Item C13BOARD OF COUNTY COMMISSIONERS
C ounty of M onroe A(I Mayor George Neugent, District 2
T he Fl orida Keys 4� �� m Mayor Pro Tem David Rice, District 4
l Danny L. Kolhage, District 1
„ Y
„; ° W Heather Carruthers, District 3
Sylvia J. Murphy, District 5
County Commission Meeting
August 16, 2017
Agenda Item Number: C.13
Agenda Item Summary #3272
BULK ITEM: Yes DEPARTMENT: Social Services
TIME APPROXIMATE: STAFF CONTACT: Sheryl Graham (305) 292 -4510
No
AGENDA ITEM WORDING: Approval of Amendment 4001 to Standard Contract 4AA -1729,
Older Americans Act (OAA) between the Alliance for Aging, Inc., (AAA) and the Monroe County
Board of County Commissioners/Monroe County Social Services /In -Home Services and Nutrition
Programs for the contract period of 1/1/2017 through 12/31/2017 in the amount of $637,986.44.
This is an increase in funding of $14,721.94 which reflects 2016 Carry Forward Funding and new
2017 funding allocations.
ITEM BACKGROUND: The OAA program is a Federally funded initiative that provides
assistance to older persons and caregivers. It is the only Federal supportive services program
directed solely toward improving the lives of older people and assisting them in remaining in their
homes as opposed to being prematurely institutionalized.
PREVIOUS RELEVANT BOCC ACTION: Approval by BOCC on 12/14/2016 of Standard
Contract 4AA -1729, Older Americans Act (OAA) between the Alliance for Aging, Inc., (AAA) and
the Monroe County Board of County Commissioners/Monroe County Social Services /In -Home
Services and Nutrition Programs for the contract period of 1/1/2017 through 12/31/2017 in the
amount of $637,986.44.
CONTRACT /AGREEMENT CHANGES:
Additional Funding
STAFF RECOMMENDATION: Approval
DOCUMENTATION:
Agenda Item
BACKUP OAA Contract Pages 1 -50
BACKUP OAA Contract Pages 51 -71
FINANCIAL IMPACT:
Effective Date: 1/1/2017
Expiration Date: 12/31/2017
Total Dollar Value of Contract: $637,986.44
Total Cost to County: 10% Cash Match
Current Year Portion:
Budgeted: YES
Source of Funds: Grant and Cash Match
CPI: NO
Indirect Costs: N/A
Estimated Ongoing Costs Not Included in above dollar amounts:
Revenue Producing: NO If yes, amount: N/A
Grant: YES
County Match: 10% Cash Match
Insurance Required: NO
Additional Details: N/A
08/16/17 NEW COST CENTER ADDED
125- 6153017
REVIEWED BY:
$637,986.44
Sheryl Graham
Completed
08/01/2017 5:55 PM
Pedro Mercado
Completed
08/01/2017 6:06 PM
Budget and Finance
Completed
08/02/2017 8:17 AM
Maria Slavik
Completed
08/02/2017 8:51 AM
Kathy Peters
Completed
08/02/2017 9:18 AM
Board of County Commissioners
Pending
08/16/2017 9:00 AM
AMENDMENT 001 CONTRACT AA -1 Pa
THIS AMENDMENT is entered into between the Alliance of Aging, Inc. hereinafter referred to as the "Alliance",
and Monroe County Board of County Commissioners, Social Services/In-Home Services, hereinafter referred to as
the "Contractor", and collectively referred to as the "Parties."
im-11 11 111 1 . 0 If 11 a I . 0 :
Iro"' "WrIll m8mxm���
3ES funding. To amend the current co"ntraic to retlect tne ZAb Larry i-uF7arb'V7M_*9_
funding allocations. Some of these funds are recurring and the others are nonrecurring.
Services
I Mi,
R-fflm=
Personal Care - 11111•
U.S. Health and Human Services
$2,867.61i
$2,103.78
Nutrition Education - C1
$762.31
$237.69
$1,000.00
Nutrition Counseling - C1
$1,498.39
$467.21
$1,965.60
Home Delivered Meals - Hot C2
$1,126.54;�
$373.46
$1,500-00
Home Delivered Meals - Frozen C2
$416.33
i�� $138.01
$554.34
Respite In-Facility - 3E
i S1,153.72
$4,628.41�
$5,782.13
Chore - 3ES
$1,453.7Z i
$1,816.09
ME=
$623,264.50 to $637,986.44
Fr rAT+"T I i I N 9 L W 9
The Alliance shall make payment to the provider for the provision of services up to a maximum number
of units of service and at the rate(s) stated on page two:
Prepared on 07/03/2017
U.S. Health and Human Services
$228679.97
Older American Act Administration
Title III E-Caregiver Support Services
0
ry
, Title III ES-Care ye�St�pporILSe 'ices
TOTAL FEDERAL AWARD
The Alliance shall make payment to the provider for the provision of services up to a maximum number
of units of service and at the rate(s) stated on page two:
Prepared on 07/03/2017
$2,103.78
$1,000.00
$1,965.60
$1,500.00
$554.34
$5,782.13
$1,816.09
k1wWww"
Non-Recur Recurring
Nutrition Edu. 1,000.00 0.34 237.69 762.30
Nutrition Couns. 1 0.66 467.21 1,498.39
2,965.60 1.00 704.90 2,260.69
Non-Recur Recurring
HDM - Hot 1,500.00 0.73 373.46 1,126.54
HDM - Frozen 554.34 0.27 138,01 416.33
2,054.34 1.00 511.47 1,542.87
Monroe County Board of County ALLIANCE FOR AGING, INC.
Commissioners, Social Services/in-Home
Services
SIGNED BY: SIGNED BY:
I
Ma FjLq1)MX1XV_*jgjV 0
OLDER AMERICANS ACT PROGRAM TITLE III
THIS CONTRACT is entered into between the Alliance for Aging, Inc., hereinafter referred to as the "Alliance," and
Monroe County Board of County Commissioners, Social Services/In-Home Services, hereinafter referred to as the
"Provider", and collectively referred to as the "Parties." The term contractor for this purpose may designate a vendor,
sub-grantee or sub-recipient, the status to be further identified in ATTACHMENT 111, Exhibit-2 as necessary.
1. Purpose of Contract
The purpose of this contract is to provide services in accordance with the terms and conditions specified in this
contract including all attachments and exhibits, which constitute the contract document.
3. Incorporation of Documents within the Contract
The contract incorporates by reference attachments, proposal(s), solicitation(s), Provider's Service Provider
Application, and the current DOEA Programs and Services Handbook. Any and all contracts or agreements executed
between the Provider and the Alliance during the effective period of this contract shall be governed in accordance
with the applicable laws and statutes.
Page 1 of 71
5. Term of Contract
This contract shall begin on January 1, 2017 or on the date on which the contract has been signed by the last party
required to sign it, whichever is later. It shall end at midnight, local time in Miami, Florida, on December 31, 2017,
unless renewed or extended as provided herein.
The parties shall re-evaluate the contract's reimbursement rates on an annual basis pursuant to DOEA's Notice of
Policy Clarification: Service Cost Reports Notice 4092815-1-PC-SC BS dated September 28"', 2015 and the approv&
Alliance's Reimbursement Rate Review Policy.
This contract may be extended upon mutual agreement for one extension period not to exceed six months to ensure
continuity of service. Services provided under this extension will be paid for out of the succeeding agreement
amount.
8.1 This contract contains federal funds. The following shall apply:
82. The Provider shall not employ oo unauthorized alien. The Alliance shall consider the cmn|o}unou1mf
����d��u����1� u�����A�(8U, S.C. l324� a ~ 1�
f�fhrozand (�cmbo|/�otoflQ86(0T].SI.]lOD. Such vio 'shall ' c cause for uni cance llation -`=----'
this contract by the Alliance.
83. DF the Provider inu provi and iu subject tn Internal Revenue Service (IRS) tax exempt
organization reporting requirements (filing u Form 9yOor Form /gO0-Nl and has d exempt
U
for failing to with the filing requirements nfthe 2006 Pension ' P rotection Act nr for any other reason,
the Provider must notify the Alliance iu writing within thirty (]0) days ofrecei the IRS notice of
0.4. The Provider shall comply with Title 2 CFR Part 175 regarding Trafficking in Persons.
0.5. Unless exempt under 2 CFR Part 170.1 10(b) the Provider shall comply with the reporting of the
Transparency Act as expressed in 2 CFR 170.
9.1. This contract ia executed and entered into iu the State of ' construed, - and
enforced io all rcmpeo�io accordance ���bthe Fgodduku�bno di Florida a �-~"------
yI The Provider shall comply with the requirements of s. 287.058 F.S. as amended.
contract except for those records which are made confidential or exempt by law. The Provider's refusal
to comply with this provision shall constitute an immediate breach of contract for which the Alliance fo
Aging, Inc. may unilaterally terminate the contract.
9.3. If clients are to be transported under this contract, the Provider shall comply with the provisions of Chapter
427, F.S., and Rule 41-2, F. A. C.
