06/19/2013 ContractAMY REAVILIN, CPA
CLERK OF CIRCUIT COURT &COMPTROLLER
MONROE COUNTY, FLORIDA
TO: Sheryl Graham, Director
Social Services
FROM: Pamela G. Han oc D. C.
At the June 19, 2013, Board of County Commissioner's meeting the Board granted approval and
authorized execution of the following:
Item C6 Community Care for the Elderly (CCE) Contract #KC 1371 between the Alliance for
Aging, Inc. (AAA) and Monroe County Board of County Commissioners (Social Services /In Home
Services) for the contract period of 7/1/13 to 6/30/14.
Item C7 Home Care for the Elderly (HCE) Contract #KH 1372 between the Alliance for Aging,
Inc. (AAA) and Monroe County Board of County Commissioners (Social Services/In Home Services)
for the contract period of 7/1/13 to 6/30/14.
Item C8 Alzheimers' Disease Initiative (ADI) Contract #KZ 1397 between the Alliance for Aging,
Inc. (AAA) and Monroe County Board of County Commissioners (Social Services/In Home Services)
for the contract period of 7/1/13 to 6/30/14.
Item C9 Amendment #0001 to Florida Department of Children and Families Standard Grant
Agreement #KPZ06, Emergency Solutions Grant formerly known as: 2011 ESG/Prevention Grant
Solicitation #LPZ06 between Monroe County Board of County Commissioners (Community
Services /Social Services) and the State of Florida, Department of Children and Families to increase
funding by $11,608.00.
Enclosed are five duplicate originals of each of the above - mentioned, executed on behalf of
Monroe County, for your handling. Please be sure to return two fully executed originals of each for the
Clerk's record and the Finance Department. Should you have any questions, please feel free to contact
my office.
cc: County Attorney w/o documents
Finance
File /
500 Whitehead Street Suite 101, PO Box 1980, Key West FL 33040 Phone: 305 -295 -3130 Fax: 305 - 295 -3663
3117 Overseas Highway, Marathon, FL 33050 Phone: 305 -289 -6027 Fax: 305- 289 -6025
88820 Overseas Highway, Plantation Key, FL 33070 Phone: 852 -7145 Fax: 305- 852 -7146
DATE: June 26, 2013
Contract Number KC 1371 7 ORIGII,
COMMUNITY CARE FOR THE ELDERLY CONTRACT
2013 -2014
THIS AGREEMENT is entered into between the Alliance for Aging, Inc., hereinafter
referred to as the "Alliance" and "Monroe County Board of Commissioners ", hereinafter
referred to as the "provider." THIS CONTRACT IS SUBJECT TO FURTHER
MODIFICATION IN ORDER TO INCORPORATE CERTAIN PASS - THROUGH
LANGUAGE REQUIRED BY THE STATE OF FLORIDA DEPARTMENT OF ELDER
AFFAIRS. ALL SUBSEQUENT MODIFICATIONS WILL BE MADE THROUGH
AMENDMENTS TO THIS CONTRACT.
Attachment I, II, III, IV, V, VI, VII, VIII, IX, X and XI are integral to this Agreement
The parties agree:
I. Provider Agrees:
A. Services to be Provided:
To plan, develop, and accomplish the services delineated, or otherwise cause
the planning, development, and accomplishment of such services and activities,
under the conditions specified and in the manner prescribed in Attachment I of
this agreement and included in the Service Provider Application (SPA). The
provider will not be allowed to provide services that are not included in the 2011
SPA and included related Unit Cost Methodology submitted as an integral part
of the 2011 application. In the event of the conflict between the Service Provider
Application and this contract, the contract controls.
B. Final Request for Payment:
The provider must submit the final request for payment to the Alliance no
later than July 15, 2014; if the provider fails to do so, all right to payment
is forfeited, and the Alliance will not honor any requests submitted
after the aforesaid time period.
2. If the contract is terminated prior to the contract end date of June 30, 2014,
then the provider must submit the final request for payment to the Alliance
no more than 45 days after the contract is terminated, but no later than July
15, 2014. If the provider fails to do so, all right to payment is forfeited,
and the Alliance will not honor any requests submitted after the
aforesaid time period.
C. Additional Reporting Requirements
1. If the Alliance has sanctioned the provider, while the sanctions are in effect
the provider shall provide to the Alliance, on a monthly basis, the provider's
financial statements that reflect the current, un- audited revenues and the
provider's cash position as well as any other financial and /or programmatic
documentation that may be requested by the Alliance.
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Contract Number KC 1371
2. If the provider is required to prepare a corrective action plan or respond to a
Fiscal and /or Programmatic Monitoring, supporting documentation as
requested by the Alliance shall be provided within the time frame stipulated
by the Alliance.
3. The provider is to provide explanations to any program surplus /deficit and/or
program spend -out plans as requested by the Alliance for Aging within the
time period requested by the Alliance.
4. The provider is responsible to report the units of services in CIRTS on a
monthly basis. The provider is ultimately responsible to ensure that sub -
providers report units of service in CIRTS as well.
5. Invoices must be submitted no Later than 90 days after the end of the month
on which the expense was incurred, except that invoices can not be
submitted after close out report date (usually July 15th.) Invoices submitted
late will not paid. Exceptions to this rule are at the discretion of the Alliance,
on a case by case basis; such exceptions must be requested prior to the
expiration of the invoicing deadline. In making a determination of the
exception the Alliance will consider whether the disruption to the billing cycle
was beyond the control of the provider, the frequency with which such
exceptions are requested by the provider, and whether the Alliance can
request reimbursement at a late date from DOEA.
The provider acknowledges that failure to meet the requirements set forth in
the 2008 CCE /Lead Agency RFP and in this agreement as well may result in
delay or termination of payment and /or in sanctions and other enforcement
actions, including termination of contract.
II. The Alliance Agrees:
A. Contract Amount
To pay for services according to the conditions of Attachment I in an amount not to
exceed 302,523 for the State Fiscal Year 2013 -2014, subject to the availability of
funds.
B. Obligation to Pay
The Alliance's performance and obligation to pay under this contract is contingent
upon an annual appropriation by the Legislature.
C. Source of Funds
The costs of services paid under any other contract or from any other source are not
eligible for reimbursement under this contract. The funds awarded to the provider
pursuant to this contract are in the state grants and aids appropriations and consists
of the following:
Contract Number KC 1371
Program Title
Year
Funding Source
CSFA#
Fund Amounts
Community Care
2013
General Revenue/Tobacco
65010
$ 302,523
for the Elderly
Settlement Trust Funds
$ 302,523
TOTAL FUNDS CONTAINED IN THIS CONTRACT:
III. Provider and Alliance Mutually Agree:
A. Effective Date:
1. This contract shall begin on July 1, 2013 or on the date the contract has been
signed by both parties, whichever is later.
2. Delivery of services shall end on June 30, 2014. This contract shall end on July
15, 2014. See Attachment I, Section III.F.
B. Termination, Suspension, and /or Enforcement:
This contract may be terminated by either party without cause upon no less than thirty
(30) calendar days notice in writing to the other party unless a sooner time is mutually
agreed upon in writing. Said notice shall be delivered by U.S. Postal Service or any
expedited delivery service that provides verification of delivery or by hand delivery to the
Contractor or the representative of the contractor responsible for administration of the
contract.
Failure to have performed any contractual obligations with the Alliance in a manner
satisfactory to the Alliance will be a sufficient cause for termination. To be
terminated as a contractor under this provision, the contractor must have (1)
previously failed to satisfactorily perform in a contract with the Alliance, been
notified by the Alliance of the unsatisfactory performance and failed to correct the
unsatisfactory performance to the satisfaction of the Alliance; or (2) had a contract
terminated by the Alliance for cause
C. Provider Responsibility:
The provider maintains responsibility for the performance of all sub providers and
vendors in accordance with all applicable federal and state laws.
D. Notice, Contact, and Payee Information:
The name, address, and telephone number of the contract manager for the Alliance
for this contract is:
Max B. Rothman, JD, LL.M.
President and CEO
760 NW 107 Ave, Suite 214
Miami, Florida 33172
(305) 670 -6500, Ext. 224
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I , I - ,
Contract Number KC 1371
2. The name, address, and telephone number of the representative of the provider
responsible for administration of the program under this contact is:
Sheryl Graham
Social Services Director
Gato Building
1100 Simonton Street
Key West FL 33040
3. In the event different representatives are designated by either party after execution
of this contract, notice of the name and address of the new representative will be
rendered in writing to the other party and said notification attached to originals of
this contract.
4. The name (provider name as shown on page 1 of this contract) and mailing address
of the official payee to whom the payment shall be made:
Monroe County Board of Commissioners
Gato Building
1100 Simonton Street
Key West FL 33040
E. Renegotiation or Modification
Modifications or changes to the funding in this contract and corresponding
services related to the increase or decrease, may be made in the form of a
written Contract Amendment signed by the Alliance's President and CEO. The
Board President or its Designee of the Provider shall sign the Notice of Award
Increase /Decrease and return it to the Alliance within fourteen (14) days or
sooner if requested by the Alliance. By signing Notice of Award
Increase /Decrease, the Board President or its Designee of the Provider
acknowledges the receipt of and agreement with the terms contained in the
Notice.
2. Upon Receipt of a Notice of Award Increase /Decrease, the provider shall update
affected information in budget summaries, deliverable schedules, or any other
applicable financial information contained in this contract. The parties shall then
incorporate such changes into a contract amendment. This shall be done within
ten working days of receipt of such notice.
IN WITNESS THEREOF, the parties hereto have caused this contract (including Attachment I-
III) to be executed by their undersigned officials as duly authorized.
PROVIDER:
Monroe County Board of Commissioners. ALLIANCE FOR AGING, INC.
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Contract Number KC 1371
SIGNED BY: j 4 4 �" V � j e. SIGNED BY: Z
NAME: Gedfige Neugent NAME: Max B. Rothman, JD, LL.M.
TITLE: MAYOR TITLE: President and CEO
DATE: (:�]� I9 4 2.-Pis DATE: JUN 2 8 2013
(SEAL)
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Contract Number KC 1371
ATTACHMENT
COMMUNITY CARE FOR THE ELDERLY PROGRAM
I. STATEMENT OF PURPOSE
The Community Care for the Elderly (CCE) Program provides community -based services
organized in a continuum of care to assist aged 60+ elders at risk of nursing home
placement to live in the least restrictive environment suitable to their needs.
