06/18/1997 1/1/97 (Rev. 6 -9 -97)
Client X Non - Client ❑
CFDA No. Multi- District ❑
Grants and Aids: XX
STATE OF FLORIDA
DEPARTMENT OF CHILDREN AND FAMILIES
STANDARD CONTRACT
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THIS CONTRACT is entered into between the State of Florida, Department of Children and Families, 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:
A. To provide services in accordance with the conditions specified in Attachment I. - t
B. Requirements of Section 287.058, FS
To provide units of deliverables, including reports, findings, and drafts, as specified in Attachment I, to be received and accepted by the contract manager prior
to payment. To comply with the criteria and final date by which such criteria must be met for completion of this contract as specified in Section III, Paragraph A.
of this contract. To submit bills for fees or other compensation for services or expenses in sufficient detail for a proper pre -audit and post -audit thereof. Where
applicable, to submit bills for any travel expenses in accordance with section 112.061, FS. The department may, if specified in Attachment I, establish rates
lower than the maximum provided in section 112.061, FS. To allow public access to all documents, papers, letters, or other materials subject to the provisions of
Chapter 119, FS, made or received by the provider in conjunction with this contract. It is expressly understood that the provider's refusal to comply with this
provision shall constitute an immediate breach of contract.
C. To Agree to the Following Governing Law
1. State of Florida Law
This contract is executed and entered into in the State of Florida, and shall be construed, performed, and enforced in all respects in accordance with the laws,
rules, and regulations of the State of Florida. Each party shall perform its obligations herein in accordance with the terms and conditions of the contract.
2. Federal Law
a. If this contract contains federal funds, the provider shall comply with the provisions of 45 CFR, Part 74, and /or 45 CFR, Part 92, and other applicable
regulations as specified in Attachment 1.
b. If this contract contains federal funds and is over $100,000, the provider shall comply with all applicable standards, orders, or regulations issued under
section 306 of the Clean Air Act, as amended (42 U.S.C. 1857(h) et seq.), section 508 of the Clean Water Act, as amended (33 U.S.C. 1368 et seq.), Executive
Order 11738, and Environmental Protection Agency regulations (40 CFR Part 15). The provider shall report any violations of the above to the department.
c. No federal funds received in connection with this contract may be used by the provider, or agent acting for the provider, to influence legislation or
appropriations pending before the Congress or any State legislature. If this contract contains federal funding in excess of $100,000, the provider must, prior to
contract execution, complete the Certification Regarding Lobbying form, Attachment N/A , If a Disclosure of Lobbying Activities form, Standard Form LLL, is
required, it may be obtained from the contract manager. All disclosure forms as required by the Certification Regarding Lobbying form must be completed and
retumed to the contract manager.
d. Not to employ unauthorized aliens. The department shall consider the employment of unauthorized aliens a violation of section 274A(e) of the
Immigration and Naturalization Act. Such violation shall be cause for unilateral cancellation of this contract by the department.
D. Audits, Records, and Records Retention
1. To establish and maintain books, records, and documents (including electronic storage media) in accordance with generally accepted accounting
procedures and practices which sufficiently and properly reflect all revenues and expenditures of funds provided by the department under this contract.
2. To retain all client records, financial records, supporting documents, statistical records, and any other documents (including electronic storage media)
pertinent to this contract for a period of five (5) years after termination of the contract, or if an audit has been initiated and audit findings have not been resolved
at the end of five (5) years, the records shall be retained until resolution of the audit findings or any litigation which may be based on the terms of this contract. •
•
3. Upon completion or termination of the contract and at the request of the department, the provider will cooperate with the department to facilitate the
duplication and transfer of any said records or documents during the required retention period as specified in Section I, Paragraph D.2. above.
4. To assure that these records shall be subject at all reasonable times to inspection, review, or audit by Federal, state, or other personnel duly authorized
by the department.
5. Persons duly authorized by the department and Federal auditors, pursuant to 45 CFR, Part 92.36(i)(10), shall have full access to and the right to examine
any of provider's contract and related records and documents, regardless of the form in which kept, at all reasonable times for as long as records are retained.
6. To provide a financial and compliance audit to the department as specified in Attachment 11 and to ensure that all related party transactions are
disclosed to the auditor.
7. To include these aforementioned audit and record keeping requirements in all approved subcontracts and assignments.
E. Monitoring by the Department
To permit persons duly authorized by the department to inspect any records, papers, documents, facilities, and /or goods and services of the provider which are
relevant to this contract, and/or to interview any clients and employees of the provider to assure the department of the satisfactory performance of the terms and
conditions of this contract. Following such evaluation the department will deliver to the provider a written report of its findings and will include written
recommendations with regard to the provider's performance of the terms and conditions of this contract. The provider will correct all noted deficiencies
identified by the department within the specified period of time set forth in the recommendations. The provider's failure to correct noted deficiencies may, at the
sole and exclusive discretion of the department, result in any one or any combination of the following: (1) the provider being deemed in breach or default of this
contract; (2) the withholding of payments to the provider by the department; and; (3) the termination of this contract for cause.
F. Indemnification
NOTE: Paragraph I.F.1. and 2. are not applicable to contracts executed between state agencies or subdivisions, as defined in section 768.28, FS.
1. The provider shall be liable for and shall indemnify, defend, and hold harmless the department and all of its officers, agents, and employees from all
claims, suits, judgments, or damages, consequential or otherwise and including attomeys' fees and costs, arising out of any act, actions, neglect, or omissions
by the provider, its agents, or employees during the performance or operation of this contract or any subsequent modifications thereof, whether direct or indirect,
and whether to any person or tangible or intangible property. /}
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2. The provider's inability to evaluate liability or its evaluation of liability shall not excuse the provider's duty to defend and indemnify within seven (7) days
after such notice by the department is given by certified mail. Only adjudication or judgment after highest appeal is exhausted specifically finding the provider
not liable shall excuse performance of this provision. The provider shall pay all costs and fees related to this obligation and its enforcement by the department.
The department's failure to notify the provider of a claim shall not release the provider of the above duty to defend.
G. Insurance
To provide adequate liability insurance coverage on a comprehensive basis and to hold such liability insurance at all times during the existence of this contract
and any renewal(s) and extension(s) of it. Upon execution of this contract, unless it is a state agency or subdivision as defined by section 768.28, FS, the
provider accepts full responsibility for identifying and determining the type(s) and extent of liability insurance necessary to provide reasonable financial
protections for the provider and the clients to be served under this contract. Upon the execution of this contract, the provider shall furnish the department written
verification supporting both the determination and existence of such insurance coverage. Such coverage may be provided by a self- insurance program
established and operating under the laws of the State of Florida. The department reserves the right to require additional insurance as specified in Attachment 1
where appropriate.
H. Safeguarding Information
Not to use or disclose any information concerning a recipient of services under this contract for any purpose not in conformity with state regulations and Federal
law or regulations (45 CFR, Part 205.50), except upon written consent of the recipient, or his responsible parent or guardian when authorized by law.
I. Assignments and Subcontracts
1. To neither assign the responsibility of this contract to another party nor subcontract for any of the work contemplated under this contract without prior
written approval of the department which shall not be unreasonably withheld. Any sublicense, assignment, or transfer otherwise occurring shall be null and void.
