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09/17/2013 Agreement r am " N 4.,:10„:-N.‘,,ta,/,,, ,?,;.; ,,,p,r, /ff . CLERK OF CIRCUIT COURT & COMPTROLLER (k \\,:F -te •rll� 74 MONROE COUNTY,FLORIDA DATE: October 24, 2013 TO: Sheryl Graham, Director Social Services Department ATTN: Dotti Albury In-Home Services Programs FROM: Vitia Fernandez, D.C. At the September 17, 2013, Board of County Commissioner's meeting the Board granted approval and authorized execution of the following items: Item C13 Aged and Disabled Adult Medicaid Waiver (ADA-MW) Referral Agreement between the Alliance for Aging, Inc. and the Monroe County Board of County Commissioners (Social Services/In- Home Services) for Home Delivered Meals. Item C14 Renewal of the Home and Community Based- Medicaid Waiver (ADA-MW) Referral Agreement between the Alliance for Aging, Inc. and Monroe County Board of County Commissioners (Monroe County Bayshore Manor) for Facility Based Respite. Enclosed are six (6) duplicate originals of each of the above-mentioned, executed on behalf of Monroe County,for your handling. Please be sure to return two fully executed duplicate originals as soon as possible. Should you have any questions,please do not hesitate to contact our office. cc: County Attorney w/o document Finance File 500 Whitehead Street Suite 101,PO Box 1980,Key West,FL 33040 Phone:305-295-3130 Fax:305-295-3663 3117 Overseas Highway,Marathon,FL 33050 Phone:305-289-6027 Fax:305-289-6025 88820 Overseas Highway,Plantation Key,FL 33070 Phone:852-7145 Fax:305-852-7146 HOME AND COMMUNITY BASED SERVICES AGED AND DISABLED ADULT (ADA) MEDICAID WAIVER REFERRAL AGREEMENT This Referral Agreement between the Alliance for Aging, Inc., the Area Agency on Aging (AAA) for Planning and Service Area (PSA) 11 and Monroe County Social Services/Bayshore Manor the Service Provider, shall begin on January 1, 2013 or on the date the agreement has been signed by both parties, whichever is later. This referral agreement is in effect for a period of time that is equal to the Medicaid waiver provider's enrollment period with the State of Florida's Medicaid fiscal agent and is contingent upon an annual appropriation by the Legislature. One purpose of this agreement is to promote the development of a coordinated service delivery system to meet the needs of the aged or disabled adults who are at risk of premature institutionalization. Another purpose of this agreement is to enable eligible elderly participants to receive home and community based services from qualified providers with oversight of the quality of care by the Medicaid Waiver Specialist employed by the AAA. These services are authorized in order that the participant may remain in the least restrictive setting and avoid or delay premature nursing home placement. Services and care are to be furnished in a way that fosters the independence of each participant to facilitate aging in place. All parties agree that routines of care provision and service delivery must be consumer driven to the maximum extent possible. All parties agree to and will treat each participant with dignity and respect. I. Objectives A. To maintain a climate of cooperation and consultation with and between agencies, in order to achieve maximum efficiency and effectiveness. B. To participate together by means of shared information in the development of services. C. To promote programs and activities designed to prevent the premature institutionalization of elders and disabled adults. D. All parties recognize that the consumer retains the right to assume risk, tempered only by the individual's ability to assume responsibility for that risk. E. All parties recognize that the consumer retains the right to choose which enrolled provider he/she will receive services from. F. To require the parties of this Agreement to provide technical assistance and consultation to each other on matters pertaining to actual service delivery and share appropriate assessment information and care plans so duplication may not occur. G. To establish an effective working relationship between the case management agency that is responsible for the development of care plans and authorization of services available under the waiver, the service provider that is responsible for the direct provision of those services to consumers served under the waiver program, and the AAA that is responsible for management and oversight of the waiver program. II. Under this Agreement, the Service Provider agrees to the following: A. To accept referrals for the 1915c Home and Community -Based Services - ADA Medicaid Waiver from the enrolled case management agency. B. To provide quality service(s) to the waiver participant as specified in Section IV., Provision of service(s), subject to quality monitoring and/or observation by the case management agency and/or the AAA and/or the Department of Elder Affairs (the "department"). C. To provide only those services specifically outlined in the Plan of Care and authorized by the enrolled case management agency. D. Notify the AAA of any change of ownership action at least 90 days prior to the effective date of closing. Medicaid Waiver provider numbers are non-transferrable. E. To attach documentation regarding the service provider's qualifications to this agreement; and to provide, as requested, any information regarding Medicaid Waiver billing, payment, or waiver participant information, to the case management agency or AAA. Provider rates shall not exceed the approved negotiated rates that are at or below the service provider's usual and customary rates. If additional services are to be added to this agreement, a written request to do so must be received by the AAA. If approved, an amendment must be prepared by the AAA indicating the service(s) to be added. The necessary documentation regarding provider qualifications for the additional services must be attached to the agreement. F. To maintain the waiver participant's confidentiality according to 42 CFR 431.301. G. Adhere to requirements contained in the Health Insurance Portability and Accountability Act (HIPPA), as applicable, and to maintain the waiver participant's confidentiality. H. To immediately report any changes in the waiver participant's condition to the case management agency. I. To maintain enrolled provider status by renewing applicable licensure, certification, contract and/or referral agreements and by maintaining all provider qualifications as contained in the Aged and Disabled Adult Medicaid Waiver under which services are provided. J. Provide copies of all licensure, certification to the AAA to ensure provider qualification as per the Florida Medicaid Aged and Disabled Adult Waiver Services Coverage and Limitations Handbook. K. To include its name and other appropriate information on a list of all enrolled providers which will be shown to consumers during development of an individualized plan of care, understanding that the consumer reserves the right at all times to a choice of enrolled providers. L. To immediately notify the case management agency of staffing shortfalls that will negatively impact provision of service to Medicaid Waiver consumers. M. To submit claim data for billing to the Medicaid fiscal agent after delivery of services has been accomplished. All services should be billed within 60 days after services have been provided or document reasons for delayed submission of claims. Such documentation shall be available for review by the area agency on agency or by the department, upon request. N. To submit claims for billing to the Medicaid fiscal agent at the agency's contracted rate, as per page 5 of this agreement. O. To submit voided or adjusted claims no later than 45 days after either party has identified the error. The provider's refusal to adjust or void erroneous claims may result in termination of this agreement and/or referral to the department, and will be referred by the department to the Agency for Health Care Administration for appropriate action. P. To develop and implement a policy to ensure that its employees, board members, and management, will avoid any conflict of interest or the appearance of a conflict of interest when disbursing or using the funds described in this agreement. A conflict of interest includes, but is not limited to, receiving, or agreeing to receive, a direct or indirect benefit, or anything of value from a service provider, consumer, vendor, or any person wishing to benefit from the use or disbursement of funds. To avoid a conflict of interest, the service provider must ensure that all individuals make a disclosure to the AAA of any relationship which may be a conflict of interest, within thirty (30) days of an individual's original appointment or placement on a board, or if the individual is serving as an incumbent, within thirty (30) days of the commencement of the agreement. Q. To report any significant changes in the waiver participant's condition to the case management agency as soon as the provider becomes aware of such changes or within 48 hours, whichever is earlier. R. To report adverse incidents that affect the health, safety & welfare of a client to the Case Management agency within 48 hours of its occurrence using the required reporting template as provided by the AAA. Adverse incidents may include injury such as death, brain or spinal damage, permanent disfigurement, fracture or dislocation of bones or joints, any condition requiring medical attention to which the client has not given informed consent, any condition that requires the transfer of the client within or outside an ALF or consumer's residence to a unit providing a more acute level of care due to the adverse incident not related to the client's condition prior to the incident, abuse, neglect or exploitation, resident elopement or an event that is reported to law enforcement (does not include Baker Act transport or deaths by natural causes). S. To report any adverse incidents involving abuse, neglect, and exploitation to the Department of Children & Families (DCF). T. Participate in training arranged by the AAA, the Department, Department of Children and Families and/or Agency for Health Care Administration, as required. U. To review and correct any CIRTS exception reports submitted by the AAA monthly by the stipulated time frame. V. To adhere to the federal waiver requirements and the policies and procedures outlined in the following manuals published by the Agency for Health Care Administration: the Florida Medicaid Aged and Disabled Adult Waiver Services Coverage and Limitations Handbook, Aged and Disabled Adult Waiver Procedure Codes and Fee Schedule, Aged and Disabled Adult Waiver Incontinence Fee Schedule and Quality Standards, and the Florida Medicaid Provider General Handbook, Department of Elder Affairs Programs and Services Handbook including any and all attachments or updates. W. If the Service Provider is enrolled as a home delivered meals vendor, the Area Agency will retain the services of a registered dietitian to perform the following: 1. Conduct site inspections of all catering facilities. These may be unannounced. 2. Monitor meal delivery times and temperatures. 3. Review all menus submitted by the service provider and suggest changes as needed. 4. Work with the service provider to ensure that standardized recipes and computer -assisted nutritional analyses are carried out. X. Comply with any additional ADA Medicaid Waiver service provider related requests for information from the Department regarding implementation of the Statewide Medicaid Managed Care Program (SMMCLTC). Y. To provide a home -like setting and community integration to all Medicaid Waiver consumers receiving ADA Medicaid Waiver services in an ALF. The ALF provider shall support the consumer's community inclusion and integration by working with the consumer and the consumer's Case Manager to facilitate the integration of the consumer's personal goals and community activities. Additional services must be offered as follows, unless medical, physical, or cognitive impairments restrict or limit exercise of these options: 1. Private or semi -private rooms 2. Roommate for semi -private rooms 3. Locking door to living unit 4. Access to telephone and length of use 5. Eating schedule 6. Participation in facility and community activities 7. Ability to have unlimited snacks as desired, maintain personal sleeping schedule, prepare snacks as desired, maintain personal sleeping schedule The ALF provider must be in compliance with the consumer's Resident Bill of Rights. Z. The AAA may impose department -approved sanctions for non-compliance with the terms of this agreement. Indemnification To the extent set forth in Florida Statute 768.28, service provider agrees to indemnify, defend, and hold harmless the AAA, and all of the AAA's officers, agents, and employees and the department and all of the department's officers, agents, and employees from any claim, loss, damage, cost, charge, or expense arising out of any acts, actions, neglect or omission, action in bad faith, or violation of federal or state law by the service provider, its agents or employees, during the performance of this agreement. 2. Service Provider obligation to indemnify, defend, and pay for the defense or, at the AAA's and/or department's option, to participate and associate with the AAA and/or department in the defense and trial of any claim and any related settlement negotiations, shall be triggered by the AAA's and/or department's notice of claim for indemnification to service provider. Service provider's inability to evaluate liability or its evaluation of liability shall not excuse service provider's or's duty to defend and indemnify the AAA and/or department, upon notice by the AAA and/or department. Notice shall be given by registered or certified mail, return receipt requested. Only an adjudication or judgment after the highest appeal is exhausted specifically finding the AAA and/or department solely negligent shall excuse performance of this provision by service providers. The service provider shall pay all costs and fees related to this obligation and its enforcement by the AAA and/or department. The AAA's or department's failure to notify the service provider of a claim shall not release service provider of the above duty to defend. 3. It is the intent and understanding of the parties that neither the service provider, nor any of its employees are employees of the AAA or the department and shall not hold themselves out as employees or agents of the AAA or department without specific authorization from the AAA or department. It is the further intent and understanding of the parties that the AAA or department does not control the employment practices of the service provider and shall not be liable for any wage and hour, employment discrimination, or other labor and employment claims against the service provider. III. Under this Agreement, the Area Agency on Aging agrees to the following: A. To ensure that new and existing waiver service providers initially meet and continue to meet waiver service provider qualifications. B. To offer technical assistance or necessary training to all ADA Medicaid Waiver service providers enrolled in the ADA Medicaid Waiver program for the purpose of administering the program. C. To assist the Department in conducting monitoring and other related management/administrative functions for compliance with state and federal laws and rules governing waiver program operations. D. To report any adverse incident reports to the Department within 48 hours of the AAA being notified by the case management agency. E. To develop and maintain written policies and procedures, as necessary, to ensure necessary performance standards. F. To assist the ADRC in maintaining the APPL (waitlist) for Medicaid Home and Community Based Waiver Service Programs. G. Assist the Department in reporting follow-up for substantiated reports of abuse, neglect, and exploitation within 10 working days of receipt. H. To review and correct the CIRTS exception reports monthly and provide the Department with a summary of the resolutions, as requested. 4 IV. Under this agreement, the following services will be delivered by the Service provider in accordance with the plan of care or service authorization: Service Unit Rate County/Region Served A. Facility Based Respite $10.00/hour Monroe B. C. D. E. V. Termination In the event this agreement is terminated, the case management agency and the service provider agree to submit, at the time notice of intent to terminate is delivered, a plan which identifies procedures to ensure services to consumers will not be interrupted or suspended by the termination. A. Termination at Will This agreement may be terminated by any party upon no less than thirty (30) calendar days notice, without cause, unless a lesser time is mutually agreed upon by both parties, in writing. Said notice shall be delivered by certified mail, return receipt requested, or in person with proof of delivery. B. Termination Because of Lack of Funds In the event funds to finance this agreement become unavailable, the area agency may terminate this agreement upon no less than twenty-four (24) hours notice in writing to the other party. Said notice shall be delivered by certified mail, return receipt requested, or in person with proof of delivery. The area agency shall be the final authority as to the availability of funds. C. Termination for Breach Unless a breach is waived by the area agency in writing, or the parties fail to cure the breach within the time specified by the area agency, the area agency may, by written notice to the parties, terminate the agreement upon no less than twenty-four (24) hours notice. Said notice shall be delivered by certified mail, return receipt requested, or in person with proof of delivery. In witness whereof, the parties have caused thisft page agreement to be executed by their uMersi-qned officials as duly authorized. S' 0 Area nc on Aging S i r er -= signature Max B. Rothman, JD, LL.M. print name President/CEO title OCT 10 �013 date signature t(II anima 1, w 08 print name Lu 4o Yb nr, rcckr title �]���3 date �— MO E C UNTY tY �ROV D AS F PEDRO J. ERCADO 5 ASSI Dgte ___ 2 d. l-3.