II. SERVICES TO BE PROVIDED
A. Services:
1. The provider's service provider application submitted in response to the 2011 CCE
/Lead Agency RFP and any revisions thereto approved by the Alliance and located
in the Contract Manager's file are incorporated by reference in this contract between
the Alliance and the provider, and prescribe the services to be rendered by the
provider.
2. Consumers may not be enrolled in a Department of Elder Affairs state general
revenue funded program, including CCE, who are also enrolled in a Medicaid
capitated long -term care health plan or program. These programs include the Frail
Elder Program operated by United Health Care, the Channeling Program operated
by Miami Jewish Home and Hospital for the Aged, the Long Term Care Community
Diversion Program and the Program of All Inclusive Care for the Elderly (PACE)
program.
B. Manner of Service Provision:
The services to be provided are those described in the provider's service provider
application submitted in response to the 2011 CCE /Lead Agency application and as
described in this contract. All CCE services will be provided in a manner consistent
with the conditions set down in the 2011 Florida Department of Elder Affairs
Programs and Services Handbook or any revisions made thereafter. and by the
Alliance. In the event either the handbook or the service provisions established by the
Alliance is revised, such revision will automatically be incorporated into the contract and
the provider will be given a copy of the revisions.
111. METHOD OF PAYMENT
A. The method of payment in this contract is based on a fixed unit rate for approved
services. The provider must ensure fixed unit rates include only those costs which are
in accordance with all applicable state and federal statutes and regulations and are
based on audited historical costs in instances where an independent audit is required.
All requests for payment and expenditure reports submitted to support requests for
payment shall be on DOEA forms 106C and 105C. Duplication or replication of both
forms via data processing equipment is permissible, provided all data elements are in
the same format as included on department forms.
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Contract Number KC 1371
B. The provider shall maintain documentation to support payment requests which shall be
available to the Comptroller, the Department of Elder Affairs, or the Alliance upon
request.
C. The provider may request a monthly advance for service costs for each of the first two
months of the contract period, based on anticipated cash needs. Detailed
documentation justifying cash needs for advances must be submitted with the signed
contract, approved by the Alliance, and maintained in the contract manager's file. All
payment requests for the third through the twelfth months shall be based on the
submission of monthly actual expenditure reports beginning with the first month of the
contract. The schedule for submission of advance requests is ATTACHMENT II to this
contract. Reconciliation and recouping of advances made under this contract are to be
completed by March and April. All advance payments are subject to the availability of
funds.
D. Advance funds may be temporarily invested by the provider in an insured interest
bearing account. All interest earned on contract fund advances must be returned to the
Alliance within thirty (30) days of the end of the first quarter of the contract period.
E. The Alliance 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:
Service to be Provided
Service
Unit
Rate
Maximum
Units of
Service
Maximum
Dollars
Case Aide
$21.98
200
$4,396
Case Management
$50.48
1,230
$51,991
Chore
$29.41
85
$2,500
Chore Enhanced
$32.19
65
$2,092
Companionship
$15.33
765
$11,726
Home Modifications
$50.00
10
$500
Homemaker
$22.06
4,101
$90,468
Personal Care
$28.67
3,614
$103,618
Facility Respite
$10.00
1 1,638
$16,380
In Home Respite
$23.08
454
$15,002
Specialized Medical Equipments
$17.00
50
850
Transportation
$40.00
75
3,000
Total
$302,523
F. Additional Reporting Conditions:
1. The provider agrees to implement the distribution of funds as detailed in the service
provider application and the Budget Summary, ATTACHMENT 111 to this contract.
Any changes in the total amounts of the funds identified on the Budget Summary
form require a contract amendment.
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Contract Number KC 1371
2. The provider is to offer services based on clients' service plans and will not be
restricted to providing the services as projected. Additional budget
revisions /contract amendments will be required to move funding among these
services. Any changes in the total amount of the funds under contract require a
formal contract amendment.
3. The Alliance reserves the right to adjust the total award as well as the contracted
unit rate to reflect provider costs and utilization rates based on actual consumers
enrolled in the program.
4. This contract is for services provided beginning July 1, 2013 through June 30, 2014,
however, the contract is in effect through July 15, 2014 in order to provide for
maximization of resources and to allow for greater flexibility to pay for the services
rendered by December 31, 2011. Services provided after June 30, 2013 cannot be
reimbursed under this contract.
5. The provider shall submit a final closeout report by July 15, 2014.
6. The final expenditure report and request for payment will be due to the Alliance no
later than July 15, 2014. No expenditure reports or requests for payment will be
accepted after July 15, 2014.
7 Any payment due by the Alliance under the terms of this contract may be withheld
pending the receipt and approval by the Alliance of complete and accurate financial
and programmatic reports due from the provider and any adjustments thereto,
including any disallowance not resolved.
8 The provider need to provide the Alliance with an expenditure plan by July 15 or two
weeks after contract has been signed, a monthly update due on the 21 of each
following month.
The expenditure plan and updates must follow the format provided by the Alliance
IV. SPECIAL PROVISIONS
A. State Laws and Regulations:
1. The provider agrees to comply with applicable parts of Rule Chapter 58C-1, Florida
Administrative Code promulgated for administration of Sections 430.201 through 430.207,
Florida Statutes, and the Department of Elder Affairs 2011 Florida Department of Elder
Affairs Programs and Services Handbook or any revisions made thereafter.
2. The provider agrees to comply with the provisions of Sections 97.021 and 97.058,
Florida Statutes, and all rules related thereto in the Florida Administrative Code.
B. Assessment and Prioritization for Service Delivery for New Consumers:
The following are the criteria to prioritize new consumers for service delivery. It is not
the intent of the Department of Elder Affairs to remove existing clients from any
program in order to serve new clients being assessed and prioritized for service
delivery.
Contract Number KC 1371
1. Abuse, Neglect and Exploitation:
The provider will ensure that pursuant to Section 430.205(5), Florida Statute, those
elderly persons who are determined by adult protective services to be victims of
abuse, neglect, or exploitation who are in need of immediate services to prevent
further harm and are referred by adult protective services, will be given primary
consideration for receiving Community Care for the Elderly Services. As used in
this subsection, "primary consideration" means that an assessment and services
must commence within 72 hours after referral to the department or as established in
accordance with department contracts by local protocols developed between
department service providers and adult protective services.
2. Priority Criteria for Individuals in Nursing Homes in Receivership
The provider will ensure that pursuant to Section 400.126 (12), Florida Statute,
those elderly persons determined through a CARES assessment to be a resident
who could be cared for in a less restrictive setting or who do not meet the criteria for
skilled or intermediate care in a nursing home, will be referred for such care, as
appropriate for the resident. Residents referred pursuant to this subsection shall be
given primary consideration for receiving services under the Community Care for
the Elderly program in a manner as persons classified to receive such services
pursuant to Section 430.205, Florida Statute.
3. Priority Criteria for Service Delivery:
a) Individuals in nursing homes under Medicaid who could be transferred to the
community;
b) Individuals in nursing homes, whose Medicare coverage is exhausted and
may be diverted to the community;
C) Individuals in nursing homes which are closing and can be discharged to the
community; or
d) Individuals whose mental or physical health condition has deteriorated to the
degree self care is not possible, there is no capable caregiver and
institutional placement will occur within 72 hours.
e) For the purpose of transitioning individuals receiving Community Care for
Disabled Adults (CCDA) and Home Care for Disabled Adults (HCDA)
services through the Department of Children and Families (DCF) Adult
Services to community -based services provided through the department,
when services are not currently available, area agency on aging staff and
lead agency case managers shall ensure that "Aging Out" individuals are
prioritized for services only after Adult Protective Services (PAS) High Risk
and Imminent Risk individuals.
4. Priority Criteria for Service Delivery for Other Assessed Individuals:
The assessment and provision of services should always consider the most cost
effective means of service delivery. Service priority for individuals not included in
groups one, two or three above, regardless of referral source, shall be determined
through the department's client assessment form administered to each applicant, to
the extent funding is available. First priority will be given to applicants at the higher
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Contract Number KC 1371
levels of frailty and risk of nursing home placement. For individuals assessed at the
same priority and risk of nursing home placement, priority will be given to applicants
with the lesser ability to pay for services.
5. Referrals for Medicaid Waiver Services:
a) The provider must identify, through the consumer assessment, potential
Medicaid eligible CCE consumers and refer these individuals for Medicaid
Waiver services.
b) Individuals who have been identified as being potentially Medicaid Waiver
eligible are required to apply for Medicaid Waiver services in order to receive
CCE services and can only receive CCE services while the Medicaid Waiver
eligibility determination is pending. If the consumer is found ineligible for
Medicaid Waiver services for any reason other than failure to provide
required documentation, they may continue to receive CCE services.
C) Individuals who have been identified as being potentially Medicaid Waiver
eligible must be advised of their responsibility to apply for Medicaid Waiver
services as a condition of receiving CCE services while the eligibility
determination is being processed.
C. Co- payment Collections:
1. The provider will establish annual co- payment goals. The Alliance has the option to
withhold a portion of the provider's Request for Payment if goals are not met
according to the Department of Elder Affairs co- payment guidelines.
2. Co- payments include only the amounts assessed consumers or the amounts
consumers opt to contribute in lieu of an assessed co- payment. The contribution
must be equal to or greater than the assessed co- payment.
3. Co- payments collected in the CCE program can be used as part of the local match.
D. Match:
The provider will assure a match requirement of at least 10 percent of the cost for all
Community Care for the Elderly services. The match will be made in the form of cash
and /or in kind resources. At the end of the contract period, all Community Care for the
Elderly funds expended must be properly matched.
E. Service Cost Reports:
The provider will submit semi - annual service cost reports which reflect actual costs of
providing each service by program. This report provides information for planning and
negotiating unit rates.