2. The provider shall be responsible for all work performed and all expenses incurred with the project. If the department permits the provider to subcontract
all or part of the work contemplated under this contract, including entering into subcontracts with vendors for services and commodities, it is understood by the
provider that the department shall not be liable to the subcontractor for any expenses or liabilities incurred under the subcontract and the provider shall be solely
liable to the subcontractor for all expenses and liabilities incurred under the subcontract. The provider, at its expense, will defend the department against such
claims.
3. The State of Florida shall at all times be entitled to assign or transfer its rights, duties, or obligations under this contract to another govemmental agency in
the State of Florida, upon giving prior written notice to the provider. In the event the State of Florida approves transfer of the provider's obligations, the provider
remains responsible for all work performed and all expenses incurred in connection with the contract. In addition, this contract shall bind the successors,
assigns, and legal representatives of the provider and of any legal entity that succeeds to the obligations of the State of Florida.
4. Unless otherwise stated in the contract between the provider and subcontractor, payments made by the provider to the subcontractor must be within
seven (7) working days after receipt of full or partial payments from the department in accordance with section 287.0585, FS. Failure to pay within seven (7)
working days will result in a penalty charged against the provider and paid to the subcontractor in the amount of one -half of one (1) percent of the amount due
per day from the expiration of the period allowed herein for payment. Such penalty shall be in addition to actual payments owed and shall not exceed fifteen (15)
percent of the outstanding balance due.
J. Return of Funds
To retum to the department any overpayments due to uneamed funds or funds disallowed pursuant to the terms of this contract that were disbursed to the
provider by the department. In the event that the provider or its independent auditor discovers that an overpayment has been made, the provider shall repay
said overpayment within 40 calendar days without prior notification from the department. In the event that the department first discovers an overpayment has
been made, the department will notify the provider by letter of such a finding. Should repayment not be made in a timely manner, the department will charge
interest of one (1) percent per month compounded on the outstanding balance after 40 calendar days after the date of notification or discovery.
K. Incident Reporting
1. Client Risk Prevention
If services to clients will be provided under this contract, the provider and any subcontractors shall, in accordance with the client risk prevention system, report
those reportable situations listed in HRSR 215 -6 Paragraph 5, in the manner prescribed in HRSR 215-6 or district operating procedures.
2. Abuse, Neglect, and Exploitation Reporting
In compliance with Chapter 415, FS, an employee of the provider who knows or has reasonable cause to suspect that a child, aged person, or disabled adult is
or has been abused, neglected, or exploited shall immediately report such knowledge or suspicion to the Florida Abuse Hotline on the single statewide toll -free
telephone number (1- 800- 96ABUSE).
L. Transportation Disadvantaged
If clients are to be transported under this contract, the provider will comply with the provisions of Chapter 427, FS, and Rule Chapter 41 -2, FAC. The provider
shall submit to the department the reports required pursuant to Volume 10, Chapter 27, HRS Accounting Procedures Manual.
M. Purchasing
1. PRIDE
It is agreed that any articles which are the subject of, or are required to carry out this contract shall be purchased from Prison Rehabilitative Industries and
Diversified Enterprises, Inc. (PRIDE) identified under Chapter 946, FS, in the same manner and under the procedures set forth in subsections 946.515(2) and
(4), FS. For purposes of this contract, the provider shall be deemed to be substituted for the department insofar as dealings with PRIDE. This clause is not
applicable to subcontractors unless otherwise required by law. An abbreviated list of products/services available from PRIDE may be obtained by
contacting PRIDE,
(904) 487 -3774.
2. Procurement of Materials with Recycled Content
It is expressly understood and agreed that any products or materials which are the subject of, or are required to carry out this contract, shall be procured in
accordance with the provisions of sections 403.7065, and 287.045, FS.
N. Civil Rights Requirements
Note: N.1. applies only to providers with fifteen (15) or more employees. N.2. applies only to providers providing direct services to clients and if fifteen (15) or
more individuals are employed.
1. The provider will not discriminate against any employee in the performance of this contract, or against any applicant for employment, because of age,
race, creed, color, disability, national origin, or sex. The provider further assures that all contractors, subcontractors, subgrantees, or others with whom it
arranges to provide services or benefits to participants or employees in connection with any of its programs and activities are not discriminating against those
participants or employees because of age, race, creed, color, disability, national origin, or sex.
2. Compliance Questionnaire
In accordance with HRSM 220 -2, the provider agrees to complete the Civil Rights Compliance Questionnaire, HRS Forms 946 A and B, if services are directly
provided to clients and if 15 or more individuals are employed.
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O. Independent Capacity of the Contractor
1. In performance of this contract, it is agreed between the parties that the provider is an independent contractor and that the provider is solely liable for the
performance of all tasks contemplated by this contract which are not the exclusive responsibility of the department.
2. Except where the provider is a state agency, the provider, its officers, agents, employees, subcontractors, or assignees, in performance of this contract,
shall act in the capacity of an independent contractor and not as an officer, employee, or agent of the State of Florida. Nor shall the provider represent to others
that it has the authority to bind the department unless specifically authorized to do so.
3. Except where the provider is a state agency, neither the provider, its officers, agents, employees, subcontractors, nor assignees are entitled to state
retirement or state leave benefits, or to any other compensation of state employment as a result of performing the duties and obligations of this contract.
4. The provider agrees to take such actions as may be necessary to ensure that each subcontractor of the provider will be deemed to be an independent
contractor and will not be considered or permitted to be an agent, servant, joint venturer, or partner of the State of Florida.
5. Unless justified by the provider and agreed to by the department in Attachment I, the department will not furnish services of support (e.g., office space,
office supplies, telephone service, secretarial, or clerical support) to the provider, or its subcontractor or assignee.
6. All deductions for social security, withholding taxes, income taxes, contributions to unemployment compensation funds, and all necessary insurance for
the provider, the provider's officers, employees, agents, subcontractors, or assignees shall be the responsibility of the provider.
P. Sponsorship
As required by section 286.25, FS, if the provider is a nongovernmental organization which sponsors a program financed wholly or in part by state funds,
including any funds obtained through this contract, it shall, in publicizing, advertising, or describing the sponsorship of the program, state: "Sponsored by
Monroe County In -Home Services and the State of Florida, Department of Children and Families." If the sponsorship reference is in written material, the
words "State of Florida, Department of Children and Families" shall appear in the same size letters or type as the name of the organization.
Q. Final invoice
To submit the final invoice for payment to the department no more than 45 days after the contract ends or is terminated. If the provider fails to do so, all right
to payment is forfeited and the department will not honor any requests submitted after the aforesaid time period. Any payment due under the terms of this
contract may be withheld until all reports due from the provider and necessary adjustments thereto have been approved by the department.
R. Use Of Funds For Lobbying Prohibited
To comply with the provisions of sections 11.062 and 216.347, FS, which prohibit the expenditure of contract funds for the purpose of lobbying the Legislature,
judicial branch, or a state agency.
S. Public Entity Crime
Pursuant to section 287.133, FS, the following restrictions are placed on the ability of persons convicted of public entity crimes to transact business with the
department: When a person or affiliate has been placed on the convicted vendor list following a conviction for a public entity crime, he /she may not submit a bid
on a contract to provide any goods or services to a public entity, may not submit a bid on a contract with a public entity for the construction or the repair of a
public building or public work, may not submit bids on leases of real property to a public entity, may not be awarded or perform work as a contractor, supplier,
subcontractor, or consultant under a contract with any public entity, and may not transact business with any public entity in excess of the threshold amount
provided in section 287.017, FS, for CATEGORY TWO for a period of 36 months from the date of being placed on the convicted vendor list.
