Item C12 BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: 7/16/2014 Division: Social Services
Bulk Item: Yes X No u Department: Social Services
Staff'Contact Person: Shml Gob -A510 w(305)292 4
AGENDA ITEM WORDING: Ratification of the Home Care for the Elderly(ACE)Conti ci#KH
1472 between the Alliance for Aging,Inc. (AAA)and Monroe County Board of County
Commissioners(Social Services/In Home Services)for the contract period of 711/14 to 6/30/15,in the
amount of$12,694.00
ITEM BACKGROUND: Approval of the HCE contract will enable Monroe County In Home
Services to continue providing services to Monroe County's elderly population under the Community
Care for the Elderly program.
PREVIOUS RELEVANT BOCC ACTION: Prior approval granted by the BOCC on 11/20/13 for
Amendment#001 to the Contract(HCE)#KH1372,contract year 13/14.
CONTRACT/AGREEMENT CHANGES: n/a
STAFF RECOMMENDATIONS: Approval
TOTAL AMOUNT OF GRANT: $12,694.00
TOTAL COST:$1,269.40(cash) BUDGETED: Yes No
COST TO COUNTY:$1,269.40(cash) SOURCE OF FUNDS: Grant funds plus match dollars
REVENUE PRODUCING: Yes N/A No— AMOUNT PER: MONTH: YEAR:
APPROVED BY: County A 09/rurchLsi I ng, Risk Management
DOCUMENTATION: Included x Not Required— To Follow
DISPOSITION: AGENDA ITEM#
Revised 8/06
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
CONTRACT SUMMARY
Contract with: Alliance For Aging, Inc. Contract: KI-I 1372
Effective Date: 7/1/2014
Expiration Date: 06/30/2015
Contract Purpose/Description: Ratification of the Home Care for the Elderly (HCE)Contract#KH 1472
between the Alliance for Aging,Inc. (AAA)and Monroe County Board of County Commissioners
(Social Services/In Home Services)for the contract period of 7/1/14 to 6/30/15, in the amount of
$12,694.00.
Contract Manager Sheryl GralWii 292-4510 Social Services/Stop i
(Name) (Ext.) (Department/Stop
For BOCC tneetinon 7/16/2014
Agenda Deadline: 7/1/2014
CONTRACT COSTS
Total Dollar Value of Contract approx.$12,694.00 Current Year Portion:
Budgeted:Yes No Account Codes: 125-6153914
Grant $12,694.00
County Match:$1,269.40(cash)
Additional Match:
Total Match$1,269.40(cash)
Estimated Ongoing Costs:$ ADDITIONAL.—COSTS
or value sime)
I (Not included in �11 ---/yr For:
(C.P- salaries,etc
CONTRACT REVIEW
Changes
Needed Da 7 0
v er t
Division Director A
17
�/ Yes 0 No P j A
Risk Management
Yes 0 No
O.M.B./Purchasing V Yest-I No
County Attorney
Yes No 14, c
Fs^
Comments:
OMB Form Revised 2/27/01 MCP#2
Contract `Junaber KH- 1472 �f
HOME CARE I'OR THE ELDERLY LEAD AGENCY CONTRAC �yt i
2014-2015 Fiscal Year
T 111S CONTRACT is entered into between the Alliance for A,_,Ing Inc., hereinafter referred to as the ".,\lliance,"' and
:Monroe County Board of Commissioners,Social Services/In-Home Services, hereinafter referred to as the provider.."
and collectively referred to as the "parties."
.Attachments I, 1I. III, IV, V. VI. VII. VIII, IX, X, A, B, C, D, F, G and I1 are incorporated herein and made a part of this
Contract.
W11E;RE AS, the .Alliance has been designated as the area agency on a-ing for Planning and Service Area 11
encompassing ,Ilami-I)ade and ylcnaroe Counties: and
WHEREAS, the Florida Department of Elder Affairs (the "Department") has entered into a Contract with the Alliance to
fund community care service systems in 'viiarni-Dade and Monroe Counties. and
WHEREAS, in accordance with Section 430.203, Florida Statutes, the Alliance has designated the provider as a Lead
agency for the Horne Care for the Elderly (HCEµ:) program,
NOW THEREFORE, in consideration of the services to he performed and payments to be made, together with tlae
mutual covenants and conditions set forth in this Contract, the Parties agree as follows:
1. Purpose of Contract
The purpose of this contract is to provide services in accordance with the terms and conditions specified in this
contract including all attachments and exhibits, which constitute the contract document.
2. Incorporation of Documents within the Contract
The contract will incorporate attachments, proposal(s), state plan(s), gaunt agreements, relevant Department of
L"Ider Affairs handbooks, manuals or desk books, as an integral part of the contract„ except to the extent that the
contract explicitly provides to the contrary. In the event of conflict in language among any of the documents
referenced above, the specific provisions and requirements of the contract document(s) shall prevail over
inconsistent provisions in the proposal(s) or other general materials not specific to this contract document and
identified attachments.
3. Term of Contract
Effective Date:
This contract shall begin on,July 1, 2014 or on the date the contract has been signed by both parties, whichever is
later.
Delivery of services shall end at midnight, local time in Miami, Ff, on June 30, 2015. The Alliance will not
reimburse the provider for services provided after this date. however, the parties recognize that they will need
to perform continued activities relating to reporting, invoicing and payment in ,July of 2015 to facilitate payment
for services rendered by the provider under this contract through and including the contract expiration date of'
.Iuly 15, 2013.
4.0 Contract Amount
The:Alliance agrees to pay for contracted services according to the terms and conditions of this contract in an
arru+unt not to exceed 12 694 or the rate schedule. subject to the availability of funds. Aray casts or services
paid for under any other contract or from any other source are not eligible for-payment under this contract.
4.1 Obli„ation to Pay
The Alhance's per tonIlalice quad ohli�oat loll to pay under this contract is contillocrit upon all
annu4i1 ,ippropriation by tlae Lel-111,lature to the Depannient and turtcling rccei%cd b", the :Alliance
under- its contract wily) the Dep<rrtrncrat.
4.2 Source of Funds
l he costs ot'sort,ices paid ar«ldcr any other contract or from tun%' other s0urcQ1 Trre not e11t121h1c: t6l,
rcinabursemcrat render this contract. The funds awarded to tlae provider pur5u`i„t to this contract
I
Contract Number 1,J 1- 147
aIre III the state (uff"IlIt", and aids appropriations 'Ind Consists ot"'llc following:
Prourarn Title Year Fundino Source CSFA# Fund Amounts
I Ionic ('are for the 20 14- Jencral Revenue TOINICCO S 12,694
I"Iderly 2015 Settlement Trust Funds
TOTAL FUNDS CONTAINED IN THIS CONTRACT: SI 2,694
5. Renewals
The contract may be renewed on a yearly basis for no more than four additional years. Such renewals shall be
contingent upon satisfactory performance evaluations as determined by the Alliance and the availability of funds.
Any renewal of a contract shall be subject to mutual agreement, confirmed in writing, and subject to the same
terms and conditions set forth in the Initial contract. The renewal price, or method for determining a renewal
price, is set forth in the bid, proposal, or reply. No other costs for the renewal may be charged.
6. Compliance with Federal Law
6.1 If this contract contains federal funds the following shall apply:
=k
6.1.1 The Provider shall comply with the provisions of 45 CI'-R 74 and/or 45 CFR 92, and other applicable regulations.
6.1.2 If this contract contains federal funds and is over $100,000.00, the Provider shall comply with all applicable
standards, orders, or regulations issued under s. 306 of the Clean Air Act as amended (42 U.S.C. 7401, et seq.), s.
4-1
508 of the Federal Water Pollution Control Act as amended (33 U.S.C. 1251, et seq.). Executive Order 1.1738, as
amended, and where applicable Environmental Protection Agency regulations 40 CFR, 30. The provider shall
report any violations of the above to the Alliance.
6.1.3 The Provider, or agent acting for the Provider, may not use any federal funds received in connection with this
contract to influence legislation or appropriations pending before the Congress or any state legislature. If this
contract contains federal funding in excess of SI00,000.00, the Provider must, prior to contract execution,
complete the Certification Regarding Lobbying form, ATTACHMENT 11. All disclosure torus as required by
the Certification Regarding Lobbying form must be completed and returned to the Contract Manager prior to
payment under this contract.
6.1.4 In accordance with Appendix A to 2 CFR 215, the Provider shall comply with Executive Order 11246, Equal
Employment Opportunity, as amended by Executive Order 11375 and others, and as supplemented in Department
of Labor regulation 41 CFR 60 and 45 CFR 92, if applicable.
6.1.5 If this contract contains federal funds and provides services to children up to age 18, the Provider shall comply
with the Pro-Children Act of 1994 (20 U.S.C. 6081
6.1.6 A contract award with an amount expected to equal or exceed 525,000.00 and certain other contract awards will
not be made to parties listed on the government-wide Excluded Parties List System, in accordance with the (Y%I B
-oudelines at 2 CFR ISO that implement Executive Orders 12549 and 12689, "Debarnient and Suspension,*' The
Excluded parties List System contains the names of parties debarred, suspended, or otherwise excluded by
aL,encies, as well as parties declared Ineligible under statutory or re(_1LIIatory aLlthority other than EXeCLIti%'C Order
12549, Ilse Provider shall comply with these provisions before doing business or cnterin'L, into Subcontract:;
reccivim-, federal funds pursuant to this contract. The Provider shall complete and sign ATTACILNIENT N' prior
10 the execution of this contract.
6.2 I"he Pro%I(Icr sliall not employ at1 ILIMILIOI(TilCd ZiliCn. Ille Alliance will consider the elliplo%nicilt of
wlawllorl/cd aliens a %IolItIon ot, the Inliniuratioll and Nation lhtv Act ('s, [. .S.C. 1324"1) and Ilse
t_:.S,('. 1101 ). SLIC11 % he cause ['()r unilateral cancellation
contralct by the "'Alliance.
(:"01Itrt.tct Number [milI- l472
6.3 If the Provider is a noti-profit provider mid is subject to lnternal Revenue Set-%Ice (IRS) tax exempt organization
reporting requirements (tiling ,I Form 990 or Form Q90A) and has its tax exempt status rc%oked for failinf.* to
comply with the tilill<" requir'cmcaats of the 2000 Pension Protection Act or f'ar any oilier reason, the Pro%ider-
must notit", the Alliance in writing within iliirty (30) days of receivim, the IRS notice of revocatioll.
Llie Provider shall comply with Title 2 CFR Part 275 regarding Trafficking in Persons.
6.4
1_`riless exempt under 2 CFR Part 170.1 10(b). the Prot~ider shall comply with the reporting requirements of the
Transparency Act as expressed in 2 CFR 170.
7. Compliance ,tiith State Law
7.1 this contract is executed and entered into in the State of Florida, and shall be construed, performed and enforced
in all respects to accordance with the 1.lot-Ida law, including Florida provisions for conflict of laws.
7.2 The Provider shall comply With requirements of s. 257.055, F.S. as amended.
7.2.1 The Provider shall provide units of dellverables, including various client services, and in some instances tilay
include reports, findings, and drafts, as :specified in this contract, which the Contract Manager must receive and
accelnt hn writing prior to payment in accordance with s. 215.971. F.S. (I) and (2).
7.2.2 The Provider shall submit bills far fees or other compensation for services or expenses in sufficient detail for a
proper pre-audit and post-audit.
7.2.3 If itemized payment for travel expenses is permitted in this contract, the Provider shall submit bills t6r any travel
expenses in accordance with s. 112,061, F.S., or at such lower rates as may be provided in this contract.
7.2.4 The Provider shall allow public access to all documents, papers, letters, or other public records as defined in
subsection 1 19.011(12), F.S., made or received by the Provider in conjunction with this contract except for those
records which are made confidential or exempt by law. The Provider's refusal to comply with this provision will
constitute an immediate breach of contract for which the Alliance may unilaterally terminate the contract.
7.3 If clients are to be transported Linder this contract, the Provider shall comply with the provisions of Chapter 427,
F.S., and Rule 41-2, F. A. C.
7.4 The provider may not subcontract with any individuals or entities on the discriminatory vendor list because they
may not transact business with any public entity, in accordance with the provisions of s. 287.134, F.S.
7.5 The Provider shall comply with the provisions of s. 11.062, F.S., and s. 216.347, F.S., which prohibit the
expenditure of contract funds for the purpose of lobbying the legislature,judicial branch or a state agency.
7.6 In accordance with s. 2S7.135 F.S., any Contractor on the Scrutinized Companies with Activities in Sudan List or
the Scrutinized Companies with Activities in the Iran Petroleum l nergy Sector List (Lists). created pursuant to s.
215.473 F.S., is ineligible to enter into or renew a contract or agreement with the Department for goods or
services of S1 million or more. Pursuant to s. 287.135 F.S., the Department may terminate this Contract and ally
contract or agreement incorporating this Contract by reference if the Contractor is found to have submitted a false
certification of its status oil the Lists or has been placed oil the Lists. Further, the Contractor is subject to civil
penalties, attorneys fees and casts and any costs for investigations that led to the finding of false certification. If
any contract or agreement incorporating this Contract contains Sl million or more, the Contractor shall complete
and sign 1ITAC11Mf�!T 1{, Certification Regardin Scrutinized Companies Lists, prior to the execution of this
Contract.
8. Background Screening
fhc: Provider shall ensure that, prior to pro\idin<<r services. all persons having access to vuhncrable elders and
children, their h%in(r area. funds or personal property. or protected health infclrmatloll pc:rtailllllg to sLlch
M(lividuals. will pass a I-evel 11 criminal I,mckgroulld screcimig, in <Iccordance with the rcquirements of s.
4 OM402 and ch. -435. F.S., as arnctided. I'llesc prov isi«sls apply to cmpioyees, subcontractors. CansrlitantS, direct
ery iec providcrs and %olmrteers. Consequently, anv cOraamitlaaeilt for- eillln[Or 'Il lt. ptll-Clase of services. o1.
yolLlntcer profgraran participation will be contingent upon the passing cat, a I-cvel 11 back-uround check. Hie
baCk1_1raund scrcenin« will include employment history cheeks as provided III s. 435,03(1 ). F.S., wind both local
a,ld national criminal record checks coordinated thraurgll Iaw clitorcclnent afuencies.
Contract Number K11- 1472
8.1 I or purposes ot` this section, the term "direct service prop,ider" means a person I S years ot` asc or older who,
pursuant to a prowxrarn to provide services to the elderly. has direct, face-to-face contact with a client while
providing) scr\ices to the client or has access to the client's living .treas or to the client's funds or personal
property. This term includes coordinators, mana(ers.. and supervisors of residential facilities and volunteers.
8.2 Background Screening Affidavit of, C olliphance - To demonstrate compliance with section b of this N1.1stcr
Contract. the Contractor shall submit ATTAC'I1MEtiT G, Backgrotuld Screening of (-'ompliance
annually. by January I5th.
8.3 Further information concerning the procedures Co back4ground screening is found at
http:, elderaffaits.stt-rte.tl.uti'doc<i.back(-,rouridscreerrinf(.l7hp.
9. Grievance and Complaint Procedures
9.1 Grievance Procedure
The Contractor shall comply with and ensure subcontractor compliance with the Minimum Guideline tar
Recipient Grievance Procedures, Appendix 1), Department of Elder Affairs Programs and Services Handbook, to
address complaints regarding the termination, suspension or reduction of services, as required for receipt of
funds.
9.2 Complaint Procedures:
.The Contractor shall develop and implement complaint procedures and ensure that Subcontractors develop and
implement complaint procedures to process and resolve client dissatisfaction with services. Complaint
procedures shall address the duality and timeliness of services, provider and direct set-vice worker complaints, or
any other advice related to complaints other than termination, suspension or reduction ill services that require the
grievance process as described in Appendix D, Department of Elder Affairs Programs and Services Handbook.
"The complaint procedures shall include notification to all clients of the complaint procedure and include tracking
the date, nature of the complaint and the determination of the complaint.
I0. Audits, inspections, Investigations, Public Records and Retention
10.1 The provider shall establish and maintain books, records, and documents (including electronic storage media) in
accordance with generally accepted accounting procedures and practices that sufficiently and properly reflect all
revenues and expenditures of funds provided by the Alliance under this contract. Provider agrees to maintain.
records, including paid invoices, payroll registers, travel vouchers, copy logs, postage logs, time sheets, etc., as
supporting documentation for service cost reports and for administrative expenses itemized for reimbursement.
This documentation will be made available upon request for monitoring and auditing purposes. Whenever
appropriate, financial information should be related to performance and unit cost data.
10.2 The Provider shall retain all client records, financial records, supporting documents, statistical records, and any
other documents (Including electronic storage media) pertinent to this contract for a period of six (6) years after
completion of the contract or lon-er when required by law. In the event an audit is required by this contract,
records shall be retained for a minimum period of six (6) years after the audit report is issued or until resolution
of any audit tindings or litigation based on the terms of this contract. at no additional cost to the Alliance.
10.3 1...'pon demand, at no additional cost to the Alliance, the Provider shall facilitate the duplication and transfer of
any records or documents duringthe required retention period in Paragraph 10.2.
10.4 File Provider shall assure that the records described in Paragraph 10 will be subject at all reasonable times to
inspection, review, copyin_7. or audit by federal, state, or other personnel duly authorized by the Alliance.
10.5 At all reasonable times for as lon4u as records are maintained, persons duly authorized by the Alliance, the
Department and federal auditors, pursuant to 45 CFR 92.36(i)(10). will be allowed full access to and the rit-tllt to
a::Vrrmine apv of the Pro\ider's cowracts and related records and documents pertinent to this ,pecitic contract.
i c,.rardlcss cif the torrla in ti\hich kept.
10.6 1lie pre>%ider shall provide a tinanciat v1.1 colliphance audit to the AHlance as specit`ted in this contract <wd in
kTTACIFNI ENT Ill ;:rrld ensure that all related third-party transactions arc disclo,ed to the auditor.
10.7 hhe Provider shall cotrlply and cooperate immediately vkith airy inspections, res iews. irmcsti!"atlolls, or audits
dcerrred necessary by the office of the hrspector('ic.ncral ptrrsuarlt to s. 20,055, F.S.
4
Contract Number Is 1472
10.8 the Provider shall maintain and t-11c with tile Alliance such prourcs,.;, fiscal and inventory and other reports as the
alliance May require Xo'It I I I I It I I e period cif this contract.
10.9 Flic Provider shall SLIblult Illanat-,cincrit, prooraill, and client identifiable data. as specified by the Department of
Elder Affair'; and , or the Alliance. ]'Ile provider must record and submit program specific data in accordance
with the I)cpa I-tirrel it's Client hitorination Registration and Tracking System (C:`RTS) Policy Guidelines.
10.10 If, Linder III,,, contract or agreement incorporating this Contract by reference, the Contractor is providing services
and acting belialfof the Department of Elder Affairs or the Alliance for Aging, Inc. as provided Linder
I I k-T oil
section 119,011(2), Florida Statutes, the Contractor, subje
ct to the terms cif section287.058(l)(c), Florida
Statutes, and any other applicable legal and equitable remedies. shall:
a) Keel) and maintain public records that ordinarily and necessarily would be required by the public agency In
order to perform the services.
b) Provide the public with access to public records on the same terms and conditions that the Department of
Elder Affairs or the Alliance for Aging. file. Would provide the records and at a cost that does not exceed the cost
zn
provided in Chapter 119, Florida Statutes, 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.
d) Meet all requirements for retaining public records and transfer, at no cost, to the Department of Elder Affairs
or the Alliance for Aging. Inc. all public records in possession of the Contractor upon termination or expiration
of any contract or agreement incorporating this Contract by reference and destroy ally duplicate public records
that are exempt or confidential and exempt from public records disclosure requirements. All records stored
electronically must be provided to the Department of Elder Affairs or the Alliance for Aging, Inc. ill a format
that is compatible with the Information technology systems of the Department.
10-11 The Alliance for Aging, Inc. may unilaterally cancel this Master Contract, and any contract or agreement
incorporating this Contract by reference, notwithstanding any other provisions of this Contract, for refusal by
the Contractor to comply with Section 8 of this Contract by not allowing public access to all documents, papers,
letters, or other material made or received by the Contractor in conjunction with the contract or agreement
incorporating this Contract by reference, unless the records are exempt from Section 24(a) of Article I of the
State Constitution and Section 11 9.07(1), Florida Statutes.
11. Nondiscrimination-Civil Rights Compliance
1.1 The Provider shall execute assurances in ATTACHMEN'r VI that it will not discriminate against any person in
the provision of'services or benefits under this contract or in employment because of age, race, religion, color,
disability, national origin, marital status or sex in compliance with state and federal law and regulations. The
Provider further assures that all Providers, subcontractors, SUbgrantees, or others with whom it arranges to
provide services or benefits in connection with any of its programs and activities are not discriminating against
clients or employees because of age, race. religion, color, disability, national origin, marital status or sex.
