to use, duplicate and dis-
close such materials in whole or in part, in any manner, for any
purpose whatsoever and to have others acting on behalf of the
department to do so. If the materials so.developed are subject
to copyright or patent legal title and every right, interest,
claim, or demand of any kind in and to any patent, trademark or
copyright, or application for the same, will vest in the State of
Florida, Department of State, for the exclusive use and benefit
of the state. Pursuant to section 286.021, Florida Statutes
(1987), no person, firm or corporation, including parties to this
contract, shall be entitled to use the copyright, patent or
trademark without the written consent of the Department of State.
8. Abuse, Neglect and Exploitation Reporting
If at any time an employee of the provider is aware of
or suspects that abuse, neglect, or exploitation of children,
disabled persons, or aged persons has occurred, as defined in
Chapter 415, Florida Statutes, he /she is required to immediately
report such known or suspected abuse or neglect to the department
by calling the Abuse Registry, 1- 800 -96- ABUSE. Failure of the
em- ployee to immediately report known or suspected abuse, neglect
or exploitation may constitute a breach of contract and may
result in termination of the contract.
9. GrieyApce and Fair Hearings Procedures
The provider will utilize the department's fair hearing
system outlined in HRSM 195 -1, Chapter 4 by which client served
by the provider under this contract may present a request for a
fair hearing.
10. Fees
No fees shall be imposed other than those set by the
department. Fees collected in compliance with departmental di-
rectives will be disposed of in a manner prescribed by the
department.
( I D ) GA08
07/01/93 Community Care for Disabled
Adults
11. Protect Independence
The department has implemented Project Independence, an
initiative to assist public assistance recipients to enter and
remain in gainful employment. Employment of Project Independence
participants is a mutually beneficial goal for the provider and
the department in that it provides qualified entry level
employees needed by many providers and provides substantial
savings to the citizens of Florida.
The provider or its agent agrees to notify the
department of entry level employment opportunities associated
with this contract that require a high school education or less.
The department will provide information to the provider
identifying Project Independence clients that are referred to the
provider. In the event that the provider or its agent employs a
person who was referred by the department's Project Independence
office, the provider will notify the department.
12. 'Plan of Care
Providers acknowledge that the Medicaid waiver client's
plan of care is the official document authorizing Medicaid
billing. If the provider serves Medicaid waiver clients, the
provider agrees to provide services in accordance with the
client's plan of care as authorized by the client's case manager.
If the provider provides adult day health care services, the
provider agrees to provide only those service units contained in
the client's plan of care and authorized by the department in
accordance with established review procedures.
13. Human Rights Advocacy Committee Clause
The provider agrees to allow properly identified
members of the HRAC access to the facility and /or agency and the
right to communicate with any client being served, as well as
staff or volunteers who serve them in accordance with Sections
402.165(8)(a)(b), F.S. Members of the committee shall be free to
examine all records pertaining to any case unless legal •
. pr °sh hition exist to prevent disclosure of those records.
[ I I ] GA08
14. Self Monitoring
The provider agrees to complete the self- monitoring each
and every quarter. The required form is Exhibit D to this
contract. Said form ds due in the office of the contract manager
by the 15th day of the month following the end of the quarter.
GAO8
CCDA -1
• Exhibit A
FY 1993 - 94
COMMUNITY CARE FOR DISABLED ADULTS
QUALITY ASSURANCE STANDARD
STANDARD: Clients receiving Community Care for Disabled
Adults (CCDA) services meet all eligibility
requirements, have been properly assessed,
have received individualized care plans based
on individualized client needs, and case
records are complete and up -to -date.
District office files include scheduled semi-
annual monitoring reports (unless district
has been granted a waiver by PDACS),
corrective action plans with documentation of
implementation of those plans, district
service plans for disabled adult population,
provider monthly summary reports, provider
semi - annual service cost reports, provider
six, nine and twelve month cumulative summary
reports, and documentation of district
tracking of fee assessment monies and
tracking of purchased durable medical
equipment.
METHODOLOGY: The program specialist will review selected
case records to determine compliance with the
following criteria:
o Client's age is 18 -59;
o Client has a permanent disability
and case plan contains
documentation supporting said
disability as defined in HRSM 140 -8
as a medically determined physical
or mental impairment that has
lasted or is expected to last for
12 months or longer and restricts
the client's ability to perform
normal activities of daily living
as determined through the initial
functional assessment and
documentation of disability;
o Client must not be eligible for
Vocational Rehabilitation services;
•
o Medicaid Waiver clients must be
assessed at risk of nursing home
placement;
•
o Client must not be receiving
comparable services from other
entities;
1 3
o Client needs a CCDA service and
documentation exists that all
comparable existing community
services and funding sources have
been explored and exhausted;
o Client must have an individual
income at or below the prevailing
Medicaid Institutional Care program
(ICP) eligibility standard in order
to receive non -fee assessed CCDA
services, clients with incomes
above the ICP standard will be
assessed for services;
o Documentation of the client's
income and assessment for fee
collection; if applicable;
o Fee assessments are tracked by the
unit or provider as applicable;
o A copy of the referral /intake form,
DOEA Form 111 A;
o Current (within one year) uniform
client assessment, DOEA Form 111 B
which has been completed, scored,
signed and dated which clearly
indicates the client's
capabilities, problems services
needed;
o Current (within six months and
evidenced to have been updated
quarterly or more if necessary)
service plan, HRS -AA 1025 form,
which coincides with client's
current assessment;
o Current (within one year) Medicaid
waiver health professional
statement, HRS-AA Form 1055, for
SSI CCDA clients who receive
Medicaid waiver services; or 3008
for ICP CCDA clients.