T. Patents, Copyrights, and Royalties
1. If any discovery or invention arises or is developed in the course or as a result of work or services performed under this contract, or in anyway connected
herewith, the provider shall refer the discovery or invention to the department to be referred to the Department of State to determine whether patent protection
will be sought in the name of the State of Florida. Any and all patent rights accruing under or in connection with the performance of this contract are hereby
reserved to the State of Florida.
2. In the event that any books, manuals, films, or other copyrightable materials are produced, the provider shall notify the Department of State. Any and all
copyrights accruing under or in connection with the performance under this contract are hereby reserved to the State of Florida.
3. The provider, without exception, shall indemnify and save harmless the State of Florida and its employees from liability of any nature or kind, including
cost and expenses for or on account of any copyrighted, patented, or unpatented invention, process, or article manufactured by the provider. The provider has
no liability when such claim is solely and exclusively due to the Department of State's alteration of the article. The State of Florida will provide prompt written
notification of claim of copyright or patent infringement. Further, if such claim is made or is pending, the provider may, at its option and expense, procure for the
Department of State, the right to continue use of, replace, or modify the article to render it non - infringing. If the provider uses any design, device, or materials
covered by letters, patent, or copyright, it is mutually agreed and understood without exception that the bid prices shall include all royalties or costs arising from
the use of such design, device, or materials in any way involved in the work.
1I. THE DEPARTMENT AGREES:
A. Contract Amount
To pay for contracted services according to the conditions of Attachment I in an amount not to exceed $113,314.58_, subject to the availability of funds. The
State of Florida's performance and obligation to pay under this contract is contingent upon an annual appropriation by the Legislature. The costs of services
paid under any other contract or from any other source are not eligible for reimbursement under this contract.
B. Contract Payment
Pursuant to section 215.422, FS, the department has five (5) working days to inspect and approve goods and services, unless the bid specifications, purchase
order, or this contract specifies otherwise. With the exception of payments to health care providers for hospital, medical, or other health care services, if
payment is not available within 40 days, measured from the latter of the date the invoice is received or the goods or services are received, inspected, and
approved, a separate interest penalty set by the Comptroller pursuant to section 55.03, FS, will be due and payable in addition to the invoice amount. To obtain
the applicable interest rate, contact the district fiscal office/contract administrator. Payments to health care providers for hospital, medical, or other health care
services, shall be made not more than 35 days from the date eligibility for payment is determined, at the daily interest rate of .03333 %. Invoices returned to a
vendor due to preparation errors will result in a payment delay. Interest penalties less than one dollar will not be enforced unless the vendor requests payment.
Invoice payment requirements do not start until a properly completed invoice is provided to the department.
C. Vendor Ombudsman
A Vendor Ombudsman has been established within the Department of Banking and Finance. The duties of this individual include acting as an advocate for
vendors who may be experiencing problems in obtaining timely payment(s) from a state agency. The Vendor Ombudsman may be contacted at (904) 488 -2924
or 1- 800 - 848 -3792, the State of Florida Comptroller's Hotline.
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III. THE PROVIDER AND DEPARTMENT MUTUALLY AGREE:
A. Effective and Ending Dates
This contract shall begin on July 1, 1997 or on the date on which the contract has been signed by both parties, whichever is later. It shall end on June 30, 1998.
B. Termination
1. Termination at Will
This contract may be terminated by either party without cause upon no less than thirty (30) calendar days notice in writing to the other party unless a lesser time
is mutually agreed upon in writing by both parties. Said notice shall be delivered by certified mail, return receipt requested, or in person with proof of delivery.
2. Termination Because of Lack of Funds
In the event funds to finance this contract become unavailable, the department may terminate the contract upon no less than twenty -four (24) hours notice in
writing to the provider. Said notice shall be delivered by certified mail, return receipt requested, or in person with proof of delivery. The department shall be the
final authority as to the availability and adequacy of funds. In the event of termination of this contract, the provider will be compensated for any work
satisfactorily completed prior to notification of termination.
3. Termination for Breach
This contract may be terminated for the provider's non - performance upon no less than twenty -four (24) hours notice in writing to the provider. If applicable, the
department may employ the default provisions in Chapter 60A -1.006 (3), FAG. Waiver of breach of any provisions of this contract shall not be deemed to be a
waiver of any other breach and shall not be construed to be a modification of the terms of this contract. The provisions herein do not limit the department's right
to remedies at law or in equity.
4. Termination for Failure to Satisfactorily Perform Prior Agreement
Failure to have performed any contractual obligations with the department in a manner satisfactory to the department will be a sufficient cause for termination.
To be terminated as a provider under this provision, the provider must have: (1) previously failed to satisfactorily perform in a contract with the department, been
notified by the department of the unsatisfactory performance, and failed to correct the unsatisfactory performance to the satisfaction of the department; or (2)
had a contract terminated by the department for cause.
C. Renegotiation or Modification
Modifications of provisions of this contract shall only be valid when they have been reduced to writing and duly signed by both parties. The rate of payment and
the total dollar amount may be adjusted retroactively to reflect price level increases and changes in the rate of payment when these have been established
through the appropriations process and subsequently identified in the department's operating budget.
D. Official Payee and Representatives (Names, Addresses, and Telephone Numbers):
1. The provider name, as shown on page 1 of this contract, and 3. The name, address, and telephone number of the contract
mailing address of the official payee to whom the payment shall be made is: manager for the department for this contract is:
Monroe County In -Home Services Theresa Phelan
5100 College Road, Wing III 1111 12th Street, Key West, FL 33040
Key West, FL 33040 (305) 292 -6810
2. The name of the contact person and street address where financial 4. The name, address, and telephone number of the representative of
and administrative records are maintained is: the provider responsible for administration of the program under this contract
Gwen Rodriguez is:
Monroe County In -Home Services Gwen Rodriguez, Project Director
5100 Colege Road, Wing III 5100 College Road, Key West, FL 33040
Key West, FL 33040 305/292 -4588
5. Upon change of representatives (names, addresses, telephone numbers) by either party, notice shall be provided in writing to the other party and the
notification attached to the originals of this contract.
E. All Terms and Conditions Included
This contract and its attachments as referenced, Attachments I. II and Exhibits A. B. C. D and E, contain all the terms and conditions agreed upon by the
parties. There are no provisions, terms, conditions, or obligations other than those contained herein, and this contract shall supersede all previous
communications, representations, or agreements, either verbal or written between the parties. If any term or provision of the contract is found to be illegal or
unenforceable, the remainder of the contract shall remain in full force and effect and such term or provision shall be stricken.
I have read the above contract and understand each section and paragraph.
IN WITNESS THEREOF, the parties hereto have caused this 30 page contract to be executed by their undersigned officials as duly authorized.
PROVIDER: STATE OF FLORIDA , DEPARTMENT OF
Monroe Coun In -H e Se • ces / CHILDREN AND FAMILIES
SIGNED : Y: ° i SIGNED BYr
• it Lr„ veJ s NAME: Anita M. Bock
1. • • i
.16 ".l ,, ,o ` J=.