11.2 During the term of this contract, the Provider shall complete and retain on file a timely, complete and accurate
Civil Rl,.,hts(..'onlpliance Checklist (ATTACHMENT B).
11.3 "f'he Pro-Oder shall establish procedures pursuant to federal law to handle complaints of discrimination involving
ser-vices or benefits through this contract. These procedures will Include notifying clients, employees, and
participants of the right to file a complaint with the appropriate federal or state entity.
11.4 If this contract contains federal funds, these assurances are a condition Of Continued receipt of or bcnetit from
federal financial assistance. and are binding upon the Provider. its Successors, transferees, and assluniees f'Orthe
period during, which such ass i,,,t a rice is prodded. -file Provider further assures that all subcontractors. %cridors. or
�)tllcrs \\Ith %\hoill it arranges to provide sc n iccs or benefits to participants or employees In connection tiv ith any
k)l its MVUrMlIs rind activities are not discri In In"Iti nu a,-YIfflst those participants or eillplovecs in \IoLltioll ol' the
hove statutes. rc,-,ulatioIlS. 1-IMCICIIIIeS. and stZindard's. III the dent of failure to comply, the Provider understand.,;
t1l"It the Alliance 111111". at It's dlscrctlk)ll. Scck a court OrdCr I-CkILIH-1111-' COMplIMICC With the terms OftillS aSSLMIIICC
or seek, k)tlicr ipproprtate Judicial or administrative I-ClICf. including" hut not 11111nCoi to , termination of and denial
Ot'further:isslsldllce.
Contract NLIIIII)Cl- II 1-1- 1472
12. Provision of Services
The Provider shall proride services in the manner described in in ATTACIEN I ENT I ot't I ils a�lrcclllcllt and in the
Z�
Service Provider A pp I icat loll (SPA). Ill the event of,a conflict between the Service Provider Application and this
contract, the contract languaoc prevails.
It, Z�I
13. Monitoring by the Alliance for Agin
I lie Alliance will perform adnilillstiatl%e and prograti-iiiiatic nionitoring, of the provider to ensure contractual
compliance, fiscal accountabilltv, progra in ilia t*1 c performance, and compliance with applicable state and federal
laws and rC(ILI lat lolls.
13.1 The provider will supply progress reports, InClUdith' data reporting requirements as specified by the Alliance or
the Department to be used for monitoring progress or performance of the contractual services as specified ill this
contract. Following the norms set down by the Department, the Alliance will track performance oil a monthly
basis, thi-01,1211 desk reviews of available fiscal, CIRTS, and research production reports and any other system or-
process designated by the Alliance. Examples of review criteria are surplus/deficit, independent audits, internal
controls, reimbursement requests, Subcontract monitoring, targeting, program eligibility, outcome measures,
service provision to clients designated as'*high risk" by the Department of Children& Families, Adult Protective
Services program, data integrity, co-payments, client satisfaction, correspondence, and client tile reviews.
1
13.2 The provider shall permit persons duly authorized by the Department or the Alliance to inspect and copy any
records, papers, documents, facilities, goods and services of the provider which are relevant to this contract, and
to interview any clients, employees, and subcontractor employees of the provider to be assure the Alliance of tile
satisfactory perforniance of the terms and conditions of this contract. Following such review, the Alliance will
deliver to the provider a written report of its findings arid request for development, by the provider, of a
Corrective action plan (CAP) where appropriate, The Contractor hereby agrees to correct all deficiencies
identified in the CAP in a timely manner as determined by the Contract Manager.
13.3 Extraordinat-
y Reporting
The provider shall notify the contract manager for the Alliance immediately, but no later than within 48 hours,
from the provider's awareness or discovery of conditions that may materially affect the provider's ability to
perform, such as problems, delays, or adverse conditions which may impair the provider's ability to meet the
objectives of this contract or that may affect the health, safety or well-being of'clients. The notice shall include a
brief SUrarnary of the probleiri(s), a statement of the action taken or contemplated, time frames for
implementation, and any assistance needed to resolve the situation.
Examples of reportable conditions may include:
• proposed client tenninations
• provider financial concerns/difficulties
• non-payment or untimely payment reported by-vendors
• set-vice documentation problems
• agreement non-compliance
• service quality problems and consumer complaint trends
■ HIPAA violations
• Potential fraud allei-,ations or accusations ot'inalicasance by hoard members, employees,
OILIMCCI-S, Or other associates
the Alliance shall Ill\esti-ate alleviations ret-'ardill'-Y falsification ot'client Hit'Ormation. sere ice records. payment
requests. and other related int'Orniation. Substantiated alle'-'atiolls shall he reported to tile Dep'll-TITICIlt's COIltract
mana�lzer anti to law enf*orcenient as appropmite.
Ill the (2\ellt that a sMlatloll I-CSLlltS HI the CeSSM1011 of sCr%lCCS by tl ',L!lIC011trICt, the provider Fet,'611S the
!-e.,Tonsibllltv for performance of all services cO%crcd by this contract 111d 111LISt C11,S1.11-C that clients C011tilILIC
ICccl%1111_1 Ncf,xlccs \LItIIOLlt I tItCrrUpt loll, C. S c\ercising, their elliergclicy procurement procedilres, telliporal-N
0
Contract NLIIIII)Cl- KI I- 1472
,1S,SLlllll1ti011 of the direct I)r(.)\ision of'scr%ices, etc.
14. Coordinated Monitoring NN ith Other Agencies
It' the Provider receives funding from one or more of the State Of' Florida other human service agencies, in
addition to the Department of Elder Affairs, then a joint monitorim, visit Including such other agencies may he
to s. 2ST0575, F.S. as amended, Florida's L I Scheduled. For the purposes of this contract, and PUls 11 11 1,111
service agencies shall include the Department of Children and Families, the Department ot'llealth, the Agency for
Persons with Disabilities, the Department of Veterans Affairs, and the Department of Elder Affairs. U'pon
notification and the subsequent scheduling of such a visit by the designated agency's lead administrative
coordinator, the Provider shall comply and cooperate with all monitors, inspectors, and,;or investigators.
15. Indemnification
The provider shall indemnify, defend, and hold harmless the Department and the Alliance and their officers,
agents, and employees from any claim, loss, damage, cost, charge, or expense whatever nature or character
arising out of any acts, actions, neglect or omission, action in bad faith, or violation of federal or state law by the
provider, its agyerits, employees, or subcontractors during the perfonnance of this contract, whether direct or
indirect, and whether to any person or property. It is understood and agreed that the provider is not required to
L_
indemnify the Alliance for claims arising out of the sole negligence of tile Alliance.
negligence
The provider's obligation to indemnify, deterid, and pay for the defense or, at the Department's and I/or the
Alliance's option,to participate and associate with the Department and/ or the Alliance in the defense and trial of
any claim and any related settlement negotiations, shall be triggered by the Department's and/ or Alliance's
notice of claim for indemnification to the provider. The provider's inability to evaluate liability or its evaluation of
liability shall not excuse the provider's duty to defend and indemnify the Department and or the Alliance, upon
notice by the Department and/or the Alliance. Notice -;hall be given by registered or certified mall, return
receipt requested. Only all adjudication or judgment after the highest appeal is exhausted specifically finding the
Alliance solely negligent shall excuse performance of this provision by the provider. The provider shall pay all
costs and fees related to this obligation and its enforcement by the Department and/or the Alliance. The
Alliance's failure to notify the provider of a claim shall not release the provider of the above duty to defend and
indemnify.
15.1 Except to the extent permitted by s. 768.28, F.S., or other Florida law, Paragraph 15 is not applicable to contracts
C,
executed between the Alliance and state agencies or subdivisions defined in s. 768.28(2), F.S.
16. Insurance and Bondin
16.1 The provider must carry adequate liability insurance and worker's compensation insurance coverage, oil a
comprehensive basis, and must hold such liability and worker's compensation insurances at all times durim-, the
effective period of this contract and any renewal(s) or extension(s) of this contract. The Alliance shall be
included as an additional insured on the provider's liability insurance policy or policies and a copy of the
Certificate of Insurance shall be provided annually or when any changes —occur. The provider accepts full
responsibility for identifying and determining the type(s) and extent of liability insurance necessary to provide
reasonable financial protections for the provider and the clients to be served under this contract. t..lpon execution
of this contract, the provider shall tuniish, the Alliance written verification supporting both the determination and
existence of such insurance coverage. The limits ofcovcrai'-,e under each policy maintained by the provider do
not limn the provider's liability and obligations under- this contract. The provider shall ensure that the Alliance
IMS the most Current written verification Of lil'ISUT'allCe covcraue tlirOL1<111OLIt the M-111 of this contract. -file
Department and the Alliance reserle the right to require additional Insurance where appropriate.
16.2 1'111-011l_'11('Llt tile tCrlll of this contract, the provider must maintain an insurance bond from a responsible
insurance.company co%cring all ot,flicers, directors, employees and ai-eiits oftlic [)ro \ILIcr. authorized
tea handle I'LindS received Or disbUrSCCI UlldCr this c,01111_aCL in all a1110LIW COMMCIISUratC With the funds ll,llldled. the
de,_,ree ot'risk as determined by Hie 111SU1,1111ce c011ipany and collSISMIt «Ith 1.100d hLLSHICSS practices.
16.3 if the prop Ider is a ,tate, agency or SU11(f1%Isioll as defined by section F,S_ the provider shall I'Linilsh. upoll
1-C(ILICSt. written %CriflCati011 of Ildhilit", protection in accordance with section -68,28, F.S. NothlnL, herein shall
7
Contract Number KI-1- 1472
be construed to extend any party's liability hc%olld that provided '(, sCCt*ojl 7 6S,_'X F.S. (See also
Irldclum fic"It loll Clause.)
17. Confidentiality of Information
The Provider shall not use or disclose ally int'01111"ItIO11 COIICcrlllllu a recipicni, of services under this cotitract. tor
MIV PLIJ-POSC prohibited by `,tate or federal law or regulations except with the written consent of I person legally
authorized to give that consent or when authorized by law.
18. Health Insurance Portabiliti, and keeountabilitv Act
Where applicable, the Provider shall comply with the Health Insurance Portability and Accountability Act (42
LJSC I 320d.). as well as all regulations promulgated thereunder(45 CFR 160, 162, and 164).
19. Incident Reportin
19.1 The Provider shall notify the Alliance immediately, but no later than forty-eight (48) hours fro rn, the Provider's
awareness or discovery of conditions that may materially affect the Provider or subcontractor's ability to perform
the set-vices required to be performed under this contract. Such notice shall be made orally to the Contract
Manager(by telephone) with all email to immediately follow.
19.2 The Provider shall immediately report knowledge or reasonable suspicion OfabLISe, neglect, or exploitation of a
child, aged person, or disabled adult to the Florida Abuse Hotline on the statewide toll-free telephone number (I-
800-96ABUSE'). As required by Chapters 39 and 415, F.S., this provision is binding upon both the Provider and
its employees.
20. Bankruptcy Notification
During the term of this contract, the Provider shall immediately notify the Alliance if the Provider, its assignees,
subcontractors or affiliates file a claim for bankruptcy, Within tell (10) days after notification, the Provider must
also provide the following information to the Alliance: (I) the date of filing of the bankruptcy petition, (2) the
case number; (3) the court name and the division in which the petition was filed (e.g., Northern District of
Florida,Tallahassee Division), and, (4)the name, address, and telephone number of the bankruptcy attorney.
21. Sponsorship and PublicitN
21.1 Any nongovernmental organization which sponsors a program financed partially by state funds or funds obtained
froril a state agency shall, in publicizing, advertising, or describing the sponsorship of the program, state:
Z:� Zn L_ 41.�
*'Sponsored by, the State of Florida, Department of Elder Affairs and Alliance for Aging Inc." If the sponsorship
reference is in written material, the words'*State of Florida, Department of Elder Affairs and the Alliance for
Aging- shall appear in the same size letters or type as the name of the organization(ref.: section 286.25, F. S.).
This shall include, but is not limited to, any correspondence or other writing, publication or broadcast that refers
to such program.
21.2 The Provider shall not use the words '*State of Florida, Department of Elder Affairs"and/or "I'lie Alliance for
Inc." to indicate sponsorship of a program otherwise tinariced unless specific authorization has been
obtained by the Alliance prior to use.
22. AssiLnments
22.1 The pro\ider shall riot assign its rights and responsibilities under this contract without the prior written approval
of the Alliance. All contracts or agreements incorporating this Contract by reference shall remain binding upon
the successors in interest of either the Contractor or the Alliance for Inc.
22.2 No approval by the ,klliance ofany assignment or subcontract shall be deemed in any C%crlt or in M111, Manner to
provide for the incurrence of all", obligation of the ,\1liarrcc in addition to the (JOILIr M110111"It ',It_1reCd Upon III this
contract.
21.3 I'lle State of Florl& Is at all times entitled to ,issi.t.,ii or transfer. Ill %\hole or part, its rights, duties, or obligation's
4'o%crI)IllcIltZll a�'CIICV In the SMW of Up011 1_11�1110 J)ri )r
'111der any contract or agreement to �Illotllel
v\rlttcll notice to the Contractor. In the event the State of Florida ippro%cs irnider of the Contractor's
01111".4atiolls, the Contractor remains responsible i'Or all %kork' pertonned and all expenses 111CL'Irl-ed Ill CoMICCtI011
with the contract or agreement.
S
("ontract N umher K l 1- 1472
23. Subcontracts:
23.1 Hie Contractor is responsible for all work performed and lur Al commodities produced ptnrsuant to this
contract, whether actually furnished by the Contractor or its subcontractors. Any subcontracts shall be
evidenced by a written a,rreement subject to all applicable terms and conditi ns ofthis contract. Alliance.
approval of the service applicator presented by the provider shall constitute .Alliance approval of the provider's
proposed subcontracts it the subcontracts follow- the service and funding information identified its the provider's
serti tc( application. All other subcontracts proposed to be funded under this contract must be approved in
advance by the alliauace. [lie provider agrees that the alliance shall not be liable to any subcontractor in any,
way or for any reason. The provider, at its expense, will indemnity and defend the Alliance a:ainst any
subcontractor claims.
23.2 The provider shall promptly pay any subcontractors. Failure to pay subcontractors pursuant to any subcontract
or as required by law may result in enforcement action under this contract.
23.3 The provider maintains responsibility for the monitoring and performance of all subcontracts in accordance with
all applicable federal and state laws.
23.4 The Contractor shall have a procurement policy that assures maximum free and open competition. Such
procurement policy must conform, as applicable, %vith Federal and State contracting and procurement
regulations, as set forth in Title 45 Code of Federal Regulations (CFR) part 74 - Sub-Part C, Ch.287.057 Florida
Statutes (F.S.), U.S. Office of Management and Budget (01MB') Circular 1 10, Florida Department of
Management Services(DNIS) Rule 60A-1, Florida Administrative Code, and with the Department of Elder
Affairs Program and Services Handbook 2012.
23.5 The Contractor shall subriut annually to the Alliance service cost reports, which reflect actual costs of providing
each service by program. This report provides information for planning and negotiatitng unit rates.
24. Independent Capacity of Provider
24.1 The provider will be acting in its independent capacity and not as an employee, agent or representative of the
Alliance or the Department. The provider shall not be deemed or construed to be an employee, agent or
representative of the Alliance or the Department for any purpose whatsoever. Nothing contained in this contract
is intended to, or shall be construed in any manner, as creating or establishing the relationship of
employeriemployce between the parties.
24.2 'fine provider shall be responsible for completely supervising and directing; the work under this contract whether
perfonned by the provider or by any subcontractor that it may utilize. The provider shall be responsible for all
subcontractors who perform work under this contract. `File provider agrees that it is as fully responsible for the
acts and omissions of its subcontractors and of persons employed by them as it is tar the acts and omissions of its
own employees,
24.3 It is further understood that the Alliance(foes not control the employment practices of the provider and shall not
be liable fur any wage and hour, employment discrimination, or other labor and employment claims against the
provider or its subcontractors. All deductions for social security, withholding taxes, income taxes,, contributions
to unemployment compensation funds and all necessary insurance for the provider shall be the sole
responsibility of the provider.
25. Pavment
25.1 Payments shall be made to tite Provider as services are rendered and invoiced by the Provider, l..he Alliance's
Contract Manager have final approval of the invoice for payment, and will approve the invoice for payment
only itthe Provider has met all terms and conditions of the contract. unless tlae bid specifications, purchase order.
or this contract specify otherwise. Hic approved in%mice will be submitted to the Alliaace's finance section f<n-
hudgetary Epproval and processing.
25.2 PaN meat Documentation Required
[ lie provider "hall maintain documemation to support payrtaent requests Much shall be ':vailahlc to the
('ornptroller, the Department, or the A111ance upon rctluest. I11d01(:c anust be subnutted in sufficient dctril f'or a
prOpCr pre audit and post audit thereof. Fhe provider shall comply with all state and federal Liws tai��ernint
paviaaents to be made tinder tills contract inc111(fin!1. but not 1itaitc°d to the inta: (a) pang rapla (10) (b) of
o
Contract Nuntbcr Kf1- 1472
section 16.1 s 1, I'. S., regarding, (b) Rule 691--40.103 F.A.C. pertaining to Restriction of Fxpenditures
h-o nl state funds; and (c) the Contract flaynient Requirements sub-section of section C of the Reference Guide
k)r State Fxpenditures from the Department o7f I''inarlcIaI Services
ltup;. �ti���� olkai'.�t;rte.11.try, iidir_�etcrc��s� ..�-'.tEif,1��)
The provider shall maintain detailed documentation to support each itern oil the itemized invoice or payrment
request for cost reimbursed expensos, imcludintia paid subcontractor invoices, and will be produced upon request
b,; the Alliance. The provider shall only request reimbursement for allowable expenses as defir7ed in the laves and
:uidim`- circulars cited in this agreement.. in the Ret`crence Guide for State Expenditures, and any other laws or
regulations, as applicable, and that administrative expenses do not exceed amounts budgeted in the providers
approved service application.
The Contractor will certit'v that detailed documentation is available to support each item on the itemized invoice
or payment request f >r cost reimbursed expenses, fixed rate or deliverables contracts or agreements
incorporating this Contract by reference, including paid Subcontractor invoices, rind will be produced upon
request by the Department. The Contractor will further certify that reimbursement requests are only for allowable
expenses as defined in the laws and guiding circulars cited in Sections 6 and 7 of this Contract, in the Reference
Guide for State Expenditures, and any other laws or regulations, as applicable, and that administrative expenses
do not exceed amounts budgeted in the Contractor's approved area plan as developed in accordance with and
pursuant to section 306(a) of the C)Ider Americans Act of 1965, as amended.
25.3 Limit on Fundintz Oblitzations
The Alliance for Aging, Inc. acknowledges its obligation to pay the Contractor for the performance of the
Contractor's duties and responsibilities set forth in any contract or agreement incorporating this Contract by
reference.
The Alliance shall not he liable to the provider for costs incurred or performance rendered unless such costs and
performances are strictly in accordance with the terms of this contract, including but not limited to terms
governing the provider's promised performance and unit rates and/or reimbursement capitations specified.
'File Alliance shall not be liable to the provider for any expenditures which are not allowable costs as defiled by
applicable federal or state lave, or which expenditures have not been made in accordance with the fiscal guidelines
and requirements outlined by the Department.
The Alliance shall not be liable to the provider for expenditures made in violation of regulations, the Older
Americans Act, Department rules, Florida Statutes, or this contract.
26. Return of Funds
.The Contractor shall return to the Alliance any overpayments due to unearned hinds or funds disallowed and any
interest attributable to such funds pursuant to the terms and conditions of any contract or agreement incorporating
this Contract by reference that were disbursed to the Contractor by the Alliance. In the event that the Contractor or
its independent auditor discovers that an overpayment has been made, the Contractor shall repay said overpayment
immediately without prior notification from the Alliance. In the event that the Alliance first discovers an
overpayment has been made. the Contract y' anal-ler will notify the C.7ontractor in writing of such findings. Should.
repayment not be made forthwith. the Contractor shall be charged at the lawful rate of interest on the outstanding
balance pursuant to s. 55.03, F.S., after Alliance's notification or Contractor discovery.
27. Data Into rite and Safe(_mardin(= Information.
Hie provider shall ensure an appropriate level of data security f'or the information the provider is collecting or
using in the performance of this contract. :ln appropriate level of security includes approving and tracking all
prig\ider employees that request system or information access and ensuring that user access has been removed
1'rom all terrmnatcd employees. Hie prov ider. ;iinonai-r other requirements, must Ginticrpate and prepare: fcrr the loss
of inforznatloll processlih! capahrhties. All data and software must be routinely backed up to insure recovery
t'rom Iosses or oortttges OC computer s'.stcrns. l lle security over the hack-rip data is to be trs >trintrclit as the
protection required of the prirnary systcrrls. I11c provider hall insure all ,Ubcorrtractors maintain written
procedures for computer system backup and recovery. "fhe provider shrill. prior to execution of this agreement,
co>mplctc the: Data Integrity Certification turnr. A1.1.ACI IMI-N I' IN'.