o An information release form signed
by the client allowing the case
manager to make arrangements for
the provision of services;
o Current (within on year) Client
Information System (CIS) HRS Form
3012;
Exhibit A
GA08
A case narrative with entries which
are reasonable timely, accurate,
and ensure that client - involved
goals and the client's changing
needs are being addressed.
(1) Notation in case.record that CCDA case
manager has viewed a check awards letter
or other indicating evidence that the
client receives SSI, SSDI, or some other
disability payment; or
(2) A written statement from a licensed
physician (M.D. or Doctor of Osteopathic
Medicine, or a mental health
professional). This "statement" must at
a minimum, include the applicant's
diagnosis, prognosis, and the author's
concurrence or nonconcurrence with a
broad statement about the client's level
of functioning and need for assistance
due to his disability.
LOCATION: Aging and Adult Service unit and /or CCDA
provider.
PERIOD OF Previous twelve months.
ASSESSMENT:
AUTHORITY: Section 410.601, F.S., Chapter 10A -16, F.A.C.
HRSM 140 -8.
SAMPLE SIZE: Three to Five active case records as time
allows.
ESTIMATE OF 20 minutes per case record; if no other
STAFF TIME: problems exist.
RATING This standard is in compliance if 100 percent
METHODOLOGY: of the elements in 100 percent of the sampled
'filne confirm that clients are eligible and
case records are up -to -date. This standard
is considered in partial compliance if at
least 90 percent of the elements in 100
percent of the sampled files confirm that
clients are eligible and /or case records are
up -to -date.
Exhibit A
GA08
STATE OF FLORIDA t K k bi t3
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
AGING AND ADULT SERVICES PROGRAM CONTRACT EKG
REPORT OF DISBURSEMENTS
•
Ccntracting Agency: MONROE COUNTY IN HOME SERVICES County :. MONROE
Address: ' 1375 WHITEHEAD STREET Phone:(305)292 -3515
KEY WEST, FLORIDA 33040
Reimbursement Period From: - • TO:
Contract Period From: TO:
•
•
UAL
DESCRIPTION APPROVED EXPENDITURES . EXPENDITURES •
BUDGET TO DATE FOR THE PERIOD
PERSONNEL: GROSS SALARIES
•
FRINGE BENEFITS
TOTAL PERSONNE
OTHER EXPENSES: •
•
•
•
•
•
•
TOTAL OTHER EXPENSES
• GROSS COST OF AGENCY
•
LESS AGENCY FEES COLLECTED
NET COST OF AGENCY N/A N/A N /A'
PLUS NET COST OF CENTER -
N/A
LESS AGENCY C.P.E. N/A N/A
LESS C.P.E. OF CENTERS _ N/A
TOTAL CASH REIMQURSEMENT - N/A N/A
PREPARED 8Y' -- -
TITLE: PROJECT DIRECTOR DATE:
1 �o
. o.
. .
EXHIBIT C ..
i •
Page 28
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Exhibit D
DISTRICT %I
COMMUNITY CARE FOR DISABLED ADULTS
PROVIDER SELF MONITORING
This form must be completed by the Agency Director each quarter.
Form must be submitted to the contract manager on or before the
15th day of the month after the quarter ends
AGENCY:
FY: 93 -94 QTR:
Total # of clients receiving service:
Total # of new, unduplicated clients during quarter:
Total # of cases closed during quarter:
Total # on waiting list:
# determined eligible:
# pending eligibility determination:
Number of client files reviewed by supervisors or administrators
during quarter:
Number of clients contacted by supervisors or administrators
during the quarter:
Staff turnover:
%/# Administrators:
%/# Supervisor:
%/# Direct services staff:
%/# Clerical:
The information contained in this report are true and correct to
the best of my knowledge.
Name /Title Date
1g
FINANCIAL AND COMPLIANCE AUDITS
ATTACHMENT Jr
- s
ttaLhment rs applicable, if the provider or grantee, hereinafter referred to as provider, is any local government
nT , ncnprofit organization, or for - profit organization.
PART l: SINGLE AUDIT
;,,rt is applicable if the provider is a local government entity or nonprofit organization and receives a total of
_5,!OJ or more from the department during its fiscal year. The provider has "received" funds when it has obtained cash from
- cirrartment or when it has incurred expenses which will be reimbursed by the department.
he :safer agrees to have an annual financial and compliance audit performed by independent auditors in accordance with the
current Government Auditing Standards ( "Yellow Book ") issued by the Comptroller General of the United States. Local
g ;+ernments shall comply with Office of Management and Budget (OMB) Circular A -128. Audits of State and Local Governments.