.( O r� TITLE: District Administrator
t � II
• DATE:
.;
•
•
1 �� , 111"''""" y �, • ��i," ' r 9 APPROVED AS TO FO M Provider Fiscal Year Ending Date: 9 /30
'� '. � l ' � • AN D SUFFICE
DEPUTY CLE .� /a.�iG / iAIL
di p IV N4 4,. T O CONTRACT NO. KC'7 Om Q =
DATE ��
07/01/97 Community Care for Disabled Adults
i< oiq
ATTACHMENT I
A. Services to be Provided.
1. Definition of Terms.
a. Contract Terms.
(1) State Fiscal Year - July 1st through June 30
(2) Invoice - A standardized form utilized by the provider to request
payment on monthly basis (Exhibit A).
(3) Provider - A organization or individual providing services or materials to
the department or an eligible client in accordance with the terms of this
contract.
(4) Contract Manager - An individual designated by the contract signer to
be responsible for the success of the contract in addition to his other
duties.
(5) Exhibit - An attachment to a Program Specific Attachment 1. The use of
the word "exhibit" avoids confusion and allows for clearer referencing.
(6) Fixed Price - Method of payment used when the service provided can
be broken down into unit cost (for example, hours, client days, etc.) or,a
fixed fee (for example, payment based on delivery of a complete service)..
(7) Advance Payment - Method of payment used by not - for - profit
corporations or government agencies to receive advances of a monthly
basis, for up to the first two months of the contract, not to exceed the
expected cash needs of the provider.
b. Program or Service Specific Terms.
See Instructional Guide, Section D, or those terms as specified in HRSM 140 -8,
both herein incorporated by reference.
2. General Description.
a. General Statement.
Service providers will insure that appropriate community -based services
(duration, frequency, scope per the client's care plan and the HRSM 140-
8) are provided to clients in the most beneficial fashion. As the client's
needs change, avoidance or reduction of unnecessary dependence and an
increase in the client's self - reliance will be achieved.
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b. Authority.
Chapter 410.601 -606, Florida statutes, Chapter 65C -2 Florida
Administrative Code and the annual appropriations act with any proviso or
instructions to the department constitute the legal base for services to be
delivered through the CCDA program.
c. Scope of Service
Services will be targeted toward adults aged 18 through 59 years who have
been diagnosed with a permanent physical or mental disability that restricts their
ability to perform normal activities of daily living as determined by the initial
functional assessment performed by the program's case management entities.
The allowable services to be contracted for an delivered to this population
are only those approved services as detailed in Section D, of the
Instructional Guide, and as specified in HRSM 140 -8, both herein
incorporated by reference.
d. Major Program Goal.
To maintain adults with disabilities in the least restrictive setting
functionally possible for them within the community, thus decreasing the
opportunity for their premature withdrawal from productive life and
increasing their opportunity for self - sufficiency, dignity, and inclusion in
society.
3. Clients to be Served.
a. General Description.
Adults with disabilities, 18 through 59 years of age, no longer eligible to
receive children's services, yet too young to qualify for community and
home based services to the elderly.
b. Client Eligibility
(1) Must be 18 through 59 years of age.
(2) Must have one or more permanent physical of mental limitations
which restrict the ability to perform normal activities of daily living
as determined through the initial functional assessment and medical
documentation of disability.
(3) Applicant 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. Client with
income above the ICP standard will be assessed clients for share of cost.
c. Client Determination
(1) Client must not be receiving comparable services from any other
entity so as to ensure non - duplication of effort.
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07/01/97 Community Care for Disabled Adults
(2) Documentation must exist that all comparable existing community
services and funding sources have been explored and exhausted.
(3) Highest priority for receipt of services will be extended to
applicants or persons referred who are victims of a report of abuse,
neglect, or exploitation.
(4) Determination of eligibility for this program will remain with the
department.
(5) The total cost, estimated or actual, for an individual receiving
Community care for Disabled Adults services, shall not exceed the
general revenue portion of a Medicaid nursing home bed within the
district area.
d. Contract Limits - None noted at this time.
B. Manner of Service Provision
1. Service Tasks
a Task List.
Approved Community Care for Disabled Adults services shall include
Adult Day Care, Case Management, Chore, Emergency Alert Response, Escort,
Group Activity Therapy, Home Delivered Meals, Home Health Aide,
Homemaker, Home Nursing, Interpreter, Medical Equipment or Supplies, Medical
Therapeutic services, Personal Care, Respite, Transportation, and Physical and
Mental Exams.
b. Task Limits.
(1) Respite care may be provided for up to 240 hours per consumer per
calendar year depending upon individual need. The service may be
extended up to 360 hours as recommended by the case manager with
documented approval by their immediate supervisor.
(2) Expenditures of more than $100 for medical equipment/supplies
are to be approved by the contract manager before purchases are made.
The amplitude of service delivery, by service, is detailed in the
Instructional Guide, Section D, or as specified in HRSM 140 -8, both
herein incorporated by reference.
2. Staffing Requirements
a. Staffing Levels. See Section D, of the Instructional Guide, or as specified in
HRSM 140 -8, both herein incorporated by reference.
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07/01/97 Community Care for Disabled Adults
b. Professional Qualification. See Section D, of the Instructional Guide, or as
specified in HRSM 140 -8, both herein incorporated by reference.
c. Staffing Changes. Major staffing changes that may affect program objectives, as
stipulated in the service contract, must be presented in writing to the contract
manager for approval prior to the implementation of the change.
d. Subcontractors. The contract does not allow for the hiring of subcontractors.
3. Service Location & Equipment
a. Service Delivery Location. See Section D, of the Instructional Guide, or as
specified in HRSM 140 -8, herein incorporated by reference.
b. Service Time. See Section D, of the Instructional Guide, or as specified in
HRSM 140 -8, both herein incorporated reference.
c. Changes in Location.
Location of service delivery must be negotiated in either the Application,
the Proposal for Bid, or the Attachment 1. Once the locale is agreed upon,
then, any proposed change must be presented, in writing, to the contract
manager for approval prior to implementation of that proposed change.
In the event of an emergency, temporary changes in location may necessitate
waiver by the district program office of this designated standard. Such a
waiver will assuredly take into consideration the continuity, safety and
quality of service to the department's clients, and is in the department's
sole discretion.
d. Equipment.
The equipment required to perform the contracted service(s) must be agreed upon
during the negotiation process, and must be stipulated in this Attachment 1. Any
change to that negotiated request, must be presented, in writing, to the contract
manager for approval prior to implementation of the proposed change. This is to
insure uniformity, safety and quality of service to the department's clients.
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4. Deliverables
a. Service Units.
A service unit is an appropriate, discrete amount of a given service. It may
include, but is no limited to: an hour or quarter hour of direct service
delivery; a meal; an episode of travel; a 24 hour period of Emergency
Alert Response maintenance, or an equipment purchase.
b. Reports.
Reporting will be as set forth in HRSM 140 -8, Community Care for
Disabled Adults. Section A, of the Instructional Guide provides
the forms to be submitted in accordance with policy.
c. Record and Documentation.
(1) It is expressly understood by the provider that any payment due the
provider under the terms of this contract may be withheld pending the
receipt and approval by the department of all financial and program
reports due from the provider as a part of this contract and any adjustments.
(2) A final report will be submitted to the department by the provider
within sixty (60) days after the contract ends or is terminated. This report
is to be completed on the form supplied by the department, identifying
total units of service and total payment received. In the event of an
overpayment resulting from revised units of service for the contract period
being reported, these funds must be returned to the Department with
the final report.