9.4. Subcontractors who are on the discriminatory vendor list may not transact business with any public entity, in
accordance with the provisions of s. 2 87.13 4, F. S.
10.1. The Provider shall ensure that the requirements of s. 430.0402 and Chapter 435, F.S., as amended, are met
regarding background screening for all persons who meet the definition of a direct service provider and who
are not exempt from the Department's level 2 background screening pursuant to s. 430.0402(2) -(3), F. The
Provider must also comply with any applicable rules promulgated by the Department and the Agency for
Health Care Administration regarding implementation of s. 430.0402 and Chapter 435, F.S.
10.2. Further information concerning the procedures for background screening is found at
sta
fl, L S o ba 1� i
10.3. Background Screening Affidavit of Compliance - To demonstrate compliance with this contract, the Provider
shall submit ATTACHMENT D, Background Screening Affidavit of Compliance annually, by January 15th.
11. Grievance Procedures
The Provider shall comply with and ensure subcontractor compliance with the Minimum Guidelines for Recipient
Grievance Procedures, Appendix D, DOEA Programs and Services Handbook, to address complaints regarding the
termination, suspension or reduction of services, as required for receipt of funds.
" M I
12.1 The Provider shall establish and maintain books, records and documents (including electronic storage media)
sufficient to reflect all assets, obligations, unobligated balances, income, interest and expenditures of funds
provided by the Alliance under this contract. Provider shall adequately safeguard all such assets and assure
they are used solely for the purposes authorized under this contract. Whenever appropriate, financial
information should be related to performance and unit cost data.
12.2 The Provider shall retain all client records, financial records, supporting documents, statistical records, and an
other documents (including electronic storage media) pertinent to this contract for a period of six (6) years aft
completion of the contract or longer when required by law. In the event an audit is required by this contract
records shall be retained for a minimum period of six (6) years after the audit report is issued or until resolutic
of any audit findings or litigation based on the terms of this contract, at no additional cost to the Alliance.
12.3 Upon demand, at no additional cost to the Alliance, the Provider will facilitate the duplication and transfer of
any records or documents during the required retention period in Paragraph 12.2.
12.4 The Provider shall assure that the records described in Paragraph 12.2 shall be subject at all reasonable times I
inspection, review, copying, or audit by Federal, State, or other personnel duly authorized by the Alliance.
12.5 At all reasonable times for as long as records are maintained, persons duly authorized by the Alliance, DOEA
and Federal auditors, pursuant to 45 CF R 92.36(1)(10), shall be allowed full access to and the right to examine
any of the Provider's contracts and related records and documents pertinent to this specific contract, regardle&
of the form in which kept.
12.6 The Provider shall provide a financial and compliance audit to the Alliance as specified in this contract and in
ATTACHMENT III and to ensure that all related party transactions are disclosed to the auditor.
12.7 The Provider shall comply and cooperate immediately with any inspections, reviews, investigations, or audits
deemed necessary by the office of the DOEA's Inspector General pursuant to s. 20.055, F.S.
13.3 The Provider shall establish procedures pursuant to federal law to handle complaints of discrimination
involving services or benefits through this contract. These procedures will include notifying clients,
employees, and participants of the right to file a complaint with the appropriate federal or state entity.
13.4 If this contract contains federal funds, these assurances are a condition of continued receipt of or benefit from
federal financial assistance, and are binding upon the Provider, its successors, transferees, and assignees for th(
I �-- "
17.1 Except to the extent permitted by s. 768.28, F.S., or other Florida law, Paragraph 15 is not applicable to
contracts executed between the Alliance and state agencies or subdivisions defined in s. 768.28(2), F.S.
Page 6 of 71
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the Alliance has copy of the most current written verification of insurance coverage throughout the to of thi!
contract. Such coverage may be provided by a self-insurance program established and operating under the law
of the State of Florida. The Alliance reserves the right to require additional insurance as specified in this
contract.
18.2 Throughout the term of this agreement, the Provider shall maintain an insurance bond from a responsible
commercial insurance company covering all officers, directors, employees and agents of the Provider
authorized to handle funds received or disbursed under all agreements and/or contracts incorporating this
contract by reference in an amount commensurate with the funds handled, the degree of risk as determined by
the insurance company and consistent with good business practices.
19. Confidentiality of Information
The Provider shall not use or disclose any information concerning a recipient of services under this contract for any
purpose prohibited by state or federal law or regulations except with the written consent of a person legally
authorized to give that consent or when authorized by law.
20. Health Insurance Portability and Accountability Act
Where applicable, the Provider shall comply with the Health Insurance Portability and Accountability Act (42 USC
1320d.), as well as all regulations promulgated thereunder (45 CF R 160, 162, and 164).
UAUMEMBC�Zy
21.1 The Provider shall notify the Alliance immediately but no later than forty-eight (48) hours from the Provider's
awareness or discovery of conditions that may materially affect the Provider or Subcontractor's ability to
perform the services required to be performed under any contract. Such notice shall be made orally to the
Contract Manager (by telephone) with an email to immediately follow.
21.2 The Provider shall immediately report knowledge or reasonable suspicion of abuse, neglect, or exploitation of
a child, aged person, or disabled adult to the Florida Abuse Hotline on the statewide toll free telephone number
(1-800-96ABUSE). As required by Chapters 39 and 415, F.S., this provision is binding upon the Provider,
Subcontractors, and their employees.
23.2 The Provider shall not use the words "The State of Florida Department of Elder Affairs" or "Alliance for
Aging, Inc." to indicate sponsorship of a program otherwise financed, unless specific authorization has been
obtained by the Alliance prior to use.
24. Assignments
24.1 The Provider shall not assign the rights and responsibilities under this Contract without the prior written
approval of the Alliance, which shall not be unreasonably withheld. Any sublicense, assignment, or transfer
otherwise occurring without prior written approval of the Alliance will constitute a material breach of the
contract.
24.2 The Alliance shall at all times be entitled to assign or transfer, in whole or part, its rights, duties, or obligations
under this contract to another agency upon giving prior written notice to the Provider. In the event the Allianc,
approves transfer of the Provider's obligations, the Provider remains responsible for all work performed and al
expenses incurred in connection with the contract.
24.3 This contract shall remain binding upon the successors in interest of either the Provider or the Alliance.
25. Subcontracts
25.1 The Provider is responsible for all work performed pursuant to this contract and the Service Provider
Application in response to the 2012 OAA RFP. Any subcontracts shall be evidenced by a written document
and subject to any conditions of approval the Alliance for Aging deems necessary. The Provider further agreeE
that the Alliance shall not be liable to the subcontractor in any way or for any reason. The Provider, at its
expense, shall defend the Alliance against any such claims.
25.2 The Provider shall promptly pay any subcontractors upon receipt of payment from the Alliance. Failure to
make payments to any subcontractor in accordance with s. 287.0585, F.S., unless otherwise stated in the
contract between the Provider and subcontractor, will result in a penalty as provided by statute.
26.1 The Alliance acknowledges its obligation to pay the Provider for the performance of the Provider's duties and
responsibilities set forth in any contract or agreement incorporating in this agreement.
26.2 The Alliance shall not be liable to the Provider for costs incurred or performance rendered unless such costs
and performances are in accordance with the terms and conditions of any contract or agreement executed
between the parties, which incorporates this Contract, including but not limited to terms, governing the
Provider's promised performance and unit rates and/or reimbursement capitations specified.
26.3 The Alliance shall not be liable to the Provider for any expenditures which are not allowable costs as defined in
the C.F.R., Title 45, Parts 74 and 92, as amended, or which expenditures have not been made in accordance
with all applicable state and federal rules.
26.4 The Alliance shall not be liable to the Provider for expenditures made in violation of regulations promulgated
under the Older Americans Act, as amended, or in violation of applicable state and federal laws, rules, or
provisions of any contract or agreement incorporating in this Contract.
28-2. The Provider agrees to submit bills for fees or other compensation for services or expenses in sufficient detail
for a proper pre audit and post audit thereof. The contractor shall comply with the particular requirements
under the following laws and guidelines that are applicable to the contracts or agreements incorporating in this
Contract by reference: (a) paragraph (16) (b) of section 216.181, F. S., regarding advances; (b) Rule 691-40,103
F.A.C. pertaining to Restriction of Expenditures from state funds; and, (c) the Invoice Requirements of the
Reference Guide for State Expenditures from the Department of Financial Services at:
b -M� f tcLudk�-'—ft a. l° _, '� -) If
28.3. The Provider and Subcontractors shall provide units of deliverables, including reports, findings, and drafts as
specified in the contracts or agreements and attachments which incorporate this Contract to be received and
accepted by the Contract Manager prior to payment.
28.4. Payments will be made to the Provider based on a complete and correct invoice, invoices that are incomplete or
with incorrect total will not be processed and will be returned to the Provider for correction. Fiscal staff will
not be able to correct or make changes to the invoices. Returning invoices for corrections may result in failure
to receive payment for that month. Invoices shall be submitted timely as per ATTACHMENT VIII in order to
avoid any payment delays.
28.5. Each service performed shall be recorded as specified in the client information and registration tracking system
(CIRTS) guidelines. Supporting documentation of services provided must be adequate to permit fiscal and
programmatic evaluation, and ensure internal management.
29. Return of Funds
The Provider will return to the Alliance any overpayments due to unearned funds or funds disallowed and any
interest attributable to such funds pursuant to the terms and conditions of this contract that were disbursed to the
.,
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.,
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consultant under a contract with any public entity; and may not transact business with any public entity in excess of
the threshold amount provided in s. 287.017, F.S., for CATEGORY TWO for a period of 36 months following the
date of being placed on the convicted vendor list.
7 M,
34.1 If the tasks to be performed pursuant to this contract include the physical care and control of clients, or the
administration and coordination of services necessary for client health, safety or welfare, the Provider shall,
within thirty (30) calendar days of the execution of this contract, submit to the Contract Manager verification
of an emergency preparedness plan (Continuity of Operations Plan.) In the event of an emergency, the
Provider shall notify the Alliance of emergency provisions.
36. The PUR 1000 Form is hereby incorporated by reference and available at:
bttj,z1_/ su - Llcdda.corn/app Y �g' �'77- ,PLJR
L_ � _ IDglumof
In the event of any conflict between the PUR 1000 Form and any terms or conditions of any contract or agreement
terms or conditions the contract shall take precedence over the PUR 1000 Form. However, if the conflicting terms or
conditions in the PUR 1000 Form are required by any section of the Florida Statutes, the terms or conditions
contained in the PUR 1000 Form shall take precedence.
37. Use of State Funds to Purchase or Improve Real Property
Any state funds provided for the purchase of or improvements to real property are contingent upon the Provider or
political subdivision granting to the state a security interest in the property at least to the amount of state funds
provided for at least 5 years from the date of purchase or the completion of the improvements or as further required
by law.
38. Dispute Resolution
Any dispute concerning performance of the contract shall be decided by the Contract Manager, who shall reduce the
decision to writing and serve a copy on the Provider.
39. Financial Consequences of Non-Performance
39.1 If the Provider fails to meet the minimum level of service or performance identified in this agreement, or that is
customary for the industry, then the Alliance may apply financial consequences commensurate with the
deficiency as referenced in ATTACHMENT 1, See. 3.5.2. Financial consequences may also include contract
suspension, refusing payment, withholding payments until deficiency is cured, tendering only partial payments,
and/or cancellation of contract and reacquiring services from an alternate source.
39.2 The Provider shall not be charged with financial consequences, when a failure to perform arises out of causes
that were the responsibility of the Alliance.
40. No Waiver of Sovereign Immunity
Nothing contained in this agreement is intended to serve as a waiver of sovereign immunity by any entity to which
sovereign immunity may be applicable.
41. Venue
If any dispute arises out of this contract, the venue of such legal recourse will be Miami-Dade County, Florida.
42. Entire Contract
This contract contains all the terms and conditions agreed upon by the parties. No oral agreements or representation,
shall be valid or binding upon the Alliance or the Provider unless expressly contained herein or by a written
amendment to this contract signed by both Parties.
43. Force Majeure
The Parties will not be liable for any delays or failures in performance due to circumstances beyond their control,
provided the party experiencing the force majeure condition provides immediate written notification to the other
party and takes all reasonable efforts to cure the condition.
44. Severability Clause
The Parties agree that if a court of competent jurisdiction deems any term or condition herein void or unenforceable,
the other provisions are severable to that void provision and shall remain in full force and effect.
45. Condition Precedent to Contract: Appropriations
The Parties agree that the Alliance's performance and obligation to pay under this contract is contingent upon an
annual appropriation by the Legislature.
46. Addition/ Deletion
The Parties agree that, notwithstanding the terms of the procurement documents and actions leading to this contract,
the Alliance reserves the right to add or to delete any of the services required under this contract when deemed to be
in the best interest of the elder population targeted by the Area Plan and reduced to a written amendment signed by
both Parties. The Parties shall negotiate compensation for any additional services added.
47. Waiver
The delay or failure by the Alliance to exercise or enforce any of its rights under this contract shall not constitute or
be deemed a waiver of the Alliance's right thereafter to enforce those rights, nor shall any single or partial exercise of
any such right preclude any other or further exercise thereof or the exercise of any other right.
48. Compliance
The Provider shall abide by all applicable current federal statutes, laws, rules and regulations as well as applicable
current State statutes, laws, rules and regulations. The Parties agree that failure of the Provider to abide by these
laws shall be deemed an event of default of the Provider, and subject the contract to immediate, unilateral
cancellation of the contract at the discretion of the Alliance.
50. Renegotiations or Modifications
Modifications of the provisions of this contract shall be valid only when they have been reduced to writing and duly
signed by both parties.
52. Termination
50.1 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 Contract Manager or the representative of the Provider responsible for administration
of the contract.
50.4 Failure to have performed any contractual obligations with the Alliance in a manner satisfactory to the Allianc(
will be a sufficient cause for termination. To be terminated as a contractor under this provision, the Provider
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.
50.5. Waiver of breach of any provisions of this contract shall not be deemed to be a waiver of any other breach and
shall not be construed to be a modification of the terms and conditions of this contract. The provisions herein
do not limit the Alliance's right to remedies at law or to damages of a legal or equitable nature.
53. 1. The Alliance's authorization pursuant to this section does not authorize electronic transactions between the
Provider and the Alliance. The Provider is authorized to conduct electronic transactions with the Alliance only
upon further written consent by the Alliance.
53.2. Upon request by the Alliance, the Provider shall provide the Alliance or DOEA with non-electronic (paper)
copies of records. Non - electronic (paper) copies provided to the Alliance of any document that was originally
in electronic form with an electronic signature must indicate the person and the person's capacity who
electronically signed the document on any non-electronic copy of the document.
54. Special Provisions:
The Provider agrees to the following provisions:
119��
55.1 In accordance with Section 430.04, F.S., the Alliance may, without taking any intermediate measures available
to it against this Contract rescind this Contract if the Alliance finds that:
55.2 An intentional or negligent act of the Provider has materially affected the health, welfare, or safety of clients
served pursuant to any contract or agreement incorporating this Master Contract by reference, or substantially
and negatively affected the operation of services covered under any contract or agreement;
55.3 The Provider lacks financial stability sufficient to meet contractual obligations or that contractual funds have
been misappropriated;
55.4 The Provider has committed multiple or repeated violations of legal and regulatory standards, regardless of
whether such laws or regulations are enforced by the Alliance, or the Provider has committed or repeated
violations of Alliance standards;
55.5 The Provider has failed to continue the provision or expansion of services after the declaration of a state of
emergency; and/or
55.6 The Provider has failed to adhere to the terms of any contract or agreement incorporating in this Contract.
55.7 In the alternative, the Alliance may, at its sole discretion, in accordance with section 430.04,F.S., take
immediate measures against the Provider, including: corrective action, unannounced special monitoring,
temporary assumption of the operation of one or more contractual services, placement of the Provider on
probationary status, imposing a moratorium on Provider action, imposing financial penalties for
nonperformance, or other administrative action pursuant to Chapter 120, F.S.
55.8 In making any determination under this provision the Alliance may rely upon the findings of another state or
federal agency, or other regulatory body. Any claims for damages for breach of any contract or agreement are
exempt from administrative proceedings and shall be brought before the appropriate entity in the venue of
Miami-Dade County.
56. Training
The Provider will attend all required trainings and meetings schedule by the Alliance.
005W
57, Official Payee and Representatives (Name, Address, and Telephone Numbers)
The name, address, and telephone number of the representative for the Alliance for this contract is:
Max B. Rothman, JD, LL.M. President and CEO
760 NW 107th Ave, Suite 214
Miami, Florida 33172
(305) 670-6500, Ext. 224
The name, address, and telephone number of the representative of the Contractor responsible for administration of the
program under this contract is:
The Contractor name, as shown on page I of this
A contract, and mailing address of the official
payee to whom the payment shall be made is:
The name of the contact person of the
B Contractor and street address where financial
and administrative records are maintained is:
The name, address, and telephone number of the
representative of the Provider responsible for
administration of the program under this
contract is:
The section and location within the AAA where
d Requests for Payment and Receipt and
Expenditure forms are to be mailed is:
The name, address, and telephone number of the
Contract Manager for the AAA for this contract
is:
Alliance for Aging, Inc.
Fiscal Department
760 NW 107th Avenue, Suite 214
Miami, Florida 33172-3155
305-670-6500
Contract Monitor
Alliance for Aging, Inc.
760 NW 107th Avenue, Suite 214
Miami, Florida 33172-3155
605-670-6500
Upon change of representatives (names, addresses, telephone numbers) by either party, notice shall be provided in
writing to the other party and the notification attached to the originals of this contract.
Wvfflffiw*�
By signing this contract, the Parties agree that they have read and agree to the entire contract.
IN WITNESS THEREOF, the Parties hereto have caused this 71 page contract, to be executed by their undersigned
officials as duly authorized.
SIGNED BY:
NAME:
TITLE:
DATE:
ATTACHMENT
ATTACHMENT DESCRIPTION
PAGE
ATTACHMENT I
STATEMENT OF WORK
19 -31
ATTACHMENT II
CERTIFICATION REGARDING LOBBYING
32
ATTACHMENT III
FINANCIAL COMPLIANCE AUDIT ATTACH
33 -35
ATTACHMENT III
AUDIT REPLATIONSHIP DETERMINATION
36 -37
EXHIBIT 1
ATTACHMENT III
FEDERAL RESOURCES AWARDED PURSUANT TO THIS
38
EXHIBIT 2
AGREEMENT
ATTACHMENT IV
CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE
39
ATTACHMENT V
CERTIFICATION REGARDING DEBARMENT, SUSPENSION,
40
INELIGIBILITY AND VOLUNTARY EXCLUSION
CONTRACTS /SUBCONTRACTS
ATTACHMENT VI
ASSURANCES - NON - CONSTRUCTION PROGRAMS
41 -42
ATTACHMENT VII
CONTRACT BUDGET SUMMARY BY SERVICE AND TITLE
43
ATTACHMENT VIII
OLDER AMERICANS ACT CONTRACT REPORT CALENDAR
44
ATTACHMENT I
REQUEST FOR PAYMENT
45
ATTACHMENT
RECEIPTS AND EXPENDITURES, TITLE 11113, IIIC 1, AND IIIC2
46
EXHIBIT I
ATTAC E X,
RECEIPTS AND EXPENDITURES, TITLE IIIE
47
EXHIBIT 2
ATTAC ENT A
DEPARTMENT OF ELDER AFFAIRS'PROGRAMS & SERVICES
48
HANDBOOK (ON Alliance FOR AGING, INC. INTERNET SITE)
ATTACHMENT B
DEPARTMENT OF ELDER AFFAIRS' CIVIL RIGHTS CO PLIANCE
49 -54
CHECKLIST AND INSTRUCTIONS
ATTACHMENT C
DEPARTMENT'S COMPUTER USE POLICY AND ITS SOCIAL MEDIA
55
POLICY, PROVIDED ON CD INSTRUCTIONS
ATTACHMENT D
BACKGROUND SCREENING - AFFIDAVIT OF COMPLIANCE
56
ATTACHMENT
VERIFICATION OF EMPLOYMENT STATUS C T F CATION
57
ATTACHMENT F
BUSINESS ASSOCIATE AGREEMENT
58 -64
ATTACHMENT G
ADRC POLICY AND PROCEDURES FOR OUTS CE FUNCTIONS
65-70
ATTACHMENT H
CERTIFICATION REGARDING SCRUTINIZED COMPANIES LIST
71
.,
1 o,,7m Fwmm
F-IT-
Alliance FOR AGING, INC.
STATEMENT OF WORK
OLDER AMERICANS ACT PROGRAM TITLE 11
ATTACHMENT
1.1 Alliance For Aging, Inc. Mission Statement
The Alliance mission is to promote and advocate for the optimal quality of life for older adults and their families.
Area Plan: A plan developed by the area agency on aging outlining a comprehensive and coordinated service
delivery system in its planning and service area in accordance with the Section 306 (42 U.S.C. 3026) of the Olde
Americans Act and DOEA instructions.
Area Plan Update: A revision to the area plan wherein the Alliance enters OAA specific data in the Client
Information and Registration Tracking System (CIRTS). An update may also include other revisions to the area
plan as instructed by the DOEA.
Child: An individual who is not more than 18 years of age or an individual with disability.
Family Caregiver: An adult family member, or another individual, who is an informal provider of in-home and
community care to an older individual.
Frail: When an older individual is unable to perform at least two activities of daily living (ADLs) without
substantial human assistance, including verbal reminding, physical cueing or supervision; or due to cognitive or
other mental impairment, requires substantial supervision because the individual behaves in a manner that poses
a serious health or safety hazard to the individual or to another individual.
Grandparent: A grandparent or step-grandparent of a child, or a relative of a child by blood, marriage or
adoption and who lives with the child is the primary caregiver of the child because the biological or adoptive
parents are unable or unwilling to serve as the primary caregiver of the child; and has a legal relationship to the
child, such as legal custody or guardianship, or is raising the child informally.
1. 3.2 Authority
In accordance with Chapter 287 F.S., amended, and Department of Financial Services' Chief Financial
Officer Memoranda, the following memoranda are hereby incorporated by reference:
(1) CFO Memo No. 02: Release date, October 3, 2012;
(2) CFO Memo No. 07: Release date, June 27, 2012;
(3) CFO memo No. 01: Release date, July 26, 2012; and
(4) CFO Memo No. 06: Release date, June 30, 2010.
1.3.3 Scope of Service
The Provider Is responsible for coordinating and assessing the needs of older persons, and assuring the
availability of quality services. The services shall be provided in a manner consistent with, and described in,
both the current DOEA Programs and Services Handbook and the Provider's Service Provider Application(s)
submitted in response to the 2012 OAA P.
1.3.4 Major Program Goals
The major goals of the OAA program are to improve the quality of life for older individuals, preserve their
independence and prevent or delay more costly institutional care. These goals are achieved through the
implementation of a comprehensive and coordinated service system that provides a continuum of service
alternatives that meet the diverse needs of elders and their caregivers.
1.4.1 General Description
Preference shall be given to those with the greatest economic and social needs, with particular attention to low-
income older individuals, including those that are low-income minorities, have limited English proficiency,
and older individuals residing in rural areas.
1.4.1.2 OAA Title RIB, Supportive Services, Client Eligibility
(1) Individuals age 60 or older
1.4.1.4 OAA Title RIC 1, Congregate Nutrition Services
0,009M
2. 1. 1 Supportive Services (111B Program)
Supportive services include a variety of community-based and home-delivered services that support the qualit3
of life for older 'individuals by helping them remain independent and productive.
2.1.1.1. Services include the following:
I -A -1 i
2.12 Use of Volunteers to Expand the Provision of Available Services
2.1.2.1 Use mf Volunteers to Expand the Provision ofAvailable Services
2.1.22 The Contractor shall submit uuannual unduplicated report of volunteer hours ou the tocnuut
by the Alliance. The data collection period i s from January l - December 31 for each cal endar -' prov -
The data submission date is 15 days following the close of the contract period.
2.1.3. Monitoring the Performance of Subcontractors
The Provider shall conduct at lea one monitnrin � per year Vf each auhcnotzaoto pa
funds provided under ddmcoo�uot. The Provider ]pn�oou�ucul,adouioim�o�programma
�-"--
uuou¢m�nQof each sub-contractor to ensure oouto�&za}monupUancc , accountability, -
prVgnaozmato
performance, and compliance with applicable state and federal laws and regulations.
2.1.4. Subcontractor Outreach Reporting Requirements
The Provider shall document its performance of outreach activities, -�--
b 4nud�rnu reporting tonoot
provided bv the AJUaocuthat includes the following: uuo�hsrnud type events
location; a1 suob '' ^ activities; -
puz��qpm�I event activity;
referral sources or information provided. The Provider shall complete and submit this report on outreach
U t 1..
activities at least semi-annually. Reports must be submitted by June 30 and December 31 of each contract
year.
2.2.1 Service Times
The Provider shall ensure the provision of the services listed in the contract during normal business hours
unless other times are more appropriate to meet the performance requirements of the contract, and it shall
monitor its subcontractors to ensure they are available to provide services during hours responsive to client
needs and during those times which best meet the needs of the relevant service community.
2.3.1 Services
The Provider shall provide the services described in the contract in accordance with the current DOEA
Program and Services Handbook. Units of service will be paid pursuant to the rates established in
ATTACHMENT 'III.
2.4 REPORTS
The Provider is responsible for responding in a timely fashion to additional routine and/or special requests for
information and reports required by the Alliance, The Provider must establish due dates for any subcontractors that
permit the Provider to meet the Alliance's reporting requirements.
2.4.2 Surplus/Deficit Report
The Provider will respond to the consolidated Surplus/Deficit report in a format provided by the
Alliance to the Alliance's contract manager. Surplus/Deficit reports must be submitted with the
monthly request for payment. This report is for all services provided in this agreement incorporating
in this Contract between the Provider and the Alliance. The report will include the following:
2.6 RECORDS AND DOCUMENTATION
The Provider shall maintain documentation to support Request for Payment that shall be available to the Alliance or
authorized individuals, such as DOEA and Department of Financial Services, upon request.
2.7.1 Outcomes and Outputs (Performance Measures) — At a minimum, the Provider must:
(1) Ensure the provision of the services described in this contract are in accordance with the current DOEA
Programs and Services Handbook and in the Manner of Service Provision described in this contract.
(2) Submit to the Alliance all information described in this contract.
(3) Develop and document strategies in the Service Provider Application (SPA) to support the Department's
performance outcome measures in the following criteria:
2.7.3 Remedies-Nonconforming Services
The Provider shall ensure that all participants served under this agreement are eligible for the program, and tha
all monthly and/or quarterly performance reports and financial records are maintained for each reporting perio(
and submitted as stipulated in 2.4, 2.5, 2.6, and 2.7.
2.8.2 Consumer Contributions
Consumer contributions are to be used under the following terms:
1) The Provider assures compliance with Section 315 of the OAA as amended in 2006, in regard to consumer
contributions;
2) Voluntary contributions are not to be used for cost sharing or matching;
3) Accumulated voluntary contributions are to be used prior to requesting federal reimbursement; and
4) Voluntary contributions are to be used only to expand services.
2.8.3 Use of Service Dollars
The Provider is expected to spend all federal, state and other funds provided by the Alliance for the purpose
specified in the contract. The Provider must manage the service dollars in such a manner so as to avoid having
a wait list and a surplus of funds at the end of the contract period, for each program managed by the Provider.
Program surpluses must be reported to the Alliance.
2.8.4 Surplus Recapture
In accordance with its surplus/deficit management policies, in order to maximize available funding and
minimize the time that potential clients must wait for services, the Alliance in its sole discretion can reduce
funding awards if the Provider is not spending according to monthly plans and is projected to incur a surplus at
the end of the year.
2.8.5 The Provider agrees to use funds as detailed in the Budget Summary, ATTACHMENT VII. Any changes in
the amounts of federal or general revenue funds identified on the Budget Summary fanir require a contract
amendment. Providers must adhere to Alliance's Modified Spending Policy
requesting changes to the budget Summary Form. , incorporated by reference, when
2.8.6 Title III Funds
The
Provider assures compliance with Section 306 of the Older Americans Act, as amended in 2006, that funds
received under Title III will not be used to pay any part of a cost (including an administrative cost) incurred by
the Provider to maintain a contractual or commercial relationship that is not carried out to implement Tilde 111.
2.9.1 Program Guidance and Technical Assistance
The Alliance will provide to the Provider guidance and technical assistance as needed to ensure the successful
fulfillment of the contract by the Provider. The Providers must attend all required training session and
meetings.
3.1 General Statement of Method of Payment
The Method of Payment for this contract is a combination of fixed-fee/unit rate, cost reimbursement, and advanced
payments, subject to the availability of funds. The Provider shall ensure include only those costs that 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.
3.2.1 The Provider may request up to two months of advances at the start of the contract period, if available, to cover
program service costs. The payment of an advance will be contingent upon the sufficiency and amount of
funds released to the Alliance. The Provider shall provide the Alliance documentation justifying the need for
an advance and describing how the funds will be distributed.
I
3.2.2 The Provider's requests for advance require the approval of the Alliance. If sufficient budget is available, the
Alliance will issue approved advance payments after January 1, 2017,
3.2.3 Requests for the first through the twelfth months shall be based on the submission of actual monthly
expenditure reports beginning with the first month of the contract. The schedule for submission of advance
requests, if available is shown on ATTACHMENT VIII of this contract.
3.2.4 All advanced payments made to the Provider shall be recouped in accordance with the Reporting Schedule,
ATTACHMENT VIII of this contract.
3.2.5 Interest earned on advances must be identified separately by source of funds, state or federal. Providers shall
maintain advances of federal funds in interest bearing accounts unless otherwise exempted in accordance with
45 CFR 74.22(k). Earned interest must be returned to the Alliance at the end of each quarter.
3.3 Invoice Submittal and Requests for Payment
3.3.1 All requests for payment and expenditure reports submitted to support requests for payment shall be on DOEA
forms 106A (ATTACHMENT IX), 105AS (ATTACHMENT X-EXHIBIT 1), an• 105AE (ATTACHMENT
X-EXHIBIT d 2).
3.3.2 The Provider shall submit all payment requests based on the submission of the Provider's actual monthly
expenditure reports beginning with the first month of the contract. The schedule for submission of advance
requests (when available) and invoices is ATTACHMENT VIII to this contract.
3.3.3 Any payment due by the Alliance under the terms of this contract may be withheld pending the receipt and
approval of all financial and programmatic reports due from the Provider and any adjustments thereto.
3.3.4 The Alliance will authorize payment only for allowable expenditures, which are in accordance with the limits
specified in ATTACHMENT VII, Budget Summary.
3.3.6 In order to properly manage the program budget, the Provider must submit invoices for payment no later than
90 days after the end of the month in which the expense was incurred, except that invoices cannot be submitted
after Close Out Report date. Invoices submitted late will require the approval of the Alliance's contract
manager. Approvals must be requested prior to the invoicing deadline. Late invoices will not be paid unless
justification is submitted and approved by the contract manager.
3.3.7 Date for Final Request for Payment
The Provider shall submit the final request for payment to the Alliance no later than 45 days after the contract
end date.
3.4.2 The Provider must enter all required data following EA's CIRTS Policy Guidelines for clients and services
in the CIRTS database. Data must be entered into CIRTS before the Providers submit their request for
payment and expenditure reports.
3.4.3 The Provider shall run monthly CIRTS reports and verify that client and service data in CIRTS is accurate.
This report must be submitted to the Alliance with the monthly request for payment and expenditure report and
must be reviewed by the Alliance before the Provider's request can be approved by the Alliance.
3.5. Remedies for Nonconforming Services
The Provider shall ensure that all goods and/or services provided under this contract are delivered timely, completely
and commensurate with required standards of quality. Such goods and/or services will only be delivered to eligible
program participants.
3.5.1. Corrective Action Plan
L Contractor shall ensure 100% of the deliverables Identified in ATTACHMENT 1, Section II (Manner of
Service Provision) of this contract, are performed pursuant to contract requirements.
�.
,'
.,
" -:- «
ATTACHMENT I
CERTIFICATION REGARDING L013BYING
CERTIFICATION FOR CONTRA T . GIP , , I J ��l
The undersigned certifies, to the best of his or her knowledge and belief, that:
(2) If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or
attempting t 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
i
with Its nstructions.
Signature
Date
Name of Authorized Individual Contract Number
MEMBOOMM,
ATTACHMENT III ATTACHMENT 11
FINANCIAL AND COMPLIANCE AUDIT
The administration of resources awarded by the Alliance to the Provider may be Subject to audits and/or monitoring by the
Alliance and/ortheDePailment as described in this section.
W
Th is Part is applicable if the Contractor is a non-state entity as defined by Section 215.97(2), F. S.
0090M
11. 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
Contractor &rectlyt each of the foll I
The Alliance at each of the following addresses: Alliance for Aging, Inc.
Attn: Fiscal Department
760 NW 107 Avenue
Suite 214
Miami, FL 33172
The Federal Audit Clearinghouse designated in ONM Circular A-133, as revised (the number of copies required by Sections .320
(d)(I) and (2), OMB Circular A-133, as revised, should be submitted to the Federal Audit Clearinghouse), at the following
address:
Federal Audit Clearinghouse
Bureau of the Census
1201 East 10"' Street
Jeffersonville, IN 47132
Other Federal agencies and pass entitles in accordance with Sect
revised. ions .320 (e) and (f), OMB Circular A-133, as
Pursuant to Sections .320(f), OMB Circular A-133, as revised, the provider shall submit a copy Of the reporting package
described in Section .320(c), ONM Circular A-133, as revised, and any management letter issued by the auditor, to the
Alliance at each of the following a
Alliance for Aging, Inc.
Attn: Fiscal Department
760 NW 107 Avenue
Suite 214
Miami, FL 33172
Additionally, copies of financial reporting packages required by Part 11 of this agreement shall be submitted by or on behalf of
the Con ftactor directly to each of the following:
The Affiance at the following address:
Alliance for Aging, Inc.
Attn: Fiscal Department
760 NW 107 Avenue
Suite 214
Miami, FL 33172
III. PART IV: RECORD RETENT101
The Contractor shall retain suffi records demonstrating its compliance with the terms of this agreement for a period of
six (6) years from the date the audit report is issued, and shall allow the Alliance and the Department or its designee,
CFO or Auditor General Access to such records upon request. The Contractor shall ensure that audit working papers are made the
available to the Alliance and the Department, or its designee, CFO, or Auditor General upon request for a period of six (6)
years from the date the auditreport is issued, unless extended inwriting by the Alliance,
ATTACHMENT III
F"NANC AND COMPLIANCE AUDIT ATTACHMENT
EXHIBIT I
IART 1: AUDIT I.; DETERMINATION
I 7 1 .. .
,'
.,
�,„
ATTACHMENT III
FINANCIAL, AND COMPLIANCE AUDIT ATTACHMEN-I
EXHIBIT 2-FUNDING SUMMARY
U
FUN
FUNDING SOURCE
SOURCE
CFA
DN
AMOUT
AMOUNT
U.S. Health and H Services
Hu
93.044
$113,535.31
U .S. Health and Human Services
93.045
$149,015.41
U. S. Health and 14 Human Servi
93.045
$ 226,625.63
U.S. Health and Human Services 93.052 $102,039.07
$32,049.08
$623,264.50
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED
CONTRACT ARE AS FOLLOWS: PURSUANT TO THIS
FEDERAL LLUL
2 CFR Part 200- Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards. OMB Circular
A -133, as amended- Audits of States, Local Governments, and Non-Profit Organizations
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS CONTRACT CONSIST OF THE
FOLLOWING:
MATCHING RESOUCES FOR FEDERAL PROGRAM
PROGRAM TITLE � FUNDING S
gff�
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS
CONTRACT ARE AS FOLLOWS:
Sl� TA TE FINA
Section 215.97, F S., Chapt 691-5 FL Ad Code Ref
rules and regulations. I eience Guide for State EXI)CElditures, Other fiscal requirenws set forth i p rogram l aws.
OMER"
STATE FINANCIAL ASSITANCE SUBJECT TO see. 215.97, F. S.
The undersigned, an authorized representative of the contractor named in the contract or agreement to which this form i
attachment, hereby certifies that: is an
Monroe County Board of County Commissioners, Social Services/In-Home Services
1100 Simonton Street, 2nd Floor
Key West, FL 33040
Signature
Title
(Revised June 2008)
M-
ATTACHMEN]
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY ANIN
VOLUNTARY EXCLUSION FOR LOWER TIER COVERED TRANSACTIONS I
The prospective contractor 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 department or agency.
(2) Where the prospective contractor is unable to certify to any of the statements in this certification, such prospective
participant shall attach an explanation to this certification.
Signature ------
Date
Title
(Certification signature should be same as Contract signature.) Agency/Organization
Instructions for Certification
rel
19
(Revised June 2000)
�
AS SURANCES - NON-CONSTRUCTION PROGRA
�
¥
�
¥
!,:
i
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL �� °�
I TITLE
APPLICANT ORGANIZATION
DATE SUBMITTED
a'
rvi e
Sece to b Provided
ice
Maximm
u
Units of
Maximum
Unit Ralte
Dollars
No. of Clients
Sery ice
Chore 11113
$25.00
$15,589.42
Homemaker 11113
$24.87
1,938
$48,203.91
Personal Care 11113
$2_900
1,662
$48,203.92
CD
Screening & Assessment 11113
$26.22
— 59
$1,538.06
CD
Congregate Meals C1
$9.25
15,773
$1_45,527.41
Congregate Meals Screening C1
$20.00
96
.41
$1,925.00
E
Nutrition Counseling Ind. C1
_
$70.56
13
$926.00
as
Education C1
$0.50
1,274 1
$637.00
E
<
Home Delivered Meals Frozen C2
$6.53
32,111
$209,684.41
1
Home Delivered Meals Hot C2
$6.53
1,706
$11,138.22
0
Nutrition Counseling Ind. C2
$70.56
3
$ 190.00
LO
Nutrition Education C2
$0.50
724
$362.00
Screening & Assessment C2
$26.22
200
$5,251.00
In-Home Respite IIIE
$22.98
653
$15,000.00
Respite In Facility IIIE
$10.74
5,867
$63010.79
Screening & Assessment IIIE
$26.22
60
$1,575.00
Caregiver Training A Grp IIIE
$100.90
71
$7,151.26
0
Caregiver Training A Su pport— nnn,+ Ind IIIE
Housing
$75.00
204
$15,302.02
L)
1
Improvement/Material Aid IIIES
Cost Reimb
$16,991 00
0
Specialized Medical Equipment iMM.nt IIIES
$8,056.03
CL
Chores IIIES
$25.00
318
$7,002.05
D
Total Contract
M
$623,264.SO
as
E
1 l J
ATTACHMENT VIII
ADVANCE BASIS CONTRACT
Report Number
Based On
Submit to Alliance
1
January Advance*
On This ate
January 1
2
3
February Advance*
January 1
4
January Expenditure Report
February 5
5
February Expenditure Report
March 5
March Expenditure Report
April 5
6
April Expenditure Report
May 5
7
May Expenditure Report
June 5
8
June Expenditure Report
July 5
9
10
July Expenditure Report
August 5
11
August Expenditure Report
September 5
September Expenditure Report
October 5
12
13
October Expenditure Report
November 5
14
November Expenditure Report
December 5
15
December Expenditure Report
January
ry
Final Expenditure and Request for Pa
q Payment
February 15
16
Close Out Report
February 29
Legend: * Advance based on projected cash need.
Note 4 1: Report #1 for Advance Basis Agreements cannot be submitted to the Department of
Financial Services (DFS) prior to January 1 or until the agreement with the Alliance has
been executed and a copy sent to DFS. Actual submission of the vouchers to DFS is
dependent on the accuracy of the expenditure report.
Note # 2: Report numbers 5 through 14 shall reflect an adjustment of one -tenth of the total advance
amount, on each of the reports, repaying advances issued the first two months of the
agreement. The adjustment shall be recorded in Part C, 1 of the report (ATTACHMENT
IX).
Note 43: Submission of expenditure reports may or may not generate a payment request. If final
expenditure report reflects funds due back to the Alliance payment is to accompany the
report.
REQUEST FOR PAYMENT
OLDER AM ERICANS ACT
PROVIDER NAME, ADDRESS, PHONEAND FED 10 NUMBER
TYPE OF REPORT:
THIS REQUEST PERIOD:
Advance
Report #
Reimbursement
Agreement
Agreement Period:
------------------
IPSA:
-
CERTIFICATION: I hereby certify to the best of my knowledge that this request conforms with the terms and the Purposes set forth in the above agreement.
Prepared By: Date: Approved By: Date:
PART A:
BUDGETSUMMARY
ADMIN.
(2)
pig
lIIC1
(4)
IIIC2
(7)
Title IIIE
(6)
TOTAL
1. Approved
Agreement Amount.
0.00
0.00
0.00
0.00
0.00
0.00
2. Previous Funds
RECEIVED for
Agreement period.
0.00
0.00
0.00
0.00
0.00
0.0c
3. Agreement Balance
0.00
0.00
0.00
0.00
0.00
0.00
4. Previous Funds
REQUESTED and
Not Received.
0.00
0.00
0.00
0.00
0.00
0.00
5. Agreement Balance
0.00
0.00
0.00
0.00
0.00
0.00
PART B:
FUNDS REQUESTED
1. lst-2nd Months
Request Only
0.00
0.00
0.00
0.00
0.00
0100
2. Net Expenditures
For Month
0,00
0.00
0.00
0.00
0.00
0.001
3. Additional
Cash Needs (Attach Doc.)
0.00
0.00
0.00
0.00
0.00
0,00
4. Total
PART C:
0.00
0.00
0.00
0.00
0.00
0.00
NET FUNDS REQUESTED:
1. Less: Over- Advance
0.00
0.00
0.00
0.00
o.00
2. Agreement Funds are
Hereby Requested For
0.00
0.00
0.00
0.00
0.00
0.00
DOFA FORM 109A revised 5110
ATTACHMENT
•
AA-1729
ATTACHMENT XEXHIBIT-
RECEIPTS AND EXPENDITURE REPORT
OLDER AMERICAN ACT
PROVIDER NAME, ADDRESS, PHONE# AND FEID# Program Funding Source REPORT PERIOD
FROM: TO:
11113 IIIC1_
CONTRACT
IIIC2 1prPinrl'.
CONTRACT#
REPORT#
J IDQAIR
CERTIFICATION : I certify to the best of my knowledge and belief that this report is complete and all outlays herein are for purposes set forth
in the contract.
Prepared by - ate :_ Approved by Date
CD
PART A: BUDGETED INCOME/ RECEIPTS
1. Federal Funds
2. State Funds
3. Program Income
4. Local Cash Match (CCE, HCE and Other)
5. SUBTOTAL: CASH RECEIPTS
6. Local In-Kind Match
7. TOTAL RECEIPTS
PART B : EXPENDITURES
1. Meals / Meal Agreements
2. Service Subcontractor
3. Other
4. Indirect Cost
5. TOTAL EXPENDITURES
PARTC: OTHER EXPENDITURES
(For Tracking Purposes only)
1. Match
a. Other and In-Kind
b. Local Match
2. USDA Cash Received
3. TOTAL OTHER
3 ART D: OTHER REVENUE AND EXPENDITL
1. Program Income (PI)
a. CAA Unbudgeted PI Receipts YTO
DOEA FORM 105as revised 11/09
CD
F_
1. Approved
2. Actual Receipts
1 Total Receipts
4. Percent of E
Budget
For This Report
Year to Date
Approved Budget r_
W
$0.00
$0.00
$0.00
E
%
$0.00
$0.00
$0.00
%
$0.00
$0.00
$0.00
%
$0.00
$0.00
$0.00
% 0
WOO
$0.00
$0.00
%
$0.00
$0.00
$0.00
% CD
$0.00
$0.00
$0.00
%
-
- tM
W
1. Approved
2. Expenditures
3. Expenditures
4. Percent of
Budget
For This Report
Year to Date
Approved Budget U
W
$0.00
$0.00
$0.00
% r_
$0.00
$0.00
KDO
% 0
$0.00
$0.00
$0.00
% L)
$0.00
$0.00
$0.00
% I
0
$0.00
$0.00
$0.00
L)
E
$0.00
$0.00
$0.00
%
Oy
$0.00
$0.00
$0.00
%
$0.00
$0.00
$0.00
%
$0.00
$0.00
$0.00
%
2. Addition Cost Alternative Program Income'
3. Interest
a. Approved Budget $__
a. Earned on GR Advances $_
b. Received YTD $_
b. Return of GR Advance $_
c. Expenditures $__
c. Other Earned $
0 _=+ •�
RECEIPTS AND EXPENDITURE REPORT
OLDER AMERICAN ACT
PROVIDER NAME, ADDRESS, PHONE# AND FEID#
Program Funding Source
THIS REPORT PERIOD
FROM: TO
CONTRACT
Title III E
PERIOD:
CONTRACT#
REPORT#
CERTIFICATION : I certify to the best of my knowledge and belief that this report is complete
and all outlays
herein are for purposes set forth
in the contract.
Prepared by
Approved by
Date,_,
PART A: BUDGETED INCOME/ RECEIPTS
1. Approved
2. Actual Receipts
3. Total Receipts
4. Percent of
Budget
For This
Report
Year to Date
Approved Budget
1. Federal Funds
$0.00
$0.00
$0.00
%
2. State Funds
$0.00
$0.00
$0.00
%
3. Program Income
$0.00
$0.00
$0.00
%
4. Local Cash Match
$0.00
$0.00
$0.00
%
5. SUBTOTAL: CASH RECEIPTS
$0.00
$0.00
& Local In-Kind Match
$a 00
$0.00
$0.00
-%
$0.00
%
7. TOTAL RECEIPTS
$0.00
$0.00
$0.00
%
PART 6: EXPENDITURES
1. Approved
2. Expenditures
3. Expenditures
4. Percent of
A: Direct Services
Budget
For This
Report
Year to Date
Approved Budget
1. Personnel
2. Travel
$0.00
$0.00
$0.00
-%
3. Building Space
$0.00
$0.00
$0.00
-%
4. Communication / Utilities
$0.00
$0.00
$0.00
$0'00
%
5. Printing / Supplies
$0.00
$0.00
$0.00
%
6. Equipment
$0.00
$0.00
%
7. Other
$0.00
$0.00
$0.00
%
6 Agreement Services
$0.00
$0.00
$0.00
%
8. Services Subcontracted
$0.00
$0.00
$0.00
-%
9. TOTAL EXPENDITURES
$0.00
$0.00
$0.00
10. DEDUCTIONS
a. Total Local Match
$0.00
$0.00
$0.00
%
b. Program Income Used
$0.00
$0.00
$0.00
c. TOTAL DEDUCTIONS
$
$0.00
$0.00
%
11. NET EXPENDITURES
$0.00
$0.00
$0.00
PART C: EXPENDITURES ANALYSIS
A. Expenditures by Services Year to Date: 2. Units of Services Year to Date
3. Number of People Served Year to Date
1. Ifflormation...... ....... - ... $0.00
W. 00
2. Assistance ............... i5:5
.........
- io_
......... .......... ..... 0.00
3. Counseling ......... ...... $0.00
........... 0
4. ite ........ ...........
. .... $0 0
-1 0 - 00
$0.00
..0
5. Supplemental
Services ...... $0 00
...... - ...... I ....... I ... 900
6. TOTAL. . ......... E00
........ .$0.00
.... I ............... '.....0.00
Part B Line 11, column 3 should be equal to this total.
PART D: GRANDPARENT SERVICES (reported by Federal Fiscal
Year)
FFY _ $ FFY_
$_
FFY_
$
Match $ Match $
Match $
DOEA FORM 105AE revised 12/08
•
EM309m,
F_7 =Qi �y�7
ATTACHMENT A
Program/Facility Name:
Monroe County Board of County Commissioners,
Social Services/In-Home Services
?'ART 1.
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.
5. ADVISORY OR GOVERNING BOARD, IF APPLICABLE.
111111111111111M. Fm ( Y- 4spanic
PART 11. USE A SEPARATE SHEET OF PAPER FOR ANY EXPLANATIONS REQUIRING MORE SPACE.
• Is an Assurance Of Compliance on file with DOEA? If NA or NO, explain.
7. Compare the staff composition to the population. Is staff representative of the population?
If NA
• NO, explain.
8. Compare the client composition to the population. Are race and sex characteristics representative
of the Population? If NA or NO, explain.
mmlffiy�*
MEM
..
RMW0
an ■ 0
9. Are eligibility requirements for services applied to clients and applicants without regard to race, NO
color, national origin, sex, age, religion or disability? If NA or NO, explain. Na YES El 1:1 0
• � } ' },,
l 1 .:.. �'
17. Is there and established grievance procedure that incorporates due process in the
resolution of complaints? If NO, explain.
YES NO
1:1 1
J�Iqpyijq 71111 11�1�11
YES NO
H F
19. Do recruitment and notification materials advise applicants, employees and
participants of nondiscrimination on the basis of disability? If NO, explain.
CHECKLIST
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 IDEA recipients and their
sub-grantees, 45 CFR 80.4 (a).
7. Is 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
i 1
*,
,`
�,
y,
�:
\,
� �,
� ..
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
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 1.5 or more persons must designate at least one person to
coordinate efforts to comply with Section 504.45 CFR 84.7 (a).
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.
LO
Department's Computer Use Policy and its Social Media Policy
Available at the Department's website at it Hel deraffai i state, fl. u slldoeaffi nancial . ph
- - ----- ---
0
mkt AlAiul kff.'N. " ' I t' 0C ATTACHMENT D
BACKGROUND SCREENING
ELDER
AH"" IRS; Affidavit of Compliance - Employer
STAIKOF FLOMIDA
AUTHORITY: This form Is required annually of M t-inployers to comply'With the attestatton
requirements set forth in section 435.05(3f, Florida Statutes.
The term "emptayer" means any person 13,- entity required by law to conduct background szreening,
including buT not limited to, Area Agencies on Aging, Aging Resource Centers, Aging end Disability-
Resorrrce Centers, Lead Agencies, Long-Term Care Ombudsman Program, Serving, Health 1"su rancel4eeds
of EldeTs program, SeTViCo Providers, Dversiun Providers, mrid any ather person or entity which mires
umpiavees or hm, voluntccrti in service who rncvc thu dufin.iflun of d dircck 5vrvicc provider, Sec. i§§
4-15 02, 430,W2, FLl 501,
A� A chretl servite provider it; 'a perSer, 7'R years of age or older WhcR, P"Ofwant to a w0gral" to prm-lde
�'.erviceq !n the elderly, has dir"t, fact -to-facp rontart wl,h a citent wlide providing sprvires %I as the client
and has access to the client's Wing area, funds, personal property, ar personal identification infarma:ion
as defined in, s. 817,S68. The term nrludes caordinators, managers, and super of residential
facilities; and volunteers.." § 430.0402(11(b1, H& Scat_
located at
Z)P code
1, do herebV affirm under penalty of perjury
Name of RePresertative
that the above -.1arned Qrnployer is in compliance with the p,o visions of Chapter 415 and section
430.0402, Florida Statutns, regarding level 2 background screening,
Signature of Repre5entative
Em
Sworn to {,fir affir-ned,� and subscribed before r thIS 11-1--r— day of 20___, by
M11133MMEM
jNarno of Representatme) who rs pefsonally known
M3zRM3MjKMMW2z=
Vnr,t, ' ni sAarip Cummisnoned Nwnr of N�nknry ViAhr Notary Public
n OF, A 2�15 A# I I A yi I ",l( Err"v"iye A J'ri 12012 Svuku, 439 05kK- F S
r i e
1
ATTACHMENT
Verification of Employment Status Certification
W
Signature
(Same as contract signature)
u
E V a XTO WIL �- I I a a
Alliance for Aging, Inc.
Business Associate Agreement
This Business Associate Agreement is dated I by the Alliance for Aging, Inc.
("Covered Entity") and Monroe County Board of County Commissioners, Social Services/In-
Home Services, ("Business Associate"), a not-for-profit Florida corporation.
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' PI 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) (as may apply)
and contained in this agreement.
The parties therefore agree as follows:
2.0 Definitions. For purposes of this agreement, the following definitions apply:
12 ARRA. The American Recovery and Reinvestment Act (2009)
2.3 Business Associate. "Business Associate" shall generally have the same meaning as the term
"business associate" at 45 CFR 160.103, and in reference to the party to this Agreement, Monroe
County Board of County Commissioners, Social Services/In-Home Services.
2.4 Covered Entity. "Covered Entity" shall generally have the same meaning as the term "covered
entity" at 45 CFR 160.103, and in reference to the party to this Agreement, shall mean Alliance
for Aging, Inc.
2.5 II AA Rules. "HIPAA Rules" shall mean the Privacy, Security, Breach Notification, and
Enforcement Rules at 45 CFR Parts 160 and 164.
i
23 All other terms used, but not otherwise defined, in this Agreement shall have the same meaning
as those terms in the HIPAA Rules.
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 under Subpart C of 45 CFR Part 164,
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, but not later
than ten (10) days following the discovery, 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.
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
infonnation.
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) AR RA § 13406 (Conditions on Certain Contacts as Part of Health Care Operations).
3.15 To the extent Business Associate is to carry out one or more of Covered Entity's obligation(s)
under the Privacy Rule, Business Associate agrees to comply with the requirements of the
Privacy Rule that apply to Covered Entity in the performance of such obligation(s).
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.
5.3 Business Associate may use PHI to provide data aggregation services to Covered Entity as
permitted by 45 CFR §164.504(c)(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 § 164.5 020)(1).
I T I T I MM I T MW MMM=
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.
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.
27-MU•
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 and HITECH 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 and HITECH 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
(c) If neither termination nor cure is feasible, Covered Entity shall report the violation to the
Secretary.
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 cPHI infeasible
shall be provided to the other party. Business Associate shall:
1. Retain only that PHI which is necessary for Business Associate to continue its proper
management and administration or to carry out its legal responsibilities;
2. Return to Covered Entity (or, if agreed to by Covered Entity, destroy) the remaining
PHI that the Business Associate still maintains in any form;
The obligations of Business Associate under this Section shall survive 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.
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).
To Covered Entity: Alliance for Aging, Inc.
Attention: Max Rothman
760 NW 107 Avenue
Miami, Florida 33172
To Business Associate: Monroe County Board of County Commissioners,
Social Services/In-Home Services
1100 Simonton Street, 2 nd Floor
Kev West, FL 33040
F-INIPWIll
EmIff-RUMM
LO
MR.=
Date:
Business Associate:
0
Monroe County Board of County Commissioners,
Social Services/In-Home Services
(signature)
E-CO4
rol! m-
rr
Alliance for Aging, Inc.
Aging and Disability Resource Center/Elder Helpline
CE CEVTERtADR
A. Perform AD RC outsourced functions in accordance with the Alliance's policies and
procedures.
i. Policies and Procedures for Outsourced Function-Screening
ii. Policies and Procedures for Outsourced Function-Triage
iii. Policies and Procedures for Activation from Waitlist- Client Services
iv. Policies and Procedures for Termination from Waitlist- Client Services
B. Maintain wait lists in CIRTS in accordance with DOEA requirements.
C. Report number of client contacts to the Aging and Disability Resource Center.
D. Adhere to prioritization policy as set forth by DOER on a monthly basis. Reference
DOEA Notice of Instruction: Assessed Priority Consumer List#: 062906- 1 -I-OVCS as
applicable.
E. Ensure the agency's Disaster Plan reflects ADRC Outsourced Functions, annually or as
needed to incorporate A outsourced functions.
F. Ensure against conflicts of interest and inappropriate self-referrals by referring consumers
in need of options counseling or long-term care services beyond the provider's scope of
services to the Aging and Disability Resource Center.
G. Ensure that services provided are in the clients' best interest, are the most cost effective,
of high quality, and are responsive and appropriate to the assessed needs.
TURRE
Alliance for Aging, Inc.
Aging and Disability Resource Center/Elder Helpline
Policy and Procedure for Outsourced function — Screenil
Creation Date: March 5, 2008
O'Cevision Date: May 2012
Objective: To ensure that a comprehensive list of clients in need of services is maintained in CIRTS by
appropriate funding source and that the ADRC is thereby able to effectively gauge the level
of elder service need in Miami-Dade and Monroe Counties.
Policy: To obtain necessary information from clients in order to assist in determining level of need
and eligibility for DOEA funded services
Procedure:
I ADRC Contracted Providers will collect information from callers and conduct a 701A
assessment. Alternatively, if a 701B assessment already exists or is provided from another
source (Le. CARES) the information from the 70 1 B can be utilized.
Based on the information provided via the 70 IA(B) assessment, the ADRC, Contracted
Provider will make a determination as to the services that the caller is in need of receiving .
The caller will be provided with general information regarding the ADRC as well as the
ADRC Elder Helpline contact number.
The caller will be informed of the services and funding sources that they are being placed on
the wait list for in CIRTS.
9. ADRC Contracted Provider will inform caller that they will receive a follow-up call (or home
visit in case of active client) to check on their status based on DOEA Wait List Reassessment
Standards and encourage caller to contact the ADRC Elder Helpl mie with any questions.
WERE
Alliance for Aging, Inc.
Aging and Disability Resource Center/Elder Helpline
Policy and Procedure for
Outsourced function - Triage
Creation Date: March 5, 2008
Revision Date: May 2012
Objective: To ensure that clients in need of DOEA fimded services receive services based on the highest
level of need, first, as funding becomes available.
Policy: To assist clients in obtaining DOEA funded services as funding becomes available, based on
level of need as determined by a CIRTS priority score.
Procedure:
1. ADRC Contracted Provider will conduct periodic follow-up calls (or home visit in case of active
client) to check on client status based on DOEA Wait List Reassessment Standards.
2. Based on the information provided via the 701A(B) assessment, the ADRC Contracted Provider
will update the client information in CIRTS specifically as it pertains to level of need for
services by funding source.
3. The ADRC Contracted Provider will ensure that the CIRTS prioritization score is accurately
maintained, according to DOEA Standards.
4. If the caller is in need of a service(s) that is not provided by the ADRC Contracted Provider, the
ADRC Contracted Provider will refer caller to the ADRC Elder Helpline utilizing the ADRC
Referral Form and/or to an ADRC Contracted Provider that provides the needed service.
5. The caller will be informed of the services and funding sources that they remain on the wait list
for and/or have been removed from the wait list for.
6. ADRC Contracted Provider will advise client of any change in their CIRTS priority score based
on the updated information.
7. ADRC Contracted Provider will remind client of the ADRC Elder Help Line contact number
and to contact the ADRC Elder Help Line with any questions or concerns.
S. As ftinding becomes available, ADRC Contracted Provider will run CIRTS Prioritization Report
and activate clients according to DOEA Standards (refer to ADRC Client Activation Policies
and Procedures). The Contracted Provider will apply targeting criteria, as appropriate, to
prioritized clients to ensure activations meet programmatic requirements.
0,029M
Alliance for Aging, Inc.
Aging and Disability Resource Center/Elder Helpline
Policy and Procedure for
Activation From Wait List — Clients/Services
Creation Date: March 5, 2008
Revision Date: May 2012
Objective: To ensure that elders in need of DOEA funded services in Miami-Dade and Monroe Counties
and on the CIRTS wait list begin to receive services as funding becomes available.
Policy: ADRC will work with ADRC Contracted Providers to ensure that clients waiting for DOER
funded services begin to receive those services as funding becomes available.
Procedure:
1. ADRC Contracted Provider will activate clients on CIRTS wait list based on DOEA
prioritization polices and funding availability.
2. ADRC Contracted Provider will update CIRTS status by funding source and service for
services being activated for the client using appropriate CIRTS codes.
3. Client may be left on wait list of a different funding source than the one being activated if
ADRC Contracted Provider determines that it is appropriate.
4. Client may also be left on wait list in CIRTS if they are being activated by the ADRC
Contracted Provider under a temporary non-DOEA funding source and ADRC Contracted
Provider determines that the clients' need will persist after the temporary funding source is
exhausted.
5. ADRC Contracted Provider will inform the client of any services/funding source that they are
being activated for as well as those services and funding sources that they will continue to be
wait listed for.
6. ADRC Contracted Provider will inform client to contact the ADRC Elder Helpline if they have
any questions or concerns regarding the status of any of their services.
Alliance for Aging, Inc.
Aging and Disability Resource Center/Elder Helpline
Policy and Procedure for
Termination From Wait List — Clients/Services
Creation Date: March 5, 2008
Revision Date: May 2012
Objective: To ensure that the comprehensive list of clients in need of services in CIRTS is appropriately
maintained by funding source and that the ADRC is thereby able to effectively gauge the
current level of elder service need in Miami-Dade and Monroe Counties.
Policy: ADRC will maintain an accurate and current list of clients in need of elder services in Miami-
Dade and Monroe Counties with the assistance of the ADRC Contracted Providers.
Procedure:
1. ADRC Contracted Provider will re-screen clients which the ADRC Contracted Provider initially
placed on the CIRTS wait list for services based on DOEA Reassessment Standards.
The re-screening may be in the form of a phone screening or a home visit depending on the
clients status (i.e. active/pending)
3. ADRC Contracted Provider will determine if the client is no longer in need (or eligible) for any
of the services they were wait-listed for.
4. ADRC Contracted Provider will terminate the client from the wait list (entirely or by specific
service) using the appropriate CIRTS termination code for any services or ftmding source for
which the client is determined to no longer be eligible for or no longer in need of
Aging and Disability Resource Centell
NOTE: All Service Providers are required to submit the Client Data Report on a monthly
basis at the same time that they submit the Surplus Deficit Report and related expenditure
plan to the Contract Manager.
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ATTACHMENT H
The undersigned, an authorized representative of the Provider named in the contract or agreement to
which this form is an attachment, hereby certifies that:
(2) The Provider understands that, pursuant to s. 287.135 F. S., any company that submits a false
certification is subject to civil penalties, attorney's fees and costs and any costs for investigations that
led to the finding of false certification.
(3) The Provider understands that the contract to which this form is an attachment may be terminated by
the Alliance if the Provider submits a false certification or has been placed on the Lists.
This certification, required by Florida law, 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.
Signature
(Same as contract signature)
Title
Company Name
Im