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o 1 �� CLERK OF CIRCUIT COURT & COMPTROLLER
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DATE: October 24, 2013 -
TO: Sheryl Graham, Director
Social Services Department
ATTN: Dotti Albury ,
In-Home Services Programs
FROM: Vitia Fernandez, D.C.
At the September 17, 2013,. Board of County Commissioner's meeting the Board granted
approval and authorized execution of the following items:
Item C13 Aged and Disabled Adult Medicaid Waiver(ADA-MW) Referral Agreement between the
Alliance for Aging, Inc. and the Monroe County Board of County Commissioners (Social Services/In-
Home Services) for Home Delivered Meals.
Item C14 Renewal of the Home and Community Based- Medicaid Waiver (ADA-MW) Referral
Agreement between the Alliance for Aging, Inc. and Monroe County Board of County Commissioners
(Monroe County Bayshore Manor) for Facility Based Respite.
Enclosed are six (6) 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 duplicate originals as
soon as possible. Should you have any questions,please do not hesitate to contact our office.
cc: County Attorney w/o document
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
HOME AND COMMUNITY BASED SERVICES
AGED AND DISABLED ADULT (ADA) MEDICAID WAIVER
REFERRAL AGREEMENT
This Referral Agreement between the Alliance for Aging, Inc., the Area Agency on Aging (AAA) for
Planning and Service Area (PSA) 11 and Monroe County Social Services/In Home
Services the Service Provider, shall begin on January 1, 2013 or on the date
the agreement has been signed by both parties, whichever is later. This referral agreement is in effect
for a period of time that is equal to the Medicaid waiver provider's enrollment period with the State of
Florida's Medicaid fiscal agent and is contingent upon an annual appropriation by the Legislature. One
purpose of this agreement is to promote the development of a coordinated service delivery system to
meet the needs of the aged or disabled adults who are at risk of premature institutionalization. Another
purpose of this agreement is to enable eligible elderly participants to receive home and community based
services from qualified providers with oversight of the quality of care by the Medicaid Waiver Specialist
employed by the AAA. These services are authorized in order that the participant may remain in the
least restrictive setting and avoid or delay premature nursing home placement. Services and care are to
be furnished in a way that fosters the independence of each participant to facilitate aging in place. All
parties agree that routines of care provision and service delivery must be consumer driven to the
maximum extent possible. All parties agree to and will treat each participant with dignity and respect.
I. Objectives
A. To maintain a climate of cooperation and consultation with and between agencies, in order to
achieve maximum efficiency and effectiveness.
B. To participate together by means of shared information in the development of services.
C. To promote programs and activities designed to prevent the premature institutionalization of
elders and disabled adults.
D. All parties recognize that the consumer retains the right to assume risk, tempered only by the
individual's ability to assume responsibility for that risk.
E. All parties recognize that the consumer retains the right to choose which enrolled provider he/she
will receive services from.
F. To require the parties of this Agreement to provide technical assistance and consultation to each
other on matters pertaining to actual service delivery and share appropriate assessment
information and care plans so duplication may not occur.
G. To establish an effective working relationship between the case management agency that is
responsible for the development of care plans and authorization of services available under the
waiver, the service provider that is responsible for the direct provision of those services to
consumers served under the waiver program, and the AAA that is responsible for management
and oversight of the waiver program.
II. Under this Agreement, the Service Provider agrees to the following:
A. To accept referrals for the 1915c Home and Community -Based Services - ADA Medicaid
Waiver from the enrolled case management agency.
B. To provide quality service(s) to the waiver participant as specified in Section IV., Provision of
service(s), subject to quality monitoring and/or observation by the case management agency
and/or the AAA and/or the Department of Elder Affairs (the "department").
C. To provide only those services specifically outlined in the Plan of Care and authorized by the
enrolled case management agency.
D. Notify the AAA of any change of ownership action at least 90 days prior to the effective date of
closing. Medicaid Waiver provider numbers are non-transferrable.
E. To attach documentation regarding the service provider's qualifications to this agreement; and to
provide, as requested, any information regarding Medicaid Waiver billing, payment, or waiver
participant information, to the case management agency or AAA. Provider rates shall not
exceed the approved negotiated rates that are at or below the service provider's usual and
customary rates. If additional services are to be added to this agreement, a written request to
do so must be received by the AAA. If approved, an amendment must be prepared by the AAA
indicating the service(s) to be added. The necessary documentation regarding provider
qualifications for the additional services must be attached to the agreement.
F. To maintain the waiver participant's confidentiality according to 42 CFR 431.301.
G. Adhere to requirements contained in the Health Insurance Portability and Accountability Act
(HIPPA), as applicable, and to maintain the waiver participant's confidentiality.