(3) Resolution of final questions regarding records will be the department's
responsibility. Provider must maintain documentation necessary to
facilitate monitoring and evaluation by the Department.
5. Performance Specification
a. Standards definitions.
90 % of individuals served will achieve care plan outcomes, which sustain
critical activities of daily living, through actual pattern of service delivery.
Providers of home and community-based services shall conduct individual
satisfaction surveys on 100% of those receiving CCDA services from them
and surveys will reflect a 90% satisfaction with services received.
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In Fiscal Year 1998 -99, standards will be incorporated into all Adult Services
contracts, establishing an acceptable quality of life expectation for all Adult
Services consumers. Successful completion of these standards will be determined
by the overall annual Adult Services Functional Assessment scores, beginning
Fiscal Year 1997 -98, each contracted case management provider will assess all
bubble scoring form on each client, and send the completed bubble forms to the
Program Office where they will be used to establish baseline for the new standard.
b. Outcomes and Outputs.
See 4. Deliverables, a. Service units.
c. Monitoring and Evaluation Methodology.
By execution of this contract the provider hereby acknowledges and agreesthat its
performance under the contract must meet the standards set forth above and will
be bound by the condition set forth below. If the provider fails to meet the
standards, the department, at its exclusive option, may allow up to six months for
the provider to achieve compliance with the standards. If the department affords
the provider an opportunity to achieve compliance, and the provider fails to
achieve compliance within the specified time frame, the department will terminate
the contract in the absence of any extenuating or mitigating circumstance. The
determination of the extenuating or mitigating circumstance is the exclusive
determination of the department.
d. Corrective Action Plan
If a Corrective Action Plan is required it should:
(1) Be prepared by the provider and submitted to DPOAA within 10
working days of receipt of request for Corrective Action Plan.
(2) Clearly identify the problem(s);
(3) Outline corrective action needed
d. Performance Definitions.
See Section D, of the Instructional Guide, or as specified in HRSM 140 -8, both
herein incorporated by reference.
6. Provider Responsibilities
a. Provider Unique Activities.
In addition to approved application, the provider will be required to:
(1) Maintain a current record on each individual in the program including:
current documentation of eligibility for services; identifying information
about the recipient and need to receive the service; service delivery date;
and other forms or record necessary for program operation and reporting
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as set forth in HRSM 140 -8, Community Care for Disabled Adults. This
must track to each invoice for payment.
(2) Maintain the facilities in which the services are provided (if the services
are not provided in the client's home) so that they conform with federal,
state, and or local fire, health and ADA standards.
(3) Maintain sufficient staff, facilities and equipment to deliver the
agreed -upon services or notify the department within thirty days
whenever the provider is unable or appears to be unable to provide
the required quality of quantity of service.
(4) Administer services only to those persons who meet program
eligibility criteria and only to the extent the funds are available,
(5) Case management providers will collect and report scores form
the Adult Services Functional Assessment Instrument on the Adult
Services bubble score form.
(6) Collect fees for services provided according to 65C- 2.007, F.A.C.
(7) Use volunteers to the fullest extent feasible in the provision of
service and program operations, and train, supervise and
appropriately support those volunteers with insurance coverage.
b. Coordination With Other Providers/Entities.
The provider must coordinate as necessary with the Department of Labor
and Employment securities, the Department of Education and the
Developmental Services Office of the Department of Children and
Families in serving those clients common to two or more service delivery
continuums.
7. Department Responsibilities
a. Department Obligations.
(1) The Department will supply all new providers with a copy of HRSM
140 -8, the Community Care for Disabled Adults program manual.
(2) The Department will provide technical assistance to all active CCDA
providers.
(3) The Department will monitor the provider at least annually. Monitoring
shall generally be conducted as set forth in Exhibit B. Exhibit B,
however, is for provider's reference only and does not constitute any
additional terms of the contract.
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b. Department Determinations.
(1) The department may, for reasonable cause, temporarily suspend the use of
funds by a provider pending corrective action, or pending a decision to
terminate the award.
(2) The department may prohibit the provider from receiving further
payments and may prohibit the provider from incurring additional
obligations of funds. The suspension may apply to only part, of the
all of the provider's operation
C. Method of Payment
The department shall make payment to the provider for a total dollar amount not to
exceed $113,314.58, 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 rates stated below:
Service # of Units Unit Rate Max. # Units Max. #
to be Clients
delivered to be Served
Case Management One Hour $40.1532.\ 880 50
Meals One Meal $ 3.3435 10,400 40
Homemaker One Hour $20.1935 1,600 30
Personal Care One Hour $40.3605 270 30
3. Rates listed in paragraph C. 2. above are the department's share of the gross cost per unit
of service. The department's share shall not exceed 90 % of the total costs.
4. Payment shall be on an advance basis in accordance with HRSM 140 -8,
Community Care for Disabled Adults, and the invoice, Exhibit A, shall be
submitted to the contract manager. Replication of the form via data processing
equipment is permissible; replication must include all data elements included on
the departmental form.
5. The provider may request a monthly advance for services to be provided for each of the
first three months of the contract period, based on anticipated cash needs. Invoices
submitted during the initial three months of the contract requesting advances are not
required to have supporting documentation attached. However, the comptroller reserves
the right to request that supporting documentation be submitted on particular invoices at
any time. All reimbursement requests for the fourth through the twelfth month shall be
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based on the submission of monthly actual units of service provided beginning with the
first month of the contract. Reconciliation and recoupment of advances made under this
contract are to be completed by the time final payment is made. The schedule for
submission of advance payment requests is found in Section B, of Instructional Guide.
6. Advanced funds may be temporarily invested by the provider in an insured interest
bearing account. Interest earned on advanced funds shall be returned to the department
on a monthly basis.
7. The provider shall submit to the contract manager an original of the invoice, Exhibit A,
for payment on a monthly basis. The due date for these invoices is the tenth day of the
month following the month being reported.
8. The department shall pay the provider the full monthly amount listed above if the
quarterly utilization rate is greater than or equal to 90 percent. The utilization rate
shall be reviewed quarterly. If the utilization rate for the quarter is less than 90
percent, then the department will pay an adjusted amount for the third month of the
quarter as outlined on the invoice which are part of this contract. In preparing the
invoice, the provider shall include any applicable adjustments.
9. If the amount of an adjustment exceeds the fixed monthly payment amount, the provider
shall refund to the department the difference between the adjustment and the fixed
monthly payment, or at the department's option subsequent monthly payments may be
reduced until the full adjustment has been made.
10. An adjustment to the payment for the third month of the quarter or a refund may not be
required if the provider can demonstrate that the under utilization of the program was
beyond the control of the provider.
Issues to be considered as beyond the control of the provider may include, but are not
limited to :
The department's failure to refer a sufficient number of families who meet the
admission criteria.
If the above situation occurs, the provider and the department agree to renegotiate the
contract within thirty (30) days of occurrence.