10
Contract Number Kl--1- 1472
28. Computer Vse and Social Media Policy
Elie Department of L"Ider Affairs has implemented a new Social Media Policy, in addition to its Computer
Policy, which applies to all employees, contracted employees. consultants, OPS and Volunteers, lncludimi all
personnel affiliated with third parties, such as, but not limited to, Area Agencies on Aging and vendors. Any
entity that uses the Department's COMPLIter resource systems must comply with the Department's policy rqYarClIM-1
social media. Social Media Includes, but is not limited to blogs, pOdCaStS, disco.Ssign forums, "ik-lS. RSS feeds,
%ldco sharim.'. social networks like MySpace. Eacebook and Twitter, as well as content sharing networks Such aIS
tllckr and You'Fubc (This poliev is available on the Department's website at:
littp://eIder-aff,,tirs.statc.fl.tis/(Ioca/rinaiieia1.php),
29. Conflict of Interest
'Elie Provider shall establish safeguards to prohibit employees, board members, management and subcontractors
from using their positions for a purpose that constitutes or presents the appearance of personal or organizational
conflict of interest or personal gain. No employee, officer or agent of the Provider or subcontractor ,,hall
participate in selection, or in the award of an agreement supported by state or federal funds if a conflict of interest.
real or apparent, would be involved. Such a conflict Would arise when: (a) the employee, officer or aocrit, (b) any
member of his,1icr immediate family; (c) his or her partner, or: (d) an or-anization which employs, or is about to
employ, any of" the above, has a financial or other interest in the firm selected for award. The Provider or
subcontractor's officers, employees or agents will neither solicit nor accept gratuities, favors or anything of
monetary value from contractors, potential contractors, or parties to subcontracts. The Provider's board members
and niaria Bement,ernent Must disclose to the Alliance any relationship which may be, or may be perceived to be, a
conflict of interest within thirty (30) calendar days of all individual's original appointment or placement in that
position, or if the individual is serving, as an incumbent, within thirty (30) calendar days of the commencement of
this contract. The Provider's employees and subcontractors must make the same disclosures described above to
the Provider's board ot'directors. Compliance with this provision will be monitored.
30. Public Entity Crime
Pursuant to s. 287.133, F.S., a person or affiliate who has been placed on the convicted vendor list following, a
conviction for a public entity crime may not submit a bid, proposal, or reply on a contract to provide any goods or
services to a public entity, may riot submit a bid, proposal, or reply on a contract with at public entity for the
construction or repair of a public building or public work; may not submit bids, proposals, or replies oil leases of
real property to a public entity; may riot be awarded or perform work as a contractor, supplier, subcontractor, or
Consultant under a contract with any public entity; and may not transact business with any public entity in excess
of the threshold amount provided in s. 287.017, F.S., for CATEGORY Two for a period of 36 months following
the(late of being placed oil the convicted vendor list.
The provider represents and warrants that the provider, Its Officers. directors, senior management, partners,
employees or agents have riot been convicted Of ally public entity crimes within the last 36 months. If the provider
Or any of its officers or directors is convicted of a public entity crime during the period of this agreement, the
provi
der shall notify the Non-compliance immediately. Non-copliance with this statute shall constitute a breach of this
a( The provider must ensure that it does not enter into with any subcontractor oil the convicted vendors
. -1reement.
list or otherwise prohibited from contracting for state fi.JlldS pursuant to section 2S7.133, F.S.
31. Purchasing
Procurement of Products or Materials with Recycled Content.
Reusable materials and products shall be used where economically technically feasible.
32. Patents, Copyrights, Royalties
If this contract is iwar(led state Cundinu ,wd if ativ (fiscoverv, invention or copvrlt-'htahle 111"Iterial is developed
produced or COr \v Inch o%\nership Was j)UI-Cha-,C(1 In the course of or as 3 I-C,,Ult ot'work or services performed under
this contract. the Pro%iier shall refer the Qlisco%cry, invention or material to the Alliance to he referred to the
[)q)arimcni of S%itc. Any :ind all patent rights or copyrights accrU1111(_1 Under this contract Lire licreb" rcscr%Vd to
the State of Florida III accordance with Chapter 2S6, F`.S.
33. Finergenev Preparedness and Continuity of Operations
II
Contract N umber K I 1- 1472
33.1 1"he Provider shall, within thirty (-,0) calendar days of the execution of this contract, sLlhllllt to the Contract
NI ana,-,er vcri i-icat I on of girt cinerlyciicy preparedness I-)I an. In the e\ent o f an cinergency, the P rov I cl er shall notify
emergency provisions.
the Alliance ofellier::!(T
33.2 In the event a situation results in a cessation of services by a subcontractor. the Provider shall retain respotisibilltv
for performance Linder this Contract aiid must follow procedures to ensure ccyntimilty of operations without
Iflterl-Lipt loll.
33.3 In preparation for the threat of an emergency event as defined in the State of Florida Comprehensive Finergenc%
Management Plan, the Department may exercise authority over in area agency or service provider agency to
Implement preparedness activities to improve the safety of the elderly in the threatened area and to secure area
I y
agency and service provider facilities to minimize the potential impact of the event. These actions will be within
Z�
the existing roles and responsibilities of the area agency and provider.
33.4 In the event the President of the United States or Governor of the State of Florida declares a disaster or state of
emergency, the Department may exercise authority over an area agency or service provider agency to implement
emergency relief measures and.'or activities.
34. Equipment
34.1 Equipment means: (a) an article of nonexpendable, tangible personal property having a useful life Of ITIOre
than one year and in acquisition cost which equals or exceeds the lesser of the capitalization level established by
the organization for the financial statement purposes, or $5,000.00 [for federal funds], or (b); nonexperidable,
tangible personal property of a non-consumable nature with an acquisition cost of$1,000.00 or more per unit, and
expected useful life of at least one year, and hardback bound books not circulated to students or the general public,
with a Value or cost of$250.00 or more [for state funds].
34.2 Contractors and Subcontractors who are Institutions of Higher Education, Hospitals, and Other Non-Protit
01-,:yanizations shall have written property management standards in compliance with 2 CFR Part 215
Administrative Requirements (formerly OMB Circular A-110) that include: (a)a property list with all the elements
identified in the circular; and, (b) a procedure for conducting a physical inventory of equipment at least once every
two years. (c) A control system to insure adequate safeguards to prevent loss, damage, or theft of the equipment;
and (d) maintenance procedures to keep the equipment in good condition. The property records must be
maintained on file and shalt be provided to the Alliance upon request. The Contractor shall promptly investigate,
I
fully document and notify the Contract Manager of any loss, damage, or theft of equipment. T'he Contractor shalt
provide the results of the investigation to the Contract Manager.
1
34.3 The Contractor's property management standards for equipment acquired with Federal funds and federally-
owned equipment shalt include accurately maintained equipment records with the following information:
(I) A description of the equipment,
(2) Manufacturer's serial number, model number, federal stock number, national stock number, or other
identification number,
(3) Source of the equipment, including the award number:
(4) Whether title vests in the Contractor or the federal government:
(5) Acquisition(late (or(late received, if the equipment was furnished by the federal government) and
cost:
(6) Intorination from %c hich one can calculate the percentage
e of federal participation in the cost of the equipment
(riot applicable to equipment furnished by the federal government):
7) 1,ocatioll "Ind Condition of the CoILlipillelit '111d the dale the infortilation wLis reported:
N) t 111t aCLJUiSiti()ll c20SL 111d
(9) L,Itimtite disposition data. illCILIdll)I-' ohltC 0fdi,')j)0s.d and ,zilcs price or the method used to dctcl-nillic
(All-I-ClIt fair iiiirket %aILIC %t here a Contractor compensates the federal awardin,,i ageticy I'Or Its share.
12
Contr,ct tiunaher KI1- 1472
34.4 1:quipment purclased with federal funds ��Ith an cicquisitiot� cast <ner S5J)00,00 and i�grnipment purchased
with state funds with an acquisition cost over 51.000.00 that is specitically identified In the area plan approved b
the Department is part of the cost of carrying out the activities and functions of' the a annt awards and fitic
(('wnership) will vest in the Contraletor, subject to the conditions of 2 C"F'R Part 215 AdtrliniStrati%C Requirements
(tOrnierly OMB Circular A-110), Subpart C. paragraph 34 f:,-gLril)r7lent purchased under these thresholds iy
considered supplies and is not Subject to property standards. Equipment purchased with funds identified in the
budw,,ct attachments to a<greernents covered by any contract or aureernent incorporatin( this Contrtct by reference.
or ufentitled III the suh-a"rcerrrents with Subcontractors (not included in a cost methodology), is subject to the
conditions of section 273, F S. and 6OA-1.0017, F, A. C. or"l"itle 45 CFR Part 74.
35.5 The Contractor shall not dispose of any equipment or materials provided by the Alliance, or purchased with
funds provided through any contract or agreement incorporating this Contract without first obtaining the: approval
of the Contract :Manager. When disposing of property or equipment the Contractor Must submit a written request
for disposition instructions to the respective Contract Manager. The request should include a brief description of
the property, purchase price, funding source, and percentage of state or federal participation. acquisition date and
condition of the property. The request should also indicate the Contractors proposed disposition (i.e., transfer or
donation to another agency that administers federal programs, offer the items for sale, destroy the items, etc.).
35.6 The Contract Manager will issue disposition instructions. If disposition instructions are not received within
120 days of the written request for disposition, the Contractor is authorized to proceed as directed in 2 CFR Part
215 Adrninistrative Requirements (formerly ON/1B Circular A-1.10).
35. Use of State Funds to Purchase or improve Real Property
Any state funds provided for the purchase of or improvements to real property are contingent upon the Provider or
political subdivision granting to the state a security interest in the property at least to the amount of state funds
provided for at least 5 years from the date of purchase or the completion of the improvements or as further
required by law.
36. Dispute Resolution
Any dispute concerning performance of the contract shall be decided by the Contract Manager, who shall reduce
the decision to writing and serve a copy on the Provider.
37. Financial Consequences of Non-Performance
If the Provider fails to meet the minimum level of service or performance identified in this agreement, or that is
customary for the industry, then the Alliance must apply financial consequences commensurate with the
deficiency. Financial consequences may include, but are not limited to, contract suspension, refusing payrnent,
withholding payments until deficiency is cured, tendering only partial payments, and/or cancellation of contract
and reacquiring services from an alternate source.
37.1 The Provider will not be charged with financial consequences, when a failure to perform arises out of causes that
were the responsibility of the Alliance.
38. No Waiver of Soverei!=n Immunity
Nothin(-, contained in this agreement is intended to serve as a waiver of sovereign immunity by any entity to %vliicl7
overeign immunity may lie applicable.
39. Vemle
[fan, dispute arn,es out Of this contract. the venue of such legal recourse will he Miart1i-Dade County, Florida.
39. 1 afire Contract
ll1is contract contains r111 the terms and conditions algrccd upon by the. Parties. No oral agreements or
representations .shall be <alid �rr binding upon the Alliance or the ProN tiler unless expre sly c«rltained herein or by
l3
Contract Number KI1. 1472
a written anaendncnt to this contract ;i'.!Iled by hoth Parties.
40. Force Maieure
'I lie Parties 1k iII not be liable fOr any delays or failures In pertorralLattcc due to circutnstances beyond then' control.
pro%ided the Marty experiencing the force majcure condition provides immediate k4ritten notification to tlae other
party and takes all reasonable efforts to cure the condition.
41. Severabilit•♦' Clause
The Parties agree that it a court Of' cotxapetetlt jurisdiction deems any term or condition herein void or
unenforceable; the other provisions are Severable to that void provision and shall remain in full force and ef`lect.
42. Condition Precedent to Contract: ;-appropriations
The Parties aaaree that the Alliance's performance and obligation to pay tinder this contract is contin4gent upon an
annual appropriation by the Legislature to the Department and It corresponding allocation under contract from the
Department to the Alliance.
43. Addition/Deletion
The Parties agree that the Alliance reserves the right to 4told or to delete any of the services required Linder this
contract when deemed to be in the State of Florida's best interest and reduced to a written amendment signed by
both Parties. "The Parties shall negotiate compensation for any additional services added.
44. Waiver
The delay or faih.ire by the Alliance to exercise or enforce any of its rights Linder this contract will not constitute or
be deemed a waiver of the Alliance's right thereafter to enforce those rights, nor will any single or partial exercise
of any such right preclude any other or further exercise thereof or the exercise of any other right.
45. Compliance
The Provider shall abide by all applicable current federal statutes, laws, rules and regulations as well as applicable
current state statutes, laws, rules and regulations. The Parties agree that failure of the Provider to abide by these
laws shall be deemed an event of default of the Provider, and subject the contract to immediate, unilateral
cancellation of the contract at tyre discretion of the Alliance.
46. Final invoice
The Provider shall submit the final invoice for payment to the Alliance as specified in Paragraphs 3.4, 3.4.1 and
3.4.2 (date for final request for payment) of A'TTACHNIENT 1. if the Provider fails to submit final request for
payment by the deadline, then all rights to payment may be forfeited and the Alliance may not honor any requests
submitted after the aforesaid time period. Any payment due under the terms of this contract may be witilheld until
all reports due from the Provider and necessary adj List ments thereto have been approved by the Alliance.
47. ReneLotiations or Modifications
Modifications of the provisions of this contract shall be valid only when they have been reduced to
writing and duly signed by both parties. The rate of payment and the total dollar amount may be
adjusted retroactively to reflect price level increases and changes in the rate of payment when these have
been established through tlae appropriations process and subsequently identified in the Alliance's
operating budget.
48. 'Termination
48.1 I`lais contract Inay be terminated by either party %k ithout cause upOn no ICSS than thirty 00) calendar (ays' notice
Ili %ritintx to the ether party unless a SOOIICr tine is Iaatatually alxrced upon ill writinfY. Said notice Shall be
delivered ley t;.S. Postal Service c)r any expedited dlivery ;er%Icc that pro\ides �critication ot` delivery or by
hand delivery to the Contract Nlana�_,cr or the representame ot`the Provider responsible COr administration of,the
,:olatract.
48.2 ha the event funds for J)X I)Ient I�.)LarSuant to this Contract become Lutacailtable. the Alliance Inav terminate tills
Contract upon no less than M ollr(34) hours' notice in ccritinta to ?lie Provider. Said notice shall be delivered
h" t .S. Postal Service orally expedited delivery Set"b'iCe that pro%idc5 %verification ot'dcII%cry or by hand delivery
14
Contract Number K11- 1472
to the ('ontract Nlaria,.ler or the representative of the Provider responsible for administration of the contract. The
Alli4nice will be the final authority as to the availability and adequacy of hinds. In the event of termination of this
contract, the Provider will be compensated for any work satisfactorily completed prior to the.date of termination.
48.3 This contract rltay be terminated for cause upon no less than twenty four (24) hours' notice in wvritingy to the
Provider. "'aiver of breach of any provisions of this contract shall not be deemed to be a waiver of any ether
breach and ,,hall not be construed to be a moditication of the terms and conditions of this contract. The
provisions herein do not limit the Alliance's or the Provider's rights to remedies at law or in equity.
48.4 Failure to have performed any contractual obligations with the Alliance in a manner satisfactory to the Alliance
will be a sufficient cause fIor termination. To be terminated as a Provider under this provision, the Provider must
have (I) previously failed to satisfactorily perfoarrn in rI contract with the Alliance, been notified by the Alliance
Of*the unsatisfactory performance, placed by the Alliance under a corrective action plan and failed to correct the
unsatisfactory performance to the satisfaction of the Alliance as outlined in the corrective action plan; or(2) had a
contract terminated by the.Alliance for cause.
48.5 Waiver of breach of any, provisions of this contract shall not be deemed to be a waiver of any other breach and
shall not be construed to be a modification of the terms and conditions of this contract. The provisions herein do
not limit the Alliance's right to remedies at law or to damages of a legal or equitable mature.
48.6 Suspension of Work:
If the Department of Elder Affairs determines in its sole discretion suspend any or all activities tinder this
Contract and any Contract or agreement incorporating this Contract by reference, at any time, when in the best
interests of the State to do so, the Alliance will suspend the contractor's work. As the Department provides the
Alliance with written notice outlining the particulars of suspension, these reasons will be communicated to the
contractor by the Alliance. Examples of the reason for suspension include, but are not limited to, budgetary
constraints, declaration of emergency, or other such circumstances. After receiving a suspension notice, the
Contractor shall comply with the notice and shall not accept any purchase orders. Within ninety days, or any
longer period agreed to by the Contractor, the Alliance shall either(1) issue a notice authorizing resumption of
work. at which time activity shall resume, or(2)terminate the Contract or purchase order. Suspension of work
shall not entitle the Contractor to any additional compensation.
49. Successors
This contract shall remain binding upon the successors in interest of either the Alliance or the provider.
50 Electronic Records and Signature
The AAA authorizes, but does note require, the Contractor to create and retain electronic records and to
use electronic signatures to conduct transactions necessary to carry out the terms of this Contract. A.
contractor that creates and retains electronic records and uses electronic signatures to conduct transactions
shall comply with the requirements contained in the UIiifarm Flew-onic Transaction Act. s. 668.50. Fla.
Stat. All electronic records must be fully auditable, are subject to Flaridu's Publics Rc°cm-ds Law, Ch. 119.
and Fla. Stat., must comply with section 28, L.)ata Lntcgi-ity and sal, Lr;farination: must maintain
Lill confidentiality, as applicable: and must be retained and maintained by the Contractor to the same
extent as non-electronic records are retained and maintained as required by this Contract.
5 0.1 The .AAA's authorization pursuant to this section does not authorize electronic transactions between the
Contractor and the .-,:VV 'The Contractor is authorized to conduct electronic transactions with the
AAA only upon further written consent by the AAA.
50.2 (,'[)oil request by the 'y.AA. the Contractor shall provide the AAA or DOEA Mill twon-electronic ipaper)
coptcs of records. Non-clectronic (paper) copies prow id4d to the AAA of' any document that wars
01,11-linally III electronic lorm wwith an electronic si�!nattrre mu t indicate they person and the person':,
capacity ww ho> cicctronically signed the doctnlIcnt on anv, 11011-c lectronic copy oi'the document.
;l Special Provisions
15
Contract NUIllbCr K 171- 147
The Contractor agrees to the lollo\\ing provisions:
5 1.1 1 rivest Ig at Ion of Crim In a I Allegations:
Ari� report that implies criminal intent oil the part of*the C n Contractor or ay Subcontractors and referred to
a o'overmilental or Investigatory agency must be sent to the Alliance. If the Contractor has reason to
believe that the allegations will be referred to the State Attorney, a law enforcement agency, the United
States Attorneys office, or other governmental agency, the Contractor shall notify the contract manager.
In
copy of all documents, reports, notes or other written material concerning the investigation, whether In
the possession of the Contractor or Subcontractors, must be sent to the Alliance's contract manager with a
summary ot'the investigation and allegations.
51.2 Volunteers:
The Contractor shall ensure the use of trained volunteers in providing direct services delivered to older.-
Individuals and individuals with disabilities needing such services. If possible, the Contractor shall work-
in coordination with organizations that have experience in providing training, placement, and stipends for
C�
volunteers or participants (such as organizations carrying out federal service programs administered by
zD
the Corporation for National and Community Service), in community service settings.
51.3 Enforcement:
51.3.1 In accordance with Section 430.04, F.S., the Alliance may, without taking any intermediate
measures available to it against the Contractor, rescind the Contractors designation as an area agency on
aging, if the Alliance finds that:
5 1.3.2 An intentional or negligent act of the Contractor has materially affected the health, welfare, or
safety of clients served pursuant to any contract or agreement incorporating this Contract
by reference, or substantially and negatively affected the operation of services covered under any contract
or agreement;
5 13.3 The Contractor lacks financial stability sufficient to meet contractual obligations or that
contractual funds have been misappropriated;
5 1.3.4 The Contractor has committed multiple or repeated violations of legal and regulatory standards,
regardless of whether such laws or regulations are entbrced by the Alliance, or the Contractor
has committed or repeated violations of Alliance standards;
5 1.3.5 The Contractor has failed to continue the provision or expansion of services after the declaration
ot'a state ot'crilergency, and,,or
5 1.3.6 'File Contractor has tailed to adhere to the terms of any contract or a-rcernent incorporating this
Contract by reference.
1_3.7 In the alternative. the Alliance may, at its sole discretion, in accordance with section 430.04.
u I actor. I -ecti Ion. unannounced
S.. take immediate measures . ga nst the Contractor, Including: con ve act'
special monitoring. temporary assumption of the Operation ot'one or more contractual scram ices,
placement of the Contractor on probationary status. imposing a moratorium on Contractor action.