4;'pr .Dfit providers receiving federal funds passed through the department shall comply with the audit requirements contained
n cob Circular A -133, Audits of Institutions of Higher Learning and Other Nonprofit Institutions, except as modified herein.
Luc' JJeilts shall cover the entire organization for the organization's fiscal year, not to exceed 12 months. The scope of
the audit performed shall include the financial audit requirements of the "Yellow Book," and must include reports on internal
control and compliance. The audit report shall include a schedule of financial assistance that discloses each state contract
y n.r.ber. An audit performed by the Auditor General shill satisfy the requirements of this attachment.
Compliance findings related to contracts with the department shall be based on the contract requirements, including any
rules, regulations, or statutes referenced in the contract. Where applicable, the audit report shall include a computation
showing whether or not matching requirements were met. All questioned costs and liabilities due to the department shall be
calculated and fully disclosed in the audit report with reference to the department contract involved. These requirements do
not expand the scope of the audit as prescribed by the "Yellow Book."
If the provider has received any funds from a grants and aids appropriation, the provider will also submit a compliance
report(s) in accordance with the rules of the Auditor General, chapter 10.600, and indicate on the schedule of financial
assistance which contracts are funded from state grants and aids appropriations.
copies of the financial and compliance audit report, management letter, and all other correspondence, if any, related to
audits performed by independent auditors, other than the Auditor General, ehall be submitted within 120 days after the end of
the provider's fiscal year, unless otherwise required by Florida Statutes, to the following:
A. Office of Audit and Quality Control Services
1317 Winewood Boulevard, Building 5, Room 116
Tallahassee, Florida 32399 -0700
B. Contract Manager for the department
•
C. Submit to this address only those reports prepared in accordance with OMB Circular A -133:
Federal Audit Clearinghouse
U.C. EL:reau of the Census
Jeifcr >.,nii;tc, Indiana 47132
D. Submit to this address only those reports prepared in accordance with the rules of the
Auditor General, chapter 10.600:
Jim Dwyer
Office of the Auditor General
P. O. Box 1735
Tallahassee, Florida 32302
, hall ensure that audit working papers are made available to the department, or its designee, upon request for a
, f five years from the date the audit report is issued, unless extended in writing by the department.
•i3. -o.2
1 C1
PART 1I: GRANTS AND AIDS A! IT /ATTESTATION
.'.'t is dpplic ;ble if the provider is awarded funds from a gran nd aids appropriation, and is either (1) a local
;,,vcrrrernt rnt:ty or nonprofit organization receiving a total of less than S25,000 from the department during its fiscal year
( ) a for - profit organization receiving any amount from the department. The provider has "received" funds when it has
- ,rued cash from the department or when it has incurred expenses which will be reimbursed by the department.
• 'ne amount received from grants and aids appropriation awards exceeds S100,000, the provider agrees to have an audit
ertc'med by an independent certified public accountant and submit a compliance report(s) in accordance with the rules of the
..o:tc.r General, chapter 10.600. The audit report shall include a schedule of financial assistance that discloses each state
tr.,ct by number and indicates which contracts are funded from state grants and aids appropriations.
omp;iance findings related to contracts with the department shall be based on the contract requirements, including any
- u!e., regulations, or statutes referenced in the contract. Where applicable, the audit report shall include a computation
- Hewing whether or not matching requirements were met. All questioned costs and liabilities due to the department shall be
aiculated and fully disclosed in the audit report with reference to the department contract involved.
If the „mocnt received from grants and aids appropriation awards exceeds $25,000, but does not exceed S100,000, the provider
m.,y have an audit as described above or have a statement prepared by an independent certified public accountant which attests
that the provider has complied with the provisions of all contracts funded by a grants and aids appropriation.
If tre amount received from grants and aids appropriation awards does not exceed S25,000, the provider will have the head of
the entity or organization attest, under penalties of perjury, that the organization has complied with the provisions of all
c_ntracts funded by a grants and aids appropriation.
Copies of the audit report and all other correspondence, if any, related to audits performed by the independent auditor, or
the attestation statement, shall be submitted within 120 days after the provider's fiscal year end to the following:
A. Office of Audit and Quality Control Services
1317 Winewood Boulevard, Building 5, Room 116
Tallahassee, Florida 32399 -0700
B. Contract Manager for the department
C. Jim Dwyer
Office of the Auditor General
P. 0. Box 1735
Tallahassee, Florida 32302
The provider shall ensure that audit working papers are made available to the department, or its designee, upon request for a
aer'ou of five years from the date the audit report is issued, unless extended in writing by the department.
PART 111: NO AUDIT REQUIREMENT •
t■r 1..,rt is applicable if the provider is not awarded funds from a grants and aids appropriation, and is either (1) a local
377nt entity or nonprofit organization receiving a total of less than $25,000 from the department during its fiscal year
pro i *. o :rnir.3tion receiving any amount from the department. The provider has "received" funds when it h,ir.
.tc,, cash from the department or when it has incurred expenses which will be reimbursed by the department.
''+e provider has no audit or attestation statement required by this attachment.
;73,/7.2 aU