11. Receipts are required for all expenses incurred, (e.g., office supplies, printing, long
distance telephone calls, etc.), and must be maintained on file by the provider for audit
and monitoring purposes
12. Travel
a. An HRS travel voucher (State of Florida Voucher for Reimbursement of
Traveling Expenses - Form C -676), Exhibit C must be completed and
maintained on file by the provider. Original receipts for expenses incurred
during officially authorized travel; items such as car rental and air
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transportation, parking and lodging, tolls and fares; must be maintained on file
by the provider. Section 287.058 (1) (b), F.S., requires that bills for any travel
expense shall be maintained in accordance with Section 112.061, F.S., governing
payments by the state for traveling expenses. HRSR 40 -1 (Official Travel of
HRS Employees and Non - Employees) provides further explanation,
clarification, and instruction regarding the reimbursement of traveling expenses
necessarily incurred during the performance of official state business.
b. Prior approval is required in accordance with Section 112.061, F.S., for
conference travel and must be certified on Form C -676C, Exhibit C (State of
Florida Authorization to Incur Travel Expense) with a copy of the program or
agenda of the conference attached. Reimbursement is in accordance with "a."
above. See HRSR 40 -1 for further explanation, clarification and instruction.
c. The provider must retain on file documentation of all travel expenses to include
the following data elements: name of the traveler, dates of the travel, travel
destination, purpose of travel, hours of departure and return, per diem or meals
allowance, map mileage, incidental expenses, signature of payee and payee's
supervisor.
13. Budget.
a. The budget submitted by the provider and approved by the department during the
negotiation of the contract shall be maintained in the contract file of the provider
and the department for audit and monitoring purposes. A budget summary is
included in this contract as Exhibit D.
b. The provider shall be authorized to transfer expenditures no more than 10
percent of the original budget amount of each cost category affected by the
transfer of expenditures without prior written approval of the contract manager.
A letter of notification is to be sent to the contract manager explaining the
necessity of the change and documenting the amount of expenditures involved
and the cost categories affected by the change.
c. Budget revision in excess of 10 percent per cost category of the original
budget amount shall require the provider to receive prior written department
approval. A complete revised budget summary and detailed budget narrative must
be submitted to the contract manager with a letter explaining the need for the
change.
14. It is expressly understood by the provider that any payment due the provider under
the terms of this contract may be withheld pending the receipt and approval by the
department of all financial and program reports due from the provider as a part of this
contract and any adjustments thereto.
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D. Special Provisions
1. The provider agrees that any donations received will be used to enhance or expand
program activities.
2. Work And Gain Economic Self - Sufficiency (WAGES): The Department of
Children and Families and the Department of Labor and Employment Security
have jointly implemented WAGES, an initiative to empower recipients in the
Temporary Assistance to Needy Families Program to enter and remain in gainful
employment. Employment of WAGES 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 agree to notify the department of all entry level
employment opportunities associated with this contract which require a high
school education or less. The department will contact the WAGES Coordinator in
the Department of Labor and Employment Security regional office and request
that WAGES participants be referred to the provider. In the event that the
provider or its agent employs a person who was referred by the WAGES office,
the provider will notify the department.
3. In accordance with HRS Regulation 0- 221 -1, Civil Rights, Accessibility of
Meetings to Handicapped Persons, any meeting, conference, workshop, hearing,
training session, seminar or other similar functions sponsored by this department,
either as sole sponsor or in conjunction with other agencies, whether such
functions are open to the public, designed for department staff, or limited by
invitation, must be scheduled in an accessible facility. This includes any training
done through contracts.
4. Non - Expendable Property
a. Non - expendable property is defined as tangible personal property of a
non - consumable nature that has an acquisition cost of $500 or more per
unit, and an expected useful life of at least one year; and hardback bound
books that are not circulated to students or the general public, the value of
cost of which is $100 or more. Hardback books with a value or cost of
$25 or more should be classified as an OCO expenditure only if they are
circulated to students or to the general public.
b. All such property, purchased under this contract, shall be listed on the
property records of the provider. Said listing shall include a description of
the property, model number, manufactures serial number, date of
acquisition, unit cost, property inventory number, and information on the
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location, use condition, transfer, replacement, or disposition of the
property.
c. All such property, purchased under this contract, shall be inventoried
annually, and an inventory report shall be submitted to the department
along with the final expenditure report. A report of non - expendable
property shall be submitted to the department along with the expenditure
report for the period for which it was purchased.
d. Title (ownership) to all non - expendable property acquired with funds from
this contract shall be vested with the department upon completion or
termination of the contract.
e. At no time shall the provider dispose of non - expendable property
purchased under this contract except with the permission of, and in
accordance with instructions from the department.
f. Prior approval is required for the purchase of any item of non - expendable
property not specifically listed in the approved contract budget.
5. The department may renegotiate the contract with the provider if service
utilization falls below Q percent.
6. Information Technology Resources. All contract providers must adhere to the
department's procedures and standards when purchasing Information Technology
Resources (ITR) as part of this contract if these resources will revert to the
department at the conclusion of the contract. ITR are data processing hardware,
services, supplies, maintenance, training, personnel and facilities. The provider
agrees to secure prior written approval through the contract manager from the
district Management Systems director for the purchase of any ITR. The provider
will not be reimbursed for any purchases made prior to this written approval.
7. Venue for any court action pertaining to this contract shall be Monroe County.
8. This contract does not require the provider to collocate their staff within or next to
existing Department of Children and Families offices from which referrals
originate.
11. The provider will make available to Children and Families District XI zip code
data on where their service recipients reside as well as certain other client
identifying information as requested. This information will be used to facilitate
department impact zone planning.
12. Provider proposal is hereby incorporated by reference for programmatic assurance
of service provision. This proposal will be part of the contract manager's file.
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13. Funds provided by the Department under this contract shall not be used by Not
For Profit Corporations to make loans to their employees, officers, directors
and/or subcontractors. Violation of this provision shall be considered a breach of
contract, the termination of this contract shall be in accordance with the Standard
Contract, Section III, Paragraph B, subsection 3. A loan is defined as any
advancement of money for which the repayment period extends beyond the next
scheduled pay period.
14. As referenced in Administrative Rule 44- 080(1)(a)(b), Employee Requirements,
and Chapter 815, Florida Statutes, "Florida Computer Crimes Act ", all employees
and contract employees with access to data through computer related media must
read and sign the security agreement form (CF 114) as identified in Exhibit E.
Fulfillment of security responsibilities shall be mandatory and violations may be
cause for civil penalties, or criminal penalties under chapters 119. 812. 815. 817.
839. or 877. Florida Statutes, or similar law.
The provider will ensure that Exhibit E will be signed by all required personnel
and a copy retained in their file. A signed original must be sent to the contract
manager which will be retained in he contract file. A copy of CF OPERATING
PROCEDURE NO. 50 -6 is available upon request.
15. State Laws and Regulation
a. The provider will comply with applicable provisions of Chapter 410.601-
606, Florida Statutes.
b. The provider will comply with the applicable provisions of Chapter 65C -2,
Florida Administrative Code.
c. The provider will comply with the applicable provisions of HRSM 140 -8,
CCDA Program Manual and any other applicable guidelines of criteria
established by the department.
16. Client Information
a. The provider of case management services agrees to submit to the
department management program data including client identifiable date 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 provided, the number of units
provided and the dates of service provision. This must track to each
invoice for payment. Requests for payment which can not be supported
with supporting documentation will be returned to the provider upon
inspection by the department.
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17. Service Reports
The provider agrees to submit to the contract manager a monthly summary report
and six, nine and twelve month cumulative summary reports as described in
Chapter 5, HRSM 140 -8 and the attached Jnstructional Guide, herein incorporated
by reference.