1111po"Ill", tinalicial penalties for nonperformance. or other adininistrat1%e action pursuant to
Chapter 120. F.S.
5 1_1.8 In making all,,, determination Under this provision the Alliance May rely upon the 1"Inding'S of
,\Ilotiler state or federal agency. (,)I-other regulatory body. -\ny claims for damaocs for breach of'
10
Contract Number KI 1- 1472
any contract or agreement incorporating this Contract by reference are exempt from
adi-ninistrative proceedings and shall be hrOLI(Illt before the appropriate entity in the NCIlLie of
klianii-Dade (:OLllltN'
1. Official Payee and Repiresentatives (Names, Addresses. and Telephone Numbers):
The name, address. and telephone number of the representative for the Alliance for this contract is:
,flax B. Rothinan, JD. LEV
Pi-esi(lent atul CEO
760 NW 107"' Ave, Suite 214
Miami, Florida 3')172
(305) 670-6500, Ext. 224
The name, address, and telephone number of the representative of the provider responsible for administration of
the program Linder this contract is:
...........
The Contractor name, as shown on page I of this
zn MONROE COUNTY SOCIAL, SERVICES
a. contract, and mailing address of the official payee to 1100 SIMONTON ST. SUITE 2-257
whom the payment shall be made is: KEY WES]", FL. 33040
The name of the contact person and street address KIM W WEAN, COMPIJANCE MANAGER
b. where financial and administrative records are 1100 SIMONTON ST. SUITE 190
maintained is: KEY WEST, FL- 33040
The name, address, and telephone number of the SHERYL GRAHAM, SR DIRECTOR SOCIAL, SERVICES
C,
representative of the Contractor responsible for 1100 SIMONTON ST. SUITE 2-257
administration of the program Linder this contract is: KEY WEST, FL. 33040
The section and location within the AAA where Associate Vice President Finance
d. Requests for Payment and Receipt and Expenditure 760 NW 107th Avenue. Suite214
forms are to be mailed is: Miami, Florida 33 172-3 155
Contract Manager
Alliance for A(,in(-,, Inc.
1 'The name, address. and telephone number of the
760 NW 107th Avenue, Suite 214
Contract Manager for the AAA for this contract is:
Miami. Florida 33 172-33 15 i
4 j
t.;pon chanoe of representatives names, addresses. telephone numbers) by either I)art%. notice shall he provided in
writing to the other party and the notification attached to the originals of this contract.
-------------
Ill the event different representatives are designated h\ either party after CXecUti011 k)t'tllls Contract. notice ot,the nallic and
address of the new representative k%ill be rendered in writing to the other pam and said notification attached to originals
of this contract.
17
Contract Number KI 1- 1472
51. A111 'Terms and Conditions Included
This his contract and its Attachments. I throuc,11 X, A, B, C, D. E. and ariv exhibits referenced in said attachmetit,
together \011 au,, documents incorporated by reference, contain all the terms and conditions agreed upon hylll-
Parties. ']'here are uo provisions, terms, couditious, or obligations other than those contained herciii, arid this coritl'ak:
shall supersede all previous C01111111.1111catiOus, representations or agreements, either timtten or verbal between th,
Parties.
1.3% sioning this contract, the Parties agree that they have read and agree to the entire contract.
IN WITNESS THI REOI`. the Parties hereto have caused this 18 page contract, to be executed by their Undersigned officials ,I
duly authorized.
Monroe County Board of
Contractor Commissioners, Social Services/1 n-Home ALLIANCE FOR AGING, INC.
Services,—
SIGNED BY: SIGNED BY.
NAME: ROMAN GASTESI NAME: MAX B. ROTHMAN,JD, LL.M.
'TITLE: COUNTY ADMINISTRATOR TITLE: PRESIDENT AND CEO
DATE: try2-6 4-, DATE:
18
Contract tiumber Ki[- 1472
INDEX TO ATTACHMENTS
Attachment I SERVICE PROVISIONS HOME CARE FOR THE ELDERLY
Attachment II CERTIFICATION REGARDING LOBBYING CERTIFICATION FOR CONTRACTS, GRANTS,
LOANS AND AGREEMENTS
Attachment 111 FINANCIAL AND COMPLIANCE AUDIT
Attachment IV CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE FOR AGREEMENTS,
GRANTS, LOANS AND COOPERATIVE AGREEMENTS
Attachment V CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND
VOLUNTARY EXCLUSION FOR LOWER TIER COVERED TRANSACTIONS
Attachment VI ASSURANCES NON CONSTRUCTION PROGRAMS
Attachment VII BUDGET SUMMARY
Attachment VIII INVOICE CONTRACT REPORT SCHEDULE
Attachment IX REQUEST FOR PAYMENT FORM
Attachment X RECEIPT AND EXPENDITURE REPORT
Attachment A DOEA HANDBOOK
Attachment B CIVIL RIGHTS COMPLIANCE CHECKLIST
Attachment C REFERRAL PROTOCOL AGING AND DISABILITY RESOURCE CENTER (ADRC)—
OUTSOURCED FUNCTIONS
Attachment D DOEA COMPUTER USE POLICY
Attachment E BUSINESS ASSOCIATE AGREEMENT
Attachment F E-VERIFY
Attachment G BACKGORUND SCREENING AFFIDAVIT OF COMPLIANCE
Attachment H CERTIFICATION REGARDING SCRUTINIZED COMPANIES LISTS
1 O
Contract Number KH- 1472
,VI-E\CII'8IENT I
lIO,NIE CARE FOR THE: ELDERLY PROGRAM
SECTION 1. SERVICES TO BE PROVIDED
1. Scope of Service and Individuals
1.1 1 he services to be provided are those described in the provider's service provider apphCatiOn ,"UhInIttcd III
response to the 2011 C.CE Lead ,,\�,eticyapplication and as described in this contract, -File Horne('are for the
Elderly Proorarn encourages the provision of care in farnily-type living arrangements in private hoaxes
on a not for profit basis as an alternative to nursing home or other institutional care.
1.2 The provider's service provider application submitted in response to the 2011 1 ICE Lead Agency R FP, as well
as the RFP itself is incorporated by reference in this contract between the Alliance and the provider and made a
part of this contract.
1.3 Individual Eligibility
In order to receive services under this contract, an applicant must:
(1) Be at least 60 vears of age;
(2) Have Income and assets which do not exceed the Medicaid Institutional Care Program limits;
(3) Be functionally unpaired and at risk of nursing,home placement as determined through the initial
comprehensive assessment, and
(4) Have an adult caregiver living in the home that: (a) is willing and able to provide care and assist in
arranging services for the client and, (b) is qualified as an HCE caregiver based on the client's choice
and the case manager's assessment;
4-
(5) Eligible applicants must be screened, prioritized and referred to the provider by the Aging Resource
Center prior to enrollment.
SECTION II—MANNER OF SERVICE PROVISION
2.0 conditions
2.1 All services under this contract will be provided in a manner consistent with the conditions set forth in the
2013 Florida Department of Elder Affairs Programs and Services Handbook or any subsequent
revisions made to the Handbook and the provider's service provider application submitted in response to
the 2011 CCE Lead Agency RIT (SPA). In case of conflict between the SPA and the Handbook, the
Handbook prevails.
2.1.1 client access to services, assessment and eligibility determination must conform to the protocols listed In
ATTA( I IMENT C.
2.1.2 The provider will offer services based on clients' service plans.
2.2 Service Tasks
2.2.1 Delivery of Service to FlIgIble Clients
'I he e prw,I(let-shall pro\Ide a Co I I t 111 U U I n of ser%ices that I i icet s the d I N erne I I ced s of 1ii net I o na I I y impaired elders.
'I lie Pro%ider shall perfOrin and report per-l'Ormance of the Collowin'g services in accordance with the currentD(+A Prou'ra I I is and Services Handbook. The sereIces include: the t'011km inZ cate2011CISI:
Contract NLII11bCI- Kil- 1-472
2.2.2 lZelct-rals, fOrMedicild Wal%cr Services
The provider shall lcici)tIfy potcirtMI Medicaid iligible I ICE clients and refer these Individuals fOr ,ipphcatl'Orl
for Medicaid Wak cr scr%ices,
2.2.3 .\-in(-, ('iut Consurners:
2.2.3.1 All Chit"" consumers will be referred by DCF to the AMW f*or enrollment into the cor-resporIding aged
program inanaged by the AllMlIce.
2.2.3.2 ('011SUrners active Ili the CCDA and 11(711-k programs that are turning 60 arid are eligible for CCE and.or FICE'
tivill be opened ira the corresponding aged program managed by the Alliance it'furIding is available. If fundilliZ,
is available, these consumers Will be made active. If funding is not available, they Will be waitlisted for these
programs but Will be given priority for activation once funding is available.
COuSLIniers active in the Medicaid Waiver, upon turning age 60, Will continue to be eligible for and receive
IMedicald Waiver services.
2.3 SERVICE TIMES AND LOCATION
2.3.1 Service Times
The Provider shall ensure the provision of the services listed in this contract is available at times appropriate to
meet client service needs at a rnininiurn, during normal business hours. Nonnal business hours are defined as
Monday through Friday, 8:00arn to 5:00prn.
2.4 REPORTS
2.4.1 The Provider shall respond to additional routine and/or special requests for information and reports required by
the Alliance in a timely manner as determined by the Contract Manager. The provider shall establish due
dates for any subcontractors that pen-nits the Provider to meet the Alliance's reporting requirements.
2.4.2 Client Information and Registration Tracking System (CIRTS) Reports
The Provider shall input IJCE specific data into CIRTS to ensure CIRTS data accuracy
2.4.2.1 The recipient must ensure all data for IICE subsidies are entered in the ciwrS by the 15th of" each month.
IICE subsidv data entered into the CIRTS by the 15th of the month will be for payments incurred between the
I 6th of the previous month and the 15th of the current month. Case management data entered into the CIRTS
by the I 5th of the month will be for units of service provided during the previous month from the 16th and up
to and Including the 15th of the current nionth, or case management units of service may be entered according
to the recipient schedule, in aggregate on the 31 st or daily, weekly or monthly."I -
2.4.2.2 The recipient will ensure data entry for IICE subsidies will cease on the 15th of the month and the CIRTS
Monthly Service Utilization Report. by consumer and by worker identification is run.
2.4.2.3 The recipient will ensure the :'Monthly Utilization 1Zeport, by consumer arid by worker identification is verified,
corrected, certified no later than the 20th of the month in which the report is generated.
2.4.2.4 The recipient Will ensure caregivers cletennined eligible for the I ICE basic subsidy after the 15th of month,
Will be processed to begin eligibility for the I ICE basic subsidy on the I st (lay ofthe next month.
1.4.3 Service Costs Reports
lhe Provider shall A1111111t to the A111,111CC ,Cu1I-Z1IIIILIal scr\ice cost reports, MIlCh reflect actual Costs Of
pro%I(ling, each scr-,ice h,,,,pro rani, Phis report pro%ides infOrniation for platirinw, ai)d rIcgotiatin"! unit rates.
1.4.4 Surplus/Deficit Report
Ilse Provider \~ Ill S'LlbIllit <l collSoll(LUCd Surplus-deficit report in zi fOrniat proNided by the .\111.,ince to the
Maii.i,-,er by the I of cacti month. Hils report is for till ;igrecnients aildol- contracts; hcmeen the
Provj(jer'.JII(j the \HIMICC. HIC report will 111CILI& the 1'0110V,111g:
Contract Number KI1- 1472
(1) C'urrent status regarding surplUS or deficit:
(2) The Provider's detailed plan on lhowv the Surplus or deficit spentlIM! cxceedin.l ra two percent threshold
will be resolved,
(3) Recommendations to transfer funds to resolve surplus deficit spendin`,
(4) Input from the Provider', Board of Directors oil resolution of spending issues. if'appticable;
2.4.5 Tlie Alliance rescry es the right to adjust the total award as well as the contracted unit rate to reflect provider
coasts and utilization rates based on active clients enrolled in the program.
2.4.6 The Alliance may withhold payment fonder the terms of this contract, pending the receipt and approval by the.
Alliance of complete and accurate financial and programmatic reports due from the provider and any
ad}ustments thereto, includini- any disallowance not resolved.
2.4.7 The provider shall provide the Alliance with an expenditure plan by July 15 or two weeks after this contract
has been signed; a monthly update is oboe on the 21" day of each following month. The expenditure plan rand
updates must follow the format provided by the Alliance.
2.4.8 The provider shrill respond to surplus;deficit inquiries and will provide ad-hoc reports as requested by the
Alliance.
2.4.9 Surplus Recapture.
In accordance with its surplusideficit ananagcment policies, in order to maximize available handing and minimize
the time that potential clients must wait for services, the AAA in its sole discretion can reduce funding awards if the
Contractor is not spending according to monthly plans and is projected to incur a surplus at the end of the year.
2.5 ELECTRONIC RECORDS AND DOCUMEN'TA'TION
The provider will ensure the collection and maintenance of client and service information on a monthly basis
from the Client Information and Registration Tracking System (CIRTS). NI.aintenance includes valid exports
and backups of all data and systems according to Alliance acid Department standards.
2.5.1 'Timely Data Entry
The provider must enter all required data per the Department's CIRTS Policy Guidelines for consumers and
services in the CIRTS database. The data must be entered into CIRTS before the provider submits its request
for payment and expenditure reports to the Alliance. The Alliance shall establish time frames to assure
compliance with due dates for the requests for payment and expenditure reports to the Department.
2.5.2 Data Accuracy
The provider will run monthly CIRTS reports and verify client and service data in CIRTS is accurate. This
report must be submitted to the Alliance with the monthly request for payment and expenditure report and
must be reviewed by the Alliance before the provider's request for payment and expenditure reports can be
approved by the Alliance.
2.5.3 Failure to ;Maintain CIRTS Database
Failure to ensure the collection and maintenance of the CIRTS data may result in the Alliance enactin<—, the
"1::nforcenacnt" clause of this agreement (see 2.7.2), including delaying or withholding payment until the
problem is corrected.
2.5.4 Computer System Backup and Recovery
loch provider. among other requirements. must anticipate and prepare for the loss of information processing
capal�ilitae fhe routine backing up of data and sofiwvare is required to recover from losses or ow<ages of the
computcr ,% tcm. Data and software essential to the continued operation of provider function, must be
Nicked rip. hlae security Controls over the backup re,oairces shall he as stringent ,as the: protection required Ot'
the primary resources. It is reconlincaaded that a copy ot'the backed up data he stored in a sccaire. <�tfsite
location. The provider shall maintain written policies and procedures tOr computer backup nand NCO%cry.
Fhc,c policies and procedures shall be made available to the Alliance upon request.
Contract Number KI-1- 14 7/2
2.6.1 Outcomes
(1) The Provider shall tillICIV Submit to the Alliance all reports described in ATTACHMENT 1, SECTION
2.5 REPORTS.
(2) The Provider shall timely Submit to the Alliance all information described in ATTACHMENT 1,
SECTION 2.6 RECORDS AND DOCUNIENTAIJON;
(3) The Provider shall ensure services in this contract are in accordance with the current DOEA Pro,-,rams and
Services Handbook.
2.6.2 The performance of the Provider in providing the seiAlices described in this contract shall be measured by the
current Area Plan strategies for the following criteria:
(1) Percent of most frail elders who remain at home or in the community instead of going into a IILII-SI114-1
home,
(2) Percent of APS referrals who are in need of linniediate services to prevent further harm who are served
within 72 hours;
(3) Average monthly savings per consumer tor home and community-based care versus mu-S11112, home care
for comparable group clients;
(4) Percent of elders assessed with high or moderate risk environments who improved their environment
score;
(5) Percent of new service recipients with high-risk nutrition scores whose nutritional status improved,
(6) Percent of new service recipients whose ADL assessment score has been maintained or improved;
(7) Percent of new service recipients whose IADL assessment score has been maintained or improved;
(8) Percent of family and family-assisted caregivers who self-report they are likely to provide care,
(9) Percent of caregivers whose ability to provide care is maintained or improved after one year of service
intervention(as determined by the caregiver and the assessor);
(10) Average time in the CCE Program for Medicaid Waiver probable customers; and
C�
(11) Percent of customers who are at imminent risk of nursing home placernent who are served with
community based set-vices.
2.7 Compliance and Enforcement
2.7.1 The provider shall comply with all the terms and conditions set-forth in this contract, the CCE Rl°11 pursuant to
which this contract was awarded, the Service Provider Application and the 2012 Department of Elder Affairs
Prograrns and Services Handbook. The provider is also responsible to respond to any fiscal or programmatic
monitoring items/issues within the tirriefrarne stipulated by the Alliance. Monitoring Items/Issues may include
Corrective Actions, Reportable Conditions or Quality Improvement Recommendations provided by the
Alliance. The provider is also responsible to provide timely response to any inquiry related to prograrn
expenditures including, but not limited to, addressing prograrn surplus or deficit and corresponding program
spend-out Ptall.
Failure to meet any of the contractual requircirients or compliance items mentioned above will result in the
imposition of sanctions and,` or other enforcement actions by the Alliance.
2.7.2 Enforcement:
I'lle Alliance 111,1%, Take Intermediate measures avaainst the provider, InClUding: corrective action, UnallnOLHICed
special temporary assumption of the Operation of one or more programs. placement oaf the provider
probatwilary Status, 11111-1o"Ing a moratorium oil provider action. imposing financial penalties 1o)r
twnpertol'Illance. or other appropriate action if the Alliance tinds that:
0 ,Ill Intentional or neull'-'ent act of the provider has niater-Mils affected The health. welf"are, or salety of
clients screed pUrSU311t to this contract, or substantially and negative!} �0'fcctcd the operation of
,)cr\,Iccs covered under this Contract.
Contract Number KI1- 1472
• the prof ider lacks financial stability sufficient to meet contractual obligations or that contractual
funds have been misappropriated.
• the provider has committed multiple or repeated G iolations of legal and regulatory standards,
re<xardless of the enforcement of'such laws or regulations,
• the prop ider has failed to continue the provision or expansion of'sere ices after the declaration of a
st<rte of enter encv.
+ the provider has failed to adhere to the terms of this contract.
+ the provider consistently misses performance measure tar<.ets. or does not dernonstrate to the
satisfaction of the Alliance that a proUgram budget surplus deficit problem is being addressed in order
to avoid closing out the contract year.with a budget variance of more than two percent.
In making any determination tinder this provision the Alliance may rely upon the findings of another state or
federal agency, or other regulatory body.
SECTION III. NIET1101) OF PAYMENT
3.1 General Statement of;Method of Payment
The method of payment in this contract is based on a fixed unit rate for approved services. The provider roust
enstrre fixed unit rates include only those costs which are in accordance with all applicable state and federal
statutes and regulations and are based on audited historical costs in instances where an independent audit is
required. All requests for payment and expenditure reports submitted to support requests for payment shall be
on Department forms 106C and 105C, included as ATTACHMENTS IX and X. Duplication or replication of
both forms via data processing equipment is permissible, provided all data elements are in the same format as
included on department fortes.
3.1.1 Provider invoices shall be submitted, no later than 60 days after the end of the month on which the expense was
incurred, except that invoices cannot be submitted beyond the date for final invoicing, as stated in this contract.
Invoices submitted late will not pay. Exceptions to this rule are at the discretion of the Alliance, on a case by
case basis. such exceptions roust be requested prior to the expiration of the invoicing deadline. In making a
determination of the exception the Alliance will consider whether the disruption to the billing cycle was beyond
the control of the provider, the frequency with which such exceptions are requested by the provider, and
whether the Alliance can request reimbursernent at a late date frorn DOE.A. Exceptions for invoicing late after
the closeout date will not be made.
3.2 Advance Payments
Non-profit providers may request a monthly advance for service costs for each of the first two months of the
contract period, based on anticipated cash needs. Detailed documentation justifying cash needs for advances
must be submitted with the signed contract, approved by the Alliance, and maintained in the contract manager's
file. All payment requests for the third through the twelfth months shall be based on the submission of monthly
actual expenditure reports beginning with the first month ofthe contract. 'The schedule for submission of
advance requests is ATTACIINIENT Vill to this contract. Reconciliation and recouping ofadvances rrrade
under this contract are to be completed by October. All advance payments are subject to the availability of
funds.
3.3 Advance funds may be temporarily Imested by the provider in an insured interest bearing,, account. All interest
earned on contract fund advances must be returned to the Alliance within thirty (30) days of,the end cif the first
,luarter of the contract period.
3.4 1,inal Request for Payment:
3.4.1 l"lae provider must s,Ubmit the Iirrarl request for payment to the Alliance no Liter than .lulu 15. 2015: it the
provider fails to do so. ,all right to payment is forfeited, and the Alliance will not honor any requests submitted
after the aforesaid time period.