H. To immediately report any changes in the waiver participant's condition to the case
management agency.
I. To maintain enrolled provider status by renewing applicable licensure, certification, contract
and/or referral agreements and by maintaining all provider qualifications as contained in the
Aged and Disabled Adult Medicaid Waiver under which services are provided.
J. Provide copies of all licensure, certification to the AAA to ensure provider qualification as per
the Florida Medicaid Aged and Disabled Adult Waiver Services Coverage and Limitations
Handbook.
K. To include its name and other appropriate information on a list of all enrolled providers which
will be shown to consumers during development of an individualized plan of care,
understanding that the consumer reserves the right at all times to a choice of enrolled
providers.
L. To immediately notify the case management agency of staffing shortfalls that will negatively
impact provision of service to Medicaid Waiver consumers.
M. To submit claim data for billing to the Medicaid fiscal agent after delivery of services has been
accomplished. All services should be billed within 60 days after services have been provided or
document reasons for delayed submission of claims. Such documentation shall be available for
review by the area agency on agency or by the department, upon request.
N. To submit claims for billing to the Medicaid fiscal agent at the agency's contracted rate, as per
page 5 of this agreement.
O. To submit voided or adjusted claims no later than 45 days after either party has identified the
error. The provider's refusal to adjust or void erroneous claims may result in termination of this
agreement and/or referral to the department, and will be referred by the department to the
Agency for Health Care Administration for appropriate action.
P. To develop and implement a policy to ensure that its employees, board members, and
management, will avoid any conflict of interest or the appearance of a conflict of interest when
disbursing or using the funds described in this agreement. A conflict of interest includes, but is
not limited to, receiving, or agreeing to receive, a direct or indirect benefit, or anything of value
from a service provider, consumer, vendor, or any person wishing to benefit from the use or
disbursement of funds. To avoid a conflict of interest, the service provider must ensure that all
individuals make a disclosure to the AAA of any relationship which may be a conflict of interest,
within thirty (30) days of an individual's original appointment or placement on a board, or if the
individual is serving as an incumbent, within thirty (30) days of the commencement of the
agreement.
Q. To report any significant changes in the waiver participant's condition to the case
management agency as soon as the provider becomes aware of such changes or within 48
hours, whichever is earlier.
R. To report adverse incidents that affect the health, safety & welfare of a client to the Case
Management agency within 48 hours of its occurrence using the required reporting template as
provided by the AAA. Adverse incidents may include injury such as death, brain or spinal
damage, permanent disfigurement, fracture or dislocation of bones or joints, any condition
requiring medical attention to which the client has not given informed consent, any condition
that requires the transfer of the client within or outside an ALF or consumer's residence to a unit
providing a more acute level of care due to the adverse incident not related to the client's
condition prior to the incident, abuse, neglect or exploitation, resident elopement or an event
that is reported to law enforcement (does not include Baker Act transport or deaths by natural
causes).
S. To report any adverse incidents involving abuse, neglect, and exploitation to the Department of
Children & Families (DCF).
T. Participate in training arranged by the AAA, the Department, Department of Children and
Families and/or Agency for Health Care Administration, as required.
U. To review and correct any CIRTS exception reports submitted by the AAA monthly by the
stipulated time frame.
V. To adhere to the federal waiver requirements and the policies and procedures outlined in the
following manuals published by the Agency for Health Care Administration: the Florida
Medicaid Aged and Disabled Adult Waiver Services Coverage and Limitations Handbook, Aged
and Disabled Adult Waiver Procedure Codes and Fee Schedule, Aged and Disabled Adult
Waiver Incontinence Fee Schedule and Quality Standards, and the Florida Medicaid Provider
General Handbook, Department of Elder Affairs Programs and Services Handbook including
any and all attachments or updates.
W. If the Service Provider is enrolled as a home delivered meals vendor, the Area Agency will
retain the services of a registered dietitian to perform the following:
1. Conduct site inspections of all catering facilities. These may be unannounced.
2. Monitor meal delivery times and temperatures.
3. Review all menus submitted by the service provider and suggest changes as needed.
4. Work with the service provider to ensure that standardized recipes and computer -assisted
nutritional analyses are carried out.
X. Comply with any additional ADA Medicaid Waiver service provider related requests for
information from the Department regarding implementation of the Statewide Medicaid Managed
Care Program (SMMCLTC).
Y. To provide a home -like setting and community integration to all Medicaid Waiver consumers
receiving ADA Medicaid Waiver services in an ALF. The ALF provider shall support the consumer's
community inclusion and integration by working with the consumer and the consumer's Case
Manager to facilitate the integration of the consumer's personal goals and community activities.