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Contract Number KC 1371
ATTACHMENT II
COMMUNITY CARE FOR THE ELDERLY PROGRAM
CONTRACT REPORT CALENDAR
Report Number
Based On
Submit To The Alliance
On This Date
1 July Advance * ............................. ...............................
2 August Advance * ......................... ...............................
3 July Expenditure Report ...1/12 Advance Reconciliation.......
4 August Expenditure Report ...1 /12 Advance Reconciliation ...
5 September Expenditure Report 1/12 Advance Reconciliation
6 October Expenditure Report ...1/12 Advance Reconciliation ..
7 November Expenditure Report ... 1 /12 Advance Reconciliation
8 December Expenditure Report ...1/12 Advance Reconciliation
9 January Expenditure Report ...1/12 Advance Reconciliation...
10 February Expenditure Report.. 1/12 Advance Reconciliation...
11 March Expenditure Report ..1/12 Advance Reconciliation ....
12 April Expenditure Report ...1 /12 Advance Reconciliation ....
13 May Expenditure Report ... 1 /12 Advance Reconciliation .......
14 June Expenditure Report ... 1 /12 Advance Reconciliation ......
16 Final Expenditure and Closeout Report ...........
Legend
July 1
July 1
August 15
September 15
October1 5
November 15
December 15
January1 5
February 15
March 15
April 15
May 15
June1 5
July 15
July 15
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,b
Contract Number KC 1371
ATTACHMENT III
ATTACHMENT III
REFERRAL PROTOCOL
REFERRAL PROTOCOL
Issue: Screening, Triage, and Referral for Activation under the Community Care for the
Elderly /Home Care for the Elderly Programs and for the Aging & Disabled Adults and the
Assisted Living for the Elderly Medicaid Waivers.
Policy: Referrals will be based on availability of funds, in accordance with prioritization requirements.
Purpose: To ensure funding is spent expeditiously and consumers are referred into programs for
appropriate services.
Procedure for Monroe County:
Dies and Responsibilities
A. Alliance for Aging / Aging and Disability Resource Center
➢ Reconciles overall program and Lead Agency specific spending levels on a monthly
basis to ensure the Lead Agency is operating within the funding allocation.
➢ Reviews the number of cases released for activation based on projected funding
available.
➢ Screens consumers to link with appropriate resources and prioritize for DOEA- funded
programs and services.
➢ Recommends potential cases for activation based upon projected funding available by
Lead Agency.
➢ Selects consumers from the waiting list based on their prioritization score.
➢ Refers consumers from the waiting list to the Lead Agency in Monroe County for
activation, based on availability of funds.
➢ Monitors compliance with service standards and outcome measures.
➢ Reviews care plans and files per the File Review Policies and Procedures.
➢ Reviews data in CIRTS.
B. Case Management Agency
➢ Requests and accepts referrals from the Aging and Disability Resource Center, to serve
an optimal caseload and to avoid surpluses or deficits in accordance with the AAA
CCE /HCE Surplus /Deficit Analysis policy.
➢ Refers inquiries from consumers interested in services to the ADRC for Information and
Referral to community resources, Screening, Triage, and Long -Term Care Options
Counseling, as appropriate.
➢ The functions of Screening and Intake are outsourced to the Lead Agency. Screening
and Intake may also be completed by the ADRC.
➢ Completes comprehensive assessments on new consumers and annual reassessment
on existing consumers and develops care plans and reviews care plans semi - annually.
➢ Authorizes service delivery and enters data into CIRTS.
➢ Screens consumers for Medicaid Waiver eligibility.
➢ Bills in CIRTS and Medicaid as appropriate.
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' ' ' Contract Number KC 1371
➢ Monitors care plans in an effort to keep costs down while sustaining the individuals in
the community.
II. Management of the Assessed Prioritized Consumer List (APCL).
A. Referrals to the ADRC are routed to the Information and Referral Specialists or Intake Unit staff
depending on the type of referral. Clients are provided information on community resources and
programs available including private pay options. Persons are directed to those resources most
capable of meeting the need they have expressed to ADRC staff. Cases presenting strong identifiers
that indicate the consumer might benefit from publicly funded long term care services are screened,
entered into CIRTS, triaged and provided options counseling. In Monroe County, the functions of
Screening and Intake are outsourced to the Lead Agency. Screening and Intake may also be
completed by the ADRC.
DOEA prioritization requirements will be adhered to by both entities, as follows:
APS High Risk Referrals (See section B)
2. Imminent Risk cases will be prioritized for activation after APS High Risk
Referrals have been served. If budgetary constraints prevent opening new cases,
clients will be placed on the APCL. ADRC staff will contact the client on a monthly basis
to determine if there has been a change in the client's situation.
3. All other CARES referrals will be screened and prioritized in accordance with DOEA
requirements.
4. Aging Out consumers will be referred by DCF for prioritization and /or
activation in the corresponding aged program managed by the Alliance, as appropriate
(See section IV).
5. Consumers applying for the Community Care for the Elderly (CCE)
and /or Home Care for the Elderly (HCE) programs will be contacted and screened using
the statewide assessment form developed by the Department of Elder Affairs for this
purpose (Form 701A). If a consumer is being served through a DOEA- funded agency
which enters their annual assessment into CIRTS, the Priority Score generated by that
assessment will determine their ranking on the APCL.
6. Consumers referred for inclusion under the Assisted Living for the Elderly
(ALE) Medicaid Waiver APCL will be interviewed and screened using the 701A form.
7. Consumers referred for inclusion under the Aging and Disabled Adult
(ADA) Medicaid Waiver APCL will be contacted and screened following the same
procedure as the one described under Section 5. Individuals who appear as potentially
eligible for other types of public assistance will be referred to the Economic Self -
Sufficiency Unit at the Department of Children and Families.
8. All other referrals will be waitlisted and prioritized, during which time other community
resources will be researched, including private pay /fee for services providers.
Consumers on the waiting lists will be reassessed according to the 2012 Department of
Elder Affairs Programs and Services Handbook, or any revisions made thereafter.
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Contract Number KC 1371
B. HIPAA forms will be sent to the consumer as appropriate.
III. Opening New Cases
A. CCE /HCE Clients
The Fiscal Department will monitor Lead Agency specific spending levels on a monthly
basis to ensure each Lead Agency is operating within its spending authority. In addition,
the fiscal department will analyze surplus /deficit projections, and share the information
with the Lead Agency to assist in their determination of slot availability. The Lead
Agency will request referrals directly from the ADRC. The Fiscal Department will be
notified of the number of new cases being referred to the Lead Agency for activation.
2. Upon receipt of the request for referrals from the Lead Agency, the ADRC Intake Unit
Supervisor will run the Prioritized Risk Report to identify the consumers on the APCL to
be opened.
3. In response to the request for referrals, the ADRC Intake Unit Supervisor will refer wait
listed clients to the Lead Agency for activation, in accordance with prioritization
requirements. The Intake Unit will update the wait list enrollment using the appropriate
code to terminate from the APCL. Upon receipt of referral, the Lead Agency will enter
the APPL enrollment, and subsequent enrollments to reflect client status.
4. Upon receipt of list of clients released from the waiting list, the Lead Agency will enter
the APPL enrollment, will contact clients to offer program enrollment, and will proceed
with activation. The Lead Agency will enter subsequent enrollments into CIRTS to reflect
client status.
5. The ADRC will oversee the enrollment process to ensure referrals have timely outcomes
in CIRTS.
B. MW /ALW Clients
1. The Department of Elder Affairs will run the APCL (Assessed Priority Consumer List) report to
review clients wait listed for the ALW and MW programs. DOEA will provide the ADRC with a list
of individuals authorized for release from the APCL.
2. For clients identified as active in CCE or HCE and authorized for release from the Medicaid
Waiver waiting list, the Lead Agency will be responsible for the Medicaid Waiver application
process.
C. APS Referrals
1. APS Low and Intermediate Risk referrals will be screened and prioritized by the ADRC
for services as per the DOEA/APS Memorandum of Understanding. Low and
Intermediate Risk referrals are also offered information and referral to additional
community resources, including private pay as appropriate.
2. APS High Risk Referrals are not waitlisted. They are immediately referred for service
from DCF in Monroe County to the Lead Agency. ARTT referrals will be forwarded
directly the Lead Agency. APS cases are to be served for a maximum of 31 calendar
days. If additional time is justified, the case management agency will staff the case with
14
' ' Contract Number KC 1371
the Alliance to obtain the extension needed.
3. Upon receipt of the APS High Risk referral, the Lead Agency will coordinate services to
begin within the 72 hour period mandated by statute. A comprehensive assessment will
be done within 72 hours of the referral. Services required under the care plan will
remain in place for a maximum of 31 days, unless an extension has been granted.
4. The Lead Agency will enter ACTV enrollment under their provider number in CIRTS. In
addition, service codes will be entered by service date for all services provided. If a
service(s) is not provided as required under the care plan, an NDP code will need to be
entered in CIRTS and the case notes under the client file should document the reason
for non - delivery of such service(s).
IV. Aging Out Consumers:
A. All "Aging Out" consumers will be referred by DCF to the ADRC for enrollment into the
corresponding aged program managed by the Alliance.
B. Consumers active in the CCDA and HCDA programs that are turning 60 and are eligible for
CCE and /or HCE will be opened in the corresponding aged program managed by the Alliance if
funding is available. If funding is available, these consumers will be made active. If funding is
not available, they will be waitlisted for these programs but will be given priority for activation
once funding is available.
C. Consumers active in the ADA Medicaid Waiver, upon turning age 60, will continue to be eligible
for and receive ADA Medicaid Waiver services.
Note: These ADRC policies and procedures are subject to change. Any modifications will be done
through a contract amendment.
15
Contract Number KC 1371
ATTACHMENT IV
CERTIFICATION REGARDING LOBBYING
CERTIFICATION FOR CONTRACTS, GRANTS,
LOANS AND AGREEMENTS
The undersigned certifies, to the best of his or her knowledge and belief, that:
(1)No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned,
to any person for influencing or attempting to influence an officer or employee of any state or federal
agency, a member of congress, an officer or employee of congress, an employee of a member of congress,
or an officer or employee of the state legislator, in connection with the awarding of any federal grant, the
making of any federal loan, the entering into of any cooperative agreement, and the extension,
continuation, renewal, amendment, or modification of any federal contract, grant, loan, or cooperative
agreement.
(2)If any funds other than federal appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any agency, a member of congress, an
officer or employee of congress, or an employee of a member of congress in connection with this
federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit
Standard Form -LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.