18. Suspension
a. The department may, for reasonable cause, temporarily suspend the use of
funds by a provider pending corrective 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 incurring a additional obligations of
funds. The suspension may apply to only part, or all the provider's
operation.
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 provider with the appropriate time period to request an
administrative hearing before the effective date of suspension (unless
provider's actions warrant on immediate suspension).
19. Grievance and Fair Hearings Procedures
The provider will utilize the department's fair hearing system outlined in HRSM
195 -1, Chapter 4 by which each served by the provider under this contract may
present a request for a fair hearing.
20. Fees
No fees shall be imposed other that those set by the department. Fees collected in
compliance with department directives will be disposed of in a manner prescribed
by the department.
21. Human Right Advocacy Committee
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
402.1655(8)(a)(b), F.S. Members of the committee shall be free to examine all
records pertaining to any case unless legal prohibitions exist to prevent disclosure
of those records.
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22. All references to "Department of Children and Families ", "Department of Health
and Rehabilitative Services" and "HRS ", here and throughout the contract, shall
be construed as the Department of Children and Family Services.
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EXHIBIT A
FIXED PRICE INVOICE
I N V O I C E
for month of , 199
DATE
PROVIDER'S NAME
CONTRACT #
PROVIDER'S ADDRESS
PERIOD OF SERVICE PROVISION
Phase or Service Amount per Phase or Unit Amount Due'
Units of Service for which funds are requested
Total Due $
Signature of Provider
Approval Signature of Contract Manager Date Approved
Exhibit
PAO
EXHIBIT A
REQUEST FOR PAYMENT AND REFUND NOTICE
COMMUNITY CARE FOR DISABLED ADULTS
FIXED PRICE CONTRACTS -
for month of , 199
Method of Payment: Reimbursement Advance
Payment
Contract #:
Provider Name:
Provider Address:
Budget Summary
1. Approved Contract Amount
2. Previous Amount Requested
3. Contract Balance
Request for Payment
Phase or Service Amount per Phase or Unit Total
Total Amount Requested
Contract Fund Summary
1. Amount received to date
2. Total Expenditures to date
3. Advance Balance (Including .this bill)
•
Signature of Provider Date
Approved Signature of Contract Manager Date"
Exhibit A
2/
Exhibit B
Program Monitoring
A. Frequency of Monitoring
1) 30 -90 Day Visit. This visit is required for a new CCDA service provider as well as a
new project director of a CCDA project. The visit should be made 30 -90 days after the
employment of a new project director, regardless of contract amount.
2). Semi - Annual Visit. The first semi - annual visit should be made between the second
and sixth month of the CCDA funding period. The second semi - annual, or prefunding
visit, should be made between the ninth and eleventh months of the funding period.
3) Special Visit. These announced or unannounced visits can be made at any time during
the funding period. It should be used to follow -up on any problem found while
conducting a regular semi - annual visit, especially if the problem required immediate
follow -up and/or a formal corrective action plan.
B. Guidelines for Monitoring CCDA Providers.
In Preparation of the monitoring visit, the monitor should review any follow -up
corrective action reports, the service provider application, advisory council or board
meeting minutes, any correspondence identifying technical assistance needs, status of
required reports, and fiscal status of the project if not covered during fiscal monitoring.
C. Monitoring Report Format/Timeframes.
All monitoring reports should be written and forwarded to the president of the provider's
board/corporation (or Project director's supervisor) with a copy to the project director
within 20 working days after the visit. A copy of the report should be sent to PDAA
within 20 working days after the visit. The following format should be observed.
1). Project name and address, funding period and funding source;
2) Purpose of visit (Initial of refunding), and date:
3) Names and titles of participants;
4). Narrative description of the visit to include matters to be followed up
at the time of the next visit.
5) Instructions for a corrective action plan, if necessary;
6). Narrative description of the exit interview;
7). Monitor's name, signature, and date of report.
ZZ
D. Topics for Discussion During the Visit.
1). Conditions of Contract: review contracts for special conditions and track progress in
meeting deadlines.
2). Follow -up of problems identified in last report.
3). Special concerns of the project director and DPOAA.
4) Year -to -date Objective (s). Achievements and Comments. Compare output reports
with state objectives; discuss provider's method for capturing statistical date (units of
service and unduplicated counts); discuss quality of service provided; measure objective
achievements in terms of percentage of funding period completed and allow 5%
over /under achievement; determine reasons for over /under achievement and corrective
action; determine object impact on budget (creation of surplus or deficit situation);
determine need for objective or budget revision. The administration monitoring checklist
and Chapter 6 of HRSM 55 -5 can be used as references.
5). Fire. Health. and Safety Standards. Review appropriate reports from proper
authorities for dates and deficiencies noted; examine fire extinguisher tags; and discuss
handicapped accessibility for fire or other emergencies.
6) Training. Compare training schedule and log of staff /volunteers (accomplished to
date) with scheduled training in grant application; assess resources provider as used to
provide identified training needs; attend training sessions provided by project; and
interview personnel and volunteers about training needs.
7). Coordination of Services. Discuss project coordination services with other service
agencies; review grant application for coordination indicators; and review programmatic
reports to determine coordination through meetings, staffing, and written agreements.
8). Technical Assistance. (TA) Review any provider requests for TA and TA provided;
discus any current need for TA.
9) Status of Client Information Forms. Review Client Information Forms and Daily
Service Logs (if appropriate) for accuracy; discuss error rate and method for
improvement; and compare manual client unduplicated count with CIS count.
10) Compliance with the Civil Rights Act and Affirmative Action. Review recruitment
documents and advertisements; discuss methods used to comply with Title VII of the
Civil Rights Act of 1964; and interview staff for staff compliance indicators. Determine
if the service provider has written affirmative action policy and review new staff hired to
assure compliance; determine if the service provider's policy meets the intention of the
law; interview minority staff members; and discuss progress made in implementing the
affirmative action plan.
11). Compliance with Section 504 of the Rehabilitation Act of 1973. Handicapped
Accessibility and with the Americans with Disabilities Act. Check the physical facility to
ensure that handicapped persons can enter and use the buildings, review assurances in
grant application; discuss methods to correct any areas which are used by clients and staff
which are non - accessible, and discuss project's policy for hiring of handicapped.
12). Evaluation of Reporting Procedures. Review reports on file prior to monitoring
visit; discuss timeliness, accuracy, and completeness of reports submitted by providers;
and discuss any corrections needed by provider and method to be used for corrections.
13) Confidentiality. Discuss methods to ensure confidentiality; check applicable files
and drawers for security; and discuss ways clients are made aware of confidentiality
rights according to 45 CFR 431.306.
14). Local Match. (Cash and In- Kind), Review fiscal reports and receipts to ascertain
accuracy of local match, compare percentage to date to confirm sufficiency to match state
funds received; review compliance with contract; identify any problem areas and discuss
methods to solve; check accuracy of donor forms and appropriate signatures; and review
match to be generated from a source later in the funding period (if appropriate).
15). In -Kind Voucher System. Determine if project has used approved in -kind match
sources; track backup documents /vouchers for compliance with approved procedures,
grant application, and budget; and track allowance to budget for accuracy.
16). Contributions. Check accuracy of contribution recording, logging, depositing, and
staff involved in this process; discuss confidentiality of contribution system; assure that
clients are aware of their right to contribute or not to contribute (posters, envelope,
etc.);and assure that all employees authorized to handle money are bonded.
