06/17/1994 Agreement 7/1/94 Contract No. K619.1-
STATE OF FLORIDA
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 II and
A.To provide services according to the conditions specified to ensure that all related party transactions are
disclosed to the auditor. Additional mdit re irements
are specified in Attachment I,
in Attachment(s) di
I p � �
: S cial ovisions,
B.Federal Laws and Regulations Section D
1. If this contract contains federal funds, the provider rnn -- ri
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 othe ( applicable keeping requirements in all approvedubcoritracts and
regulations as specified in Attachment N / A _ assignments.
2. If this contract contains federal funds and is over 6. If this contract contains federal funds, tl CFDA
$100,000, the provider shall comply with all applicable number(s) is N /A
standards, orders, or regulations issued under Section
306 of the Clean Air Act, as amended (42 U.S.C. 7. This contract 1 s funded from a grants and aids
1857(h) et seq.), Section 508 of the Clean Water Act, appropriation.
as amended (33 U.S.C. 1368 et seq.), Executive Order
11738, and Environmental Protection Agency D. Retention of Records
regulations (40 CFR Part 15). The provider shall report 1. To retain all client records, financial records,
any violations of the above to the department. supporting documents, statistical records, and any
other documents (including electronic storage media)
3. If this contract contains federal funding in excess of pertinent to this contract for a period of five (5) years
$100,000, the provider must, prior to contract after termination of this contract, or if an audit has
execution, complete the Certification Regarding been initiated and audit findings have not been
Lobbying form, Attachment N /A . If a Disclosure resolved at the end of five (5) years, the records shall
of Lobbying Activities form, Standard Form LLL, is be retained until resolution of the audit findings.
required, it may be obtained from the contract
manager. All disclosure forms as required by the 2. Persons duly authorized by the department and federal
Certification Regarding Lobbying form must be auditors, pursuant to 45 CFR, Part 92.36(i)(10), shall
completed and returned to the contract manager. have full access to and the right to examine any of said
C.Audits and Records records and documents during said retention period or
1. To maintain books, records, and documents (including as long as records are retained, whichever is later.
electronic storage media) in accordance with generally
accepted accounting procedures and practices which 3. Upon completion or termination of the contract and at
sufficiently and properly reflect all revenues and the request of the department, the provider will
expenditures of funds provided by the department cooperate with the department to facilitate the
under this contract. duplication and transfer of any said records or
documents during the required retention period as
2. To assure that these records shall be subject at all specified in paragraph D.1. above.
reasonable times to inspection, review, or audit by
state personnel and other personnel duly authorized E. Monitoring
by the department, as well as by federal personnel. 1. To provide reports as specified in Attachment
. These reports will be used for monitoring
3. To maintain and file with the department such progress or performance of the contractual services as
progress, fiscal and inventory reports as specified in specified in Attachment I
Attachment I , and other reports as the
department may require within the period of this 2. To permit persons duly authorized by the department
contract. Such reporting requirements must be to inspect any records, papers, documents, facilities,
reasonable given the scope and purpose of this goods and services of the provider which are relevant
contract. to this contract, and /or interview any clients and
employees of the provider to be assured of satisfactory
performance of the terms and conditions of this
i
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contract. Following such inspection the department that it is an independent contractor and not an agent or
will deliver to the provider a list of its comments with employee of the department.
regard to the manner in which said goods or services
are being provided. The provider will rectify all noted G.Insurance
deficiencies provided by the department within the 1. To provide adequate liability insurance coverage on a
specified period of time set forth in the comments or comprehensive basis and to hold such liability
provide the department with a reasonable and insurance at all times during the existence of this
acceptable justification for not correcting the noted contract. The provider accepts full responsibility for
shortcomings. The provider's failure to correct or identifying and determining the type(s) and extent of
justify within a reasonable time as specified by the liability insurance necessary to provide reasonable
department may result in the withholding of payments, financial protections for the provider and the clients to
being deemed in breach or default, or termination of be served under this contract. Upon the execution of
this contract. this contract, the provider shall furnish the department
written verification supporting both the determination
F. Indemnification and existence of such insurance coverage. Such
If the provider is a state agency or subdivision as defined coverage may be provided by a self- insurance
in section 768.28, Florida Statutes, only No. 2 below is program established and operating under the laws of
applicable. Other than state agencies or subdivisions the State of Florida. The department reserves the right
refer only to No. 1. to require additional insurance as specified in
Attachment I where appropriate.