(3)The undersigned shall require that the language of this certification be included in the award documents
for all sub - awards at all tiers (including subcontracts, sub - grants, and contracts under grants, loans and
cooperative agreements) and that all subproviders shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this
transaction was made or entered into. Submission of this certification is a prerequisite for making or
entering into this transaction imposed by section 1352, Title 31, U.S. Code. Any person who fails to file
the required certification shall be subject to a civil penalty of not less than $10,0'OQ.00 and not more than
$100,000.00 for each such failure.
i 44 .ek. &C 11, z.o1 3
Signature 6 1 ate
0(�
G 131
(SEAL)
q y H LtN, CLERK
Name o"? Authorized Individual Application or Agreement Number
Nlowc ' l , w� 3 OGC p Savo v+bt,3 `s4f j K�j s4" F.2. 3 3u`Fo
Name and Address4 Organization v
DOEA Form 103 (Revised Nov 2002)
16
' ' I I Contract Number KC 1371
ATTACHMENT V
FINANCIAL AND COMPLIANCE AUDIT
The administration of resources awarded by the Alliance of Elder Affairs to the provider may be subject to audits
and /or monitoring by the Alliance of Elder Affairs, as described in this section.
MONITORING
In addition to reviews of audits conducted in accordance with OMB Circular A -133, as revised, and Section
215.97, F.S., (see "AUDITS" below), monitoring procedures may include, but not be limited to, on -site visits by the
Alliance staff, limited scope audits as defined by OMB Circular A -133, as revised, and /or other procedures. By
entering into this agreement, the provider agrees to comply and cooperate with any monitoring
procedures /processes deemed appropriate by the Alliance for Aging. In the event the Alliance for Aging
determines that a limited scope audit of the provider is appropriate, the provider agrees to comply with any
additional instructions provided by the Alliance to the provider regarding such audit. The provider further
agrees to comply and cooperate with any inspections, reviews, investigations, or audits deemed necessary by any
level of government.
AUDITS
PART I: FEDERALLY FUNDED
This part is applicable if the provider is a State or local government or a non -profit organization as defined in OMB
Circular A -133, as revised.
In the event that the provider expends $500,000.00 or more in Federal awards during its fiscal year, the provider
must have a single or program - specific audit conducted in accordance with the provisions of OMB Circular A-
133, as revised. EXHIBIT 1 to this agreement indicates Federal resources awarded through the Alliance of Elder
Affairs by this agreement. In determining the Federal awards expended in its fiscal year, the provider shall
consider all sources of Federal awards, including Federal resources received from the Alliance of Elder Affairs. The
determination of amounts of Federal awards expended should be in accordance with the guidelines established by
OMB Circular A -133, as revised. An audit of the provider conducted by the Auditor General in accordance with the
provisions of OMB Circular A -133, as revised, will meet the requirements of this part.
In connection with the audit requirements addressed in Part I, paragraph 1, the provider shall fulfill the
requirements relative to auditee responsibilities as provided in Subpart C of OMB Circular A -133, as revised.
If the provider expends less than $500,000.00 in Federal awards in its fiscal year, an audit conducted in
accordance with the provisions of OMB Circular A -133, as revised, is not required. In the event that the provider
expends less than $500,000.00 in Federal awards in its fiscal year and elects to have an audit conducted in
accordance with the provisions of OMB Circular A -133, as revised, the cost of the audit must be paid from non -
Federal resources (i.e., the cost of such audit must be paid from provider resources obtained from other than
Federal entities.)
An audit conducted in accordance with this part shall cover the entire organization for the organization's
fiscal year. Compliance findings related to agreements with the Alliance of Elder Affairs shall be based on the
agreement's requirements, including any rules, regulations, or statutes referenced in the agreement. The financial
statements shall disclose whether or not the matching requirement was met for each applicable agreement. All
questioned costs and liabilities due to the Alliance of Elder Affairs shall be fully disclosed in the audit report with
17
Contract Number KC 1371
reference to the Alliance of Elder Affairs agreement involved. If not otherwise disclosed as required by Section
.310(b)(2) of OMB Circular A -133, as revised, the schedule of expenditures of Federal awards shall identify
expenditures by agreement number for each agreement with the Alliance of Elder Affairs in effect during the
audit period. Financial reporting packages required under this part must be submitted within the earlier of 30 days
after receipt of the audit report or 9 months after the end of the provider's fiscal year end.
As an Alliance requirement the Statement of Functional Expenses need to be part of the Financial and Compliance
Audit Report.
PART II: STATE FUNDED
This part is applicable if the provider is a nonstate entity as defined by Section 215.97(2), Florida Statutes.
In the event that the provider expends a total amount of state financial assistance equal to or in excess of
$500,000.00 in any fiscal year of such provider (for fiscal years ending September 30, 2004 or thereafter),
the provider must have a State single or project- specific audit for such fiscal year in accordance with
Section 215.97, Florida Statutes; applicable rules of the Alliance of Financial Services; and Chapters 10.550
(local governmental entities) or 10.650 (nonprofit and for - profit organizations), Rules of the Auditor
General. EXHIBIT I to this agreement indicates state financial assistance awarded through the Alliance of
Elder Affairs by this agreement. In determining the state financial assistance expended in its fiscal year,
the provider shall consider all sources of state financial assistance, including state financial assistance
received from the Alliance of Elder Affairs, other state agencies, and other nonstate entities. State
financial assistance does not include Federal direct or pass- through awards and resources received by a
nonstate entity for Federal program matching requirements.
In connection with the audit requirements addressed in Part 11, paragraph 1, the provider shall ensure that
the audit complies with the requirements of Section 215.97(8), Florida Statutes. This includes submission of
a financial reporting package as defined by Section 215.97(2), Florida Statutes, and Chapter 10.550 (local
governmental entities) or 10.650 (nonprofit and for - profit organizations), Rules of the Auditor General.
If the provider expends less than $500,000.00 in state financial assistance in its fiscal year (for fiscal years
ending September 30, 2004 or thereafter), an audit conducted in accordance with the provisions of Section
215.97, Florida Statutes, is not required. In the event that the provider expends less than $500,000.00 in
state financial assistance in its fiscal year and elects to have an audit conducted in accordance with the
provisions of Section 215.97, Florida Statutes, the cost of the audit must be paid from the nonstate entity's
resources (i.e., the cost of such an audit must be paid from the provider resources obtained from other than
State entities).
An audit conducted in accordance with this part shall cover the entire organization for the
organization's fiscal year. Compliance findings related to agreements with the Alliance of Elder Affairs
shall be based on the agreement's requirements, including any applicable rules, regulations, or statutes.
The financial statements shall disclose whether or not the matching requirement was met for each
applicable agreement. All questioned costs and liabilities due to the Alliance of Elder Affairs shall be fully
disclosed in the audit report with reference to the Alliance of Elder Affairs agreement involved. If not
otherwise disclosed as required by Rule 691 - 5.003, Fla. Admin. Code, the schedule of expenditures of state
W .
' ' ' ' Contract Number KC 1371
financial assistance shall identify expenditures by agreement number for each agreement with the Alliance
of Elder Affairs in effect during the audit period. Financial reporting packages required under this part
must be submitted within 45 days after delivery of the audit report, but no later than 12 months after the
provider's fiscal year end for local governmental entities. Non - profit or for - profit organizations are
required to be submitted within 45 days after delivery of the audit report, but no later than 9 months after
the provider's fiscal year end. Notwithstanding the applicability of this portion, the Alliance of Elder
Affairs retains all right and obligation to monitor and oversee the performance of this agreement as
outlined throughout this document and pursuant to law.
As an Alliance requirement the Statement of Functional Expenses need to be part of the Financial and Compliance
Audit Report.
PART III: REPORT SUBMISSION
Copies of reporting packages for audits conducted in accordance with OMB Circular A -133, as revised, and
required by PART I of this agreement shall be submitted, when required by Section .320 (d), OMB Circular
A -133, as revised, by or on behalf of the provider directly to each of the following:
The Alliance for Aging, Inc. at the following address:
Alliance for Aging, Inc.
Attn: Carlos Lahitte
760 NW 107"' Ave. Suite 214
Miami, FL 33172
19
Contract Number KC 1371
ATTACHMENT V
EXHIBIT -2
PART I: AUDIT RELATIONSHIP DETERMINATION
Providers who receive state or federal resources may or may not be subject to the audit requirements of OMB
Circular A -133, as revised, and /or Section 215.97, Fla. Stat. Providers who are determined to be recipients or
subrecipients of federal awards and /or state financial assistance may be subject to the audit requirements if the
audit threshold requirements set forth in Part I and /or Part H of Exhibit 1 are met. Providers who have been
determined to be vendors are not subject to the audit requirements of OMB Circular A -133, as revised, and /or
Section 215.97, Fla. Stat. Regardless of whether the audit requirements are met, providers who have been
determined to be recipients or subrecipients of Federal awards and /or state financial assistance, must comply
with applicable programmatic and fiscal compliance requirements.
In accordance with Sec. 210 of OMB Circular A -133 and /or Rule 691 - 5.006, FAC, provider has been determined to
be:
Vendor or exempt entity and not subject to OMB Circular A -133 and /or Section 215.97, F.S.
X Recipient /subrecipient subject to OMB Circular A -133 and /or Section 215.97, F.S.
NOTE: If a provider is determined to be a recipient /subrecipient of federal and or state financial assistance and
has been approved by the Alliance to subcontract, they must comply with Section 215.97(7), F.S., and Rule 69I-
.006(2), FAC [state financial assistance] and Section _ .400 OMB Circular A -133 [federal awards].
PART II: FISCAL COMPLIANCE REQUIREMENTS
FEDERAL AWARDS OR STATE MATCHING FUNDS ON FEDERAL AWARDS. Providers who receive
Federal awards or state matching funds on Federal awards and who are determined to be a subrecipient, must
comply with the following fiscal laws, rules and regulations:
STATES, LOCAL GOVERNMENTS AND INDIAN TRIBES MUST FOLLOW:
2 CFR Part 225 Cost Principles for State, Local and Indian Tribal Governments (Formerly OMB
Circular A -87)*
OMB Circular A -102 — Administrative Requirements
OMB Circular A -133 — Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
NON - PROFIT ORGANIZATIONS MUST FOLLOW-
2 CFR Part 230 Cost Principles for Non -Profit Organizations (Formerly OMB Circular A -122 - Cost
Principles)*
2 CFR Part 215 Administrative Requirements (Formerly OMB Circular A -110 - Administrative
Requirements)
Requirements)
OMB Circular A -133 - Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
20
Contract Number KC 1371
EDUCATIONAL INSTITUTIONS (EVEN IF A PART OF A STATE OR LOCAL GOVERNMENT) MUST
FOLLOW:
2 CFR Part 220 Cost Principles for Educational Institutions OMB (Formerly Circular A -21- Cost
Principles)*
2 CFR Part 215 Administrative Requirements (Formerly OMB Circular A -110 - Administrative
Requirements)
OMB Circular A -133 — Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
*Some Federal programs may be exempted from compliance with the Cost Principles Circulars as noted in
the OMB Circular A -133 Compliance Supplement, Appendix 1.