3.4.2 If the contract is terminated prior to the contract erld date of''Imic 30, 't115, then the prop ider must submit tlte
Beal request for payment to the AlliMice no more than 45 days alter tic contract is tcrimnated, but no later than
24
Contract ",,*Ull1hcr KI-1- 1472
J111v 15, 201 3. If tile provider fails to do so, all right to Payment is forfeited, and the Alliance will not
honor any requests submitted after the aforesaid time period.
3.5 Documentation for Payment
['he Contractor will maintain (10CLUAWntati011 to SUppOrt INlyInCrit NCILICStS that Shall be available to the
Department or authorized individuals, such as Department of Financial Services, upon request.
3.5.1 The Contractor must I-CLILIH-C subcontractors to enter all required data per the Departments CIRTS Policy
Guidelines for clients and services in the CIR I'S database. The data must be entered into the CIRTS before the
Subcontractors submit their request for payment and expenditure reports to the Contractor. The Contractor shall
establish time frames to assure compliance with due dates for the requests for payment and expenditure reports
to the Department.
3.5.2 'File Contractor Must require subcontractors to run monthly C.IRTS reports and verify client and service data in
the CIRTS is accurate. This report must be submitted to the Contractor with the monthly request for payment
and expenditure report and must be reviewed by the Contractor before the subcontractor's request for payment
and expenditure reports call be approved by the Contractor.
3.6 Level of Effort,Co-pay and Cost Sharing
3.6.1 Matching, Level of Effort, and Earmarking Requirement
'I"he provider will assure a match requirement of at least 10 percent of the cost for all CCE services. The
match will be made in the 'form of cash and/or in-kind resources. At the end of the contract period, all CCE
funds expended must be properly matched. State funds cannot be used to match another state-funded
program.
3.6.2 Cost Sharing and Co-payments
The provider in conjunction with the Alliance shall establish an annual co-payment real (amount to be
collected from clients). Using the method prescribed in the 2012 Department of Elder Affairs Prograrn and
Services Handbook, the provider shall project the annual co-payments to be collected from each active client
in all 'income ranges prior to the start of each fiscal year. The provider is required to meet at least 90 percent
of the goat. Co-payments collected in the CCE program call be used as part of the local match.
The Alliance For Aging Inc. will hold back 5'?Io of t lie provider*s contract amount. The amount held back
shall be released to the provider after 50'N) of the adjusted annual goal is collected, but no later than February
15th of the fiscal year. Hold back amounts not earned by providers as of February 15th will be reallocated to
other providers meeting or exceeding 50%of their annual goal, except when no provider agency is meeting
or exceeding its annual g I goal, or when an agency that is meeting or exceeding such goal affirms that it lacks
the capacity to receive additional funds.
3.6.3 This contract is for services provided beginning July 1. 2014 through June 30, 2015. However, the parties
recognize that they will need to perform continued activities relating to reporting, invoicing and payment ill
July ot'2014 to facilitate payment for services rendered by the provider under this contract through and
ulcludin(7 the contract expiration date of July 15, 2015. Services provided after June 30, 2015 will not be
reimbursed under this contract.
SECTION IN' Invoicing and Additional Reporting Requirements
f�
4.1 If the AllMnce has sanctioned the provider. %vilile the sanctions are in effect, at the request of the Alliance.
the provider shall provide. on a lnolltllly basis. tile provider's financial statements that reelect the Current, un-
aLlofitccl r(:%elilles <Ind the provider's ens11 po"ItIO11 as %v cil as itnv s)ther financial an(I or pro,-minunatic
olOCLIMCIIUMMI that may be rCclLle',IC(i by the Alllllllcc.
4.2 If the provider is required to prepare<i corrective action plan or re,,pond to a Fiscal and.or Prograininatic
supporting documentation tt5 requested by the Alliance sliill he pro%ivied within the time
t'rallle stipulzited by the. Alliance.
Contract Number K.1-1- 1472
ATTACHMENT 11
CERTIFICATION REGARDING LOBBYING
CERTIFICATION FOR CONTRACTS, GRANTS, LOANS AND
AGREEMENTS
The Undersigned certifies, to the best ot'lils or her knovlcdge and belief'. that:
(1) No federal appropriated fluids have been paid or will be paid. by or on behalf of the undersigned. to any person for
i[ItILIC11CHIg or attempting to influence all officer or employee of all-,., state or federal agency, a member of"congress, an
officer or employee of congress, an employee of a member of congress. or ,in officer or employee of the state
legislator, in connection with the awarding of any federal grant, the making of any federal loan, the entering, into of
any cooperative agreement, and the extension. Continuation, renewal, amendment, or modification of any federal
contract. grant. loan, Or Cooperative agreement.
(2) If any fluids other than federal appropriated funds have been paid or will be paid to any person for influencing or
attempting to influence an officer or employee of any agency, a member of congress, an officer or employee of
congress, or an employee of a member of congress in connection with this federal contract, grant, loan, or cooperative
agreement, the undersigned shall complete and submit Standard Form-LI-L, "Disclosure Form to Report Lobbying,"
in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the award documents for all Sub-
awards at all tiers (including Subcontracts, sub-grants, and contracts Linder grants, loans and cooperative agreements)
and that all subcontractors shall certit'v, and disclose accordingly.
I
This certification is a material representation of fact upon which reliance was placed when this transaction was made
or entered into. Submission ofthis certification is a prerequisite for making or entering Into this transaction imposed
by section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil
penalty of not le,s-than $10,000 and not more than $100,000 for each such failure.
Signature I7 to
ROMAN G ASTES I COUN'rY ADMINISTRATOR K11-1472
Name of Authorized Individual Application or Agreement Number
)JONROE COUNTY BOCC
Name and Address of Organization
POFA Form 103
",'o\ 1-00-1)
6
Contract Number K1I- 1472
ATTACHMENT III
FINANCIAL, .AND COMPLIANCE AUDIT
file adttIinistratiorr of`resrn.trces awarded by the Alliance for Aging. Inc. to the provider may be sub ect to audits and or
monitoring by the Alliance or the Florida Dcpat-tment of E lde;r Affairs, as described in this section.
MONITORING
In addition to reviews of,audits conducted in accordance with OMB Circular A-133, as revised, and Section 215.97. F.S.,
(see -AUDITS" below), monitoring procedures may include, but not be limited to, on-site visits by the Department of
staff, limited scope audits as defined by OMB Circular A-f 33, as revised, and or other procedures. By entering into this
agreement, the provider agrees to comply and cooperate with any monnoting proceduresiprocesses deemed appropriate by
the Alliance or the Department of Elder .affairs. In the event the Alliance for Aging, Inc. determines that a limited scope
audit of the provider is appropriate, the provider agrees to comply with any additional instructions provided by the
Alliance for Aging, Inc. to the provider regarding such audit. The provider further agrees to comply and cooperate with
any inspections, reviews, investigations, or audits deemed necessary by the Chief Financial Officer (CFO) or Auditor
General.
AUDITS
PART" I: FEDERALLY FUNDED
This part is applicable if rile provider is a State or local government or a non-profit organization as defined in ON113
Circular A-133, as revised.
In the event that the provider expends S500,000 or more in federal awards during its fiscal year, the provider must have a
single or prograrn-specific audit conducted in accordance with the provisions of OMB Circular A-133, as revised.
EXHIBIT I to this agreement indicates federal resources awarded through the Department of Elder Affairs and the
.Alliance by this agreement. In determining the federal awards expended in its fiscal year, the provider shall consider all
source's of federal awards, including federal resources received from the Alliance or the Department of Elder Affairs. The
determination of arnounts of federal awards expended should be in accordance with the guidelines established by OMB
Circular A-133, as revised. An audit of the provider conducted by the Auditor General in accordance with the provisions
of OMB Circular A-133, as revised, will meet the requirements of this part.
In connection with the audit requirements addressed in fart 1, paragraph 1, the provider shall fulfill the requirements
relative to auditee responsibilities as provided in Subpart C of OMB Circular A-133, as revised.
If the provider expends less than S500,000 in federal awards in its fiscal year, an audit conducted in accordance with the
provisions of OMB Circular A-133, as revised, is not required. In the event that the provider expends less than S500,000
in federal awards in its fiscal year and elects to have an audit conducted in accordance with the provisions of OMB
Circular A-133, as revised, the cost of the audit must be paid from non-federal resources (i.e„ the cost of such audit must
be paid from provider resources obtained from other than federal entities.)
Ali audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal year.
Compliance findings related to agreements with the Alliance for .- gin<-,, Inc. shall be based on the aCgreernent's
requirements, including any rules, regulations, or statutes referenced in the agreement. The financial statements shall
disclose whether or not the matching requirement was met for each applicable agreement, All questioned costs and
liabilities due to to Alliancc for ;y4_rina, file, shall be t`ully disclosed in the audit report with reference to the ;alliance for
Au,inu, Inc. agreement involved. If not otlicnvise disclosed as required by Section 310(b)(2) of O\,IB Circular A-133. tts
rep t eel, the schedule of expenditures of federal ,swards shall identify expenditures by agreement number for each
,rgreement with the Alliance t01- AI-IiMt. Inc... in effect durint,, the audit period. Financial reportitra= packag<a required under
181 as, I)<rrrt imPst be submitted within the earlier r _ f 30 days after receipt Of the audit report or i) months after the end of`the
prov ider,s fiscal \,car end.
,?
Contract "-,umbcr KI-l- 1 472
r,,Nwi, ii: s,rlvu FTJI'NDED
I'llis part is applicable li'the provider Is a lionstate clitity as dcFmcd by Section 215.97(2), Florida Statutes.
it, the event that the 1) 's of* IIIIV
,ro%idcr expends a total alliount of'state financial assistance equal to Or in excess '500,000 '
fiscal vear Of Such provider (for fiscal years criding, September 30, 2004 Or thereafter). the provider inust have a State
sillule or project-specifi
c audit forSuch fiscal year in accordance with Section 215,97, Florida Statutes: applicable rules of'
the Department of' Fillancial Scl-%Iccs: acid Chapters 10.550 (local ,o%erIjjjIeIjta1 entities) or 10.o5,0 (nonprofit and for-
profit Organizations). Rules of' the Auditor General. EXHIBIT I to this atn-cenient indicates state financial assistance
awarded thrOLI(_111 the Alliance for Inc, by this agreement, In determining the state financial assistance expended in
its fiscal year, the provider shall consider all sources of state financial assistance, IIICILIdulg State financial assistance
received from the z",111ance t*(-)r Agolnu, Inc., other state agencies, and other nonstate entities. State financial assistance does
not include federal direct or pass-through awards and resources received by a nonstate entity for federal prograrn matching
requirements.
In connection with the audit requirements addressed in Part 11, paragraph I, the provider shall ensure that the audit
complies with the requirements of Section 215.97(8), Florida Statutes. This includes submission ot'a financial reporting,
package as defined by Section 215,97(2), Florida Statutes, and Chapter 10.550 (local governmental entities) or 10.650
(nonprofit and fur-profit organizations), Rules of the Auditor General.
If the provider expends less than S500,000 in state financial assistance in its fiscal year (for fiscal years ending September
30, 2004 or thereafter). an audit conducted in accordance with the provisions of Section 215.97, Florida Statutes, is not
required. In the event that the provider expends less than S500,000 in state financial assistance in its fiscal year and elects
to have an audit conducted in accordance with the provisions of Section 215.97, Florida Statutes, the cost of the audit
Must be paid from the nonstate entity's resources (i.e., the cost of such an audit must be paid from the provider resources
obtained from other than State entities).
An audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal year.
Z_
Compliance findings related to agreements with the Alliance for Aging, Inc. shall be based on the agreement's
Z,
requirements, including any applicable rules, regulations, or statutes. The financial statements shall disclose whether or
not the matching requirement was met for each applicable agreement. All questioned costs and liabilities due to the
Alliance for Aging, Inc. shall be fully disclosed in the audit report with reference to the Alliance for Aging, Inc.
aL,reernent involved. If not otherwise disclosed as required by Rule 691-5,003, Fla. Admin. Code, the schedule of
expenditures of state financial assistance shall identify expenditures by agreement number for each agreement with the
Alliance for Aging, Inc. in etTect during the audit period. Financial reporting packages required under this part must be
submitted within 45 days after delivery ot'the audit report, but no later than 12 months after the provider's fiscal year end
t*or local governmental entities, Non-profit or for-profit organizations are required to be submitted within 45 days after
delivery of the audit report, but no later than 9 months after the provider's fiscal year end. Notwithstanding the
applicability of this portion. the Alliance and the Department of Elder Affairs retain all right and obligation to monitor and
oversee the perforinance of this agreement as outlined throlU,1110LIt this document and pursuant to law.
PART III: RI POR,r SUBMISSION
Copies of reporting packages 1'(.)r audits conducted in accordance with ()%,IB Circular ,-\-I 33, as revised. and required by
PART I of*this agreement shall be submitted. when required by Section .320 (4 0%MB Circular A-I 33. as revised, by or
on behalf of,the proN ider directly to each ot'the t'ollo%viml:
[lie Alliance tar Aging. Inc. at each ot'the f`O1lokvin_,_, addresses:
Alliance for A-in-, Inc.
I
.kttn: Fiscal :Manager
760 NW 107" Ave. Suite 214
Miarni, Fl.. 33172-3155
1"he Federal Audit (1c,,iriii,_,hotIse designated In W013 CirCLII.ir A-13 1. as revised (tile immher of' copies required hN
Contract Number Kll- 1472
Sections 320 (d)(I ) and (2). (-)'\113 Circular A-1 33. as revised. ShoUld be Submitted to the. I�CdCrl I Audit 0 cai-III Ldlou""c). <It
the followim-, address:
Federal Audit Clearinghouse
Bureau of the Census
1201 Fast 1()Ih Street
Jeffersonville, IN 47132
Other- federal agencies and pass-through entities in accordance with Sections .320 (e) and (t), 0\113 Circular A-133, as
revised.
Pursuant to Sections .320(t), OMB Circular A-133, as revised, the provider shall submit a copy of the reporting package
described in Section .320(c), OM13 Circular A-133, as revised, and any management letter issued by the auditor, to the
Alliance for A(,irio, Inc. at each of the followim, addresses:
Alliance for Aging, Inc
Attn: Fiscal N, ,Ianager
760 NW I07'hAve. Suite 214
Miami, FL.33172-31550
Additionally, copies of financial reporting packages required by Part 11 of this agreement shall be submitted by or oil
behalf of the provider�directl to each of the following:
The Alliance for Aging, ]lie. at each of the following addresses:
Alliance for Aging, Inc
Attn: Fiscal Manager
760 NW 107'h Ave. Suite 214
Miami, FL. 33172-3155
The Auditor General's Office at the following address:
State of Florida Auditor General
Claude Pepper Building, Room 574
111 West Madison Street
Tallahassee, Florida 32399-1450
Any reports, management letter, or other infonnation required to be submitted to the Alliance for Aging, Inc. Pursuant to
this agreement shall be submitted timely in accordance with OMB Circular A-133, Florida Statutes. and Chapters 10.550
(local' goverrimcrital entities) or 10.650 (nonprofit and for-profit organizations). Rules of the Auditor General, as
applicable.
Providers, "'lien submitting financial reporting packages to the Alliance for Aging. file. for audits done in accordance with
entities) or 10,650 (nonprofit and for-profit organizations),
Circular A-1 13 or Chapters lo.5'50 (local governmental
Rules of the Auditor General, should, indicate the (late that the reporting package was delivered to the provider in
cOrrCS'poriderice accompativim-) the reporting package.
PART IV: RECORD RETEXrION
I he provider Shall retain sufficient records deniouStr"ItIM-1 its compliance with the terms of this agrccmciit l'or a period of
Si x ears t'rom the date the audit report IS I SSUed, and slial 1 alien( the AI I I'mcc for ,\gitig, Inc. or its desi�'IICC. the ol-
Auditor General aCCCSS to SLICh records Upon I-CCILICSt. I Ile provider shall ensure ill,'It audit working-, papers are 111,1de
a\ailallle to the Alliance for file., or its desiunce, the Department or its designee, 0:0. or ALIdItOrGelIffal upon
re(juest 601- a period of'sip, veirs from the (late the audit report is Issued. unless extended III writim-, by the Alliance for
file,.
Contract Number K I 1- 147')
ATTAc"IFNIENT III
EXHIBIT — 1
I FDIRAL RES(.)t. RCLS -1\w \R I)FF)To -T[I E SL FIR NT M RY'A\F F() I I I IS \(jki I F%I I AT(-O\S IS T OF FILL FOLL(M 1\G
PROGRAMiri-LE FUNDING SOURCE CF D A kNIOUNT
..........--------
TOTAL FEDERAL AWARD
COMPLIANCE REQUIREMENTS APPLICABLE TO T11E FEDERAL RESOURCES AWARDED
PURSUANT TO TtIIS AGREEMENT ARE AS FOLLOWS:
2. STATE RESOURCES AWARDED To ,r1lE RECIPIENT PURSUANT TO,I"lItS AGREEMENT CONSIST
OFTIlE FOLLOWING:
INIATcIIING RESOURCES FOR FEDERAL PROGRAMS
�ROGRANfTtfff FUNDING SOURCE CFDA VNIOUNT
----------------
TOTAL STATE AWARD SO
ST%,TE FINANCIAL ,,kSSISTANCE SUBJECT TO See. 215.97, F.S.
CSF k �VNIOUNT i
PROGRANITITLE FUNDING SOURCE
cominunity Care for the Elderly Program General 1Zevenue 6'010 4, S12.694
---—-------
I'OTAL AWARD S 12,694
---------- -------------------------------- ---------- -------11111.--—
COMPLIANCE lZt-,QUIRE.NIEN'I'S .kPPI,I(",kBt,E '1'0 STAT RESOUR(-J-1S .kW,klZDFD PURSUANT "TO
'I'll ISAGIZEEMENTAIMAS FOLLMNS:
(._'ontract Numba K,1 1- 1472
ATTA('11NIENT III
EX11mur-2
PART 1: AUDIT RELATIONSHIP DETERMINATION
Providers who receive state or fecte.ral resources may or may not be subject to the audit requirements of OMB Circular A-133, as,
re%ised. and or Section 21 5.97 I la. SLO. PT-0%iders who are determined to be recipients or subrecipients of federal mards and.or state
financial assistance may be sub'ject to the audit requirements it the audit threshold requirements set forth in Part I and.or Part If of
Fxhibit I are met, Providers who have been determined to be vendors are not SUb'jeCt to the audit requirements ot'01MB Circular A-
133, as re\ised, and or Section 215.97.
i.9". Fla. Stat. Reoardless of Miether the audit requirements are met. providers %kho have been
determined to be recipients or subrecipientS of federal awards and,or state financial assistance. must comply with applicable
programmatic and fiscal compliance requirements.
In accordance with Sec. 210 of ONIB Circular A-133 arid or Rule 69 1-5.006, FAC, provider has been determined to be:
Vendor or exempt entity and not subject to ONIB Circular A-133 and,or Section 2 15,97, F.S.
X Recipient,subrecipient subject to ONIB Circular A-133 arid,or Section 2 15,97, F.S.
NOTE: If a provider is cleteminied to be a recipient subrecipient of federal and or state financial assistance and has been approved by
the Department to subcontract,they Must COMPIV With Section 21597(7), F.S., and Rule 691-.006(2). FAC [state financial assistance]
and Section .400 ONIB Circular A-133 [federal awards].
PART II: FISCAL COMPLIANCE REQUIREMENTS
FEDERAL AWARDS OR STATE MATCHING FUNDS ON FEDERAL AWARDS. Providers who receive federal awards or
state matching funds on federal awards and who are determined to be a SUbrecipient, must comply with the following fiscal laws, ales
and regulations:
sTAT ES, LOCAL GOVERNMENTS AND INDIAN 'TRIBES MUST
STFOLLOW:
2 CFR Part 225 Cost Principles for State, Local and Indian Tribal Governments(Formerly OMB Circular A-87)*
ONIB Circular A-102 -- Administrative Requirements
0NIB Circular A-133 -Audit Requirements
Rcference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
NON-PROFIT ORGANIZATIONS MUST FOLLOW:
2 CFR Part 230 Cost Principles for Non-Profit Organization,,;(Formerly OMB Circular A-122---Cost Principles)*
2 CFR Part 215 Administrative Requirements(Formerly ONIB Circular A-110-- Administrative Requirements)
Requirements)
ONIB Circular A-133--Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
EDUCATIONAL. I.NsTrruriom (EVEN IF A PART OF A STATE OR LOCAL GOVERNMENT) VIusT
FOLLOW:
CFR Part 220 Cost Principles for Educational Institutions ONIB (Formerly Circular A-2 I Cost Principles)*
CFR Part 215 Administrative Requirements(Formerly ONIB Circular A-I 10 Administrative Requirements)
0%IB Circular A-133 Audit Requirements
Rcfc.rence Guide lor State Expenditures
(Aher fiscal requirements set forth in program laws, rules and regulations
'Some tederal programs may be exempted from compliance with the Cost Principles Circulars as noted in the OMB Circular
\-133 Compliance Supplement, Appendix 1.