1. The provider agrees to be liable for all claims, suits, .
judgments, or damages, including court costs and 2. If the provider is a state agency or subdivision as
attorney's fees, arising out of the negligent or defined by section 768.28, Florida Statutes, the
intentional acts or omissions of the provider, and its provider shall furnish the department, upon request,
agents, subcontractors, and employees, in the course written verification of liability protection in accordance
of the operation of this contract. Further, the provider with section 768.28, Florida Statutes. Nothing herein
agrees to indemnify the department against all claims, shall be construed to extend any party's liability
suits, judgments, or damages, including court costs beyond that provided in section 768.28, Florida
and attorney's fees, arising out of the negligent or Statutes.
intentional acts or omissions of the provider, and its
agents, subcontractors, and employees, in the course H.Safeguarding Information
of the operation of this contract. Also, the provider Not to use or disclose any information concerning a
agrees to defend the department, upon receiving recipient of services under this contract for any purpose
timely written notification from the department, against not in conformity with the state regulations and federal
all claims, suits, judgments, or damages, including regulations (45 CFR, Part 205.50), except upon written
costs and attorney's fees, arising out of the negligent consent of the recipient, or his responsible parent or
or intentional acts or omissions of the provider and its guardian when authorized by law.
agents, subcontractors, and employees, in the course
of the operation of this contract. Where the provider I. Client Information
and the department commit joint negligent acts, the To submit management, program, and client identifiable
provider shall not be liable for nor have any obligation data as specified by the department in Attachment
to defend the department with respect to that part of .
the joint negligent act committed by the department.
In no event shall the provider be liable for or have any J. Assignments and Subcontracts
obligation to defend the department against such 1. To neither assign the responsibility of this contract to
claims, suits, judgments, or damages, including costs another party nor subcontract for any of the work
and attorney's fees, arising out of the sole negligent contemplated under this contract without prior written
acts of the department. The provider agrees that it is approval of the department. No such approval by the
an independent contractor and not an agent or department of any assignment or subcontract shall be
employee of the department. deemed in any event or in any manner to provide for
the incurrence of any obligation of the department in
2. Any provider who is a state agency or subdivision, as addition to the total dollar amount agreed upon in this
defined in section 768.28, Florida Statutes, agrees to contract. All such assignments or subcontracts shall
be fully responsible for its negligent acts or omissions be subject to the conditions of this contract (except
or tortious acts which result in claims or suits against Section I, Paragraph 0.1.) and to any conditions of
the department, and agrees to be liable for any approval that the department shall deem necessary.
damages proximately caused by said acts or
omissions. Nothing herein is intended to serve as a 2. Unless otherwise stated in the contract between the
waiver of sovereign immunity by any provider to which provider and subcontractor, payments made by the
sovereign immunity applies. Nothing herein shall be provider to the subcontractor must be within seven (7)
construed as consent by a state agency or subdivision working days after receipt of full or partial payments
of the State of Florida to be sued by third parties in any from the department in accordance with section
matter arising out of any contract. The provider agrees 287.0585, Florida Statutes. Failure to pay within seven
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(7) working days will result in a penalty charged Administrative Code. The provider submit to the
against the provider and paid to the subcontractor in department the reports required pursuant to Volume 10,
the amount of one -half of one (1) percent of the Chapter 27, HRS Accounting Procedures Manual.