STATE FINANCIAL ASSISTANCE. Providers who receive state financial assistance and who are
determined to be a recipient /subrecipient, must comply with the following fiscal laws, rules and regulations:
Section 215.97, Fla. Stat.
Chapter 691 -5, Fla. Admin. Code
State Projects Compliance Supplement
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
21
Contract Number KC 1371
ATTACHMENT VI
CERTIFICATION REGARDING DATA INTEGRITY
COMPLIANCE FOR AGREEMENTS, GRANTS, LOANS AND
COOPERATIVE AGREEMENTS
The undersigned, an authorized representative of the provider named in the contract or agreement to
which this form is an attachment, hereby certifies that:
(1)The provider and any sub - providers of services under this contract have financial management
systems capable of providing certain information, including: (1) accurate, current, and complete disclosure
of the financial results of each grant- funded project or program in accordance with the prescribed
reporting requirements; (2) the source and application of funds for all agreement supported activities;
and (3) the comparison of outlays with budgeted amounts for each award. The inability to process
information in accordance with these requirements could result in a return of grant funds that have not
been accounted for properly.
(2)Management Information Systems used by the provider, sub - provider(s), or any outside entity on
which the provider is dependent for data that is to be reported, transmitted or calculated, have been
assessed and verified to be capable of processing data accurately, including year -date dependent
data. For those systems identified to be non - compliant, provider(s) will take immediate action to assure
data integrity.
(3)If this contract includes the provision of hardware, software, firmware, microcode or imbedded
chip technology, the undersigned warrants that these products are capable of processing year -date
dependent data accurately. All versions of these products offered by the provider (represented by the
undersigned) and purchased by the State will be verified for accuracy and integrity of data prior to
transfer.
In the event of any decrease in functionality related to time and date related codes and internal
subroutines that impede the hardware or software programs from operating properly, the provider
agrees to immediately make required corrections to restore hardware and software programs to the
same level of functionality as warranted herein, at no charge to the State, and without interruption to
the ongoing business of the state, time being of the essence.
(4) The provider and any sub - provider(s) of services under this contract warrant their policies and
procedures include a disaster plan to provide for service delivery to continue in case of an
emergency including emergencies arising from data integrity compliance issues.
The provider shall require that the language of this certification be included in all subagreements,
subgrants, and other agreements and that all sub - providers shall certify compliance accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction
was made or entered into. Submission of this certification is a prerequisite for making or entering into this
transaction imposed by OMB Circulars A -102 and 2 CFR Part 215 (formerly OMB Circular A -1 10).
� O C.C_ . 1 t o O Snti tom 5 «'� K� (�•ks�� �C . v`Eo
AiNe and Addre s f I ovider t '�
0'&�5 H o - - - -- -- - - - - -�' 4. 2 91 :5
�1 - -- -- - -- - - -- - - --
Signature r Title
Name ol AuthcrWd Signer
(SEAL) 7 7
A MY HEA N, CLERK
B7 __ EP CLERK
NTY
AS l
�EL7R0 J. M c;Al JU
ASSISTANT COU w AT fOR EY
Contract Number KC 1371
(Revised June 2013)
23
Contract Number KC 1371
ATTACHMENT VII
CERTIFICATION REGARDING DEBARMENT, SUSPENSION,
INELIGIBILITY AND VOLUNTARY EXCLUSION FOR LOWER TIER
COVERED TRANSACTIONS
(1)The prospective provider certifies, by signing this certification, neither it nor its principals.,are
presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded
from participation in this transaction by any federal Alliance or agency.
(2)Where the prospective provider is unable to certify to any of the statements in this certifications such
prospective participant shall attach an explanation to this certification.
Signature Dat B , s3EP c,LE
G eArY,� t�feo►�n� -� N�o�., oCZ.. tci�C4� o E c c _ e _ .
Title Agency/ Organiz OV D AS O
��
(Certification signature should be same as Contract signature.)
PE
Instructions for Certification SISTANT COUP NI
l .The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered
transaction," "person," "primary covered transaction," and "voluntarily excluded," as used herein, have
the meanings set out in the sections of rules implementing Executive Order 12549. (2 CFR 180.5-
180.1020, as supplemented by 2 CFR 376.10- 376.995). You may contact the Contract Manager for
assistance in obtaining a copy of those regulations.
2.This certification is a material representation of facts upon which reliance was placed when the
parties entered into this transaction. If it is later determined that the provider knowingly rendered an
erroneous certification, in addition to other remedies available to the federal government, the
Alliance may pursue available remedies, including suspension and /or debarment.
3.The provider will provide immediate written notice to the Contract Manager if at any time the
provider learns that its certification was erroneous when submitted or has become erroneous by
reason of changed circumstances. The provider may decide the method and frequency by which it
determines the eligibility of its principals. Each participant to a lower tier covered transaction may,
but is not required to, check the Excluded Parties List System (EPLS).
4.The provider will include a "Certification Regarding Debarment, Suspension, Ineligibility and
Voluntary Exclusion - Lower Tier Covered Transaction" in all its lower tier covered transactions and in
all solicitations for lower tier covered transactions.
.The provider agrees that it shall not knowingly enter into any lower tier covered transaction with a
person who is debarred, suspended, determined ineligible or voluntarily excluded from participation,
unless otherwise authorized by the federal government.
6.If the provider knowingly enters into a lower tier covered transaction with a person who is
suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in
addition to other remedies available to the federal government, the Alliance may pursue available
remedies, including suspension, and /or debarment.
7.The provider may rely upon a certification of a prospective participant hi a lower tier covered
transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered
transaction, unless it knows that the certification is erroneous.
,4
Contract Number KC 1371
ASSURANCES —NON- CONSTRUCTION PROGRAMS
ATTACHMENT VIII
Public reporting burden for this collection of information is estimated to average 45 minutes per
response, includin time for reviewing instructions searching existing data sources gathering and
maintaining the ata needed and completing ana reviewing the collection of information. Send
comments regarding the burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden, to the Office of Management and Budget. Paperwork Reduction
Project (0348 -0043) , Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND
BUDGET, SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
Note: Certain of these assurances may not be applicable to your project or program. If you have questions please
contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to
additional assurances. If such is the case, you will be notified.
l .Has the legal authority to apply for Federal assistance, and the institutional, managerial and financial capability
(including funds sufficient to pay the non - Federal share of project cost) to ensure proper planning, management, and
completion of the project described in this application.
2.Will give the awardin g agency, the Comptroller General of the United States, and if appropriate, the State,
through any authorized representative, access to and the right to examine all records, books, papers, or
documents related to the award; and will establish a proper accounting system in accordance with generally
accepted accounting standards or agency directives.
3.Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or
presents the appearance of personal or organizational conflict of interest, or personal gain.
4.Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding
agency.
5.Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C.. 4728 -4763) relating to prescribed
standards for merit systems for programs funded under one of the 19 statutes or regulations specified in
Appendix A of OPM's Standards for a Merit System of Personnel Administration (5 C.F.R. 900, Subpart F).
6.Will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title
VI of the Civil Rights Act of 1964 (P.L. 88 -352) which prohibits discrimination on the basis of race, color or
national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C.. 1681 -1683, and 1685-
1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as
amended (29 U.S.C.794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act
of 1975, as amended (42 U.S.C.. 6101 - 6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse
Office and Treatment Act of 1972 (P.L. 92 -255), as amended, relating to nondiscrimination on the basis of drug
abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970
(P.L. 91 -616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g). 523 and 527
of the Public Health Service Act of 1912 (42 U.S.C.. 290 dd -3 and 290 ee 3), as amended, relating to confidentiality of
alcohol and drug abuse patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C.. 3601 et seq.), as
amended, relating to nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination
provisions in the specific statute(s) under which application for Federal assistance is being made; and (j) the
requirements of any other nondiscrimination statute(s) which may apply to the application.
7.Will comply, or has already complied, with the requirements of Titles II and III of the uniform Relocation
Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91 -646) which provide for fair and equitable
treatment of persons displaced or whose property is acquired as a result of Federal or federally assisted programs.
These requirements apply to all interests in real property acquired for project purposes regardless of Federal
participation in purchases.
8.Will comply, as applicable, with the provisions of the Hatch Act (5 U.S.C.. 1501 -1508 and 7324 - 7328), which limit the
political activities of employees whose principal employment activities are funded in whole or in part with Federal
funds.
25
Contract Number KC 1371
9.Will comply, as applicable, with the provisions of the Davis -Bacon Act (40 U.S.C..276a to 276a -7), the Copeland
Act (40 U.S.C. 276c and 18 U.S.C. 874) and the Contract Work Hours and Safety Standards Act (40 U.S.C. 327 -333),
regarding labor standards for federally assisted construction subagreements.
10.Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster
Protection Act of 1973 (P.L. 93 -234) which requires recipients in a special flood hazard area to participate in the
program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000.00 or
more.
11.Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution
of environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91 -190) and
Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of
wetlands pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (e)
assurance of project consistency with the approved State management program developed under the Coastal
Zone Management Act of 1972 (16 U.S.C..1451 et seq.); (f) conformity of Federal actions to State (Clear Air)
Implementation Plans under Section 176(c) of the Clear Air Act of 1955, as amended (42 U.S.C..7401 et seq.);
(g) protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as
amended, (P.L. 93 -523); and (h) protection of endangered species under the Endangered Species Act of 1973, as
amended, (P.L. 93 -205).
12 Will comply with the Wild and Scenic Rivers Act of 1968 components of the national wild and scenic rivers
system. (16 U.S.C..1721 et seq.) related to protecting components or potential
13.Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation
Act of 1966, as amended (16 U.S.C..470), EO 11593 (identification and protection of historic properties), and the
Archaeological and Historic Preservation Act of 1974 (16 U.S.C..469a -1 et seq.).