Additional services must be offered as follows, unless medical, physical, or cognitive impairments
restrict or limit exercise of these options:
1. Private or semi -private rooms
2. Roommate for semi -private rooms
3. Locking door to living unit
4. Access to telephone and length of use
5. Eating schedule
6. Participation in facility and community activities
7. Ability to have unlimited snacks as desired, maintain personal sleeping schedule, prepare
snacks as desired, maintain personal sleeping schedule
The ALF provider must be in compliance with the consumer's Resident Bill of Rights.
Z. The AAA may impose department -approved sanctions for non-compliance with the
terms of this agreement.
Indemnification
1. To the extent set forth in Florida Statute 768.28, service provider agrees to indemnify,
defend, and hold harmless the AAA, and all of the AAA's officers, agents, and employees
and the department and all of the department's officers, agents, and employees from any
claim, loss, damage, cost, charge, or expense arising out of any acts, actions, neglect or
omission, action in bad faith, or violation of federal or state law by the service provider, its
agents or employees, during the performance of this agreement.
2. Service Provider obligation to indemnify, defend, and pay for the defense or, at the AAA's
and/or department's option, to participate and associate with the AAA and/or department in
the defense and trial of any claim and any related settlement negotiations, shall be triggered
by the AAA's and/or department's notice of claim for indemnification to service provider.
Service provider's inability to evaluate liability or its evaluation of liability shall not excuse
service provider's or's duty to defend and indemnify the AAA and/or department, upon notice
by the AAA and/or department. Notice shall be given by registered or certified mail, return
receipt requested. Only an adjudication or judgment after the highest appeal is exhausted
specifically finding the AAA and/or department solely negligent shall excuse performance of
this provision by service providers. The service provider shall pay all costs and fees related
to this obligation and its enforcement by the AAA and/or department. The AAA's or
department's failure to notify the service provider of a claim shall not release service provider
of the above duty to defend.
3. It is the intent and understanding of the parties that neither the service provider, nor any of its
employees are employees of the AAA or the department and shall not hold themselves out
as employees or agents of the AAA or department without specific authorization from the
AAA or department. It is the further intent and understanding of the parties that the AAA or
department does not control the employment practices of the service provider and shall not
be liable for any wage and hour, employment discrimination, or other labor and employment
claims against the service provider.
III. Under this Agreement, the Area Agency on Aging agrees to the following:
A. To ensure that new and existing waiver service providers initially meet and continue to meet waiver
service provider qualifications.
B. To offer technical assistance or necessary training to all ADA Medicaid Waiver service providers
enrolled in the ADA Medicaid Waiver program for the purpose of administering the program.
C. To assist the Department in conducting monitoring and other related management/administrative
functions for compliance with state and federal laws and rules governing waiver program
operations.
D. To report any adverse incident reports to the Department within 48 hours of the AAA being
notified by the case management agency.
E. To develop and maintain written policies and procedures, as necessary, to ensure necessary
performance standards.
F. To assist the ADRC in maintaining the APPL (waitlist) for Medicaid Home and Community Based
Waiver Service Programs.
G. Assist the Department in reporting follow-up for substantiated reports of abuse, neglect, and
exploitation within 10 working days of receipt.
H. To review and correct the CIRTS exception reports monthly and provide the Department with a
summary of the resolutions, as requested.
1
IV. Under this agreement, the following services will be delivered by the Service provider
in accordance with the plan of care or service authorization:
Service
Unit Rate
County/Region Served
A. Home Delivered Meals $5.00 per meal Monroe
B.
C.
D.
E.
V. Termination
In the event this agreement is terminated, the case management agency and the service provider agree
to submit, at the time notice of intent to terminate is delivered, a plan which identifies procedures to
ensure services to consumers will not be interrupted or suspended by the termination.
A. Termination at Will
This agreement may be terminated by any party upon no less than thirty (30) calendar days
notice, without cause, unless a lesser time is mutually agreed upon by both parties, in writing.
Said notice shall be delivered by certified mail, return receipt requested, or in person with proof
of delivery.
B. Termination Because of Lack of Funds
In the event funds to finance this agreement become unavailable, the area agency may
terminate this agreement upon no less than twenty-four (24) hours notice in writing to the other
party. Said notice shall be delivered by certified mail, return receipt requested, or in person with
proof of delivery. The area agency shall be the final authority as to the availability of funds.
C. Termination for Breach
Unless a breach is waived by the area agency in writing, or the parties fail to cure the breach
within the time specified by the area agency, the area agency may, by written notice to the
parties, terminate the agreement upon no less than twenty-four (24) hours notice. Said notice
shall be delivered by certified mail, return receipt requested, or in person with proof of delivery.
In witness whereof, the parties have caused this 4 page agreement to be executed by their undersigned
officials as duly authorized.
Max B. Rothman, JD, LL.M.
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