amount due, per day from the expiration of the period
allowed herein for payment. Such penalty shall be in O.Purchasing
addition to actual payments owed and shall not exceed 1. PRIDE
fifteen (15) percent of the outstanding balance due. It is expressly understood and agreed that any articles
which are the subject of, or are required to carry out
K. Financial Reports this contract shall be purchased from Prison
To provide financial reports to the department as Rehabilitative Industries and Diversified Enterprises,
specified in Attachment I Inc. (PRIDE) identified under Chapter 946, Florida
Statutes, in the same manner and under the
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 sections 403.7065, and 287.045, 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 it 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
2. Abuse, Neglect and Exploitation Reporting U.S.C. 6101 et seq., which prohibits discrimination
In compliance with Chapter 415, Florida Statutes, an on the basis of age.
employee of the 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 Act of 1981, as amended, 42 U.S.C. 9849, which
exploited, shall immediately report such knowledge or prohibits discrimination on the basis of race, creed,
suspicion to the central abuse registry and tracking color, national origin, sex, handicap, political
system of the department on the single statewide toll- affiliation or beliefs.
free telephone number (1- 800- 96ABUSE).
f. The Americans with Disabilities Act of 1990, P.L 101 -
N.Transportation Disadvantaged 336, which prohibits discrimination on the basis of
If clients are to be transported under this contract, the disability and requires reasonable accommodation
provider will comply with the provisions of Chapter 427, for persons with disabilities.
Florida Statutes, and Rule Chapter 41 -2, Florida
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g. All regulations, guidelines, and standards as are now 3. Unless justified by the provider and agreed to by the
or may be lawfully adopted under the above department in Attachment I, Section D the
statutes. department will not furnish services of support (e.g.,
office space, office supplies, telephone service,
The provider agrees that compliance with this secretarial, or clerical support) normally available to
assurance constitutes a condition of continued career service employees.
receipt of or benefit from funds provided through
this contract, and that it is binding upon the S. Sponsorship
provider, its successors, transferees, and assignees As required by section 286.25, Florida Statutes, if the
for the period during which services are provided. provider is a nongovernmental organization which
The provider further assures that all contractors, sponsors a program financed wholly or in part by state
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 N /A
against those participants or employees in violation
of the above statutes, regulations, guidelines, and
standards. PROVIDER
and the State of Florida, Department of Health and
2. Compliance Questionnaire Rehabilitative Services ". If the sponsorship reference is in
In accordance with HRSM 220 -2, the provider agrees written material, the words "State of Florida, Department
to complete the Civil Rights Compliance Questionnaire, of Health and Rehabilitative Services" shall appear in the
HRS Forms 946 A and B, if services are provided to same size letters or type as the name of the organization.
clients and if 15 or more people are employed.
Q.Requirements of Section 287.058, Florida Statutes T. Discounted Invoices
Q.R
eq To allow a N/A percent discount on selected
1. To submit bills for fees or other compensation for invoices which are paid in less than N /A days. The
services or expenses in sufficient detail for a proper provider must clearly mark any invoice with the discount
pre -audit and post -audit thereof. if it is to be allowed. The provider may submit invoices
with or without the negotiated discount terms. The
2. Where applicable, to submit bills for any travel department shall comply with subsection 215.422(4),
expenses in accordance with section 112.061, Florida Florida Statutes, if a discounted invoice is offered.
Statutes. The department may, when specified in
Attachment I , establish rates lower than the U.Final Invoice
maximum provided in section 112.061, Florida The provider must submit the final invoice for payment to
Statutes. the department no more than 6 0 days after the
contract ends or is terminated; If the 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, judicial
letters, or other materials subject to the provisions of branch or a state agency.
Chapter 119, Florida Statutes, and made or received II. THE DEPARTMENT AGREES:
by the provider in conjunction with this contract. It is
expressly understood that substantial evidence of the A. Contract Amount
provider's refusal to comply with this provision shall To pay for contracted services according to the
constitute a breach of contract. conditions of Attachment I in an amount not to exceed
$ 121,821.00 , subject to the availability of
R. Withholdings and Other Benefits funds. The State of Florida's performance and obligation
1. The provider is responsible for Social Security and to pay under this contract is contingent upon an annual
Income Tax withholdings. appropriation by the Legislature. The costs of services
paid under any other contract or from any other source
2. The provider is not entitled to state retirement or leave are not eligible for reimbursement under this contract.
benefits except where the provider is a state agency.
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B. Contract Payment
Pursuant to section 215.422, Florida Statutes, the B.Termination
voucher authorizing payment of an invoice submitted to 1. Termination at Will
the department shall be filed with the State Comptroller This contract may be terminated by either party upon
not later than twenty (20) days from the latter of the date no Tess than thirty (30) calendar days notice, without
a proper invoice is received or receipt, inspection and cause, unless a lesser time is mutually agreed upon by
approval of the goods or services, except that in the case both parties. Said notice shall be delivered by certified
of a bona fide dispute the voucher shall contain a mail, return receipt requested, or in person with proof
statement of the dispute and authorize payment only in of delivery.
the amount not disputed. The date on which an invoice is
deemed received is the date on which a proper invoice is 2. Termination Because of Lack of Funds
first received at the place designated by the department. In the event funds to finance this contract become
Invoices which have to be retumed to a vendor because unavailable, the department may terminate the
of vendor preparation errors will result in a delay in the contract upon no less than twenty -four (24) hours
payment. The invoice payment requirements do not start notice in writing to the provider. Said notice shall be
until a properly completed invoice, as defined in Rule delivered by certified mail, return receipt requested, or
Chapter 3A -24, Florida Administrative Code, is provided in person with proof of delivery. The department shall
to the department. Approval and inspection of goods or be the final authority as to the availability of funds.
services shall take no longer than five (5) working days
unless the bid specifications, purchase order or contract 3. Termination for Breach
specifies otherwise. Such approval is for the purpose of Unless the provider's breach is waived by the
authorizing payments and does not constitute a final department in writing, the department may, by written
approval of services purchased under this contract. A notice to the provider, terminate this contract upon no
payment is deemed to be issued on the first working day less than twenty -four (24) hours notice. Said notice
that payment is available for delivery or mailing to the shall be delivered by certified mail, return receipt
provider. If a warrant in payment of an invoice is not requested, or in person with proof of delivery. If
issued within forty (40) days, or thirty -five (35) days for applicable, the department may employ the default
health care providers as defined in Rule Chapter 3A -24, provisions in Chapter 60A- 1.006(4), Florida
Florida Administrative Code, after the receipt of the Administrative Code. Waiver of breach of any
invoice and receipt, inspection, and approval of the provisions of this contract shall not be deemed to be a
goods and services, the department shall pay to the waiver of any other breach and shall not be construed
provider, in addition to the amount of the invoice, interest to be a modification of the terms of this contract. The
at a rate of one (1) percent per month calculated on a provisions herein do not limit the department's right to
daily basis on the unpaid balance from the expiration of remedies at law or to damages.
such forty (40) day period, or thirty -five (35) day period
for health care providers as defined in Rule C.Notice and Contact
Chapter 3A -24, Florida Administrative Code, until such 1. The name, address and telephone number of the
time that the warrant is issued to the provider. The contract manager for the department for this contract
temporary unavailability of funds to make a timely is:
payment due for goods or services does not relieve the Barbara Adkison
department from this obligation to pay interest penalties. 6600 S . W . 57th. Avenue
C.VendorOmbudsman Miami, Florida 33143
A Vendor Ombudsman has been established within the (3 0 5) 6 4 3-2 0 9 3
Department of Banking and Finance. The duties of this
individual include acting as an advocate for vendors who 2. The name, address and telephone number of the
may be experiencing problems in obtaining timely representative of the provider responsible for
payment(s) from a state agency. The Vendor administration of the program under this contract is:
' Ombudsman may be contacted at (904) 488 -2924 or by p g
calling the State Comptroller's Hotline, 1-800- 848 -3792. Gwen Rodriguez
5100 College Road, Wing III
III. THE PROVIDER AND DEPARTMENT MUTUALLY Key West, Florida 33040
AGREE:
(305) 292 -4420
A. Effective Date
1. This contract shall begin on July 1, 19 9 4 3. In the event that different representatives are
or on the date on which the contract has been signed designated by either party after execution of this
by both parties, whichever is later. contract, notice of the name and address of the new
representative will be rendered in writing to the other
2. This contract shall end on June 30, 19 9 5 party and said notification attached to originals of this
contract.
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Contract No. K6191
D.Renegotiation or Modification 2. The name of the contact person and street address
1. Modifications of provisions of this contract shall only ains e nancial and administrative records are
m
be valid when they have been reduced to writing and maintained:
duly signed. The parties agree to renegotiate this Gwen Rodriguez, Director
contract if federal and /or state revisions of any Monroe County In —Home Services
applicable laws, or regulations make changes in this 5100 College Road, Wing III
contract necessary. Key West, Florida 33040
2. The rate of payment and the total dollar amount may
be adjusted retroactively to reflect price level increases F. All Terms and Conditions Included
and changes in the rate of payment when these have Thi t Q ac ienasg its & atichments as referenced,
been established through the appropriations process
and subsequently identified in the department's Exhibits A, B, C, & D.
operating budget.
E. Name, Mailing and Street Address of Payee ), all the terms and conditions agreed upon by th
1. The name (provider name as shown on page 1 of this parties.
contract) and mailing address of the official payee to
whom the payment shall be made:
Monroe County In —Home Services
5100 College Road, Wing III
Key West, Florida 33040
IN WITNESS THEREOF, the parties hereto have caused this 2, / 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 REHABILITATIVE SERVICES
SIGNED BY: SIGNED Y: l /1 _
NAME: fri'' C:K LONDON NA NITA M. BOCK ,( q
TITLE: MAYOR TITLE: DISTRICT ADMINISTRATOR
DATE: JUNE 17, 1994 DATE: Y /0)-} /( %
FVF5 Number for an individual): SIGNED BY
NAME: ANN RHODE
STATE AGENCY 29 DIGIT SAMAS CODE:
TITLE: SUB — DISTRICT ADMINISTRATOR
PROVIDER FISCAL YEAR ENDING DATE: DATE :
September 30, 1994
CONTRACT IS NOT VALID UNTIL SIGNED AND DATED BY
BOTH PARTIES
A- AS TO FOIVA
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Aging and Adult Services
Fixed Price
/C6/ 9/
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 $121,821.09 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 $33.05336 1,000
Homemaking Services One Hour $20.90963 960
Home Del, Meals One Meal $4.901353 8,254
Personal Care OnezHour $2205589 4 9 0 E�0
Respite Care f)nP Hrnmr $1
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07/01/94 Community Care for Disabled )
Adults
3. Rates listed in paragraph C -2 are the department's 90%
share of the gross cogt 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 B 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.
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07/01/94 Community Care for Disabled
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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.
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07/01/94 Community Care for Disabled
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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. Grievance 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.
/a _ ,,,,
07/01/94 Comminity Care for Disabled
Adults
11. Project 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
prohibition exist to prevent disclosure of those records.
14. Self- Mgnitorin
The Provider agrees to complete the - monitoring each
and every quarter. The required form is Exhibit, D. to this
contract. Said form is due in.Ithe offfice of the contract manager
by the 15th. of the month following the end of the quarter.
•
CCDA -1
Exhibit A
E6 a/
FY1994 -95
COMMUNITY CARE FOR DISABLED ADULTS
QUALITY ASSURANCE STANDARD
STANDARD:
Clients receiving Community Care for Disabled Adults (CODA)
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;
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
!3 GA08
o 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 ASSESSMENT:
Previous twelve months.
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 STAFF TIME:
20 minutes per case record, if no other problems exist.
RATING METHODOLOGY:
This standard is in compliance if 100 percent of the elements in
100 percent of the sampled files 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 ivibr-
•
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
AGING AND ADULT SERVICES PROGRAM CONTRACT #1<elg1
REPORT OF DISBURSEMENTS
Contracting Agency: - County :. MONROE
• Address: Phone:(305)•
Reimbursement Period From: • TO:
Contract Period From: TO:
-- - - - - - -- • - - UAL
DESCRIPTION APPROVED EXPENDITURES EXPENDITURES •
BUDGET TO DATE FOR THE PERIOD
PER • •NEL: IS • ALARIE
FRINGE BENEFITS
TOTAL PERSONNE
OTHER EXPENSES: •
•
•
•
•
U
TOTAL OTHER EXPENSES
• GROSS COS f OF AGENCY
LESS AGENCY FEES COLLECTED N/A N/A N /A--
NET COST OF AGENCY
PLUS NET COST OF CENTER N/A N/A N/A
LESS AGENCY C.P.E.
LESS C.P.E. OF CENTERS N/A N/A N/A
TOTAL CASH REJt,1 BURSEMENT - --
PREPARED BY- ---___
TITLE: PROJECT DIRECTOR DATE:
Exhibit C (Page 1) L`a -
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Exhibit C (Page 2) - -
MONROE COUNTY IN HOME SERVICES
WING III - PUBLIC SERVICE BUILDING
5100 COLLEGE ROAD
KEY WEST FL 33040
STATE CCDA CONTRACT KG-
FY 1994 -1995
TOTAL UNITS OF SERVICE PROVIDED:
GROSS RATES:
CASE MANAGEMENT 1000 UNITS X $ 36.72595 $36,725.95
HOMEMAKERS 960 UNITS X $ 23.23292 22,303.60
MEALS 8254 UNITS X $ 5.445949 44,950.86
PERSONAL CARE 960 UNITS X $ 24.50654 23,526.28
RESPITE CARE 400 UNITS X $ 19.62495 7,849.98
TOTAL COST $135,356.67
COUNTY MATCH:
CASE MANAGEMENT 1000 UNITS X $ 3.67259 $3,672.59
HOMEMAKERS 960 UNITS X $ 2.323292 2,230.36
MEALS 8254 UNITS X $ 0.544595 4,495.09
PERSONAL CARE 960 UNITS X $ 2.450656 2,352.63
RESPITE CARE 400 UNITS X $ 1.9625 785.00
TOTAL COUNTY COST $13,535.67
NET RATES:
CASE MANAGEMENT 1000 UNITS X $ 33.05336 $33,053.36
HOMEMAKERS 960 UNITS X $ 20.90963 20,073.24
MEALS 8254 UNITS X $ 4.901353 40,455.77
PERSONAL CARE 960 UNITS X $ 22.05589 21,173.65
RESPITE CARE 400 UNITS X $ 17.66245 7,064.98
TOTAL STATE COST $121,821.00
12 -May -94 04:04 PM
�7
•
Exhibit D .6iq/
DISTRICT AI
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:
- 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
/8
• FINANCIAL AND COMPLIAN AUDITS
ATTACHMENT "J
This attachment is applicable, if the provider 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 receives a total of $25,000 or more in federal funds passed through the
department during its fiscal year. The provider has "received" federal funds when it has
obtained the cash from the department or when it has incurred reimbursable expenses.
Local governments shall comply 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 audit report shall
include a schedule of financial assistance that discloses each state contract by number.
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 state whether or not matching
requirements were met. 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
will also submit a compliance report 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.
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 receives a total
of $100,000 or more from the department during its fiscal year, which is not paid on a set
state or area -wide fixed rate for service, and of which less than $25,000 is federally
funded. 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 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 audit report shall
include a schedule of financial assistance that discloses each state contract by number.
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 state whether or not matching
requirements were met. 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
will also submit a compliance report 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.
The provider agrees to submit the required reports as shown in Part IV.
07/01/94
• PART III: CHAPTER 10.600, OR NO AUDIT REQUIREMENT 6
This part is applicable if the provider is either (1) a for - profit organization, (2) a
local government entity receiving less than $25,000 in federal funds from the department
during its fiscal year, (3) a nonprofit organization receiving less than $100,000 from the
department, of which less than $25,000 is federally funded, during its fiscal year, or (4)
a nonprofit organization receiving a total of $100,000 or more from the department based
on a set state or area -wide fixed rate for service, of which less than $25,000 is
federally funded. The provider has "received" funds when it has obtained cash from the
department or when it has incurred reimbursable expenses.
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 the rules of the
Auditor General, chapter 10.600. The audit report shall include a schedule of financial
assistance that discloses each state contract by number and indicates which contracts are
funded from state grants and aids appropriations.
The provider agrees to submit the required reportd as shown in Part IV.
Otherwise, if the provider does not recieve funds from a grants and aids appropriation,
the provider has no audit or attestation requirement required by 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, unless otherwise required by Florida
Statutes, to the following:
A. Audit and Evaluation
1317 Winewood Boulevard, Building B, Room 492
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 -133:
•
Federal Audit Clearinghouse
P. 0. Box 5000
Jeffersonville, Indiana 47199 -5000
S
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. 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 period of five years from the date the audit report is
issued, unless extended in writing by the department.
07/01/94
.Z 0
•
O ] /c..,/ ' Contract with individual, private partnership, /� & � ,1— Attestation Audit Audit Attachment Part
or for - profit corporation:
Receives no grants and aids appropriation funding: N/A N/A III
Receives some grants and aids (G&A) appropriation funding:
Total G&A funds are less than $25,000: CEO N/A III
Total G&A funds exceed $25,000 but
are not more than $100,000: CPA or AG 1I1
Total G&A funds exceeds 5100,000: N/A AG III
Contract with nonprofit corporation:
Receives no grants and aids appropriation funding:
Total contract funds are less than $100,000: N/A N/A III
Total contracts are equal to or greater than $100,000 *,
but less than $25,000 in Federal financial assistance: N/A GAS II
*NOTE: if $100,000 or more based on a set state or
area -wide fixed rate for service N/A N/A I11
Total funding includes Federal financial assistance
equal to or greater than $25,000: N/A A -133 I
Receives some grants and aids appropriation funding:
Total contract funds are less than $25,000: CEO N/A III
Total G&A funds exceed $25,000 but
are not more than $100,000: CPA or AG III
Total contracts are equal to or greater than 5100,000 *,
but less than $25,000 in Federal financial assistance: N/A GAS +AG I1
*NOTE: if $100,000 or more based on a set state
or area -wide fixed rate for service N/A AG III
Total funding includes Federal financial assistance
equal to or greater than 525,000: N/A A- 133 +AG I
Contract with local government entity:
Receives no grants and aids appropriation funding:
Total contract funds contain less than $25,000 in
Federal financial assistance: N/A N/A I1I
Total funding includes Federal financial assistance
equal to or greater than $25,000: N/A A -128
Receives some grants and aids appropriation funding:
Total contract funds are less than $25,000: CEO N/A II
Total G&A funds exceed $25,000 but
are not more than $100,000: CPA or AG III
Total contracts are equal to or greater than
$100,000, but less than 525,000 in Federal financial
assistance: N/A GAS +AG
Total funding includes Federal financial assistance
equal to or greater than $25,000: N/A A- 128 +AG 1
Code for
HRS 1122 form
(line 16) Types of attestations /Audits
C,I,M,P,T N/A - Not applicable
A AG - Financial audit in accordance with the Rules of the Auditor General. Chapter 10.600.
B CPA - Attestation statement prepared by independent CPA as required by Section 216.349, FS
D CEO - Attestation statement by head of organization as required by Section 216.349, FS
E GAS - Organization wide financial audit in accordance with Goverment Auditing Standards.
G A -133 - Organization wide financial audit in accordance with OMB Circular A -133.
H A -128 - Organization wide financial audit in accordance with OMB Circular A -128.
J GAS +AG - Organization wide financial audit in accordance with Government Auditing Standards
and the Rules of the Auditor General, Chapter 10.600
K A- 133 +AG - Organization wide financial audit in accordance with OMB Circular A -133
and the Rules of the Auditor General, Chapter 10.600
A - 12R +Ar. - nraani7atinn uiiio financial aivii+ in rlanre uir6 rwo r:.....,i....