14.Will comply with P.L. 93 -348 regarding the protection of human subjects involved in research, development,
and related activities supported by this award of assistance.
15.Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89 -544, as amended, 7 U.S.C..2131 et seq.)
pertaining to the care, handling, and treatment of warm blooded animals held for research, teaching, or other
activities supported by this award of assistance.
16.Will comply with the Lead -Based Paint Poisoning Prevention Act (42 U.S.C..4801 et seq.), which prohibits the
use of lead- based paint in construction or rehabilitation of residence structures.
17.Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act
Amendments of 1996 and OMB Circular No. A -133, Audits of States, Local Governments, and Non -Profit
Organizations.
18.Will comply with all applicable requirements of all other Federal laws, executive orders, regulations and
policies governing this program.
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL
TI
MAYOR
GEORGE NEUGENT
APPLICANT ORGANIZATION
DATE SUBMITTED
MONROE COUNTY BOARD OF COUNTY CONI IISSIONERS
2. 013
(SEAL)
A ►u�r H�,a lua, cLe�c 26
MO E C UNTY 0 N
ROV D A
NE Y
_ ASSIST NT C Nom`' A� 31/� ,✓
-- � _ - --
Contract Number KC 1371
ATTACHMENT IX
STATE OF FLORIDA ALLIANCE OF ELDER AFFAIRS
CIVIL RIGHTS COMPLIANCE CHECKLIST
Program /Facility Name CCE GRANT
County
MONROE
Provider MONROE COUNTY
130AM OF COUNTY
COM1vII%IONERS
Address 1100 SIMONTON STREET
Completed By: KIM WEAN
City, State, Zip Code; KEY WEST, FL. 33040
Date: 5/30/13
Telephone: (305)292-4588
PART I. READ THE ATTACHED INSTRUCTIONS FOR ILLUSTRATIVE INFORMATION WHICH WILL HELP YOU IN
THE COMPLETION OF THIS FORM.
1. Briefly describe the geographic area served by the program/ facility and the type of service provided: The entire Florida
Keys (Monroe County, approximately 120 miles) which are considered rural with some urban characteristics. Services
MCIHS will provide with this grant are: case management, homemak perso care a r espite.
2 PnPT TT ATTC)N T C) ARFA ';FRVFT)_ Snu rcp of data:
Total# — - -v
% White
% Black
% Hispanic
% Other
% Female
% Disabled
% Over 40
73,165
723%
5.7
19.6%
2.0%
46.6%
0%
100%
3 STAFF CURREN'T'LY EMPLOYED. Effective date: 4/1/2013
Total#
%White
%Black
% Hispanic
% Other
% Female
% Disabled
% Over 40
20
70%
30%
1%
0%
80%
0%
100%
4. CLIENTS CURRENTLY ENROLLED OR REGISTERED Effective date: 5/30/13
Total#
% White
% Black
% Hispanic
% Other
% Female
% Disabled
% Over 40
285
86.8%
12.2%
16%
71%
72%
100
100%
5. ADVISORY OR GOVERNING BOARD, IF APPLICABLE.
Total #
% White
% Black
% Hispanic
% Other
% Female
% Disabled
5
100
0%
0%
0%
60
0
PART IL USE A SEPARATE SHEET OF PAPER FOR ANY EXPLANATIONS REQUIRING MORE SPACE.
6. Is an Assurance of Compliance on file with the Alliance? If NA or NO explain
NA YES (X) NO
7. Compare the staff composition to the population. Is staff representative of the population? If NA
or NO, explain.
NA YES (X) NO
8. Compare the client composition to the population. Are race and sex characteristics representative
of the Population? If NA or NO, explain. NA YES (X) NO &�A
27 j 3.13.
Contract Number KC 1371
9. Are eligibility requirements for services applied to clients and applicants without
regard to race, color, national origin, sex, age, religion or disability? If NA or NO,
explain.
NA YES (X) NO
10. Are all benefits, services and facilities available to applicants and participants in an equall y
effective manner regardless of race, sex, color, age, national origin, religion or disability? It NA or
NO, explain.
NA YES NO (X) Allgrants /programs under the AAA that we provide services for are for people 60 and under.
11. For in- patient services are room assignments made without regard to race, color, national origin
or disability? If NA or PTO, explain.
NA (X) YES NO
12. Is the program /facility accessible to non - English speaking clients? If NA or NO, explain.
NA YES ( X) NO
13. Are employ
explain. ees applicants and participants informed of their protection against
discri n. ation� It yes, how? Verbal ❑ Written ❑ Poster ❑ If NA or NO,
FO-1
0 1 Contract Number KC 1371
14. Give the number and current status of any discrimination complaints
regarding services or employment filed against the program / facility. Z E:K0
15. Is the proggrram /facility physically accessible to mobility, hearing, and sight - impaired individuals?
If NA or IVO, explain.
NA&O
PART III. THE FOLLOWING QUESTIONS APPLY TO PROGRAMS AND FACILITIES WITH 15 OR MORE EMPLOYEES
❑ ❑
16. Has a self - evaluation been conducted to identify any barriers to serving disabled
individuals, and to make any necessary modifications? If NO, explain.
yts
17. Is there and established grievance procedure that incorporates due process in
the resolution of complaints? If NO, explain.
ES
YES NO
18. Has a person been designated to coordinate Section 504 compliance activities? If YES NO
NO, explain.
Q ZD
19. Do recruitment and notification materials advise applicants, employees and
participants of nondiscrimination on the basis of disability? If NO, explain.
�5
29
Contract Number KC 1371
❑■
20. Are auxiliary aids available to assure accessibility of services to hearing and
sight impaired individuals? If NO, explain.
■■
PART IV. FOR PROGRAMS OR FACILITIES WITH 50 OR MORE EMPLOYEES AND FEDERAL CONTRACTS OF $50,000 OR
MORE.
21. Do you have a written affirmative action plan? If NO, explain.
1L�
DOEA USE ONLY
Reviewed By
Incompliance: YES ❑ NO* ❑
Program Office
"Notice of Corrective Action Sent
Date
Telephone
Response Due
On -Site n Desk Review n
r esponse Received
DOEA Form 101 -A, Revised May 2013 Page 2 of 2
30
Contract Number KC 1371
ATTACHMENT IX
INSTRUCTIONS FOR THE CIVIL RIGHTS COMPLIANCE CHECKLIST
1.Describe the geographic service area such as a district, county, city or other locality. If the program /facility
serves a specific target population such as adolescents, describe the target population. Also, define the type of
service provided.
2.Enter the percent of the population served by race and sex. The population served includes persons in the
geographical area for which services are provided such as a city, county or other regional area. Population
statistics can be obtained from local chambers of commerce, libraries, or any publication from the 1980 Census
containing Florida population statistics. Include the source of your population statistics. ( "Other" races
include Asian/Pacific Islanders and American Indian/Alaskan Natives.)
3.Enter the total number of full-time staff and their percent by race, sex and disability. Include the effective
date of your summary.
4.Enter the total number of clients who are enrolled, registered or currently served by the program or facility,
and list their percent by race, sex and disability. Include the date that enrollment was counted.
5.Enter the total number of advisory board members and their percent by race, sex, and disability. If there is
no advisory or governing board, leave this section blank.
6.Each recipient of federal financial assistance must have on file an assurance that the program will be
conducted in compliance with all nondiscriminatory provisions as required in 45 CFR 80. This is usually a
standard part of the contract language for DOEA recipients and their sub - grantees, 45 CFR 80.4 (a).
7.1s the race, sex, and national origin of the staff reflective of the general population? For example, if 10% of
the population is Hispanic, is there a comparable percentage of Hispanic staff?
8.Where there is a significant variation between the race, sex or ethnic composition of the clients and their
availability in the population, the program /facility has the responsibility to determine the reasons for such
variation and take whatever action may be necessary to correct any discrimination. Some legitimate
disparities may exist when programs are sanctioned to serve target populations such as elderly or disabled
persons, 45 CFR 80.3 (b) (6).
9. Do eligibility requirements unlawfully exclude persons in protected groups from the provision of services
or employment? Evidence of such may be indicated in staff and client representation (Questions 3 and 4) and
also through on -site record analysis of persons who applied but were denied services or employment, 45 CFR
80.3 (a) and45CFR80.1 (b) (2).
l O.Participants or clients must be provided services such as medical, nursing and dental care, laboratory
services, physical and recreational therapies, counseling and social services without regard to race, sex, color,
national origin, religion, age or disability. Courtesy titles, appointment scheduling and accuracy of record
keeping must be applied uniformly and without regard to race, sex, color, national origin, religion, age or
disability. Entrances, waiting rooms, reception areas, restrooms and other facilities must also be equally
available to all clients, 45 CFR 80.3 (b).
31
CONTRACT KC 1371 Page 32
11.For in- patient services, residents must be assigned to rooms, wards, etc., without regard to race, color,
national origin or disability. Also, residents must not be asked whether they are willing to share
accommodations with persons of a different race, color, national origin, or disability, 45 CFR 80.3 (a).
12.The program /facility and all services must be accessible to participants and applicants, including those
persons who may not speak English. In geographic areas where a significant population of non - English
speaking people live, program accessibility may include the employment of bilingual staff. In other areas, it is
sufficient to have a policy or plan for service, such as a current list of names and telephone numbers of
bilingual individuals who will assist in the provision of services, 45 CFR 80.3 (a).
13.Programs /facilities must make information regarding the nondiscriminatory provisions of Title
VI available to their participants, beneficiaries or any other interested parties. This should include
information on their right to file a complaint of discrimination with either the Florida Alliance of
Elder Affairs or the U.S. Alliance of HHS. The information may be supplied verbally or in writing to
every individual, or may be supplied through the use of an equal opportunity policy poster
displayed in a public area of the facility, 45 CFR 80.6 (d).
14.Report number of discrimination complaints filed against the program/ facility. Indicate the basis,
e.g., race, color, creed, sex, age, national origin, disability, retaliation; the issues involved, e.g.,
services or employment, placement, termination, etc. Indicate the civil rights law or policy alleged to
have been violated along with the name and address of the local, state or federal agency with whom
the complaint has been filed. Indicate the current status, e.g., settled, no reasonable cause found,
failure to conciliate, failure to cooperate, under review, etc.
