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4 j1,(411',y CLERK OF CIRCUIT COURT & COMPTROLLER
o`. , r '- las MONROE COUNTY,FLORIDA
DATE: October 22, 2013
TO: 'Sheryl Graham, Director
Social Services Department
ATTN: Dotti Albury .
In-Home Services Progr' s
FROM: Vitia Fernandez, D.C.
At the May 15, 2013, Board of C. . ty Commissioner's meeting the Board granted approval and
authorized execution of Item C 15 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 Case Management.
Enclosed are six (6) duplicate originals 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
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HOME AND COMMUNITY BASED SERVICES Idu
AUG 0 9 2013
AGED AND DISABLED ADULT (ADA) MEDICAID WAIVER
CASE MANAGEMENT REFERRAL AGREEMENT _ ILa ,tz.
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 In -Home
Services , a case management agency, 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. The
purpose of this agreement is to enable eligible elderly participants to receive case management 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.
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 and expansion 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 case
management agency he/she will receive services from.
F. The parties of this agreement will 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 will 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 Area Agency on Aging agrees to the following:
A. To facilitate the enrollment of providers with the Medicaid Fiscal Agent.
B. To ensure the case management agency is an active Medicaid Waiver provider prior to serving
any consumer under the Aged and Disabled Adult (ADA) Medicaid Waiver Program.
C. To provide technical assistance and training to the case management agencies.
D. To complete a new referral agreement signed by all parties when unit rate changes are approved.
E. 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.
F. To report any adverse incident reports to the Department within 48 hours of the incident being
notified to the AAA by the case management agency.
G. To develop and maintain written policies and procedures, as necessary, to ensure necessary
performance standards.
H. To assist the ADRC (Aging and Disability Resource Center) in maintaining the Applicant (APPL)
on the waitlist for Medicaid Home and Community Based Waiver Service Programs.
I. Assist the Department in reporting follow-up for substantiated reports of abuse, neglect, and
exploitation within 10 working days of receipt of the information.
J. To review and correct the CIRTS (Client Information and Registration Tracking System) exception
reports monthly and provide the Department with a summary of the resolutions, as requested.
III. Under this Agreement, the Case Management Agency agrees to the following:
A. Assign qualified case managers as contained in the ADA Medicaid Waiver to provide case
management services under the Medicaid Home and Community Based Waiver for Aged and
Disabled Adults. Provider rates shall not exceed the approved negotiated rates that are at or
below the service provider's contracted rates.
B. Develop and implement the Plan of Care specifically outlining the service(s) to be delivered that
must be signed by the consumer.
C. Adhere to the federal waiver requirements and 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, Florida Medicaid Provider General Handbook,
and Department of Elder Affairs Programs and Services Handbook including any and all
attachments or updates.
D. Refer consumers to any qualified Service Providers as selected by the consumer.
E. Issue written service authorizations to the service provider with at least 24 hours notice. The
referral will contain at a minimum:
1. Name
2. Address (with directions if not easily accessible)
3. Pertinent information regarding consumer's health or disabilities and living situation
4. Detailed service description including frequency, duration and specific tasks to be
performed.
F. Evaluate quality of services and service documentation by the service provider.
G. Accept financial responsibility for service claims found to be out of compliance if the non
compliance was the result of a failure by the case management agency to update, renew, or
terminate the service authorization.
H. Monitor service providers for adherence to authorized care plans, authorized
reimbursement rates, and to ensure that the service provider is billing only for services authorized
in the care plan.
I. 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 or when contracting with
another entity which will be paid by 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 case management
agency 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.
J. To submit voided and/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 to the Agency for Health Care
Administration for appropriate action.
K. Adhere to requirements contained in the Health Insurance Portability and Accountability Act
(HIPPA), as applicable, and to maintain the waiver participant's confidentiality.
L. 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 aging or by the Department, upon request.
M. To submit claims for billing to the Medicaid fiscal agent at the agency's contracted rate, as per
page 4 of this agreement.
N. To report adverse incidents that affect the health, safety & welfare of a client to the AAA within 48
hours of its occurrence using the required reporting template as provided by the AAA. Adverse
incidents may include injuries such as death, brain or spinal damage, permanent disfigurement,
fracture or dislocation of bones or joints, and conditions 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).
O. To report any adverse incidents involving abuse, neglect, and exploitation to the Department of
Children & Families (DCF).
P. Participate in training arranged by the AAA, the Department, Department of Children and
Families and/or Agency for Health Care Administration, as required.
Q. To review and correct any CIRTS (Client Information and Registration Tracking System) exception
reports submitted by the AAA monthly by the stipulated time frame.
R. Comply with any additional ADA Medicaid Waiver case management related requests for
information from the Department regarding implementation of the Statewide Medicaid Managed
Care Program (SMMCLTC).
S. To submit written follow up of how the critical incidents as reported by the Department were
addressed within 5 days of receiving the report from the AAA. Weekly reports/updates must be
provided by the case management agency until the issue is resolved.
T. To provide care plans and other documents for upload in a format specified by the Department
prior to the transition period to SMMCLTC. Additional requirements must be met as follows:
1. To ensure coordination of care for consumers transitioning to SMMCLTC.
2. To share and pass records and information including current care plans, service
authorizations, and optional 701 B assessments, as requested, by AHCA and/or the
Department pursuant to the method and time frames requested by AHCA and/or the
Department.
3. Failure to comply with the terms of this agreement may result in Medicaid payments being
recouped or withheld for non -compliant case management providers.
U. 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 -transferable.
V. The AAA may impose Department -approved sanctions for non-compliance with items of this
agreement.
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. Case Management_$45.00 an hour Monroe
B.
C.
D.
E.
V. Termination
In the event this agreement is terminated, the case management agency agrees to submit, at the time
notice of intent to terminate is delivered, a plan that identifies procedures to ensure services to
consumers will not be interrupted or suspended by the termination.
3
A. Termination at Will
This agreement may be terminated by either party upon no less than thirty (30) calendar days
notice, without cause, unless a lesser time is mutually agreed upon by both parties, in writing.
Said notice shall be delivered by certified mail, return receipt requested, or in person with proof of
delivery.
B. Termination Because of Lack of Funds
In the event funds to finance this agreement become unavailable, the area agency may terminate
this agreement upon no less than twenty-four (24) hours notice in writing to the other party. Said
notice shall be delivered by certified mail, return receipt requested, or in person with proof of
delivery. The area agency shall be the final authority as to the availability of funds.
C. Termination for Breach
Unless a breach is waived by the area agency in writing, or the parties fail to cure the breach
within the time specified by the area agency, the area agency may, by written notice to the
parties, terminate the agreement upon no less than twenty-four (24) hours notice. Said notice
shall be delivered by certified mail, return receipt requested, or in person with proof of delivery.
In witness whereof, the parties have caused this 4 page agreement to be executed by their undersigned
officials as duly authorized.
Area Agency on Aging
signature
Max B. Rothman, J LL.M.
print name
President/CEO
title OCT $ 8
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date
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Case Management Agency
ignature
Georae Neuaent
print name
_Mayor
title
_9-18-2013
date
Signature
Roman Gastesi
County Administrator
14 August 2013
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