STATE FINANCIAL ASSISTANCE. Providers who receive ;tote financial assistance and %%ho are determined to lie a
nitlst c0nllflv %pIth the follo%vinu fiscal rules and
Chapter(,'d- Ha. Admin. Code
`Mate Projects Compliance Supplement
Retcrence (Inide fir State f-xperiditures
)tlicr fiscal requirements set fOrtli in program ld\kS. rules and rcuulatlk)TIS
Contract NunobcrK8- !472
ATTA C0M E NT IV
CERTIFKC,krIONfkE(:ARDING DATA WTEGR0[YCOMPLIANCE FOR AGREENILNTS, GRANTS,
LOANS AND COOPERATIVE A(;REEMF.Nl[S
Thuondersi—ined, an authorized rcprcxenk8iveufihe Contractor named in the contract or agreement k` v.hich this 6onn is
,in all,
chmcnt, hcreby certifies that:
(|) The Contractor and any subcootructors of services under this contract have financial management systcms capable of
providing certain infbnno1ion, including: (l) accurate, Current, and complete disclosure of the financial osu|$ o[cuuh
grant-funded p ject or program in accordance with the prescribed reporting requirements-, (2) the source and
application of funds for all agreement supported activities, and (3) the comparison of outlays with budgeted amounts
for each uxan1. The inability toprocess information in accordance with these requirements could result in a return *f
grant funds that have not been accounted for properly.
(2) Management |nfbmnudon 9�m�� ns used v the Cn ,uc�n suhcn �,ac(om , or a � outside entity oil which the
Contractor is dependent for data that ie to be reported,transmitted or calculated, have been assessed and verified to be
capable of processing data accurately, including year-date dependent data. For those systems identified to be non-
compliant, con/rucnnr(e) ni|| take immediate action to assure data integrity.
(3) |f this contract includes the provision ofhardware, aobwunr, Unn*unc, microcode or imbedded chip technology, the
undersigned warrants that these products are capable of processing year-date dependent data accurately. All versions
of these products offered by the Contractor (n:pncyeuUc6 by the undersigned) and Purchased by the State will be
*mriU�d fbruouuracy and integrity of data prior(otransfer.
In the event of any decrease in functionality related to bmc and date rc|u1cd codes and internal subroutines that
impede the hundvvuvo or software programs from operating properly, the Contractor agrees to immediately make
required corrections to restore hardware and software programs to the smme }mvc| of functionality as warranted herein,
at no charge to the State. and without interruption to the ongoing business of the state, time being ofthe essence.
(4) The Contractor and any subcontractor(s) of services Linder this contract warrant their policies and procedures include a
disaster plan to provide for service delivery to continue in case of ail emergency including emergencies arising from
data integrity compliance issues.
'rhe Contractor shall require that the language of this certification be iucluded in all SUbagreernents. SLIborants.
and other agreements and that all subcontractors shall certify compliance accordingly.
This certification is u mu\crio| representation ofh/ct upon vvbicb reliance was placed when this transaction wus made or
entered into. Submission of this certification is u prerequisite for making or entering into this transaction imposed by
O}10 [irou|urs /l-|O2 and 2CFk Part 2|5 ([bnncr|y0NIB Circular/\-l \O).
Name &t'ontr4ctor
ROMAN
ESI
Mmco|'/\uUhorircd Si--uer
.xvn*umn/2ow�
S7 / /
Contract NunnbcrKi{- |472
ATTA( 0NIENTN/
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELKKABlLlTY AND
VOL 0NTARY EXCLUSION FOR LOWER TIER COVEREDTRANSAcT{WNS
( | } Thc prospective contractor certifies. b, signing this certi6cahon, neither it nor its principals is presently
debarred. Suspended. proposed for debarment, declared in6igiNe, orvo|un\ah|y csc|uduJ hnm participation in
this transaction bvany federa| department cxug
ency.
(2) VVhevu thc prospecti tractor is unable to certifN' to any of the sN(erncnts in this certification. such
pros, Weti.,vP li,a'�icipq*shall qttach fit explanation to this certification.
Signature Date
_ROWAN GASTES|-[0UNTY ADM|N|STRA0R____ _MON ROE COUNTY BOCC
Title Agency/Organization
(Certification signature should bc same i Instructions for Certification
|. The tcono "covered transaction," "debarred," "suspended," "ineligible." "lower tier covered <nunudChon,^'
"per000,'' "primaryu"vered {runmuoton," and "vo)un1oh|ycxu|udcd," umuscdhcrcin, huvethemcunin@smctout
in the sections ufrm|ca implementing Executive Order \2549. (2CFK |80.j-|8O.|02O, ap Supplemented by2
[[R376.l0-37b.995). You may contact the Contract Manager for assistance in obtaining a copy ofthose
regulations.
2. This certification is u material representation of facts upon which reliance was placed when the parties entered
into this transaction. If it is later determined that the Contractor knowingly rendered an erroneous certification.
in addition to other rorncdioa available to the federal government, \hc Department may Pursue available
remedies, including suspension and/or debarment,
3. The Contractor will provide immediate written notice to the Contract Manager if at any time the Contractor
!earns that its ccrtiKcm1ion was erroneous when submitted or has become erroneous by reason of changed
cinzums(onces. Tile Contractor may decide the mu/hmd and frequency by which i1 determines tile eligibility of'
its principals, Each participant to o lower der covered transaction may. but is not required to, check the
Excluded Parties List System (EPLS).
4. The Contractor will include "Certification Regarding Debarment, Suspension. Ineligibility in(] Voluntary
Exclusion - LnocrTier Covered Transaction- in all its lower tier covered transactions and in all solicitations
hzr |oxer tier covered |n/osocdony.
5. The Contractor agrees that it shall not knuv/iog|y enter into any lower h v�rcovcrcdtrunauctioni|haperoon
wh* is debarred, suspended, determined inc|iLiNcorvo|ontori|y excluded from purticipadon, un|cysothcrwiye
authorized bv the fcdum| gorcrnmcnL
6. If the Contractor kowwinlg|y enters into u lower tier covered transaction `viU' u person oho is suspundcd.
Jchuncd. inc|i.gih|c. or \o|untoh}', excluded from puniuipuduo in this transaction. in addition to other remedies
uvai|uh|e to the federal govcrnmcnt. the Department moy pumuo uvai|ab|c remedies. inc|odinl s(,IspVnsiou.
uxd/orJcbunneor�
71 [hc Contractor mu\ reh upon a certification o[u prospective participant in a |oxcr tier corcrcd transaction that
it is not debarred. soopcnde6. Ineligible, orrn|untarIhexcluded kom /hcu*vcrcd tmusucdmn. on|Css it knows
that tile ceni6cu loll 'IS cnvncmos,
.xcv`o/*u_)ix'x'
��
Contract Number KH- 1472
ATTACIMENT V1
.kSSt,"R,k.NCES—NON-(-ONS-I'IZUC'I'ION PROGRAMS
I'Ll 11C reporting hurden for this collection of Information is estimated to avera,-,e 43 Minutes per rc,,ponsc, including time tar
review III,-, instructions, earching, existing data sources. gathering and maintainin- the data needed and completing, and revicwn tile
collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information.
Including suggestions for reducing this burden, to the Office of Management and BLId(-ICt. Paperwork. Reduction Project (0348-041 0 ).
t -6c Wa,"hill- oil, 503.
PLEASE DO NOT-RETURN N'Ot''R COMPLETED FORM 'CO THE OFFICE OF MANAGEMENT AND BUDGET, SEND
IT TO THE ADDIZESS PROVIDED BY THE SPONSORING AGENCY'.
Note: Certain of these assurances may not be applicable to%,our project or program. If you have questions please contact the
awarding agency. Further,certain federal awarding agencies may require applicants to certify to additional assurances.
If such is the case,you will be notified.
1. Ulas the le-al authority to apply for federal assistance, and the Institutional, managerial and financial capability (includin); funds
sufficient to pay the non-federal share ofproject cost) to ensure proper planning, management, and completion of the project
described in this,application.
2. Will (,i%e the awarding agency, the Comptroller General of the United States, and if appropriate, the State, through any authorized
representative, access to and the right to examine all records, books, papers, or documents related to the award; and will establish
a proper accounting system in accordance with generally accepted accounting standards or agency directives.
3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the
appearance of personal or organizational conflict of interest, or personal gain.
4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency.
5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. 4728-4763) relating to prescribed standards for
merit systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPM's Standards for a
Merit System of Personnel Administration(5 C.F.R. 900, Subpart F),
6. Will comply with all federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil
Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the
ducation. Amendments of 1972, as amended (N U.S.C. 168 1-1693, and 1685-1686), which prohibits discrimination on the
basis of sex, (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. 794), which prohibits discrimination on
the basis of handicaps; (d) the Age Disc rinifination Act of 1975, as amended (42 U.S.C, 6101-6107), which prohibits
discrimination on the basis of age: (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 921-2155), its amended, relatint-, to
nondiscrimination on the basis of drug abuse: (t) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and
Rehabilitation Act of 1970 (PJ_ 91-616), as amended. relating to nondiscrimination on the basis of alcohol abuse or alcoholism;
(g) 5213 and 5217 of the Public Health Service Act of 1912 (42 U.S.C. 290 dd-3 and 290 ee 3). as amended, relatiniz, to
c0midentialitv of alcohol and drug abuse patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. 3601 et
seq.), as amended. relating to nondiscrimination in the sale, rental or financing of housing. (i) any other nondiscrimination
provisions in the specific statute(s) under%-,,,Inch application for federal assistance is being made; and (j) the requirements of any
other nondiscrimination statute(s) which may apply to the application.
-itles 11 and III of the uniform Relocation Assistance and Real
dy complied. with the requirements of''I
Will comply. or has already
Property Acquisition Policies Act of 107() (1) J_ 9 1-640) which provide for fair and equitable treatirient of persons displaced or
hose property is acquired as a result of federal or federally assisted programs. f'licse requirements apply to all interests in real
property ,icquired for project purposes re<.,ardlcss of federal participation in purchases.
S. will comply. as applicable. with the provisions of the Klatch Act (5 U S 1501-1508 and 7124--328). ".kIllch limit the
poohtical ,icticities o�ferttployc:e; whose 17rincipal employment activities are !'trnded in whole or in part with federal funds.
Q Al"ill comply, as _ with the pro%isions, of the I)aN is-Bacon :let (40 t C. 276a to 270a-7), the opeland Act (40
2-fic and Is U ').C. 874) and the Contract fr ork Hours ind Safet% Standards Act (40 1 S,C.
lahor standards for fedcrally assisted construction sul%igreenicnts.
I if applicable, %p ith flood insurance purchase requirement,; ot'Section I 02(a) of the 1,lood Di,,aster Protection Act of
(.on1rurt Number K8- l472
1973 (P1. 93-234) which requires recipients in u special flood hazard area to participate in the pm,,rum and to purchase flood
inmmncci the(u|a| Cost o(inmm6|c construction und acquisition is S|O.0O0ormore.
) | Will comp|y vhh environmental ymndunJs which moy be prescribed pursuant to the foUowino: (u) institution ufcnvimomunn|
qua|it} contro| measures under the National Enviroxmcnm| Policy Act of |06Y (PL- v)'|90) and EzccubvcVrdo (EU) 11514:
(b) nmi6m4ion ofvin|utin� facilities pursuant to E0 11738: (c) pro�ctinn pursuantofvc \ands toEO 11440� (d) um|uuioo of
flood huauds in Ooodp|ains in accordance with EO 11988: (c) assurance of project consigcnc} �ith the approved State
manu�cmrntpmgram developed under the Coustu| Zone K1unag,mcnt Act of |u72 (|6U�SL \�5| 4scqJ� (hconhonnh} of
6edcm| actions w ony ,o 5� e <UcorAih Implementation plans Under Section |76(c) of the OearAir Act of 14��, as umcndcd (4-1
U.S.C. 7401 ctscq protection of underground sources o/drinkinI water under the Safe Drink in Water ,Act n( }474. us
amended. (Pl. A3'�23)� and (h) protection ofcndun-yercd species under the Endunl-yeod Species Act of |97lusumrndcd, (P.L
w3-205)�
11 Will comply with the Wild and Scenic Rivers Act of 1968 (16 B.S.C. 1721 «xseq] related to protecting components or
potential components of national wild and Scenic rivers system.
|I Will assist the awarding inasuurin� compliance with Section 186of the National Historic Preservation Act of |466, as
amended (|6O.S.C� 470), EQ 11593 (identification and protection of historic properties), and the Archaeological and Historic
Preservation Act oflg74 (|6D.S�C, 469u-I ctn:ql
14. Will comply with P.L. 43-34* regarding the protection of' human subjects involved in nocaoh, development. and related
activities supported 6y this award mfassistance.
15, Will comply with the Laboratory Animal Welfare Act of |g66 (P.L8A-544. 00 amended, 7USI. 2131 mtscq.) penuinin�tu
the care, handling, and treatment of warm blooded animals held for research, teaching. or other activities supported by this award
of assistance.
|b. Will comply with the Lead-Based Paint Poisoning Prevention Act (42 U.S.C. 4801 ci seq.), which prohibits the use nf lead-
based poiocincunytructionorrahu6ilixaionofnaidcnucgzuc|mzw.
17, Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act Amendments of
1996 and OMB Circular No. A-133, Audits olStates, Local Governments, and Non-Profit Organizations.
l#. Will comply with all applicable requirements ufall other federal |ano. cuccmivc *ndors, regulations and policies governing this
program.
ROMAN GASTFSI COUNTY ADMINISTRATOR
Monroe County Board of Commissioners, Social Services/I n-Home
]�
Contract NLIIIII-)Cl- KI 1- 147"
ATTACHNIENT VII
HOME CARE FOR THE ELDERLY PROGRAM
BL;D(,',E'F SUNINIARY
'rhe Alliance shall inake payment to the provider for provision cif sere ices up to a maximurn number of units of service
and at the rates) stated helokV:
Service Nlaximu
Nlaximuni7l
Service to be Provided Unit Units of
Dollars
Rate Service
Case Management $50.48 251 $12,694
i L Total S12,
16
Contract NUmhcr KC 1- 1472
ATTA C',I I N I E N'r N,,I I I
HOME CARE FOR THE ELDERLY
INVOICE REPORT SCHEDULE
Report Number Based On Submit to State on this Date
I July Advance* July 1
2 ALIOUSt Advance* July 1
3 July Expenditure Report August 25
4 August Expenditure Report September 25
5 September Expenditure Report October 25
6 October Expenditure Report November 25
7 November Expenditure Report December 25
8 December Expenditure Report January 25
9 January Expenditure Report February 25
10 February Expenditure Report March 25
11 March Expenditure Report April 25
12 April Expenditure Report May 25
13 May Expenditure Report June 25
14 June Expenditure Report July 25
15 Final Expenditure August 15
16 Closeout Report August 31
Legend: Advance based on projected cash need.
,7
Contract N L111-11-11101- K I 1- 1472
,vi*,r,,k(IiNIEN'I' IX
REQUEST FOR PAYMENT
HOME CARE FOR THE ELDERLY
RECIP,Ft,JT NAl`,'E ADDRESS PH(JNEt aril FFI,,.),$ T'wPE OF PAYtOENT T",s Request Penod: Frorn To
Rcgufar Contract Period
Contract 9
Advance ReperI#
PSA 4
CERT(FICATION i hereby cerlrfy to the best of my knowledge that this request or refund conforms with the terms and the purposes of the above contract-
Prepared —------- Date Approved by ...... Date
PART A BUDGET SUMMARY CCE Admin CCE Services TOTAL
1 Approved Contract Amount $ $
2 Previous Funds Received for Contract Period ........... $--
3 Contract Balance $
4 Previous Funds Requested and Not Received for Contract Period
5 CONTRACT BALANCE
PART 6: CONTRACT FUNDS REQUEST
I Anticipated Cash Need(1st-2nd months) $
2,Net Expenditures For Month
tDOEA Form 105C,Part 6,Line 4)
3 TOTAL
PART C NET FUNDS REQUESTED
1 Less Advance Applied $-—----- $
2 TOTAL FUNDS REQUESTED(Part B Line 3,minus Part C Line 1) $
OCEA FORM 106C
S
Contract NLJ111hC1- KI 1- 1472
ATTACHINIENT x
RECEIPT AND EXPENDITURE REPORT
HOME CARE FOR THE ELDERLY
P r,JAME ADDRESS l-I'(DNE 4,1111j FEIED'r
Ad...... C,(.)N I PACT PERIOD
C.)r,41 R A C,T 0
REPORT I
PSA9
n,,e,j arc3 fo,;,,,,posoS Set forth in the contract.
PART BUDGETED INC(DME/ RECEIPTS 1 Af)prc>,,,d 2 Actual Roc opts 3. Total ROCO.PtS 4 Pwcentof
__E 2 Ttr r�Rc;!t+OLt t2—Q�?jft............ARpalvw7_±3..j�jet_
1 $0,00 $0,00 $0 00 nn:v,10'
Income $000 $0,0 $0 0 40 v01
3 Lo,,,,a I CaSh Match $000 $000 $0 0 Ato v Of
4 SUBTOTAL—CASH RECEIPTS
5 Ljwal ln-K.ocl Match
6, TOTAL RECEIPTS $0.00 $0,00 $000 "DIV/W
PART B C=XPENDITURES AI)p,o,(,,-d 2, Expenditures 3, Elpendnures 4 Percent of
Bud(jet For Pit-,Report Year to D�ute Appio,ed Budget
I A ...:ulstlahves $(-)(,)Q $000 $000 oolvlol
2 d Sewage Sub'�o'ltractof(S) $0J)0 $000 90:V/0,
3, Adult
P'Ot"Ctl—�Sef-(,05 $000 $000 $0,00 #0 v 0-
,I TOTAL EXPENDITURES $0.00 $0,00 $0,00 41DIV10!
I
PART C OTHER REVENUE AND EXPENDITURES 11, Interest: III Advance Recouped
I. P,Ocj,a,, Income(PI) I Earned on GR.Advance
I CCE: F11 Collected YT0 $-- L. Return of GR Advance
(InClud(IS fees collected) 3, Other Earned
PART Cl CO-PAYMENTS CURRENT MONTH YEAR-TO-DATE
1. Total of Co-payrnents assessed $...... "— $---------
2. Total of Co-payr,00ts collected .................
(For Tracking P—poses only)
Contract Numlicr KFI- 14
ATTACHMENT A
Department of Elder Affairs Programs & Services Handbook, provided on CD.
Also, available at the Department's Intranet site under, -Publications-.
40
Contract NUmba KIJ- 1472
.-VFTACIVNIENT B
STATF OF FLORIDA I)EP.,kR'FNIE'.\"t' (.)E' EI.I)ER.kFFAIRS
PAR V I: READ H I E AFTACHED I's SFR L CHONS FOR II.1A'SI'R krwE INFORMATION k�[I KJI \N I L L HELP NO[ COMPLETE I"HIS FOR NI.
1, Briefly describe the geographic area served by the program t"acility and the type of service provided: TINe— U*nt Pe- 02�A
ce.l&
2. POPULA VION OF AREA SERVED, Source ofdata:
Fftil i Wwc Black
Other
C)
3. -STAFF 0JRUNTLY EMPLOYED. Effective date:
i ".Female
-1 o1a):-, I hite Black Other
C.>
ac) 0 �6 Q
----------------------
4. CLIENTS CURRENTLY ENROLLED OR REGISTERED. Effective date:
I 'A hite opBlack Other Female n Disabled o 0vei-40
G too
5. ADVISORY OR GOVERNING BOARD, If:APPLICABLE.
TotalWhite 1 3 kic k Hispanic Other Disabled
I
PART II: LSE.kSEP,%R,,kl'E SHEET"OF P,,kPt.'RF'OR,kNN'EXPI,:kN,kl'10,N'SREQL!IRIN(;,NlORESP2%CE.
6. tsati Assurance of Compliance on file with DOEA'? ITN/Aor NO,explain. N/A Nk NO
T Compare the staffcomposition to the population. Is staff representative of the Population?
If N/A or NO, explain. N/A YES NO
El El
8. Compare the client composition to the population. Are race and sex characteristics representative of the
population'? If N1,'A or NO, explain, NiA YES NO
c. Are eligibility requirements for services applied to clients and applicants without rev I regard to race,color,
national origin,sex, age, religion or disability'? If N,'A or NO.explain. N,'A NO
D 0
--------------------
10, Are all benefits. services and facilities available to applicants and participants in an equally effective
manner reuardless of race.sex. color, age national origin,relig,ion or disability'! If N A or NO. explain. N A YES NO
El
—--------------
11, For in-patient services, are room assigurnents made without regard to race. color. national origin
Or disability? If AL
or No . explain." %.. YES NC)
j �n.D%Ai-r L-*— I
T -
---------- ------------------------------------
41 5
Contract Nunibcr KI-1- 147"
1-1, Is the program facility accessible to non English speaking clients'.' If N A or NO, explain. NSA YTS No
L—
El
13. Are employees, applicants and participants informed of their protection against discrimination'? If YES.
how? Verbal E] Written ❑ Poster F If A or No , explain. N A YT'S N
El ❑
14 Give the number and current status of any discrimination complaints regarding services or employment Cited
against the prograirt facility. N A NU.\IBLR
F] C1
15. Is the program,facility physically accessible to mobility, hearing. and sight-impaired individuals? IfNiA or
NO, explain. N/A NT NO
El 0
PART HI:THE FOLLOWING QUESTIONS APPLY TO PROGRAMS AND FACILITIES WITH 15 OR MORE EMPLOYEES.
16, Has a self-evaluation been conducted to identify any barriers to serving disabled individuals, and to make
any necessary, modifications? If NO, explain, NO
F-1
17. Is there an established grievance procedure that incorporates due process in the resolution of complaints? If
NO.explain. ) S NO
IS. Has a person been designated to coordinate Section 504 compliance activities'? If NO,explain. w NO
El
19. Do recruitment and notification materials advise applicants, employees and participants of nondiscrimination
on the basis ot'disability? If NO, explain. NO
19 11
"0. Are auxiliary aids available to assure accessibility of services to hearing and sight-impaired individuals? If
NO,explain. N,-,S NO
PART IV: FOR PROGRAMS 014 FACILITIES WITH 50 OR,MORE EMPLOYEES AND FEDERAL.CONTRACTS OF 550.000.00 ORNIORE.
1. Do you have a written affirmative action plan? If NO. explain. YS NO
------------
ALLIANCE USE ONLY
Re%ie�\ed l3v In Compliance: )TS
ProLrarn Office 'Notice k)f'(-'()rrecti\e Action Sent
r I
Re�,Porise Due
Date ephone 3 71— 636J- ,
42
Contract Number KH- 147?
On Site Desk Rev ie%� Resporise Recei%ed �
RcNi,cd \uuw t'_t)10,Paige 2 o(2
INSTRUCTIONS FOR THE CIVIL RIGHTS COMPLIANCE CHECKLIST
1. Describe the geographic service area such as a district, county, city or other locality. 11'the pro;rare facility
serves a 517eC'Cie target population such as adolescents, describe the target population. Also, define the type Of
service provided.
2. Enter the percent of the population served by race and sex. 'File population served includes persons in the
geographical area for which services are provided such as a city, county or other regional Area. Population
statistics can be obtained from local chambers of commerce, libraries, or any, publication from the 1980 Census
containing Florida population statistics. Include the source of your population statistics. ('Other" races include
Asiall,Pacific Islanders and American Indian/Alaskan Natives.)
3. Filter the total number of hall-tinge staff and their percent by race, sex and disability. Include the effective date
of your summary,
4, Enter the total number of clients who are enrolled, registered or currently served by the program or facility, and
list their percent by mace, sex and disability. Include the date that enrollment was counted.
S. Enter the total number of advisory board members and their percent by race, sex, and disability. If there is no
advisory or governing board, leave this section blank.
6. Each recipient of federal financial assistance must have on file an assurance that the program will be conducted
in compliance with all nondiscriminatory provisions as required in 45 CFR 80. This is usually a standard part
of the contract language for DOER recipients and their sub-grantees, 45 CFR 80.4 (a).
7. Is the race, sex, and national origin of the staff reflective of the general population? For example, if 10% of the
Population is Hispanic, is there a comparable percentage of"Hispanic staff'?
8. Where there is a significant variation between the race, sex or ethnic composition of the clients and their
availability in the population, the prograrrvfacility has the responsibility to determine the reasons for such
variation and take whatever action may be necessary to correct any discrimination. Some legitimate disparities
may exist when programs are sanctioned to serve target populations such as elderly or disabled persons, 45
CFR 80.3 (b) (6).
9. Do eligibility requirements unlawfully exclude persons in protected groups from the provision of services or
employment'? Evidence of seICII may be indicated in staff and client representation (Questions 3 and 4) and also
through on-site record analysis of persons who applied but were denied services or employment, 45 CFR 80.3
(a) and 45 C'FR 80.1 (b)(2).
111. Participants or Clients must be provided services such as medical, nursing and dental hare, laboratory services,
physical and recreational therapies, counseling and social services lvrthout regard to race, `;ex. color, national
orla:�'in, reh(ulon. age or disability. Courtesy titles, appointment scheduling alld aCCuracy of record keepillg InLISt
he applied uniformly and without regal-d to race, .sex, color, national origin, rellL,*on. aagc or disability.
1:11tranccs. %\altlnk MOMS. receptwil areas, restroolils arld other facilities must also be equally available to all
chcrits. 4;5 (_TR ti41 0)1.
.4 3 5 t)
Contract Number KH- 1472
l 1. For in-patient services, residents Inust be asshined to rooms, wards, etc., without re(-,ard to race, color, national
origin or disability. 1lso, residents riulst not be asked whether they are to share accommodations with
persons of a (11f'ferent race, color, national oritzin. or disability, 45 C'I R 80.3 (a).
1� _l lle program,facility and all services must be accessible to participants and applicants, including those persons
who may not speak English, In wgeo2raphic areas where a significant population of non-English speaking
people live, program accessibility may include the employment of bilingual staff. In other areas, it is SuftiCient
to have a policy or plan for service, such as a current list of names and telephone numbers of bilingual
individuals who will assist in the provision of services, 45 CFR S0.3 (a).
13. Proftrams/faacilities must make information regarding the nondiscriminatory provisions of Title VI available to
their participants, beneficiaries or any other interested parties. This should include information on their right to
file a complaint of discrimination with either the Florida Department of Elder:'affairs or the U.S. Department of
TIHS. The information may be supplied verbally or in writing to every individual, or may be supplied through
the use of an equal opportunity policy poster displayed in a public area of the facility, 45 CFR 80.6 (d),
14. Report number of discrimination complaints filed against the prograni/facility. Indicate the basis, e.g., race,
color, creed, sex, age, national origin, disability, retaliation, the issues involved, e.g., services or employment,
placement, termination, etc. Indicate the civil rights law or policy alleged to have been violated along with the
name and address of the local, state or federal agency with whole the complaint has been tiled. Indicate the
current status, e.g., settled, no reasonable cause found, failure to conciliate, failure to cooperate, under review,
etc.
15. The prograin/facility must be physically accessible to disabled individuals. Physical accessibility includes
designated p4arLing areas, curb cuts or level approaches, ramps and adequate widths to entrances. The lobby,
public telephone, restroom facilities, water fountains, information and admissions offices should be accessible.
Door widths and traffic areas of administrative offices, cafeterias, restrooms, recreation areas, counters and
serving lines should be observed for accessibility, Elevators should be observed for door width, and Braille or
raised numbers, Switches and controls for light, heat, ventilation, fire alarms, and other essentials should be
installed at an appropriate height for mobility impaired individuals.
16. Section 504 of the Rehabilitation Act of 1973 requires that a recipient of federal financial assistance conduct a
self-evaluation to identify any accessibility barriers. Self-evaluation is a four step process:
a. With tlae assistance of a disabled individual/organization, evaluate current practices and policies which (to
not comply with Section 504.
b. Modify policies and practices that do not meet Section 504 requirements.
c. 'rake remedial steps to eliminate any discrimination that has been identified.
d. Maintain sclf-evaluation oil file. (This checklist may be used to satisfy this requirement if these four steps
have been followed.), 45 CT='R 54.6
17. Prov,Irams or facilities that employ 15 or more persons must adopt grievance procedures that incorporate
appropriate due process standards and provide for the prompt and equitable resolution of complaints alleging
any action prohibited by Section 504.45 CFR 54.7 (b).
1 S. Pro4grarns or facilities that employ 15 or more persons must designate at least one person to coordinate efforts to
comply ~kith Section 504.45 C:'FR S4.7 (a). _
l >. C'ontinuin(-' ,taps must be tsiken to notify eraiplovees and tlae public of' the program facility's policy of
nolld Ise rilinnatloll oil the basis of disaability. fibs includes recruitincnt material. notices Cot- hearira�-Is,
ncv�spaper :ids, and other appropriate written canainuiiication, 45 ( R S-I.S (a).
44,59
Contract dumber KH- 1472
2o. Programs facilities that employ 15 or more persons must provide appropriate auxiliary aids to persons with
m1paired sciisory, 111,11ILial or speaking skills where necessary, Auxiliary aids may 111CILICIC, but are not limited
to, interpreters for hearing impaired individuals, taped or Braille materials, or any alternative resources that call
he Used to provicle equally effective services, 45 ('FR 84.52 (d).
21. Proi-n-arris facilitics with 50 or more ciriployees and S50,000,00 in federal contracts 111LIst de%elop, implement
and maintain a written affirmative action compliance program in accordance with Executive Order 11246, 41
CFR 60 and Title VI of the('),v il Rights Act of 1964, as amended.
DOFA For III 10 1-B.Ro ised August 2010
4.+ ti9
Contract Number Kll- 1472
ATTACHMENT C
REFERR.kL PROTOCOL MONROE
Issue: Screening, Tr".u-,c. and Referral for activation under the C ni
oinunity("are for the Elderly I loine Care for tile
I
Elderly.
Policv: Referrals will be based on availability ot'Hinds, in accordance �k'lth prioritization requirements.
Purpose: 'To ensure funding is spent expeditiously and consumers are referred into programs for appropriate services.
Procedure for Monroe County:
I. Roles and Responsibilities
A, Alliance for Aging/ Aging and Disability Resource Center
0 Reconciles overall program and Lead Agency specific spending levels on a monthly basis to ensure the
Lead Agency is operating within the funding allocation.
• Reviews the number of cases released for activation based on projected funding available.
• Screens consumers to link with appropriate resources and prioritize for DOER-funded programs and
services.
• Recommends potential cases for activation based upon projected funding available by Lead Agency.
• Selects consumers from the waiting list based on their prioritization score.
• Refers consumers from the waiting list to the Lead Agency in Monroe County for activation, based on
availability of funds.
• Monitors compliance with service standards and outcome measures.
• Reviews care plans and files per the File Review Policies and Procedures.
• Reviews data in CIRTS.
13. Case Management Agency
• Requests and accepts referrals from the Aging and Disability Resource Center, to serve an optimal
caseload and to avoid surpluses or deficits in accordance with the AAA CCE111JCE Surplus/Deficit
Analysis policy.
• Refers inquiries from consumers interested in services to the ADRC for Information and Referral to
community resources. Scrccrung, Triage, and Long-Term Care Options Counseling, as appropriate.
• The functions of Screen'rii-, and Intake Lire outs(,)urcc(,t to the Lead Agency. Screening, and Intake may
also be completed by the ADR.C.
• Completes comprehensive assessments on new consumers and annual reassessment oil existing
C011SUIllers and dc%clol)s care plans and review~ care plans scini-annually.
• ALIthorl/.es service delivery and enters data into IRTS.
• Screens consumers t,(,)r SNINICI-TC cllinbility% Bills in CIRTS as appropriate,
• Monitors care plans in an effort to keep costs down 1111C SLISLIIIIIIII-1 the Individuals III the community.
.40 59
Contract N U I III-)er K f I- 1472
It. %lanauenlent of,the Assessed Prioritized Consumer List (APCI.J.
A. Referrals, to the ADRC arc routed to the Inforinat ion and Referral Specialists or Intake Unit staff depending on the
type of referral. Clients are provided Hitorniatt'011 Oil COMITILLI'litV I'CSOUrCCS and programs available Including private pa"
options. Persons are directed to those resources most capable of meeting the need they have expressed to ADRC staff.
Cases presentirio strong identifiers that indicate the consumer might benefit from publicly funded long term Care services
are screened, entered into CIRTS, triaged and provided options Counseling. in Monroe County, the functions of
Screening and Intake are oUtsourced to the Lead Agency. Screening and Intake inay also be completed by the ADRC.
DOFA prioritization requirements will be adhered to by both entities, as follows:
1. APS High Risk Referrals (See section B) .
2. Imminent Risk cases will be prioritized for activation after APS High Risk Referrals have been served. If budgetary
constraints prevent opening new cases, clients wilt be placed on the APCL. ADRC staff will contact the client on a
monthly basis to determine if there has been a change in the client's situation.
3. All other CARES referrals will be screened and prioritized in accordance with DOEA requirements.
4. Aging Out consumers will be referred by DCF for prioritization and/or activation in the corresponding aged program
managed by the Alliance, as appropriate(See section IV).
5. Consumers applying for the Community Care for the Elderly (CCE) and/or Home Care for the Elderly(110E)
programs will be contacted and screened using the statewide form developed assessment by the Department of Elder
Zn
Affairs for this purpose (Form 701 S). If a consumer is being served through a DOEA-funded agency \vIuch enters their
annual assessment Into CIR,rs, the Priority Score generated by that assessment will determine their ranking on the APCL
6. Consumers referred for inclusion under the Statewide Medicaid Managed Care Long Term Care Prograrn APCL will
be contacted and screened following the same procedure as the one described under Section 5.
7. Individuals who appear as potentially eligible for other types of public assistance will be referred to the Economic Self-
Sufficiency Unit at the Department of Children and Families.
8. All other referrals will be waitlisted and prioritized, during which time other community resources will be researched,
including private pay/fee for services providers. Consumers on the waiting lists will be reassessed according to the 2013
Department of Elder Affairs Pro,-,,rai-ns and Services Handbook, or any revisions made thereafter.
13. 1 11PAA farms will be sent to the consumer as appropriate.
Ill. Opening New Cases
A. CCEJICL, Clients
1. Fhe Fiscal Deparmient will nionitor Lead Agency specific spending le\els oil a monthly hasis to ensure each Lead
\fscrlcv is orcratin(.! within its "pending authority. hi addition, the fiscal department will analyze surplus deficit
projections, and share the Information with the Lead A,-,cnc%, to assist in their detcrinniation of'slot a%all,,ihilitv, Fhe Lead
4 7 59
Contract Number KI-1- 147-1
,-\,.,Cllcv will N(JUCst rC1'Cl-l-a1S LIINCtly I'Forn the. ADRC. Hie Fiscal Department will be notified of tile Mlnibcrof'new cases
bc1mz referred to the Lead Agency f*or activation.
2. L,,'pon receipt of the request for referrals Froin the Lead Agency, the ADRC Intake Unit Super\iSO1- will R111 tile
Prioritized Risk Report to identify the consumers oil the APCL to be opened.
3. In response to the reClUC.St for referrals, the ADRC Intake [..'nit Supervisor will refer wait listed clients to the Lead
Agency for activation, in accordance with prioritization requirements. The Intake Unit will update the wait list enrollment
US11h,4 the appropriate code to terniniate from the APCL. Upon receipt of referral, the Lead Agency will enter the APPL
enrollment, and subsequent enrollments to reflect client status.
4. [Jrpon receipt of list ot'clients released from the waiting list, the Lead Agency will enter the APPI. enrollment, will
ontact clients to offer program enrollment, and will proceed with activation. 'File Lead Agency will enter subsequent
Zn --
enrollments into CIRTS to reflect client status.
5. In accordance with the DOEA Progyrarn clz' Services Handbook, consumers who were screened Using Form 701 S and
received a priority
score or rank of'3, 4 or 5 with a CIRTS Enrollment Screen program status code set to "AIICI.."and subsequently assessed
using 701 B and receive a new priority score or rank- of I or 2 must be returned to the APCL to allow for prioritization,of
other consumers on the APCL with priority score or
ranks of 3, 4 or 5.
The ADRC will oversee the enrollment process to ensure referrals have timely outcomes in CIRTS.
B. Statewide Medicaid Managed Care LongTerm Care Program Clients
1. The Department of Elder Affairs will run the APCL (Assessed Priority Consumer List) report to review clients wait
listed for the SMMCUFCP . DOEA will provide the ADRC with a list of individuals authorized for release from the
APCL.
2. For clients active in CCE or I ICE and authorized for release from the Medicaid Waiver waiting list, the ADRC will be
responsible for the application process. For CCE active clients the ADRC will notify the Lead Agency in order to waive
Zn
the co-pay.
(1'. APS Referrals
1. APS Low and Intermediate Risk referrals will be screened and prioritized by the ADRC for services as per the
DOFN APS Memorandum ot'U'ndcrstandim,,. Low and Intermediate Risk ret'errals are also offered information and
referral to additional community resources, Including private pay as appropriate.
2. APS High Risk Referrals are not waltllsted, Hicy are lninic(flatelv referred for service from DCF in Monroe Garrity
to tile Lead Agency. \RTT referrals will be forwarded directly the Lead Azencv. APS cases are to lie ser%ed 1'or a
maxinium of,31 calendar days. if additional time is jUStifiCd, the case 111,11lauelilent a(-'encV will stalfthe case with the
Alliance to ohlaill the extension lice(ie(l.
-4 S 5
Contract Number K 1-1- 1472
3. Upon receipt of the APS Iligh Risk rdAml the 1-vad agency will coordinate services to begin Wthin the 72 hour
period mandated by suatitc. A comprehensive anessment will be done within 72 hours ofthe retOnS. Services nquired
under the cue plan W mniain in place Or a
inaxinurn of 31 days, unless an extension has been granted,
4. Fhe Ivad Agency will enter ACTV enrollment under their provider number in CIRTS. In addition, service codes will
he emend by service date Or all services provNed. If a service(s) is not prodded as required under the care plan, an
NDP code will need to be entered in CIRTS and the case notes tinder the client file should document the reason Or non-
delivery of such savico s).
IV. Al-ling Out Consurners:
A. All -Aging Out- consumers will be referred by F)CF to the ADRC for enrollment into the corresponding aged
prograrn managed by the Alliance.
11 Consumers active in the CCDPA and HCDA programs that arc turning 60 and are eligible for CCE and/or HCE will be
opened in the corresponding aged prograrn managed by the Alliance if funding is available. If funding is available, these
consumers will be inade active. IT fun-Ing is not available, they will be waitlisted for these programs but will be given
priority for activation once funding is available.
Note: 'these ADRC policies and procedures are subject to change. Any modifications will be done through a
contract amendment.
4q 50
Contract NUMber KH- 1472
ATTACHMENT D
Depat-tinent's Computer Use Policy and its Social Ivledia Policy, provided on CD.
Page 5|
ATTACHMENT
Alliance for Aging. Inc.
Business Associate Agreement
This Business 4 . by the Alliance for Aging, Inc
("Covenm� �ndty") ond (^Bu�i6ess Assooiate^). anot�oppnz�tF|ondo
corporation, '
1.0 Background.
1"I Covered Entity has entered into one or more contracts or agreements with Business Associate
that involves the use ofProtected Health Information (PHI).
12 Covered Entity, recognizes the requirements of the Health Insurance Portability and
Accountability Act of1Q9G (H|PAA) and has indicated its intent to comply in the Counh/s Policies and Procedures.
13 HIPAA regulations establish specific conditions on when and how covered entities may share
information with contractors who perform functions for the Covered Entity.
1.4 H|P/A requires the Covered Entity and the Business Associate to enter into o contract or
agreement containing specific requirements to protect the confidentiality and security of patients' PHI, as set forth
in, but not limited to the Code cfFederal Regulations (C.F.Rj. specifically 46C.F.R. §§ 184.502(e). 164.504(o).
164.308(b). and 1G4.314(s,b)(2O1O) (as may apply) and contained in this agreement.
13 The Health Information Technology for Economic and Clinical Health Act(2OO8). the American
Recovery and Reinvestment Act(20OQ) and Pert | — Improved Privacy Provisions and Security provisions located
at 42 United States Code (U,S.C.) §§ 17931 and 17934 (2010) require business associates of covered entities to
comply with the HIPAA Security Rule, as set forth in, but not limited to 45 C.F.R. §§ 1S43O8. 1S4.310. 1G4312.
and 164.316 (2009) and such sections shall apply to a business associate of a covered entity in the same manner
that such sections apply to the covered entity.
The parties therefore agree asfollows:
2.8 Definitions. For purposes of this agreement, the following definitions apply:
2.1 Access, The ability or the means necessary to read, write, modify, orcommunicate
data/information or otherwise use any system resource.
2.2 Administrative Safeguards. The administrative actions, and policies and procedures, to
manage the ae|edinn, development, imp|ementodon, and maintenance of security measures to protect e|eotnmmo
Protected Health Information (ePHI) and to manage the conduct of the covered entity's workforce in relation to the
protection of that information.
2.3 ARRA. The American Recovery and Reinvestment Act (2009)
2.4 Authentication. The corroboration that a person io the one claimed.
2.5 Availability, The property that data or information is accessible and useable upon demand by an
authorized person.
2.6 Breach. The unauthorized anquieihon, access, use, or disclosure of PHI which compromises the
security or privacy of such information.
2.7 Compromises the Security, Posing a significant risk of financial, reputationei or other harm to
individuals.
2,8 Confidentiality. The property that data or information is not made available or disclosed to
unauthorized persons orprocesses.
Page 52
2,0 Electronic Protected Heath |nfonnatk,n.<ePH|> Health information as specified in 45CFR
§160.103(l)(j) or (1)(ii), limited to the information created or received by Business Associate from or on behalf of
Covered Entity,
210 HITECH, The Health Information Technology for Economic and Clinical Health Act (2009)
2,11 Information System. An interconnected set of information resources under the same direct
management control that shares common functionality. A system normally includes hardware, software,
information, data, applications, communications, and people.
2.12 Integrity. The property that data or information have not been altered or destroyed in an
unauthorized manner,
2.13 Malicious software. Softwarm, for example, a virum, designed to damage or disrupts a system.
2,14 Part |. Port | — Improved Privacy Provisions and Security provisions located ot42 United States
Code (U.S.C.) §§ 17A31 and 17834(201O).
215 Password. Confidential authentication information composed of a string of characters,
2.16 Physical Safeguards. The physical measureo, pu|icieo, and procedures to protect ocovered
entity's electronic information systems and related buildings and equipment, from natural and environmental
hazards, and unauthorized intrusion.
2.17 Privacy Rule. The Standards for Privacy of Individually Identifiable Health Information at 45 CFR
Part 1GO and Part 1G4. subparts A and E.
2.18 Protected Health Information. (PHI) Health information uadefined in45CFR §160.103. limited
to the information created or received by Business Associate from or on behalf ofCovered Entity,
2,19 Required By Law. Has the same meaning as the term "required by law" in 45 CFR § 164103,
2.20 Secretary. The Secretary of the Department of Health and Human Services or his orher
designee.
221 Security incident. The attempted or successful unauthorized access, use, disclosure,
modification, or destruction of information or interference with system operations in an information system.
2,22 Security or Security measures. All of the adminim1rahvm, phyeioa|, and technical safeguards in
mn information system,
2.23 Security Rule, The Security Standards for the protection pf Electronic Protected Health
Information at45 CFR part 164, subpartC. and amendments thereto,
224 Technical Safeguards. The technology and the policy and procedures for its use that protect
electronic protected health information and control access to it.
225 Unsecured PHI. Protected health information that is not secured through the use of technology or
methodology specified by the Secretary in guidance issued undmr42 U.S.C. section 17932(h)(2)�
2.26 All other terms used, but not otherwise defined, in this Agreement shall have the same meaning
us those terms in the Privacy Rule.
3O Obligations and Activities of Business Associate.
31 Business Associate agrees to not use or disclose PHI other than as permitted or required by this
agreement oros Required byLaw.
��
Page �3
32 Business Associate agrees to:
(a) Implement policies and procedures to prevent, detect, contain and correct Security
violations in accordance with 45CFRQ 184306;
(b) Prevent use or disclosure of the PHI other than as provided for by this Agreement or as
required by law;
(o) Reasonably and appropriately protect the confidentiality, integhty, and availability ofthe
ePH| that the Business Associate omeekys, receives, maintains, or transmits on behalf ofthe Covered Entity; and
(d) Comply with the Security Rule requirements including the Administrative Safeguordo,
Physical Safeguards, Technical Safeguards, and policies and procedures and documentation requirements set
forth in45CFR §§ 164,308. 164310. 164.312. and 164,316,
3.3 Business Associate agrees to mitigate, to the extent practicable, any harmful effect that is known
to Business Associate of use or disclosure of PHI by Business Associate in violation of the requirements of this
Agreement.
34 Business Associate agrees to promptly report to Covered Entity any use or disclosure of the PHI
not provided for by this Agreement of which it becomes aware. This includes any requests for inspection, copying
or amendment of such information and including any security incident involving PHI.
3.5 Business Associate agrees to notify Covered Entity without unreasonable delay of any security
breach pertaining to:
(a) Identification of any individual whose unsecured PHI has been, or is reasonably believed
by the Business Associate tohave been, anceosed, aoquired, or disclosed during such security breach; and
(b) All information required for the Notice to the Secretary of HHS of Breach of Unsecured
Protected Health Information.
3.8 Business Associate agrees to ensure that any agent, including a subnontroctor, to whom it
provides PHI received from, or created or received by Business Associate on behalf of Covered Entity, agrees to
the same restrictions and conditions that apply through this Agreement to Business Associate with respect to such
information.
31 |f Business Associate has PHI ina Designated Record Set:
(a) Business Associate agrees to provide access, at the request of Covered Entity during
regular business hours, to PHI in a Designated Record Set, to Covered Entity or, as directed by Covered Entity, to
an individual in order tVmeet the requirements under 45CFR §164.G24; and
(b) Business Associate agrees to make any amendment(s) toPHI in Designated Record
Set that the Covered Entity directs ur agrees to pursuant Vy45CFR § 1G4.526at the request of Covered Entity or
an Individual within 10 business days o/receiving the request.
18 Business Associate agrees to make internal praoboes, buoks, and records, including policies and
procedures and PHI, relating to the use and disclosure of PHI received from, or created or received by Business
Associate on behalf ofCovered En|ity, available to the Covered Entity or to the Secretary upon request of either
for purposes of determining Covered Entity's compliance with the Privacy Rule,
3.9 Business Associate agrees to document such disclosures of PHI and information related to such
disclosures as would be required for Covered Entity to respond to a request by an individual for an accounting of
disclosures ufPHI in accordance with 45CFRQ 164 628.
3 10 Business Associate agrees to provide ioCovered Entity or an individua|, upon request,
information collected to permit Covered Entity to respond to a request by an Individual for an accounting of
disclosures o/ PHI in accordance with 45 CFR § 164.528 and ARRA § 13404
��
Page 54
311 Business Associate specifically agrees to use security measures that reasonably and
appropriately protect the oonfidentio|ity, inteQrih/, and availability of PHI in electronic or any other form, that it
crenUsa, receives, maintains, or transmits on behalf ofthe Covered Entity.
312 Business Associate agrees to implement security measures to secure passwords used hzaccess
ePH| that it acoesaes, maintuino, or transmits as part ofthis Agreement from malicious software and other man-
made and natural vulnerabilities to assure the availability, integrity, and confidentiality mfsuch information,
313 Business Associate agrees to implement security measures to safeguard ePHI that it accesses,
maintains, or transmits as part of this agreement from malicious software and other man-made and natural
vulnerabilities to assure the availability, integhty, and confidentiality ofsuch information.
314 Business Associate agrees to comply with:
(a) ARRA§ 13404 (Application of Knowledge Elements Associated with Contnads)�
(b) ANRA§ 13405 (Restrictions on Certain Disclosures and Sales ofHealth Information); and
(c) ARRA§ 13406 (Conditions on Certain Contacts as Part of Health Care Dperations).
4.0 Permitted Uses and Disclosures by Business Associate. Except am otherwise limited inthis
Agreement or any related agreement, Business Associate may use or disclose PHI to perform functions, activities,
or services for, or on behalf of, Covered Entity as specified in any and all contracts with Covered Entity provided
that such use or disclosure would not violate the Privacy Rule if done by Covered Entity orthe minimum
necessary policies and procedures of the Covered Entity.
5.0 Specific Use and Disclosure Provisions.
5.1 Except as otherwise limited in this agreement or any related agreement, Business Associate may
use PHI for the proper management and administration of the Business Associate or to carry out the legal
responsibilities uf the Business Associate.
52 Except as otherwise limited in this agreement or any related agreement, Business Associate may
disclose PHI for the proper management and administration of the Business Amsooiat*, provided that disclosures
are Required By Law, or Business Associate obtains reasonable assurances from the person to whom the
information is disclosed that it will remain confidential and used or further disclosed only as Required By Law or
for the purpose for which it was disclosed to the person, and the person notifies the Business Associate of any
instances of which it is aware in which the confidentiality of the information has been breached.
5.3 Business Associate may use PHI to provide data aggregation services toCovered Entity as
permitted by45CFR§1G4.SO4(m)(2)(i)(B). only when specifically authorized by Covered Entity.
5.4 Business Associate may use PHI to report violations of law to appropriate Federal and State
authorities, consistent with 46CFR §164.602(j)(1).
O�U Obligations of Covered Entity.
6,1 Covered Entity shall notify Business Associate of any limitation(s) in its notice of privacy practices
of Covered Entity in accordance with 45 CFR § 164.520, to the extent that such limitation may affect Business
AoonoioLe'a use or disclosure of PHI, by providing a copy o/the most current Notice of Privacy Practices (NPP) to
Business Associate asAttachment X| tn this Agreement, Future Notices and/or modifications tn the NPP shall be
posted onCovered Entity's websiteat www.alhanceforqgin org.
62 Covered Entity shall notify Business Associate of any restriction to the use or disclosure of PHI
,hat Covered Entity has agreed to in accordance with 45 CFR § 1S4 522. to the extent that such restriction may
affect Business Associate's use ur disclosure ofPHI.
70 Permissible Requests by Covered Entity. Except for data aggregation or management and
administrative activities of Business Associate. Covered Entity shall not request Business Associate to use or
disclose PHI in any manner that vvnu|d not be permissible under the Privacy Rule if done by Covered Entity,
54
PGge55
80 Effective Date and Termination.
8,1 The Parties hereby agree that this agreement amends, restates and replaces any other Business
Associate Agreement currently in effect between Covered Entity and Business Associate and that the provisions
of this agreement shall be effective aafollows:
(a) These Business Associate Agreement provisions, with the exception of the electronic
security provisions and the provisions mandated byARRA. H|TECH and Part | shall be effective upon the later uf
April 14. 2003. or the effective date of the earliest contract entered into between Business Associate and Covered
Entity that involves the use ufPHI:
(b) The electronic security provisions hereof shall be effective the later of April 21. 2005 or
the effective date of the earliest contract entered into between Business Associate and Covered Entity that
involves the use ufPHI; and
(c) Provisions hereof mandated byARRA. H|TECH and/or Port | shall be effective the later of
February 17, 2010 or the effective date of the earliest contract entered into between covered entity and business
associate that involves the use of PHI orePH|.
8.2 Termination for Cause, Upon Covered Entity's knowledge ofu material breach byBusiness
Asamoiate, Covered Entity shall either:
(a) Provide an opportunity for Business Associate to cure the breach or end the violation and
terminate this agreement if Business Associate does not cure the breach or end the violation within the time
specified by Covered Entity;
(b) Immediately terminate this agreement if Business Associate has breached o material term
of this Agreement and cure is not possible; or
(o) If neither termination nor cure is feasible, Covered Entity shall report the violation to the
Secretary.
8.3 Effect of Termination. Except as provided in subparagraph (b) of this section, upon termination
of this mqreement, for any reason, Business Associate shall return all PHI and ePH| received from Covered Entity.
or created or received by Business Associate on behalf uf Covered Entity,
(o) This provision shall apply to PHI and ePHI that is in the possession of subcontractors or
agents of Business Associate. Business Associate shall retain no copies mf the PHI and ePH|,
(b) |n the event that Business Associate or Covered Entity determines that returning the PHI
or ePH| is infeasib|e, notification of the conditions that make return of PHI or ePH| infeasible shall be provided to
the other party. Business Associate shall extend the protections of this Agreement to such retained PHI and ePHI
and limit further uses and disclosures of such retained PHI and ePHI, for a minimum of six years and so long as
Business Associate maintains such PHI and oPH|, but no less than six (8) years after the termination of this
agreement.
M Regulatory References. Areferonce in this agreement to npohnn in the Privacy Rule or
Security Rule means the section then in effect or as may be amended in the future.
10.0 Amendment. The Parties agree to take such action as is necessary to amend this agreement
from time to time as is necessary for Covered Entity to comply with the requirements of the Privacy Rule, the
Security Rule and the Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191
11.0 Survival. Any term, condition, covenant or obligation which requires performance by either party
hereto subsequent to the termination of this agreement shall remain enforceable against such party subsequent to
such termination,
12.0 Interpretation. Any ambiguity in this agreement shall be resolved to permit Covered Entity to
comply with the Privacy Rule and Security Rule.
��
Page 56
13,0 Incorporation byreference. Any future new requirement(m). changes ovd*Jedon(a) enacted in
federal law which create new or different obligations with respect to HIPAA privacy and/or security, shall be
automatically incorporated by reference ko this Business Associate Agreement on the respective effective date(s).
140 Notices. All notices and communications required, necessary or desired to be given pursuant to
this agreement, including a change of address for purposes of such notices and oommunioahons, shall be in
writing and delivered personally to the other party or sent by express 24-hour guaranteed courier or delivery
oervice, nrbycertified mail of the United States Postal Sen/iue, postage prepaid and return receipt requested,
addressed to the other party as follows (or to such other place as any party may by notice to the others specify):
To Covered Entity: Alliance for Aging, Inc.
Attention: Max Rothman
780 NW 107Avenue
Miami, Florida 33172
To Business Associate:
rev
Any such notice shall be deemed delivered upon actual receipt. |f any notice cannot ba delivered ordelivery
thereof is refused, delivery will be deemed to have occurred on the date such delivery was attempted.
15.0 Governing Law. The laws of the State nf Florida, without giving effect to principles of conflict of
laws, govern all matters arising under this agreement.
16.0 5evcrabi|ihy. |f any provision in this agreement is unenforceable to any extent, the remainder of
this agreement, or application of that provision to any persons or circumstances other than those as to which it is
held unenforceable, will not be affected by that unenforceability and will be enforceable to the fullest extent
permitted bylaw.
17�0 Successors. Any successor to Business Associate(whether by direct or indirect or by purchase,
merger, consolidation, or otherwise) is required to assume Business Associate's obligations under this agreement
and agree to perform them in the same manner and to the same extent that Business Associate would have been
required hoif that succession had not taken place. This assumption by the successor of the Business Associate's
obligations shall beby written agreement satisfactory(o Covered Entity.
18.0 Entire Agreement. This agreement constitutes the entire agreement of the parties relating to the
subject matter ofthis agreement and supersedes all other oral or written agreements or policies relating thereto,
except that this agreement does not limit the amendment of this agreement in accordance with section 1O.Oofthis
agreement.
Covered Entity:
By:: Date:
Buein Associate:
By: Date:
Page 57
Al"I"ACHNIENTF
Verification of Employment Status Certification
As a condition of contractive, with the Alliance for Aging, Inc.,
� r')C�,OrL(Oe- cg�-u� v 6 hereby referred to as contractor, certifies the
use Of the U.S. Departibent of Homeland Security's E-verify system to verify the employment
eligibility of all new employees hired by Contractor during the contract term to perforrn employment
duties pursuant to this Agreement and (b) that any subcontracts include in express requirement that
subcontractors performing work or providing services pursuant to this Agreement Utilize the E-verify
system to verify the employment eligibility of all new employees hired by the subcontractor during the
contract term.
Signature Date
(Same as contract signature)
Title
AN12PI-roe—
Company Name
j
I/a
i7
Page 58
11 F k C I Fk 11.N F G
BACKGROUND SCREENING
1) F R
FF�\I'WS Affidavit of Compliance - Employer
JATC 01'#LUAIDA
AUTHORIM This faun Is reqLared rvinttmily tit Al etnployers to coriapty o"with the�41o�4,11,oh
�YorfctaStateAe
tr(y pef�10 ,r r�114Y W11kH."I it 1.1w to r,,wtfi3O
110"Ird to, "!,J ,I) 1,t,, pc t i,1'r-l" :,wd 01,dW Pj
"A Atiew x-,,I cng v otwit,riAll Ir,� Ht-,rhlt V r4et.d.,
w IN,4, "JI(t -I lif"O 1A
Li.airof,
ri'vidol it, -4 11"t'l-al tiuvoi.ifil it) I pi,y:j,im i proodr
Kvr ,Idtrrt,hir r 1,firr rriat,Trt, -Jtt-:t C 1K.ot 1'.mv,d rip, j,r,,C-f,K'ltg!4,14
,)I 1)I S kfti tO I I I v t f w;W; tg 11 tt.).I I) plupet re,u I sr I'.I,,I I,11 i-I-,'I It M k,.�I P--I a It I or I It.)I k)I I
41 t,. jrll,hldv°r 'I"Id
jtpaj, it
, IJ I 1 1,1
AMMTION:
As tie duty autdorized representative of
Ircated at
'(We
do hereby affirm under ceralry of perjury
.1bov( rili-101 rrng,710yer is in mth thf- ptrvi-,wr-, of (friiptr-.r 435 and -,T�;tiun
1=2,F(oiida Statutes, levtll Z bacApea jod,cteening,
1,1pavire of Ilepresentat've Date
A T",t:)F F LU R 11)A.c ej P4 r Y o
`or affirrred) and s�;bscrtbed before me this day of
)rn�o 20_ by
vho -;;,etwnady known
to me or produced is pfoof of ident�flcatlan.
Page 59
ATTACHMENT H
CERT1F1(7A,r1ON REG.XRDING SCRUTINIZED COMPANIES LISTS
The unclerslLnicd, rut authotizcd representative of the Contractor named in the contract or agreement to which
this form isariattachment. hereby certifies that:
(1) The Contractor understands that pursuant to s. 287.135 F.S., any company at the time of bidding or
SUbinittino a proposal for a new contract or renewal of an existing contract, that is on the -Scrutinized
I
Companies with Activities in Sudan List-or the *'Scrutinized Companies with Activities in the Iran I)ctroleUrn
Sector List (collectively, ..the Lists-) is ineligible for, and may not bid on, submit a proposal for, or enter into
or renew a Contract pursuant to �vhicli funding is provided by the Department of Elder Affairs (Department)
for goods or services of$I million or more.
(2)The Contractor understands that, pursuant to s. 287,135 F.S., any company that submits a false certification
is Subject to civil penalties, attorney's fees and costs and any costs for investigations that led to the finding of
false certification.
(3)The Contractor understands that the contract to which this form is an attachment may be terminated by the
AAA If the Contractor submits a false certification or has been placed on the Lists.
This certification, required by Florida law, is a material representation of fact upon which reliance was placed
when this transaction was made or entered into. Submission of this certification is a prerequisite for making or
entering into this transaction.
� ��r �,N� -�� ail
(v Ll
Si-nature DatJ
(Same as contract signature)
,,--, k
-4 rc+o
Title
�v tto3t�p%C-, A
Company Name
✓ 421
'7
Amendment 001 CONTRACT ! H 1372 �'`` �. .� .f� `�,��„ , Page 1
THIS AMENDMENT, entered into between the Alliance for Aging, Inc. hereinafter referred to as the
"Alliance', and Monroe County Board of Commissioners, Social Services/In-Home Services.
,,`he purpose of this amendment is to modify Attachment 11 of the original contract to read:
ATTACHMENT 11
HOME CARE FOR THE ELDERLY
INVOICE REPORT SCEIEDULE
Based On Submit to AAA
Report Number On This Date
1 July Advance* July 1
2 August Advance* July 1
3 July Expenditure Report August 15
4 August Expenditure Report September 15
5 September Expenditure Report October 15
6 October Expenditure Report. November 15
7 November Expenditure Report December 1.5
8 December Expenditure Report January 1.5
9 January Expenditure Report February 15
1O February Expenditure Report March 15
11 March Expenditure Report April 15
12 April Expenditure Report May 15
13 May Expenditure Report June 15
14 June Expenditure Report July 15
15 Final Expenditure and Request for Payment July 25
16 Close Out Report August 15
Legend: * Advance based on projected cash need.
Note # 1: Report #1 for Advance Basis Agreements cannot be submitted to the Department of Financial Services
(DFS) prior to July 1 or until the agreement with the AAA has been executed and a copy sent to DFS.
Actual submission of the vouchers to DFS is dependent on the accuracy of the expenditure report.
Note It 2: All advance payments made to the Contractor shall be returned to the AAA by the submission date of
report #9.
Note #3: Submission of expenditure reports may or may not generate a payment request. If final expenditure
report reflects funds due back to the AAA payment is to accompany the report.
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 are hereby amended to conform with this amendment.
This amendment and all its attachments are hereby made a part of the contract. This amendment and
-a11 its attachments are hereby made a part of the contract.
Amendment 001 CONTRACT KH 1372 Page 2
(N WITNESS WHEREOF, the parties hereto have caused this 1-page amendment to be executed by their
undersigned officials as duly authorized.
PROVIDER:
Monroe County Board of ALLIANCE FOR AGING, INC.
Commissioners, Social
ervices'n- e ervices.
SIGNED Y• SIGNED BY:
Sylvia M rphy Max B. Rothman D,
NAME: is UlytrISIVUyulit NAME:
President & CEO
TITLE: Mayor TITLE:
DATE: 11/20/13 DATE: L. -n �D
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DECDale
24 2013