15.The program/ facility must be physically accessible to disabled individuals. Physical accessibility
includes designated parking areas, curb cuts or level approaches, ramps and adequate widths to
entrances. The lobby, public telephone, restroom facilities, water fountains, information and
admissions offices should be accessible. Door widths and traffic areas of administrative offices,
cafeterias, restrooms, recreation areas, counters and serving lines should be observed for
accessibility. Elevators should be observed for door width, and Braille or raised numbers. Switches
and controls for light, heat, ventilation, fire alarms, and other essentials should be
installed at an appropriate height for mobility impaired individuals.
16.Section 504 of the Rehabilitation Act of 1973 requires that a recipient of federal financial assistance
conduct a self - evaluation to identify any accessibility barriers. Self- evaluation is a four step process:
-With the assistance of a disabled individual/ organization, evaluate current practices and
policies which do not comply with Section 504.
-Modify policies and practices that do not meet Section 504 requirements.
-Take remedial steps to eliminate any discrimination that has been identified.
-Maintain self- evaluation on file. (This checklist may be used to satisfy this requirement if
these four steps have been followed.), 45 CFR 84.6.
17.Programs or facilities that employ 15 or more persons must adopt grievance procedures that
incorporate appropriate due process standards and provide for the prompt and equitable resolution
of complaints alleging any action prohibited by Section 504.45 CFR 84.7 (b).
18.Programs or facilities that employ 15 or more persons must designate at least one person to
coordinate efforts to comply with Section 504.45 CFR 84.7 (a).
32
'I 1 11 CONTRACT KC 1371 Page 33
19.Continuing steps must be taken to notify employees and the public of the program/ facility's
policy of nondiscrimination on the basis of disability. This includes recruitment material, notices for
hearings, newspaper ads, and other appropriate written communication, 45 CFR 84.8 (a).
20.Programs /facilities that employ 15 or more persons must provide appropriate auxiliary aids to
persons with impaired sensory, manual or speaking skills where necessary. Auxiliary aids may
include, but are not limited to, interpreters for hearing impaired individuals, taped or Braille
materials, or any alternative resources that can be used to provide equally effective services, (45 CFR
84.52 (d).
21.Programs /facilities with 50 or more employees and $50,000 in federal contracts must develop,
implement and maintain a written affirmative action compliance program in accordance with
Executive Order 11246.41 CFR 60 and Title VI of the Civil Rights Act of 1964, as amended.
33
,* I
ATACHMENT X
CONTRACT KC 1371
Verification of Employment Status Certification
Page 34
As a condition of contracting with the Alliance for Aging, Inc., Monroe County Board of
Commissioners, hereby referred to as contractor, certifies the use of the U.S. Department of Homeland
Security's E -verify system to verify the employment eligibility of all new employees hired by Contractor
during the contract term to perform employment duties pursuant to this Agreement and (b) that any
subcontracts include an express requirement that subcontractors performing work or providing services
pursuant to this Agreement utilize the E -verify system to verify the employment eligibility of all new
employees hired by the subcontractor during the contract term.
Signature
(Same as contract signature)
MAYOR
Title
MONROE COUNTY BOARD OF COUNTY
COMMISSIONERS
Company Name
"
l y
2. 0 13
Date
(SEAL)'
ATTEST -GAMY HEA/ILIN, CLERK
E CLERK
34
CONTRACT KC 1371
ATTACHMENT XI
Alliance for Aging, Inc.
Business Associate Agreement
Page 35
This Business Associate Agreement is dated , by the Alliance for Aging, Inc
( "Covered Entity ") and _MONROE COUNTY BOCC , (`Business Associate "), a not - for - profit Florida
corporation.
1.0 Background.
1.1 Covered Entity has entered into one or more contracts or agreements with Business Associate
that involves the use of Protected Health Information (PHI).
1.2 Covered Entity, recognizes the requirements of the Health Insurance Portability and
Accountability Act of 1996 ( HIPAA) and has indicated its intent to comply in the County's Policies and Procedures.
1.3 HIPAA regulations establish specific conditions on when and how covered entities may share
information with contractors who perform functions for the Covered Entity.
1.4 HIPAA requires the Covered Entity and the Business Associate to enter into a contract or
agreement containing specific requirements to protect the confidentiality and security of patients' PHI, as set forth
in, but not limited to the Code of Federal Regulations (C.F.R.), specifically 45 C.F.R. §§ 164.502(e), 164.504(e),
164.308(b), and 164.314(a- b)(2010) (as may apply) and contained in this agreement.
1.5 The Health Information Technology for Economic and Clinical Health Act (2009), the American
Recovery and Reinvestment Act (2009) and Part I — Improved Privacy Provisions and Security provisions located
at 42 United States Code (U.S.C.) §§ 17931 and 17934 (2010) require business associates of covered entities to
comply with the HIPAA Security Rule, as set forth in, but not limited to 45 C.F.R. §§ 164.308, 164.310, 164.312,
and 164.316 (2009) and such sections shall apply to a business associate of a covered entity in the same manner
that such sections apply to the covered entity.
The parties therefore agree as follows:
2.0 Definitions. For purposes of this agreement, the following definitions apply:
2.1 Access. The ability or the means necessary to read, write, modify, or communicate
data /information or otherwise use any system resource.
2.2 Administrative Safeguards. The administrative actions, and policies and procedures, to
manage the selection, development, implementation, and maintenance of security measures to protect electronic
Protected Health Information (ePHI) and to manage the conduct of the covered entity's workforce in relation to the
protection of that information.
2.3 ARRA. The American Recovery and Reinvestment Act (2009)
2.4 Authentication. The corroboration that a person is the one claimed.
2.5 Availability. The property that data or information is accessible and useable upon demand by an
authorized person.
2.6 Breach. The unauthorized acquisition, access, use, or disclosure of PHI which compromises the
security or privacy of such information.
35
CONTRACT KC 1371 Page 36
2.7
individuals.
Compromises the Security. Posing a significant risk of financial, reputational, or other harm to
2.8 Confidentiality. The property that data or information is not made available or disclosed to
unauthorized persons or processes.
2.9 Electronic Protected Health Information.(ePHI) Health information as specified in 45 CFR
§160.103(1)(i) or (1)(ii), limited to the information created or received by Business Associate from or on behalf of
Covered Entity.
2.10 HITECH. The Health Information Technology for Economic and Clinical Health Act (2009)
2.11 Information System. An interconnected set of information resources under the same direct
management control that shares common functionality. A system normally includes hardware, software,
information, data, applications, communications, and people.
2.12 Integrity. The property that data or information have not been altered or destroyed in an
unauthorized manner.
2.13 Malicious software. Software, for example, a virus, designed to damage or disrupts a system.
2.14 Part I. Part I — Improved Privacy Provisions and Security provisions located at 42 United States
Code (U.S.C.) §§ 17931 and 17934 (2010).
2.15 Password. Confidential authentication information composed of a string of characters.
2.16 Physical Safeguards. The physical measures, policies, and procedures to protect a covered
entity's electronic information systems and related buildings and equipment, from natural and environmental
hazards, and unauthorized intrusion.
2.17 Privacy Rule. The Standards for Privacy of Individually Identifiable Health Information at 45 CFR
Part 160 and Part 164, subparts A and E.
2.18 Protected Health Information. (PHI) Health information as defined in 45 CFR §160.103, limited
to the information created or received by Business Associate from or on behalf of Covered Entity.
2.19 Required By Law. Has the same meaning as the term "required by law" in 45 CFR § 164.103.
2.20 Secretary. The Secretary of the Department of Health and Human Services or his or her
designee.
2.21 Security incident. The attempted or successful unauthorized access, use, disclosure,
modification, or destruction of information or interference with system operations in an information system.
2.22 Security or Security measures. All of the administrative, physical, and technical safeguards in
an information system.
2.23 Security Rule. The Security Standards for the protection of Electronic Protected Health
Information at 45 CFR part 164, subpart C, and amendments thereto.
2.24 Technical Safeguards. The technology and the policy and procedures for its use that protect
electronic protected health information and control access to it.
2.25 Unsecured PHI. Protected health information that is not secured through the use of technology or
methodology specified by the Secretary in guidance issued under 42 U.S.C. section 17932(h)(2).
2.26 All other terms used, but not otherwise defined, in this Agreement shall have the same meaning
as those terms in the Privacy Rule.
we
CONTRACT KC 1371 Page 37
3.0. Obligations and Activities of Business Associate.
3.1 Business Associate agrees to not use or disclose PHI other than as permitted or required by this
agreement or as Required by Law.
3.2 Business Associate agrees to:
(a) Implement policies and procedures to prevent, detect, contain and correct Security
violations in accordance with 45 CFR § 164.306;
(b) Prevent use or disclosure of the PHI other than as provided for by this Agreement or as
required by law;
(c) Reasonably and appropriately protect the confidentiality, integrity, and availability of the
ePHI that the Business Associate creates, receives, maintains, or transmits on behalf of the Covered Entity; and
(d) Comply with the Security Rule requirements including the Administrative Safeguards,
Physical Safeguards, Technical Safeguards, and policies and procedures and documentation requirements set
forth in 45 CFR §§ 164.308, 164.310, 164.312, and 164.316.
3.3 Business Associate agrees to mitigate, to the extent practicable, any harmful effect that is known
to Business Associate of a use or disclosure of PHI by Business Associate in violation of the requirements of this
Agreement.
3.4 Business Associate agrees to promptly report to Covered Entity any use or disclosure of the PHI
not provided for by this Agreement of which it becomes aware. This includes any requests for inspection, copying
or amendment of such information and including any security incident involving PHI.
3.5 Business Associate agrees to notify Covered Entity without unreasonable delay of any security
breach pertaining to:
(a) Identification of any individual whose unsecured PHI has been, or is reasonably believed
by the Business Associate to have been, accessed, acquired, or disclosed during such security breach; and
(b) All information required for the Notice to the Secretary of HHS of Breach of Unsecured
Protected Health Information.
3.6 Business Associate agrees to ensure that any agent, including a subcontractor, to whom it
provides PHI received from, or created or received by Business Associate on behalf of Covered Entity, agrees to
the same restrictions and conditions that apply through this Agreement to Business Associate with respect to such
information.
