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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 1 7/1/94 • 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 2 ' 7/1/94 (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 3 7/1/94 . 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. 4 • .7/1/94 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. 5 i/ I /y4 • 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 ' r 341_ SUFFICIE Y ' � �/ _ 's s°!i 6 741 07/01/94 Community Care for Disabled Adults 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 [ 7 1 GA08 • 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. r 8 (lama 07/01/94 Community Care for Disabled Adults 2. Client Information a. The provider of case management services agrees to submit to the department management program data including client identifiable data in accordance with instructions provided by the department. b. The provider must maintain records documenting the clients, by name or unique identifier, to whom services are pro- vided, the number of units provided and the dates of service provision. This must track to each invoice for payment. Requests for payment which cannot be supported with supporting documentation will be returned to the provider upon inspection by the department. 3. Service Reports The provider agrees to submit to the contract manager a monthly summary report and six, nine and twelve months cumulative summary reports as described in Chapter 5, HRSM 140 -8. 4. Expenses Receipts are required for all expenses incurred, (e.g., office supplies, printing, long distance telephone calls, etc.). Receipts are required for all expenses of this nature. 5. Subcontracts a. Departmental approval of the provider's application shall constitute approval of the provider sub- contracts if the subcontracts follow the service and funding information as identified in the approved provider application. b. The provider will provide technical assistance to all subcontractors, as necessary. c. The provider agrees to conduct monitoring of subcontract agencies. Copies of reports of such monitoring visits will be submitted to the department and other appropriate agents in a format and within the time frames approved by the department. 6. Suspension • a. The department may, for reasonable cause, temporarily suspend the use of funds by a provider pending cor- rective action, or pending a decision to terminate the award. b. The department may prohibit the provider from receiving further payments and may prohibit the provider from in- curring additional obligations of funds. The suspension may apply to only part, or all of the provider's operation. [ �' ) GA08 07/01/94 Community Care for Disabled Adults c. To suspend operations of the provider, the department will notify the provider in writing by Certified Mail of: the action to be taken; the reason(s) for such action; and the conditions of the suspension. The notification will also: indicate what corrective action(s) are necessary to remove the suspension; indicate the provider's right to an administrative hearing; and provide the provider with the appropriate time period to request an administrative hearing before the effective date of the suspension (unless provider's actions warrant an immediate suspension). 7. Copyrights Clause Where activities supported by this contract produce original writing, sound recordings, pictorial reproductions, drawings or other graphic representation and works of any similar nature, the department has the right to use, duplicate -and dis- close such materials in whole or in part, in any manner, for any purpose whatsoever and to have others acting on behalf of the department to do so. If the materials so developed are subject to copyright or patent legal title and every right, interest, claim, or demand of any kind in and to any patent, trademark or copyright, or application for the same, will vest in the State of Florida, Department of State, for the exclusive use and benefit of the state. Pursuant to section 286.021, Florida Statutes (1987), no person, firm or corporation, including parties to this contract, shall be entitled to use the copyright, patent or trademark without the written consent of the Department of State. 8. Abuse, Neglect and Exploitation Reporting If at any time an employee of the provider is aware of or suspects that abuse, neglect, or exploitation of children, disabled persons, or aged persons has occurred, as defined in Chapter 415, Florida Statutes, he /she is required to immediately report such known or suspected abuse or neglect to the department by calling the Abuse Registry, 1- 800 -96- ABUSE. Failure of the em- ployee to immediately report known or suspected abuse, neglect or exploitation may constitute a breach of contract and may result in termination of the contract. 9. 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 - 2 N0000000 �D (0 (0 00 M Mir w wwor'. M WNOOOOooO N N0 Noo(D<DCIO)ON w - odo0 ( 1)000M 10 eo (00 0 C9 NN v(0 M !- N U M^ N 0)) el. o �N C. N d Mo W P CO o fD 40 1. r 04 m r - a g , 00000000,.. 1.. 1,... P- 0 0 0) 00 1- ( 0 0) 0 tt Q 0! CR 0 0 0 0 0 0 CI 00 00 OR o 0 1.: O to QO c0 v M CO (JD gi ZW ;: OOOO2OAN000 - O CI' 00 00 r-0I;2 Ow N1. M 1w two P-.. e ere N 11� N W 0 !' N N r N Ol N OO CV N N r W . a 00000000V 00((0 0(00 } Oaf 0 0 0 0 0 0 0 e0 1t) fA 0 (0 0 0 1 t0 0 ) M 00 _ /... e'0000111oCON N. hM h000tOWC;MO O { M e-00 ON M 0 0 • 0 1�MM1- at r woo.- c) M 1N 1�`. h 0)1-.1)0 0 0 0 �� 0) T- T- r IL - N N 4 x O 11!00000000 r C. CD CD C. o C. 1ft v o 1. O coo0oo00n0 f` co coo c0000000M rX N000001 cie'OM CO 00g OO00%-wwwN0 N a JUN for W u r r • r p... .ICOW0 P, 111 }, g4:1 to N ti NA/ ti Q) 1: ti er v co 03 0) 0) 0) 0) 0) M 1!) et O 3 W M 2" r co M M M r J M my" oz wm N00000000 (.1 ON.0 NO0 . • 1 1) 0M01- _ ID 0 0 0 0 0 0 011') r o - O M M O M t ) w V 1 W 00000 e'Or O e: O O r orool�)�D1�M0M o N Q N tf)f` 11) e{N NN O rM W r 0 (') el C) M M N "' M M CO 0 e eh 0= '' m ., ..._ ...� 0)000000011) ' er oX NN NXXXXX 0)000OOOON N C1 XNXO11' N.) <XX XX Z} — Zr.00aoa<i000v u 1riKu>>Co1eMMXXXKX m1- 2N SON. N ti N. N ,-XXXXX K X X X K X OW ow u) (r)11)X T-Tr4xXXXX "04 4" r r K r) r r X K X X X 0.00 • X X XXXX X om0 X X XXKXX N000000 CR (00 0(00 U U D O X C XX C4 CD o c0 0tDpCf00018rXrXXXX ..IM V (0 W 10 11) 11) MNXNXXXX < ' M 1f) O e M a M 1A 0o X 00 X X K X OO M r 0) M C e) .r" M e NXNXXXX 0 E. r r r r r X e X X X K Z X X X X X X X X X X i X XXXX m D W N F F- &W" N �G 1- WZ m�W�o0 N 0 00x =ca ° ~ NNQ N WW � N W (� C_� V U f� V � e O M W Q~ oZW 1LQ Z O'mLLreF W h Zmn el m 11.-- m U F-- WQ W Z 32mWJNO OW NF- p- m 1 z070 OO� V' Z m Z N 1-N MZCOOMZ u.1 -u.J 0012--11-°D W O OW W 0,0-mW ymWC�O y J } M 1- ZJ2_ObZ� W WJC) > >LL =ZOO O�a� O OWWM 0(1/›..J-62P ..N.IUW�oo1Q.WWWWNNQy'1N..WBW W Z0 05 Z 1 =Q W =m »Oa W W W W W W 04Z W Z W ZMZ Na�mVaW�NO?mmF- Z03051 M 1.Mtr_ 205WNLa4. O 0r-0 0 �r r �e M - V � eM�-eM- 1 rtM- 2eM-ilINNN 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....