17). Participants Interviews. Discuss, with a variety of participants the quality of service
(s); determine what services are actually received as compared to client file information
(if appropriate); if survey forms are used for client feedback, check the percentage of
clients who complete them without help from project staff and check percentage of forms
returned by mail against number sent out; and visit clients in their homes, if appropriate,
to ascertain above. A home - delivered meals route should be ridden at least annually to
check temperatures of home delivered meals, validate participant eligibility, obtain
participant input, etc.
18). Advisory Council. When applicable, review minutes of advisory council meetings;
attend advisory council meetings to discuss their evaluation of services; examine methods
by which client feedback is obtained; discuss with council members their roles and
responsibilities, and compare to responsibilities outlines in the approved application.
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27
EXHIBIT E
FLORIDA DEPARTMENT OF
CHILDREN
& FAMILIES
•
SECURITY AGREEMENT FORM
The Department of Children and Families has authorized you:
Employee's Name /Organization
to have access to sensitive data through the use of computer- related media (e.g., printed
reports, microfiche, system inquiry, on -line update, or any magnetic media).
Computer crimes are a violation of the department's disciplinary standards and, in
addition to departmental discipline, the commission of computer crimes may result in
felony criminal charges. The Florida Computer Crimes Act, Chapter 815, Florida
Statutes, addresses the unauthorized modification, destruction, disclosure, or taking of
information resources.
• I have read the above statements and have been provided a copy of fhe Computer
Related Crimes Act, Chapter 815, F.S.
• By my signature, I acknowledge that I have received, read and understand Chapter
815, F.S., and have received any necessary clarification from my supervisor.
1 understand that a security violation may result in criminal prosecution according to the
provisions of Chapter 815, F.S., and may also result in disciplinary action against me
according to the provisions in the Employee IHandbook.
•
The minimum security requirements are:
• Personal passwords are not to be disclosed.
• Information is not to be obtained for my own or another person's personal use.
Print Employee Name Signature of Employee Date
Print Supervisor Name Signature of Supervisor Date
CF 114. Dec 96 (Replaces Oct 96 edition which may be used) Distribution of Copies: White - Personnel File /Contract File
(Stock Number 5740- 000 - 0114 -6) Yellow - Security File
Pink - Employee Copy
2 .
ATTACHMENT 11
FINANCIAL AND COMPLIANCE AUDIT
This attachment is applicable, if the rovider or grantee, hereinafter referred to as provider, is
any local government entity, nonprofit organization, or for - profit organization. An audit
performed by the Auditor General shall satisfy the requirements of this attachment.
PART I: FEDERALLY FUNDED
This part is applicable if the provider is a local government entity or nonprofit organization
and expends a total of $300,000 or more in federal funds passed through the department
during its fiscal year. The determination of when a provider has "expended" federal funds is
based when the activity related to the award occurs.
Local governments shall corn& with the audit requirements contained in Office of
Management and Budget (OMB) Circular A -128, Audits of State and Local Governments.
Nonprofit providers shall comply with OMB Circular A -133, Audits of Institutions of Higher
Learning and Other Nonprofit Institutions, except as modified herein. Such audits shall cover
the entire organization for the organization's fiscal year. The reporting package shall include
a schedule that discloses the amount of expenditures and /or receipts by contract number for
each contract with the department m effect during the audit period.
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. The
financial statements shall disclose whether or not the matching requirement was met for each
applicable contract. All questioned costs and liabilities due to the department shall be fully
disclosed in the audit report with reference to the department contract involved.
If the provider has received any funds from a grants and aids appropriation, the provider shall
have an audit or submit an attestation statement, in accordance with Section 216.349, Florida
Statutes, and indicate on the schedule of financial assistance which contracts are funded from
state grants and aids appropriations. The provider has "received" funds when it has obtained
the cash from the department or when it has incurred reimbursable expenses.
The provider agrees to submit the required reports as shown in Part IV.
PART II: STATE FUNDED
This part is applicable if the provider is a nonprofit organization that expends a total of
$100,000 or more in funds from the department during its fiscal ear, which was not paid
from a rate contract based on a set state or area -wide fixed rate tor service and of which less
than $300,000 is federally funded. The determination of when a provider has "expended"
funds is based on when the activity related to the award occurs.
The provider agrees to have an annual financial audit performed by independent auditors in
accordance with the current Government Auditing Standards issued by the Comptroller
General of the United States. Such audits shall cover the entire organization for the
organization's fiscal year. The scope of the audit performed shall cover the financial
statements and include reports on internal control and compliance. The reporting package
shall include a schedule that discloses the amount of expenditures and /or receipts by contract
number for each contract with the department in effect during the audit period.
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. The
financial statements shall disclose whether or not the matching requirement was met for each
applicable contract. All questioned costs and liabilities due to the department shall be fully
disclosed in the audit report with reference to the department contract involved.
If the provider has received any funds from a grants and aids appropriation, the provider shall
have an audit or submit an attestation statement, in accordance with Section 216.349, Florida
Statutes, and indicate on the schedule of financial assistance which contracts are funded from
state grants and aids appropriations. The provider has "received" funds when it has obtained
the cash from the department or when it has incurred reimbursable expenses.
Page 1 of 2
06/01/97
Zy.
The provider agrees to submit the required reports as shown in Part IV.
PART III: SECTION 216.349 FLORIDA STATUTES (GRANTS AND AIDS
APPROPRIATIONS)
This part is applicable if the provider is either (1) a for - profit organization, (2) a local
government entity expending less than $300,000 in federal funds passed through from the
department during its fiscal year, (3) a nonprofit organization expending less than $100000 in
funds from the department during its fiscal year, or (4) a nonprofit organization expending a
total of $100,000 or more in funds from the department paid from a rate contract based on a
set state or area -wide fixed rate for service of which less than $300,000 is federally funded.
The determination of when a provider has 'expended" funds is based on when the activity
related to the award occurs.
If the provider receives funds from a grants and aids appropriation, the provider shall have an
audit, or submit an attestation statement, in accordance with Section 216.349, Florida Statutes.
The audit report shall include a schedule of financial assistance which discloses each state
contract by number and indicates which contracts are funded from state grants and aids
appropriations. The provider has "received" funds when it has obtained cash from the
department or when it has incurred reimbursable expenses.
The provider agrees to submit the required reports as shown in Part IV.
Otherwise, if the provider does not receive funds from a grants and aids appropriation, the
provider has no audit or attestation requirement under this attachment.
PART IV: SUBMISSION OF REPORTS
Copies of the audit report and any management letter by the independent auditors, or
attestation statement, required by this attachment shall be submitted within 180 days after the
end of the provider's fiscal year to the following, unless otherwise required by Florida
Statutes:
A. Office of Internal Audit (OSIA)
1317 Winewood Boulevard
Building 1, Room 301G
Tallahassee, Florida 32399 -0700
B. Contract manager for this contract.
C. Submit to this address only those reports prepared in
accordance with OMB Circular A -r33:
Federal Audit Clearinghouse
Bureau of the Census
1201 E. 10th Street
Jeffersonville, Indiana 47132
D. Submit to this address only those audits performed,
or attestation statements prepared in
accordance with Section 216.349, Florida Statutes:
Jim Dwyer
Office of the Auditor General
P.O. 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 period of five years from the date the audit report is issued,
unless extended in writing by the department.
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06/01/97