3.7 If Business Associate has PHI in a Designated Record Set:
(a) Business Associate agrees to provide access, at the request of Covered Entity during
regular business hours, to PHI in a Designated Record Set, to Covered Entity or, as directed by Covered Entity, to
an individual in order to meet the requirements under 45 CFR §164.524; and
(b) Business Associate agrees to make any amendment(s) to PHI in a Designated Record
Set that the Covered Entity directs or agrees to pursuant to 45 CFR § 164.526 at the request of Covered Entity or
an Individual within 10 business days of receiving the request.
3.8 Business Associate agrees to make internal practices, books, and records, including policies and
procedures and PHI, relating to the use and disclosure of PHI received from, or created or received by Business
Associate on behalf of Covered Entity, available to the Covered Entity or to the Secretary upon request of either
for purposes of determining Covered Entity's compliance with the Privacy Rule.
3.9 Business Associate agrees to document such disclosures of PHI and information related to such
disclosures as would be required for Covered Entity to respond to a request by an individual for an accounting of
disclosures of PHI in accordance with 45 CFR § 164.528.
37
9 1 11 • 6
CONTRACT KC 1371
Page 38
3.10 Business Associate agrees to provide to Covered Entity or an individual, upon request,
information collected to permit Covered Entity to respond to a request by an Individual for an accounting of
disclosures of PHI in accordance with 45 CFR § 164.528 and ARRA § 13404.
3.11 Business Associate specifically agrees to use security measures that reasonably and
appropriately protect the confidentiality, integrity, and availability of PHI in electronic or any other form, that it
creates, receives, maintains, or transmits on behalf of the Covered Entity.
3.12 Business Associate agrees to implement security measures to secure passwords used to access
ePHI that it accesses, maintains, or transmits as part of this Agreement from malicious software and other man-
made and natural vulnerabilities to assure the availability, integrity, and confidentiality of such information.
3.13 Business Associate agrees to implement security measures to safeguard ePHI that it accesses,
maintains, or transmits as part of this agreement from malicious software and other man -made and natural
vulnerabilities to assure the availability, integrity, and confidentiality of such information.
3.14 Business Associate agrees to comply with:
(a) ARRA § 13404 (Application of Knowledge Elements Associated with Contracts);
(b) ARRA § 13405 (Restrictions on Certain Disclosures and Sales of Health Information); and
(c) ARRA § 13406 (Conditions on Certain Contacts as Part of Health Care Operations).
4.0 Permitted Uses and Disclosures by Business Associate. Except as otherwise limited in this
Agreement or any related agreement, Business Associate may use or disclose PHI to perform functions, activities,
or services for, or on behalf of, Covered Entity as specified in any and all contracts with Covered Entity provided
that such use or disclosure would not violate the Privacy Rule if done by Covered Entity or the minimum
necessary policies and procedures of the Covered Entity.
5.0 Specific Use and Disclosure Provisions.
5.1 Except as otherwise limited in this agreement or any related agreement, Business Associate may
use PHI for the proper management and administration of the Business Associate or to carry out the legal
responsibilities of the Business Associate.
5.2 Except as otherwise limited in this agreement or any related agreement, Business Associate may
disclose PHI for the proper management and administration of the Business Associate, provided that disclosures
are Required By Law, or Business Associate obtains reasonable assurances from the person to whom the
information is disclosed that it will remain confidential and used or further disclosed only as Required By Law or
for the purpose for which it was disclosed to the person, and the person notifies the Business Associate of any
instances of which it is aware in which the confidentiality of the information has been breached.
5.3 Business Associate may use PHI to provide data aggregation services to Covered Entity as
permitted by 45 CFR §164.504(e)(2)(i)(B), only when specifically authorized by Covered Entity.
5.4 Business Associate may use PHI to report violations of law to appropriate Federal and State
authorities, consistent with 45 CFR §164.502(j)(1).
6.0 Obligations of Covered Entity.
6.1 Covered Entity shall notify Business Associate of any limitation(s) in its notice of privacy practices
of Covered Entity in accordance with 45 CFR § 164.520, to the extent that such limitation may affect Business
Associate's use or disclosure of PHI, by providing a copy of the most current Notice of Privacy Practices (NPP) to
Business Associate as Attachment XI to this Agreement. Future Notices and /or modifications to the NPP shall be
posted on Covered Entity's website at www.alliancefora-gin.g.org
6.2 Covered Entity shall notify Business Associate of any restriction to the use or disclosure of PHI
that Covered Entity has agreed to in accordance with 45 CFR § 164.522, to the extent that such restriction may
affect Business Associate's use or disclosure of PHI.
38
9 , � ,,
CONTRACT KC 1371
Page 39
7.0 Permissible Requests by Covered Entity. Except for data aggregation or management and
administrative activities of Business Associate, Covered Entity shall not request Business Associate to use or
disclose PHI in any manner that would not be permissible under the Privacy Rule if done by Covered Entity.
8.0 Effective Date and Termination.
8.1 The Parties hereby agree that this agreement amends, restates and replaces any other Business
Associate Agreement currently in effect between Covered Entity and Business Associate and that the provisions
of this agreement shall be effective as follows:
(a) These Business Associate Agreement provisions, with the exception of the electronic
security provisions and the provisions mandated by ARRA, HITECH and Part I shall be effective upon the later of
April 14, 2003, or the effective date of the earliest contract entered into between Business Associate and Covered
Entity that involves the use of PHI;
(b) The electronic security provisions hereof shall be effective the later of April 21, 2005 or
the effective date of the earliest contract entered into between Business Associate and Covered Entity that
involves the use of PHI; and
(c) Provisions hereof mandated by ARRA, HITECH and /or Part I shall be effective the later of
February 17, 2010 or the effective date of the earliest contract entered into between covered entity and business
associate that involves the use of PHI or ePHI.
8.2 Termination for Cause. Upon Covered Entity's knowledge of a material breach by Business
Associate, Covered Entity shall either:
(a) Provide an opportunity for Business Associate to cure the breach or end the violation and
terminate this agreement if Business Associate does not cure the breach or end the violation within the time
specified by Covered Entity;
(b) Immediately terminate this agreement if Business Associate has breached a material term
of this Agreement and cure is not possible; or
Secretary. (c) If neither termination nor cure is feasible, Covered Entity shall report the violation to the
8.3 Effect of Termination. Except as provided in subparagraph (b) of this section, upon termination
of this agreement, for any reason, Business Associate shall return all PHI and ePHI received from Covered Entity,
or created or received by Business Associate on behalf of Covered Entity.
(a) This provision shall apply to PHI and ePHI that is in the possession of subcontractors or
agents of Business Associate. Business Associate shall retain no copies of the PHI and ePHI.
(b) In the event that Business Associate or Covered Entity determines that returning the PHI
or ePHI is infeasible, notification of the conditions that make return of PHI or ePHI infeasible shall be provided to
the other party. Business Associate shall extend the protections of this Agreement to such retained PHI and ePHI
and limit further uses and disclosures of such retained PHI and ePHI, for a minimum of six years and so long as
Business Associate maintains such PHI and ePHI, but no less than six (6) years after the termination of this
agreement.
9.0 Regulatory References. A reference in this agreement to a section in the Privacy Rule or
Security Rule means the section then in effect or as may be amended in the future.
10.0 Amendment. The Parties agree to take such action as is necessary to amend this agreement
from time to time as is necessary for Covered Entity to comply with the requirements of the Privacy Rule, the
Security Rule and the Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104 -191.
39
CONTRACT KC 1371 Page 40
10.0 Amendment. The Parties agree to take such action as is necessary to amend this agreement
from time to time as is necessary for Covered Entity to comply with the requirements of the Privacy Rule, the
Security Rule and the Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104 -191.
11.0 Survival. Any term, condition, covenant or obligation which requires performance by either party
hereto subsequent to the termination of this agreement shall remain enforceable against such party subsequent to
such termination.
12.0 Interpretation. Any ambiguity in this agreement shall be resolved to permit Covered Entity to
comply with the Privacy Rule and Security Rule.
13.0 Incorporation by reference. Any future new requirement(s), changes or deletion(s) enacted in
federal law which create new or different obligations with respect to HIPAA privacy and /or security, shall be
automatically incorporated by reference to this Business Associate Agreement on the respective effective date(s).
14.0 Notices. All notices and communications required, necessary or desired to be given pursuant to
this agreement, including a change of address for purposes of such notices and communications, shall be in
writing and delivered personally to the other party or sent by express 24 -hour guaranteed courier or delivery
service, or by certified mail of the United States Postal Service, postage prepaid and return receipt requested,
addressed to the other party as follows (or to such other place as any party may by notice to the others specify):
To Covered Entity: Alliance for Aging, Inc.
Attention: Max Rothman
760 NW 107 Avenue
Miami, Florida 33172
To Business Associate: MONROE COUNTY BOCC
_SOCIAL SERVICES /IN HOME SERVICES PROGRAM
1100 SIMONTON STREET, KEY WEST, FL. 33040
Any such notice shall be deemed delivered upon actual receipt. If any notice cannot be delivered or delivery
thereof is refused, delivery will be deemed to have occurred on the date such delivery was attempted.
15.0 Governing Law. The laws of the State of Florida, without giving effect to principles of conflict of
laws, govern all matters arising under this agreement.
16.0 Severability. If any provision in this agreement is unenforceable to any extent, the remainder of
this agreement, or application of that provision to any persons or circumstances other than those as to which it is
held unenforceable, will not be affected by that unenforceability and will be enforceable to the fullest extent
permitted by law.
17.0 Successors. Any successor to Business Associate (whether by direct or indirect or by purchase,
merger, consolidation, or otherwise) is required to assume Business Associate's obligations under this agreement
and agree to perform them in the same manner and to the same extent that Business Associate would have been
required to if that succession had not taken place. This assumption by the successor of the Business Associate's
obligations shall be by written agreement satisfactory to Covered Entity.
18.0 Entire Agreement. This agreement constitutes the entire agreement of the parties relating to the
subject matter of this agreement and supersedes all other oral or written agreements or policies relating thereto,
except that this agreement does not limit the amendment of this agreement in accordance with
agreement.
Covered Entity:
By: —
Business
By. ;
(signature
Date: JUN 2 S 2013
Z.
COUNTY,
4-C
EO �EUGENT, MAYOR
AMY HEA 1 N, CLEQ //
g
DEPu i r CLERK
Date: