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Item F34BOARD OF COUNTY COMMISSIONERS County of Monroe A Mayor Heather Carruthers, District 3 f T$ne Florida Keys (, S �� Mayor Pro Tem George Neugent, District 2 t� ) ��` �� �' Danny L. Kolhage, District 1 David Rice, District 4 Sylvia J. Murphy, District 5 County Commission Meeting November 22, 2016 Agenda Item Number: F.34 Agenda Item Summary #2341 BULK ITEM: Yes DEPARTMENT: Social Services TIME APPROXIMATE: STAFF CONTACT: Sheryl Graham (305) 292 -4510 N/A AGENDA ITEM WORDING: Approval of Amendment 40002 to Community Care for Disabled Adults (CCDA) Contract 4 KG -070 between the Florida Department of Children and Families (DCF) and Monroe County Board of County Commissioners (BOCC) /Monroe County Social Services /In -Home Services to revise pricing terms for the contract year FY16 resulting in no financial increase to the contract. ITEM BACKGROUND: Amendment 40002 is to revise the unit rates for Homemaker, Case Management, Home Delivered Meals, and Personal Care services pursuant to Section 216.0113, F.S. in compliance with the Preferred Pricing Clause identified on Page 10, Standard Integrated Contract 2015, Section7.6, Preferred Pricing Affidavit. This amendment also adds language to EXHIBIT A- SPECIAL PROVISIONS, SECTION 6: PENALTIES, TERMINATION AND DISPUTE RESOLUTION, to allow the Provider to terminate the contract. PREVIOUS RELEVANT BOCC ACTION: Approval granted by the BOCC on January 20, 2016 for Amendment 40001 to Contract KG -070 for Community Care for Disabled Adults (CCDA) for FY16. CONTRACT /AGREEMENT CHANGES: Revised Pricing Terms STAFF RECOMMENDATION: Approval DOCUMENTATION: Amendment 40002 CCDA 11 -07 -16 Backup part 1- CCDA Amend. 40002 Backup part 2- CCDA Amend. 40002 Backup part 3- CCDA Amend. 40002 UPDATED CCDA Amend. 40002 11 -7 -16 FINANCIAL IMPACT: Effective Date: 11/22/2016 Expiration Date: 12/31/2018 Total Dollar Value of Contract: $226,065.50 Total Cost to County: 10% cash match Current Year Portion: Budgeted: Source of Funds: Grant CPI: Indirect Costs: Estimated Ongoing Costs Not Included in above dollar amounts: Revenue Producing: No Grant: Yes County Match: 10% Insurance Required: No Additional Details: If yes, amount: 11/22/16 125- 6153715 - COMM CARE DISABLED ADULT $3,402.99 REVIEWED BY: Sheryl Graham Completed 11/02/2016 3:57 PM Pedro Mercado Completed 11/02/2016 4:29 PM Budget and Finance Completed 11/02/2016 4:38 PM Maria Slavik Completed 11/03/2016 7:43 AM Kathy Peters Completed 11/03/2016 10:58 AM Board of County Commissioners Pending 11/22/2016 9:00 AM Amendment #0001 replaced the CF Standard Contract 2014, Exhibits A -F and Attachments 1 -2 with the CF Standard Integrated Contract 2015, Exhibits A -F and Attachments 1 -2. Furthermore, the amendment decreased the contract funding to align with the AOB; revised the Deliverables; added required language pursuant to Section 215.97, F.S.; and corrected the additional financial consequences language. The purpose of this Amendment #0002 is to revise the unit rates for Homemaker, Case Management, Home Delivered Meals, and Personal Care services pursuant to Section 216.0113, F.S. in compliance with the Preferred Pricing Clause identified on Page 10, Standard Integrated Contract 2015, Section 7.6, Preferred Pricing Affidavit. This amendment also adds language to EXHIBIT A- SPECIAL PROVISIONS, SECTION 6: PENALTIES, TERMIATiON AND DISPUTE RESOLUTION, to allow the Provider to terminate the contract. The revised pricing terms shall be effective with this Amendment #0002 retroactively to the effective date of this contract. Payments made in excess of such pricing are deemed to be overpayments and any overpayment shall be promptly returned to the Department as provided in Section 3.4 of the Standard Integrated Contract 2015. 1. Page 12, CF Standard Integrated Contract 2015, EXHIBIT A- SPECIAL PROVISIONS, SECTION 6: PENALITIES, TERMIATION AND DISPUTE RESOLUTION, Paragraph A- 6.2.5, is hereby amended to add: SECTION 6: PENALTIES, TERMINATION AND DISPUTE RESOLUTION A -6.2.5 This Contract may be terminated by the Provider upon no less than thirty (30) calendar days' notice in writing to the Department unless a sooner time is mutually agreed upon in writing. 2. Page 36, CF Standard Integrated Contract 2015, EXHIBIT F- METHOD OF PAYMENT (Revised 01101/2016), Section F -1.2, is hereby amended to read: F -1.2 Service Unit A Service Unit is defined in CFOP 140 -8, Community Care for Disabled Adults Operating Procedures, and listed in Sections C -1.2 and D -1. CF1127 Effective July 2015 Monroe County Board of County Commissioners (CF -1127 -1516) Department of Alliance for Service Children and Families Alliance for Aging /Older Ut Contract Rate Aging Rate American Act Di Homemaker Case Mana ement $23.47 $22.06 Rate $22.00 Home Delivered Meals $50.96 $6.33 $50.48 N/A Personal Care $23.25 N/A $28.67 $ $22.00 1. Page 12, CF Standard Integrated Contract 2015, EXHIBIT A- SPECIAL PROVISIONS, SECTION 6: PENALITIES, TERMIATION AND DISPUTE RESOLUTION, Paragraph A- 6.2.5, is hereby amended to add: SECTION 6: PENALTIES, TERMINATION AND DISPUTE RESOLUTION A -6.2.5 This Contract may be terminated by the Provider upon no less than thirty (30) calendar days' notice in writing to the Department unless a sooner time is mutually agreed upon in writing. 2. Page 36, CF Standard Integrated Contract 2015, EXHIBIT F- METHOD OF PAYMENT (Revised 01101/2016), Section F -1.2, is hereby amended to read: F -1.2 Service Unit A Service Unit is defined in CFOP 140 -8, Community Care for Disabled Adults Operating Procedures, and listed in Sections C -1.2 and D -1. CF1127 Effective July 2015 Monroe County Board of County Commissioners (CF -1127 -1516) Amendment #0002 F'1.2.1 The Department shall make payments to the Provider for the provision of services at the units and rates shown below, in accordance with the client's care plan. STANDARDICORE SERVICES UNIT RATE Case Management 1 hour $50.48 Home Delivered Meals 1 meal delivered $6.00 Homemaker 1 hour $22.00 Personal Care 1 hour $22.00 THE REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK opn2r Effective July 2015 Monroe County Board of County Commissioners (CF-1 127-1516) Amendment #0002 Contract No. KG070 This amendment shall begin on November 1, 2016 or the date on which the amendment has been signed by both Parties, whichever is later. All provisions in the contract and any attachments thereto in conflict with this amendment shall be and are hereby changed to conform with this amendment. All provisions not in conflict with this amendment are still in effect and are to be performed at the level specified in the contract. This amendment and all its attachments are hereby made a part of the contract. IN WITNESS THEREOF, the parties hereto have caused this four (4) page amendment to be executed by their officials' thereunto duly authorized. PROVIDER: STATE OF FLORIDA •. SIGNED BY: NAME: Heather Carruthers TITLE: Monroe County Mayor AM Federal ID Number: 59.6000749 NAME: Bronwyn Stanford TITLE: Regional Managing Director CF 1127 Effective July 2015 3 Monroe County Board of County Commissioners (CF- 1127 -1516) a a PROVIDER NAME: Monroe County Board of County Commissioners ADDRESS: 500 Whitehead Street VENDOR NUMBER: 59- 6000749 Key West, Florida 33040 STANDARD/CORE Case Management Home Delivered Meals Homemaker Personal Care $6,858.89 per FY Current Month I Match Balance Local Cash Match Local in -Kind Total Ma tch Match Balance �1 DUE Less any financial consequences Imposed as per Section F -4: By signing this report, 1 certify to the best of my knowledge and belief that the report is true, complete and accurate and the expenditures, disb u rsements and cash receipts are for the purposes and objectives set forth in the terms and conditions of this agreement. 1 am aware that any false, fictitious, or fraudulent information or the omission of any material fact, may subject me to criminal, civil or administrative penalties for fraud, false statements, false claims, or otherwise. Additionally, I certify that all reports supporting this invoice have been submitted to the Department in accordance with this agreement. Authorizing Signature: Title: $50.48 $6.00 $22.00 $22.00 TOTAL Q Date CF Standard Integrated Contract 2015 38 Contract No. KG070 Revised 11 -01 -2016 Monroe County Board of County Commissioners MINEWEEffix"A ffil I x a N1 0 1 L 711 Wi1jur Meeting Date: January 20, 2016 Department: Social Services Bulk Item: Yes X No Staff Contact AGENDA ITEM WORDING: Rescission of Item C-1 9, �2015 ` rega�rlsch�eduled BOCC meeting due to a scrivener's error and Approval of Amendment #0001 to Contract #KG070, Community Care for Disabled Adults (CODA) between the Florida Department of Children and Families (DCF) and Monroe County Board of County Commissioners (BOCC)/Monroe County Social Services/In Home Services. PREVIOUS RELEVANT BOCC ACTION: Prior approval granted by the BOCC on 12/11/2014 for the Florida Department of Children and Families Standard Grant Agreement #KG070, Community Care for the Disabled Adults (CCDA), contract year FYI 5. Prior approval granted on 12/9/2015 of Item C-15 of Amendment 40001 to Contract #KG070. CONTRACT/AGREEMENT CHANGES: Adding summary page prior to Page I of agreement. COSTTOCOUT: RQ% Cash Match SOURCE OF FUNDS: Grant Funds REVENUE PRODUCING: Yes -- No X AMOUNT PER MONTH Year APPROVED BY: County At OMB/Purchasing 1— Risk Management DOCUMENTATION: IncYlued x Not Required DISPOSITION: AGENDAITEM# Contract Manager: Sheryl Graham (305) 2924510 Social Services #1 (Name) 2 (Ext.) (Department/Stop #) For BOCC meeting on 1/20/2016 j � /(- . . .... . ..... , �jgenda Deadline: 1/5/2016 Director Risk Management O.M.B./Purchasing County Attorney I Comments: Date In 6 fzr> f(" .- ---. ---- -1 -1 1 V1 -.- i A� Fufly W ORIGINAL LF Contract No. KG070 Executed Amendment #0001 Date: 01/01/2016 THIS AMENDMENT, entered into between the State of Florida, Department of Children and Families, hereinafter referred to as tht "Department," and Monroe County Board of County Commissioners, hereinafter referred to as the "Provider," amends and restates Contract No. KG070. The purpose of this Amendment #0001 is to replace the CF Standard Contract 2014, Exhibits A-F and Attachments 1-2 with the CF Standard Contract 2015, Exhibits A-F and Attachments 1-2, Furthermore, this amendment decreases the contract funding to align with the A013; revises the Deliverables; adds required language pursuant to Section 215.971, F.S.; and corrects the additional financial consequenceslanguage. 'i. The Department is amending the existing contract to incorporate the new CF Standard Integrated Contract 2015 and revised Exhibits A-F, and Attachments 1-2, as follows: 1.1 Pages 1-17, CF Standard Integrated Contract 2014, inclusive of Exhibit A, are hereby deleted in their entirety and Pages I- 19, CF Standard Integrated Contract 2015, Inclusive of Exhibit A, are inserted in lieu thereof, and attached hereto. 111111111 111111111111111 1 iiiiiiiiiiiij IIIIIIIIIIIIIIIIIII III III! II 1.3 Pages 18-35, CF Integrated Contract 2014, Exhibits B-F, are hereby deleted in their entirety and Pages 20-39, CF Integrated Contract 2015, Exhibits B-F, are inserted in lieu thereof, and attached hereto. a iAN =RrIVL'�J their entirety and Pages 0. Integrated Contract 2015, Attachment 1, Finance and Compliance Audit (5/4/2015), are inserted in lieu thereof, and'attached hereto, I # Iff, MIA11 W.—,NPp#V msv the level specified in the contract. This amendment is hereby made a part of the contract. IN WITNESS THEREOF, the parties hereto have caused this forty-seven (47) page amendment to be executed by their officials' thereunto duly authorized. NAME: Bronwyn Stanford UIM1.4hroe Count7 TITLE: Regional Managing Director DATE: Federal ID NunI 59-6000 749 DATE: 2— 3 a. Contract No. KG070 CFDA No. CSFA No. 60.008 1 . ENGAGEMENT. TERM AND CONTRACT D2�U�j 1.1 Purpose and Contract Amount. ,lop Section 2 hereof, payable as provided in Section 3 hereof, in an amount not to exceed $226,065.50. 1111 1 iq�l directed on behalf of the Provider are: Department forth is Contract are: Name: Monroe County BOC Name: Debra Allan Kuhn Address: 500 Whitehead Street to r Address: Contract Management Administrator 401 NW 2ns Avenue, Suite N-1007 City: Key West State:FL Zip Code:33040 City: Miami State: FIL Zip Code: 33128 Phone: 305-292-4500 Phone: 786-257-5081 Ext: N/A Ext: E-mail: NIA E-mail: debra.kuhn@myflfamilies.com b. The name of the contact person and address, telephone, d. The name, address, telephone number and e and e-mail address where the Provider's financial and mail of the Provider's representative responsible fo administrative records are maintained are: administration of the program under this Contrac; Name: Sheryl Graham (and primary point of contact) are: Name: Sheryi Graham Address: I 100 Simonton Street Address: 1100 Simonton Street City: Key West State:FL Zip Code:33040 City: Key West State:FL Zip Gode:33040 Phone: 305-292-4510 Phone: 305-292-4510 Ext: Ext: Per section 402,7305(l)(a), F.S,, the Department's Contract Manager is the primary point of contact through which all contracting information flows between the Department and the Provider. Upon change of representatives (names, addresses, telephone numbers ♦ e-mail addresses) by either party, notice shall be provided in writing to the other party. CF Standard Integrated Contract 2015 1 Contract No. KG07 0 11.4.2 The PUR 1000 Form (10/0• version) is hereby incorporated into and made a part • this Contract. Sections U., 2-4, 6, 8- 13, 23, 27 and 31 • the PUR 1000 Form are not applicable to this Contract, In the event • any conflict between the PUR 1000 Form and any other terms • conditions • this Contract, such other terms • conditions shall take precedence over the PUR 1000 For . 1.4.3 The terms of Exhibit A, Special Provisions, supplement or modify the terms of Sections I through 7 hereof, as provided therein. 2. STATEMENT OF C. 2.1 Scope of Work. 6 ME - 5711 '47171 K374 11718i 2.2 Task List. The Provider shall perform all tasks set forth in the Task List, found in Exhibit C, in the manner set forth therein. CIF Standard Integrated Contract 2015 2 Contract No. KG070 23 Deliverables. Deliverables shall be as described in Exhibit D. 2AYMENT, I CE AND REILATE D TERMS. 3.1 Method of Payment, The Provider shall be paid in accordance with Exhibit F, Method of Payment and Invoices. 12 Invoices. C2,11 Generally. The Provider shall submit bills for fees or other compensation for services or expenses in sufficient detail for proper pre-audit and post-audit. Where itemized payment for travel expenses is permitted in this Contract, the Provider shall iubmit bills for any travel expenses in accordance with section 112.061, F,S., or at such lower rates as may be provided in thb Contract. 3.2.2 Final Invoice, The final invoice for payment shall be submitted to the Department no more than 45 days after the Contract ends or is terminated. If the Provider fails to do so, all rights to payment are forfeited and the Department will not honor any requests submitted after the aforesaid time period. Any payment due under the terms of this Contract may be withheld until performance of services and all reports due from the Provider and necessary adjustments thereto, have been approved by the Department. 3.3 Financial Consequences. CF Standard Integrated Contract 2015 3 Contract No. KG07 0 3.4 Overpayments and Offsets. 9 ITMVI M M, W. Mi TIMM [1GZ x,I1Vh011L LU U111C[b UldL IL 15 d1l dYU11L U1 U1 the authority to bind the Department by virtue of this Contract, unless specifically authorized in writing to do so. This Contract does not create any right in any individual to State retirement, leave benefits or any other benefits of »z• employees as a result of performing the duties or obligations of this Contract. CIF Standard 4.8 Real Property. 211190h=1 Without limitation, the Provider and its employees, agents, and representatives will not, without prior Departmental written consent in each instance, use in advertising, publicity or any other promotional endeavor any State mark, the name of the State's mark, the ham,- of the State or any State agency or affiliate or any officer or employee of the State, or any State program or service, or represent, directly or indirectly, that any product or service provided by the Provider has been approved or endorsed by the State, or refer to the existence of this Contract in press releases, advertising or materials distributed to the Provider's prospective customers. 4.10 Sponsorship. 'MMT61 W F Ogram nancellYnoilyorin part by State funds, including any funds obtained through this Contract, it shall, in publicizing, advertising, or describing the sponsorship of the program state: "Sponsored by (Provider's name) and the State of Florida, Department of Children and Families". If the sponsorship reference is in written material, the words "State of Florida, Department of Children and Families" shall appear in at least the same size letters or type as the name of the organization. 3��� The Provider a rees that it will n -lira CF Standard Integrated Contract 2015 6 Contract No. KG07 0 -01 M 74 Ul =I 5.3.1 By executing this Contract, the Provider acknowledges that, having been provided an opportunity to review all provisions hereof, all provisions of this Contract not specifically identified in writing by the Provider prior to execution hereof as "confidential" or "exempt" will be posted by the Department on the public website maintained by the Department of Financial Services pursuant to section 215.985, F.S. The Provider agrees that, upon written request of the Department, it shall promptly provide to the CF Standard Integrated Contract 2015 7 Contract No. KG070 terminated by the Department for cause. Termination shall be upon no less than twenty-four (24) hours notice in writing to the Provider. In the event of termination under Sections 6.2.1 or 6,2.2 hereof, the Provider will be compensated for any work satisfactorily completed through the date of termination or an earlier date of suspension of work per Section 21 of the PUR 1000. 6.3 Dispute Resolution. Fj=1wgW1n1 LA r1 I I norm Im IKO] fforg 1 1 FIA FM E 1YJ=,11g1LJk14g1 7.1 Governing Law and Venue, This Contract is executed and entered into in the State of Florida, and shall be construed, performed and enforced in all respects in accordance with Florida law, without regard to Florida provisions for conflict of laws. Courts of competent jurisdiction in Florida shall have exclusive jurisdiction in any action regarding this Contract and venue shall be in Leon County, Florida. Unless otherwise provided in any other provision or amendment hereof, any amendment, extension or renewal (when authorized) may be executed in counterparts as provided in Section 46 of the FUR 1000 Form, 7.2 No Other Terms, There are no provisions, terms, conditions, or obligations other than those contained herein, and this Contract shall supersede all previous communications, representations, or agreements, either verbal or written between the parties. 7.3 Severability of Terms. If an% term or vrovision of this Contract is IaV4 determined unlawful or unenforceable the full force and effect and such term or provision shall be stricken. 7.4 Survival of Terms. 4 itseli or a named provision, all provisions of this Contract concerning obligations of the Provider and remedies available to the Department are intended to survive the ending date or an earlier termination of this Contract. The Provider's performance pursuant to such surviving provisions shall be without further payment, as the contract payments received during the term of this Contract are consideration for such performance. 7e 5 Modifications, If I is 1111 - PRE MM R? oi lt#AJ- W, IWIFIR me*_t payment when these have been established through the appropriations process and subsequently identified in the Department's operating budget, The Provider represents and warrants that the prices and terms for its services under this Contract are no less favorable to the Department than those for similar services under any existing contract with any other party. The Provider further agrees that, within 90 CF Standard Integrated Contract 2415 10 Contract No. KG070 7.13 Client Risk Prevention, AS requirea Dytnlapters WS- F.S., this provision is binding upon both the Provider and its employees. 7.14 Emergency Preparedness Plan If the tasks to be performed pursuant to this contract include the physical care or supervision of clients, the Provider shall, within thirty (30) days of the execution of this contract, submit to the Contract Manager an emergency preparedness plan which shall include provisions for records protection, alternative accommodations for clients in substitute care, supplies, and a recovery plan that will allow the Provider to continue functioning in compliance with the executed contract in the event of an actual emergency. For the purpose of disaster planning, the term "supervision" includes a child who is under the jurisdiction of a dependency court. Children may remain in CF Standard Integrated Contract 2015 11 Contract No. KG070 Heather Carruthers IN Title: Monroe Coun g2L tL ��2tq r Title: Date: Date: B ro qmj LrLStaLfqrd geglonal liana In Directo The parties agree that any future amendment(s) replacing this page will not affect the above execution, STATE AGENCY 29 DIGIT FLAIR CODE: Federal Tax ID # (or SSN): 59-6000749 Provider Fiscal Year Ending Date: 09/30. CF Standard Integrated Contract 241 5 12 Contract No. KG07 0 EXHIBIT A — SPECIAL PROVISIONS SECTION 7: OTHER TERMS A-701. Program or Service Specific Terms A-7.1.5 Client -Any person who is eligible and is at least eighteen (18) years through age fifty-nine (59), has one (1) or more permanent physical or mental limitations that restrict the client's ability to perform normal activities of daily living, and impede the client's capacity to live independently or with relatives or friends without the provision of community-based services, A-7.1.6 Home Delivered Meals — Provision of meals delivered to the home for those who have difficulty shopping for groceries or preparing nutritious meals, CF Standard Integrated Contract 2015 13 Contract No. KG070 A-7.11 The case management provider will collect fees for services provided according to Rule 65C-2.007, F.A.C. IWILIQ MA 7 A-7.3. Policy and Procedures Manuals Comprehensive Policy and Procedures Manuals must be developed and maintained by the provider. All manuals must include the specific reguirements neces2ar% the agency's current business practices. All manuals should contain an overview page describing the purpose of the manual, a table of contents, numbered pages, be revised/update d regularly and should reflect approval (with date) by the board of directors (or designee). Emm" = � <°= I 111MIMMUNI2 01114 FUM E 2««x24 d2m 11 g1gamiall 1111111 ! 111 l!"I l! ", I � ", jj�� i 'll 111111 Iiii As provided in Section 4.1 of this Contract, the Provider is required to comply with the following requirements, as applicable to performance under this Contract, as they may be enacted or amended from time to time. Provider acknowledges that it independently responsible for investigating and complying with all State and Federal laws, rules and regulations relating to performance under this Contract and that the below is only a sample of the State and Federal laws, rules and regulations that m;1 govern its performance under this Contract. A1-1 Federal Law. CF Standard Integrated Contract 2015 15 Contract No. KG070 Al - 6 Public Records, Ai-6,11 As required by section 287,058(l)(c), F.S., the Provider shall allow public access to all documents, papers, letters, or other public records as defined in subsection 119.011(12), F.S. as prescribed by subsection 119.07(l) F.S., made or received by the Provider in conjunction with this Contract except that public records which are made confidential by law must be protected from disclosure. It is expressly understood that the Providers failure to comply with this provision shall constitute an immediate breach of contract for which the Department may unilaterally terminate this Contract. A1-6.2 As required by section 119.0701, F.S., to the extent that the Provider is acting on behalf of the Department within the meaning of section 119.011(2), F.S., the Provider shall: a. Keep and maintain public records that ordinarily and necessarily would be required by the Department in order to perform the service. b. Provide the public with access to public records on the same terms and conditions that the Department would provide the records and at a cost that does not exceed the cost provided in Chapter 119, F.S., or as otherwise provided by law. C. Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law. A11-7.2 If the Provider or any of its subcontractors employs 15 or more employees, the Provider shall designate a Single-Point- of-Contact (one per firm) to ensure effective communication with deaf or hard-of-hearing customers or companions in accordance with Section 504 of the ADA, and CFOP 60-10, Chapter 4. The Provider's Sing le-Point-of-Contact and that of its Subcontractors will process the compliance data into the Department's HHS Compliance reporting Database by the 5th business day of tht CF Standard Integrated Contract 2015 16 Contract No. KG070 I A1-7.8 The Department requires each contract/subcontract provider agency's direct service employees to complete Serving ou 1* 1 Customers who are Deaf or Hard-of-Hearing and sign the Attestation of Understanding. Direct service employees performing C under this Contract will also print their certificate of completion, attach it to their Attestation of Understanding, and maintain them N CD in their personnel file. CD CF Standard Integrated Contract 2015 17 Contract No. KG0 70 Al-12.1 FFATA 2006. The Provider will complete and sign the FFATA Certification of Executive Compensation Reporting Requirements form (CF 1111 or successor) if this Contract includes $25,000 or more in Federal Funds (as determined over its entire term). The Provider shall also report the total compensation of its five most highly paid executives if it also receives in excess of 80% of its annual gross revenues from Federal Funds. UU1117ANCTITIN rM 11111174 1 INJIM en #104 IN r 0 r-mej I I I I p M Lei I I inj tm La rd#J I?j M 1 IV 11 Mi I Al -15.1. The Provider shall ensure that all staff utilized by the Provider and its subcontractors that are required by Florida law to be screened in accordance with chapter 435, F.S., are of good moral character and meet the Level 2 Employment Screening standards specified by sections 435.04, 110.1127, and subsection 39.001(2), F.S, as a condition of initial and continued employment that shall include but not be limited to: CIF Standard Integrated Contract 2015 1 8 Contract No. K 07 Al -16 Human Subject Research. The Provider shall comply with the requirements of CFOP 215-8 for any activity under this Contract involving human subject research within the scope of 45 CFR, Part 46, and 42 U.S.C. section 289, et seq., and may not commence such activity until review and approval by the Department's Human Protections Review Committee and a duly constituted Institutional Review Board. IM1411MALO *J& ILN JEC a LTAI . . . I , 0 - I MMp'rni JML4hJM- -71 I'MINFAMMM&I is] 1141cX410361 I I all I go N I POEMP R fill III ,-- See N/A for additional laws, rules and regulations affecting performance of this Contract, r . CIF Standard Integrated Contract 2015 19 Contract No. KG 70 EXHIBIT B - SCOPE OF WORK B-1 Scope of Service B-2 Major Contract Goals Q 11' 1 If I 1M . The goal of the Community Care for Disabled Adults (CCDA) Program is to prevent unnecessary institutionalization of disabled Homemaker Services, Personal Care Services and Home Delivered Meals. The program is designed to serve totally and E&Ar�n with disabilities. B-3 Service Area/Locations/Times Iftaft'l rofes - *4 W04MUMNI-It lid III MINI Uri in the client care plan, ' vtwtm - wewayc' descriptions and minimum requirements for each service listed in the "CFOP 140-8, Community Care for Disabled Adults Operating Procedures". B-3.1 Changes in Location B-4 Clients to be Served ll 2rl TIME Case Management ' 7Metermined by care plan Home Delivered NN Determined by care plan 11 Client's Home Determined by care plan xpmwe =111111011 1011 M-2 V1.11#1 Determined _bLcarepj�q___ _ _ � ' vtwtm - wewayc' descriptions and minimum requirements for each service listed in the "CFOP 140-8, Community Care for Disabled Adults Operating Procedures". B-3.1 Changes in Location B-4 Clients to be Served Amendment 0001 B-8 Contract Limits CF Integrated Contract 2015 21 Contract # KG070 (Revised 01/01/2016) Monroe County Board of County Commissioners Amendment 0001 1 MAY-FiAn ITer; of services including, but not limited to, t following: i C-1 Service Tasks C-1.1 Service Providers will ensure that appropriate community-based services are provided to clients in a manner designed to meet the client' s changing needs, to assist the client in avoiding or reducing unnecessary dependence on the delivered service(s), and to increase the client's self-reliance. C-1.1.1 Each CCDA client must receive case management services and at least one other CCDA In-Home service each month, C-1.2 The community-based services that shall be performed under this contract, as defined in CFOP 140-8, Community I for Disabled Adults Operating Procedures, which is incorporated by reference and available from the contract manag include: e C-1 22 Home Delivered Meals are hot or other appropriate, nutritionally sound meals that meet one-third of the Daily Recommended Dietary Allowances (RDA) served in the home to a disabled person who is homebound and at nutritional risk. Home delivered meals are for clients who have difficulty in shopping for groceries or preparing meals and have no caregiver capable of providing the services. A choice of meals from a menu provided in advance should be provided to the client. The meals should be appropriate for the client and they are satisfied with the meals. Amendment 0001 C-1.2.3.2 The unit of service is one hour (or quarter hour portion) of time spent in the provision of designate homemaker duties by a trained homemaker, It does not include time in transit to and from the client's place residence except when providing shopping assistance, performing errands or other tasks on behalf of the client. If the service is to be provided to a couple, the unit of service must be assigned to either the eligible husband or wife, preferably the one who usually performs homemaking duties. I Amendment 0001 Contract # KG070 Monroe Cm.itv liy-fAm , , Reports Report Title Reporting Report Due Date # of Copies DCF Office to Receive Report Frequency Due Monthly 25t' day of each month Cumulative Monthly immediately following One Contract Manager Summary the month being --se—port reported — 25 — tlday CCDA of each month Performance Monthly immediately following One Contract Manager Data Monthly the month being Report reported CCDA 30 day of the month Performance Annually following the end of One Contract Manager Data Annual each Fiscal Year - Contract Period 25 day of each month Invoice Monthly immediately following One Contract Manager the month being reported Contract # KG070 Monroe Cm.itv liy-fAm , , Amendment 0001 ENEJ� iiiii MM =1 C-3.1.2 The Provider will maintain an accurate and current active caseload list, CF Integrated Contract 2015 25 Contract # KG070 (Revised 01101/2016) Monroe County Board of County Commissioners Reports Report Title Reporting Report Due Date # of Copies DCF Office to Receive Report Frequency Due Civil Rights Within 30 days of Contract Manager Compliance Annually contract execution and One Checklist annuiiiiiiii Proof of Liability Annually Within 30 days of contract execution and One Contract Manager Insurance annuiall thereafter Of The Office of Support of the Civil Rights Deaf and Hard Form Site: E-Mail Verification Receipt from of Hearing as 51h business day of I o of System to Contract Manager specified in Monthly each month Exhibit A-1, immediately following DCF"I , Section 7 of the the report period 2014 Standard 8 Urn Contract rn Emergency Within 30 days of Preparedness Annually contract execution and One Contract Manager Plan every July 1. ENEJ� iiiii MM =1 C-3.1.2 The Provider will maintain an accurate and current active caseload list, CF Integrated Contract 2015 25 Contract # KG070 (Revised 01101/2016) Monroe County Board of County Commissioners Amendment 0001 C-3.1.3 The Provider will maintain a current monthly billing ledger of all Provider claims submitted to the Department, including all corrected claims and adjustments to claims for services that were delivered to clients being served through this contract. C-3.1.6 The Provider shall provide to individuals requesting services a contact name and phone number tot nearest APS Regional Program Office. i ff'T41"11rM-1U%M= CIF Integrated Contract 2015 26 Contract # KG070 (Revised 01/0112016) Monroe County Board of County Commissioners j , A , EXHIBIT C1 CCDA CARE PLAN SERVICES CC DA CARE PLAN SERVICES CLIENT NAME: CASE SOCIAL SECURITY DATE OF INITIAL CARE PLAN: GOAL (check all goals that apply): CARE PLAN REVIEW DATE (initial for each Review): []1. Self Support 02. Prevent abuse/neglect/exploitation []3. Prevent institutionalization E14. Institutionalization ❑5. Personal goals E]6. Other: Service and Pattern of Delivery Date. Service Date Problem Problems Desired Provi der (Frequency & Duration) Began (B) Resolved Outcomes (Fonnal and - T - - Actual Ended (. (RS) --T -- Problent In Forma I) F - Need Revised (RV) Na. I Date This Care Plan has been discussed with me (client) and/or significant farnify members or friends and I accept the services described in the plan. (For Medicaid Waiver Clients, also read) I accept the service described and discussed with me in this Care Plan instead of nursing home Placement. CLIENT/RESPONSIBLE PARTY: DATE: CASE MANAGER: DATE: ------ r . CF Integrated Contract 2015 27 Contract # KG070 (Revised 01/01/2016) Monroe County Board of County Commissioners Amendment 0001 EXHIBIT C2 lf,FAIIEST FOR &PRIANAL OF CQUA CARE PLAN SERVICES INCREASE mart I.' Keel ient inrormaiion Name: Last name, first name, middle name or initial Date of birth: Social security number: Medicaid/Medicare Medical assistance number: Current Address: Address where services will be received: Agency name: Agency contact person: Agency address: Part 11- Summary of Recioient's Presentine Phone:___ Fax: E-mail address: to form instructions for details about the type the space below or include attachment.) Part I [it Prnnaqpd New Service Renue%t. (Please indicate the new care nlan services being reauested and the corresponding, anticipated service start Part JN7: Specific Description of Proposed New Service(s) As Tailored To Meet Recipient's Need. (Refer to the form instructions for details about the type of information required here. Use the space below or include attachment.) Part V. Cost Detail for Proposed New Care Plan Service(s). A. Attach a Cost Detail page for each service requested in Part 111. Each Cost Detail page should reflect the total annual cost of serving the consumer for that service type. CF Integrated Contract 2015 28 Contract # KG070 (Revised 11101/2015) Monroe County Board of County Commissioners Amendment 0001 Part VI: Care Plan Modifleation of Number of Service Units. The Budget Entity Tearn will not consider authorization to increase service unit quantity of an authorized service on a Recipient's care plan for any of the following documented reasons unless this section is accurately and fully completed. [To justify unit service rates, please present comparative information: unit rate quotes from a minimum of three other service agencies providing this same service within a ten mile radius; reasons for choosing this specific vendor; a statement attesting to the fact that selected vendor is a sole source provider of this service in this geographic area, etc. Attach information as necessary (e.g., agency administrative costs, your agency salary scale, etc.). Refer to the form instructions.] Failing Support System: List proposed add-on number of monthly service units by service component with annualized service costs projected to safety maintain Recipient at home and to ameliorate this risk factor. Decrease in Functional Capacity: List proposed add-on number of monthly service units by service component with annualized set costs projected to safely maintain Recipient at home and to ameliorate this risk factor. EI Rapidly Deteriorating Health: List care plan add-on number of monthly service units by service component with annualized service costs projected to safely maintain Recipient at home and to ameliorate this risk factor. Part VII. Signatures. (Please note: Final approval of all requests for Care Plan increases rest with the Budget Entity Team. Providers will receive an Letter from the Budget tntity I earn or one of its members) when the p nas been _apEroveu ) re indicates that the information presented in this Request for Care Plan Services Increase and Date: ents are accurate and complete.) I Recipient/Representative: (Signature indicates that the Recipient/ Representative has reviewed the Request for Care Plan Date: Services Increase and attachments.) I District/Regional Program Staff. (Signature indicates that the district/regional program staff and provider have agreed Date: upon the services to be funded.) I District/Regional Adult Services Program Plan.) approval of the Service Funding 29 Contract# KG074 (Revised 11/01/2015) Monroe County Board • C1 unty Commissioners RE 2-4 z 0 Vk, e1 h 4 x z Lid CD O E E o yy 4 to 0. O A fz � � w y LL O JAL:: I x z Lid CD O E E o yy 4 to 95 a; I Lid O w22» «! \§� � � / eat FAwow OW. Reporting MonthNear .DA Active ©. CCDA Client YTD CC DA Unduplicated YTD CCDA Waiting List YTD I Monthly Nursing Home Placements---,- Nursing Home placements YTD ZZMEM WIMSMOMM mm DUE H E ��2T � Amendment 0001 CF Integrated Contract 2015 31 Contract # KG070 (Revised 01/01/2016) Monroe County Board of County Commissioners EXHIBIT C5 PE Z.F01MANCE DATA ANNUAL REPORT �� / \d Agency/County Reporting Reporting Fiscal Year Prepared By:--- Date: DUE THE 30 OF THE MONTH FOLLOWING TH END OF THE FISCAL YEAR OR CONTRAdA Amendment 0001 CF Integrated Contract 2015 32 Contract # KG070 (Revised 01/01/2016) Monroe County Board of County Commissioners Amendment 0001 D-1 Service Units. A Service Unit is defined in CFOP 140-8, Community Care for Disabled Adults Operating Procedures, and described in Sections D-1.1 The following services are available to all CCDA clients if required in the client's care plan. SERVICES UNIT Case Management 1 hour Home Delivered Meals 1 meal delivered — Home - maker IIII Personal Care D-2.1 Service provision is based upon the individual needs of the clients as detailed in each clients'care plan and is therefore variable. Each client must receive case management services and one additional in-home service each month. D-3 Performance Measures for Acceptance of Deliverables, Failure to comply with the following provisions will result in additiona' financial consequences detailed in Section F-4. D-3.1 At a minimum, every client shall receive case management services and one additional CCDA In-Home service monthly. CF Integrated Contract 2015 33 Contract # KG070 (Revised 01101/2016) Monroe County Board of County Commissioners EXHIBIT E - MINIMUM PERFORMANCE MEASURES E-1 Minimum Performance Measures Amendment 0001 E•3 PERFORMANCE EVALUATION METHODOLOGY rik T6 �bl R _f )' - TTTffRVt:ft7. MT I I For any and all performance measures suggested in the proposal, the following format shall be used: For the measure in Section E-1.1, the percentage • completion that meets standards will be determined by dividing the number of active clients not admitted to a nursing home by the total number of active clients receiving services. Numerator # of Active Clients Not Admitted to A Nursing Home = 90% Denominator Total # of Active C iving Services For the measure in Section E-1.2, the percentage of completion that meets standards will be determined by dividing t4v- number of active clients reported to the Abuse Hotline by the total number of active clients suspected of being abused, neglected or exploited. Numerator # of Active Clients Reported to the Abuse Hotline 100% Denominator Total # of Active Clients Suspected of Being Abused, Neglected or Exploited E-3.3 For the measure in Section E-1.3, the percentage of completion that meets standards will be determined by dividing the number of active clients receiving case management and at least one other CCDA in-home service each month by the total number • active clients receiving services each month, Numerator # of Active Clients Receiving Case Management And At Least One Other CCOA In-Home Service Each Month = 100% Denominator tal # of Active Clients Receiving Services Each Month CF Integrated Contract 2015 34 Contract # KG070 (Revised 01/01/2016) Monroe County Board of County Commissioners Amendment 0001 E-4.2 The Department may conduct random surveys or contract with an outside entity to conduct random or structured surveys during the term of the contract to gauge a variety of factors including client satisfaction, location, Provider responsiveness, professionalism, and cultural and linguistic accommodations. CF Integrated Contract 2015 35 Contract # KG070 (Revised 01101/2016) Monroe County Board of County Commissioners off F-CIA Pursuant to section 215.971, F. S., as a recipient or subrecipient of federal or state financial assistance, the Provider may expend funds only for allowable costs resulting from obligations incurred from January 1, 2015 through June 30, 2018. F-1.1,2 Pursuant to section 215.971, F. S., any balance of unobligated funds which has been advanced or paid must 1i refunded to the Department. F-1,11.3 Pursuant to section 215.971, F. S., any funds paid in excess of the amount to which the recipient or subrecipient is entitled under the terms and conditions of this contract must be refunded to the Department. F-i.2 The Department shall make payments to the Provider for the provision of services at the units and rates shown below, in accordance with the client's care plan. A Service Unit is defined in CFOP 140-8, Community Care for Disabled Adults Operating Procedures, and listed in Sections C-1.2 and D-1. SERVICES Case Man2ge Home Delivered Meals Homemaker Care F-1.3 The Provider agrees to provide local matching funds in the amount of $4,590.00 for State Fiscal Year 2014-2015; $6,858.89 for State Fiscal Year 2015-2016; of $6,858.89 for State Fiscal Year 2016-2017 and of $6,858.89 for Sta Fiscal Year 2017-2018, totaling $25,166.67 for the contract period. WE Invoice Requirements a a CF Integrated Contract 2015 37 Contract # K070 (Revised 01/01/2016) Monroe County Board of County Commissioners Amendment 0001 MONTHLY REQUEST FOR PAYMENT AND EXPENDITURE REPORT DEPARTMENT OF CHILDREN AND FAMILIES 0 OFFICE OF ADULT SERVICES MONTHLY REQUEST FOR PAYMENT AND EXPENDITURE REPORT A V �' MyF1,1 A mILIES.COM NAME AND MAILING ADDRESS OF PAYEE CONTRACT REIMBURSEMENT YTD,: CONTRACT BALANCE: DATE: CONTR ACT #: PERIOD OF SERVICE PROVISION:_, --------- Approved By: Title: If this invoice is for a fixed price contract, the request for payment will be determined by dividing the length of the contract into the contracted amount (example: $12,000 [allocation] divided by 12 months [the length of the contract] = $1,000 payment request). On a cost reimbursement contract, the payment request will be the monthly request expense. CHILDREN AND FAMILIES USE ONLY Date Invoice Received: Approved By: Date: RG 13,0 013J DESC. AMNT. OCA CF Integrated Contract 2015 38 Contract # KG070 (Revised 01/01/2016) Monroe County Board of County Commissioners Signature of Preparers Date Completed: EXHIBIT F2 — ADDITIONAL FINANCIAL CONSEQUENCES Amendment 0001 I =,, 104MY4115, 13MMIT-11F I MI M RE= � IP I lip, TO IN M 100 1 a being notified by the Adult 7W. ELVA 11MMM11111 1 0 M the adverse circumstances beyond the Provider's control to the regional contract manager. One-hundred percent (100%) of active 10% reduction of the clients who are suspected of being a amount of each client's Funds will be returned to the victim of abuse neglect or exploitation abuse, total monthly charges Department within 30 days of 2 will be reported the Abuse Hotline and <100% 2% of total contract being notified by the Adult 3 an incident report will be sent to the <100% award expended Protective Services Program case manager and copied to the Adult management contact Office of non-compliance. Protective Services Specialist & and at least one other Contract Manaqer. CCDA in-home service the adverse circumstances beyond the Provider's control to the regional contract manager. 10% reduction of the amount of each client's One - hundred percent (100%) of active total monthly charges clients served through this contract will who do not receive at To be deducted from the 3 be provided case management and at <100% least one case reporting month invoice when least one other CCDA in-home service management contact the non-compliance occurred. monthly. and at least one other CCDA in-home service monthly. the adverse circumstances beyond the Provider's control to the regional contract manager. Amendment 0001 FINANCE AND COMPLIANCE AUDIT as described in this attachment. PART 1: FEDERAL REQUIREMENTS Guidance, Section 200.500-200.521, as revised. PART II: STATE REQUIREMENTS Amendment 0001 HIM ii! 1 11 1 M , V I RVIVE lffl! I Pil I I Tal . #. I • T TINW-VINT - Vew,1177 =1 effect during the audit period. The financial statements should disclose whether or not the matching requirement was met for each applicable contract, All questioned costs and liabilities due the Department shall be fully disclosed in the audit report package with reference to the specific contract number. PART Ill: REPORT SUBMISSION Single Audit Unit Building 5, Room 237 1317 Winewood Boulevard Tallahassee, FL 32399-0700 Email address: !r1QV11(JG Q it ct ftl � � m av - 'es co VATJ MEN as revised, by or on behalf of the recipient directly to the Federal Audit Clearinghouse using the Federal Audit Clearinghouse's Internet Data Entry System at: ilt­ MUn! and other Federal agencies and pass-through entities in accordance with Section 200.512 (e), OMB Uniform Guidance, as revised. CF 1120 (514/2015) a. CIF Integrated Contract 2015 41 Contract # KG070 (Revised 01/0112016) Monroe County Board of County Commissioners Amendment 0001 D. Copies of reporting packages required by Part 11 of this agreement shall be submitted by or on behalf of the recipie directly to the following address: I Auditor General Local Government Audits/342 ii M-INi 1 1 10 1 M. IW�111112 0=1 I - M11111E PART IV: RECORD RETENTION The recipient shall retain sufficient records demonstrating its compliance with the terms of this agreement for a period of six years from the date the audit report is issued and shall allow the Department or its designee, Chief Financial Officer or Auditor General access to such records upon request. The recipient shall ensure that audit working papers are made available to the Department or its designee, Chief Financial Officer or Auditor General upon request for a period of three years from the date the audit report is issued, unless extended in writing by the Department. CF 1120 (5/4/2015) CF Integrated Contract 2015 42 Contract # KG070 (Revised 01/01/2016) Monroe County Board of County Commissioners ATTAMRE-V 2 LIP it W-T Amendment 0001 - ifi - is — ex - ffib - Iff - co - ritams tne terms ana conaitions governing tflr� i TT ME provides the permissible uses and disclosures of protected health information by the Provider, also called "Business Associate." Section 1. Definitions 1.1 Catch-all definitions: j73 1 1 j III I I I i 1 Practices, Protected Health Information, Required by Law, Security Incident, Subcontractor, Unsecured Protected Health Information, and Use. 1.2.1 "Business Associate" shall generally have the same meaning as the term "business associate" at 45 CFR 160.103, and for purposes of this Attachment shall specifically refer to the Provider. 1.2.2 "Covered Entity" shall generally have the same meaning as the term 'covered entity" at 45 CFR 160.103, and for purposes of this Attachment shall refer to the Department. 1.2.3. "HIP AA Rules" shall mean the Privacy, Security, Breach Notification, and Enforcement Rules at 45 CFR Part 160 and Part 164. 1.2.4. "Subcontractor shall generally have the same meaning as the term "subcontractor" at 45 CFR § 160.103 and is defined as an individual to whom a business associate delegates a function , activity, service , other than in the capacity of a member of the workforce of such business associate, Section 26 Obligations and Activities of Business Associate 2.1 Business Associate agrees to: I I _ 1 I _r IFT =611 111111 ITIT, IBM 117 r . a. CF Integrated Contract 2015 43 Contract # KG070 (Revised 01/01/2016) Monroe County Board of County Commissioners Amendment 000 21A Report to covered entity any use or disclosure of protected health information not provided for by this Attachment of which it becomes aware, including breaches of unsecured protected health information as required at 45 CFR 164.410, and any security incident of which it becomes aware; 2.1.5 Notify the Department's Security Officer, Privacy Officer and the Contract Manager as soon as possible, but no later than five (5) business days following the determination of any breach or potential breach of personal and confidenfial departmental data; 2.1.6 Notify the Privacy Officer and Contract Manager within (24) hours of notification by the US Department of Health and Human Services of any investigations, compliance reviews or inquiries by the US Department of Health and Human Services concerning violations of HIPAA (Privacy, Security Breach). 2.1.7 Provide any additional information requested by the Department for purposes of investigating and responding to a breach; u1s] 4 tall Kom WAP"IftLel I- A I - 41411174 1141%,1111 W 11 IVALOrti'VA!,m& U11431-110ft-1-11 V4AI#j Its) MONK wifolgillemagis ra HF. - Ittrom N RMARI no F MR 2.1.10 Take immediate steps to limit or avoid the recurrence of any security breach and take any other action pertaining to such unauthorized access or disclosure required by applicable federal and state laws and regulations regardless of any actions taken • the Department; 2.1.12 Make available protected health information in a designated record set to covered entity as necessary to satisfy covered entity's obligations under 45 CFR 164.524; 2.1.13 Make any amendment(s) to protected health information in a designated record set as directed or agreed to by the covered entity pursuant to 45 CFR 164.526, or take other measures as necessary to satisfy covered entity's obligations under 45 CFR 164.526; 2.1.14 Maintain and make available the information required to provide an accounting of disclosures to the covered entity as necessary to satisfy covered entity's obligations under 45 CFR 164.528; 2.1.15 To the extent the business associate is to carry out one or more of covered entity's obligation(s) under Subpart E of 45 CFR Part 164, comply with the requirements of Subpart E that apply to the covered entity in the performance of such obligation(s); and Section 3. Permitted Uses and Disclosures by Business Associate —11-1611-1 of r I I I I IRWIN 111 11111111 3.1.1 The Business Associate may use and disclose the Department's PHI and/or ePHI received or created by Business Associate (or its agents and subcontractors) in performing its obligations pursuant to this Attachment. 3.1.2 The Business Associate may use the Department's PHI and/or ePHI received or created by Business Associate (or its agents and subcontractors) for archival purposes. 3.1.3 The Business Associate may use PHI and/or ePHI created or received in its capacity as a Business Associate of the Department for the proper management and administration of the Business Associate, if such use is necessary (a) for the proper management and administration of Business Associate • (b) to carry out the legal responsibilities of Business Associate. 3.1.5 The Business Associate may aggregate the PHI and/or ePHII created or received pursuant this Attachment with the PHI and/or ePHI of other covered entities that Business Associate has in its possession through its capacity as a Business Associate of such covered entities for the purpose of providing the Department of Children and Families with data analyses relating to the health care operations • the Department (as defined in 45 C.F.R. §164.501). 3.1.6 The Business Associate may de-identify any and all PHI and/or ePHI received or created pursuant to this Attachment, provided that the de-identification process conforms to the requirements of 45 CFR § 164.514(b) 3.1.7 Follow guidance in the HIPAA Rule regarding marketing, fundraising and research located at Sections 45 CFR § 164.501, 45 CFR § 164.508 and 45 CFR § 164.514. Section 4. Provisions for Covered Entity to Inform Business Associate of Privacy Practices and Restrictions 1 Covered ter. notify business associate of any limitation(s) in the notice of privacy practices ♦ covered entity under 45 CFR 164.520, to the extent that such limitation may affect business associate's use or disclosure of protected health information. 4.2 Covered entity shall notify business associate of any changes in, or revocation of, the permission by an individual to use or disclose his or her protected health information, to the extent that such changes may affect business associate's use or disclosure of protected health information. 4.3 Covered entity shall notify business associate of any restriction on the use or disclosure of protected health information that covered entity has agreed to or is required to abide by under 45 CFR 164.522, to the extent that such restriction may affect business associate's use or disclosure of protected health information. Section 5. Termination 5.1 Termination for Cause CIF Integrated Contract 2015 45 Contract # KG070 (Revised 01(0112016) Monroe County Board of County Commissioners Amendment 0001 5.1.1 Upon the Department's knowledge of a material breach by the Business Associate, the Department shall either: iffliffliNiTill ! ill Mill i R�IlMl M mummm= 5.2.1 Upon termination of this Attachment for any reason, business associate, with respect to protected health information received from covered entity, or created, maintained, or received by business associate on behalf of covered entity, shall: 5.2.1.1 Retain only that protected health information which is necessary for Business Associate to continue its proper management and administration or to carry out its legal responsibilities; 11 1 !!ill lilligpippi pl��lll g lig 071f, � pqllli�pglzilil�; Section 6, Miscellaneous CIF Integrated Contract 2015 46 Contract # KG070 (Revised 01/01/2016) Monroe County Board of County Commissioners Bronwyn Stanford Regiona �n�n D�x ��E����RANDU����F NEGOTIATION - Procurement History Contract KG070 was procured pursuant to Section 287.057(3)e. 12., Florida Statutes, utilizing the Regulated Exemption IGA- Services or commodities provided by governmental entities. KG070 has an effective date of January 1, 2015 and an ending date of June 30, 2018. The Department notified the Provider on August 28. 2O1G they were not in compliance with the Preferred Pricing Clause found on Page 1C Standard Integrated Contract 2015, Section 7.6, Preferred Pricing Affidavit. It was determined that several of the rates contained in Contract KG071 were less favorable tuthe Department than for those similar oorvioao under their existing contracts with the Alliance for Aging, Inc. The Standan Integrated Contract 2015 requires that the same pricing terms shall be effective as an amendment to this contract retroactively to the earlier of thi effective date of this contract or the date they were first contracted or offered to the other party and any payment in excess of such pricing shall bi deemed overpayments. The more favorable rates for Homemaker, Case Management, Home Delivered Meals and Personal Care services are indicated in the chart belovA Based Ona review of the payment history for Fiscal Years 2015'2O17,it was determined that there has been an overpayment nY$3.4O2.99baua/ on the following calculations: Mission: Work in Partnership with Local Communities to Protect the Vulnerable, Promote Strong and Economically Self- Sufficient Department of Alliance Unit Rate Children and for Aging/ Alliance for Difference Number of Number of Total Service Families Older Aging Rate for Units Paid In Units Paid In Overpayment Contract Rate American Preferred FY 15-16 FY 16-17 Act Rate Price Case Management $50.96 N/A $50.48 $0.48 164 11 $84.00 Home Delivered Meals $6.33 $6.00 N/A $0.33 705 10 $235.95 Personal Care $23.25 $22.00 $28.67 $1.25 611.75 26 $797.19 Mission: Work in Partnership with Local Communities to Protect the Vulnerable, Promote Strong and Economically Self- Sufficient Amendment #0002 0 (1al NAL Contract No. KG070 THIS AMENDMENT, entered into between the State of Florida, Department of Children and Families, hereinafter referred to as the "Department," and Monroe County Board of County Commissioners, hereinafter referred to as the "Provider," amends Contract No. KG070. Amendment #0001 replaced the CF Standard Contract 2014, Exhibits A -F and Attachments 1 -2 with the CF Standard Integrated Contract 2015, Exhibits A -F and Attachments 1 -2, Furthermore, the amendment decreased the contract funding to align with the AOB; revised the Deliverables; added required language pursuant to Section 215.97, F.S.; and corrected the additional financial consequences language. The purpose of this Amendment #0002 is to revise the unit rates for Homemaker, Case Management, Home Delivered Meals, and Personal Care services pursuant to Section 215.0113, F.S. in compliance with the Preferred Pricing Clause identified on Page 10, Standard Integrated Contract 2015, Section 7.6, Preferred Pricing Affidavit. This amendment also adds language to EXHIBIT A- SPECIAL PROVISIONS, SECTION 6: PENALTIES, TERMIATION AND DISPUTE RESOLUTION, to allow the Provider to terminate the contract. The revised pricing terms shall be effective with this Amendment #0002 retroactively to the effective date of this contract. Payments made in excess of such pricing are deemed to be overpayments and any overpayment shall be promptly returned to the Department as provided in Section 3.4 of the Standard Integrated Contract 2015. 1. Page 12, CF Standard Integrated Contract 2015, EXHIBIT A- SPECIAL PROVISIONS, SECTION 6: PENALITIES, TERMIATION AND DISPUTE RESOLUTION, Paragraph A- 6.2.5, is hereby amended to add: SECTION 6: PENALTIES, TERMINATION AND DISPUTE RESOLUTION A -6.2.5 This Contract may be terminated by the Provider upon no less than thirty (30) calendar days' notice in writing to the Department unless a sooner time is mutually agreed upon in writing. 2. Page 36, CF Standard Integrated Contract 2015, EXHIBIT F- METHOD OF PAYMENT (Revised 01/01/2016), Section F -1.2, is hereby amended to read: F -1.2 Service Unit A Service Unit is defined in CFOP 140 -8, Community Care for Disabled Adults Operating Procedures, and listed in Sections C -1.2 and D -1. CF1127 Effective July 2015 Monroe County Board of County Commissioners a a (CF- 1127 -1516) Department of Alliance for Service Children and Families Alliance for Aging /Older Unit Rate Contract Rate Aging Rate American Act Difference Rate Homemaker $23.47 $22.06 $22.00 $1.47 Case Management $50.96 $50.48 N/A $0.48 Home Delivered Meals $6.33 N/A $6.00 $0.33 Personal Care $23.25 $28.67 $22.00 $1.25 1. Page 12, CF Standard Integrated Contract 2015, EXHIBIT A- SPECIAL PROVISIONS, SECTION 6: PENALITIES, TERMIATION AND DISPUTE RESOLUTION, Paragraph A- 6.2.5, is hereby amended to add: SECTION 6: PENALTIES, TERMINATION AND DISPUTE RESOLUTION A -6.2.5 This Contract may be terminated by the Provider upon no less than thirty (30) calendar days' notice in writing to the Department unless a sooner time is mutually agreed upon in writing. 2. Page 36, CF Standard Integrated Contract 2015, EXHIBIT F- METHOD OF PAYMENT (Revised 01/01/2016), Section F -1.2, is hereby amended to read: F -1.2 Service Unit A Service Unit is defined in CFOP 140 -8, Community Care for Disabled Adults Operating Procedures, and listed in Sections C -1.2 and D -1. CF1127 Effective July 2015 Monroe County Board of County Commissioners a a (CF- 1127 -1516) Amendment #0002 Contract No. KG070 F-1.2.1 The Department shall make payments to the Provider for the provision of services at the units and rates shown below, in accordance with the client's care plan. STANDARD/CORE SERVICES UNIT RATE Case . Management 1 hour $50.48 Home Delivered Meals I meal delivered $6.00 Homemaker 1 hour $22.00 Personal Care I hour $22.00 3. Pages 38, CF Standard Integrated Contract 2015, EXHIBIT Fl-MONTHLY REQUEST FOR PAYMENT AND EXPENDITURE REPORT (Revised 01/01/2016), is hereby deleted in its entirety and REVISED Exhibit Fl-Monthly Invoice (Revised 11.01-2016), is inserted in lieu thereof and attached hereto. THE REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK CR 127 Effective July 2015 2 Monroe County Board of County Commissioners (CF- 1127 -1516) Amendment #0002 Contract No. KG070 This amendment shall begin on November 1, 2016 or the date on which the amendment has been signed by both Parties, whichever is later. All provisions in the contract and any attachments thereto in conflict with this amendment shall be and are hereby changed to conform with this amendment. All provisions not in conflict with this amendment are still in effect and are to be performed at the level specified in the contract. This amendment and all its attachments are hereby made a part of the contract. IN WITNESS THEREOF, the parties hereto have caused this four (4) page amendment to be executed by their officials' thereunto duly authorized. . SIGNED BY: NAME: Heather Carruthers TITLE: Monroe County Mayor I•T_W Federal ID Number: 59. 6000749 STATE OF • NAME: Bronwyn Stanford TITLE: Regional Managing Director r� CH 127 Effective July 2015 3 Monroe County Board of County Commissioners (CF -1127 -1516) a a a a PROVIDER NAME: Monroe County Board of County Commissioners ADDRESS: 500 Whitehead Street VENDOR NUMBER: 59- 6000749 Key West, Florida 33040 STANDARDICORE SERVICES RATE #of UNITS AMOUNT DU'E Case Management $50.48 Home Delivered Meals $6.00 Homemaker $22.00 Personal Care $22.00 TOTAL PAYMENT REQUESTED $ Less any financial consequences Imposed as per Section F -4: By signing this report, I certify to the best of my knowledge and belief that the report is true, complete and accurate and the expenditures, disbursements and cash receipts are for the purposes and objectives set forth in the terms and conditions of this agreement. I am aware that any false, fictitious, or fraudulent information or the omission of any material fact, may subject me to criminal, civil or administrative penalties for fraud, false statements, false claims, or otherwise. Additionally, I certify that all reports supporting this invoice have been submitted to the Department in accordance with this agreement. Authorizing Signature: Date Title: CF Standard Integrated Contract 2015 38 Contract No. KG070 Revised 11 -01 -2016 Monroe County Board of County Commissioners