Item C34
/
&~
Louis LaTorre, Senior Director
Social Services/tabt
-~ .
Revised 2/95
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
MEETING DATE: 5/17-18/00
DIVISION: COMMUNITY SERVICES
BULK ITEM: YES _X_
NO
DEPARTMENT: SOCIAL SERVICES
AGENDA ITEM WORDING: APPROVAL OF AMENDMENT 002TO 99-00 HOME CARE FOR THE
ELDERLY CONTRACT #KH-972 BETWEEN THE ALLIANCE FOR AGING, INC. , THE AREA
AGENCY ON AGING FOR PLANNING AND SERVICES AREA 11 AND MONROE COUNTY
BOARD OF COUNTY COMMISSIONERSI MONROE COUNTY SOCIAL SERVICES (MONROE
COUNTY IN HOME SERVICE PROGRAM, THE CASE MANAGEMENT AGENCY).
ITEM BACKGROUND: The purpose of this amendment is to amend contract clauses to extend the
contract period, and to replace Attachment II.
PREVIOUS RELEVANT BOCC ACTION:
Approved
STAFF RECOMMENDATION: APPROVAL
TOTAL COST: $62,944.00
BUDGETED: YES X NO
COST TO COUNTY: $-0-
REVENUE PRODUCING:
YES
NOX AMT.PER MONTH
YEAR
APPROVED BY: COUNTY ATTY.....K.. OMB/Purchasing....K.. RISK M AGEMENT-X
TO FOLLOW_. ~_ NOTI:E~UJ,~f_
AGENDA ITEM#:~
DIVISION DIRECTOR APPROVAL:
DOCUMENTATION: INCLUDED-X
DISPOSITION:
AGENDA. DOC
TABT
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
CONTRACT SUMMARY
Contract #KH-972 AMENDMENT. 002
Contract with:Alliance For Aging, Inc. Effective Date:July 1, 1999
Expiration Date:June 30, 2000
Contract Purpose/Description:Approval of Amendment~qfto 99-00 Home Care For The
Elderly Contract #KH-972 to amend contract clauses to extend the contract period and replace
Attachment II.
~'; /t/
Contract Manager:Louis La Torre/tabt i~>fJ4572
(Name) (Ext.)
Social Services
(Department)
for BOCC meeting on 5/17-18/00
Agenda Deadline: 05/03/00
CONTRACT COSTS
Total Dollar Value of Contract: $62,944.00 Current Year Portion: $N/A
Budgeted?Yescg] NoD Account Codes: _-_-_-_
Grant: $62,944.00 NA-_-_-_
County Match: $-0- NA-_-_-_
NA-_-_-_
ADDITIONAL COSTS
Estimated Ongoing Costs: $_/yr For:
(Not included in dollar value above) (eg. maintenance, utilities, janitorial, salaries, etc.)
CONTRACT REVIEW
Changes Date Out
DateIn Needed..---..-/ ~ RevieneD P ,/
Division Director '5/ll/C;D YesD No~ _. (,'\1) J..Gf!. , s IL./; 0 J
~skManagewent 51'\\00 YesDNo~ O. ~~ 5/<+)60
o~lPurc~g 5M'''' YesDNoQZJ ,/.' u-U 4~
~LY:;~
County Attorney 5'/1-/ ~ Yes~Nol.l s-- r- 00
comments:-v:-J!g~ uit J d(}
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OMB Form Revised 9/11/95 Mep #2
AMENDMENT 002
CONTRACT # KH 972
Page 1
THIS AMENDMENT, entered into between the Alliance for Aging, Inc.,
hereinafter referred to as the "Alliance", and Monroe County Board of Commissioners,
hereinafter referred to as the "provider", amends contract KH 972.
The purpose of this amendment is to amend contract clauses to extend the contract
period, and to replace ATTACHMENT II.
1. Section L,C. is hereby amended to read:
C. Final Request for Payment
1. The provider must submit the final request for payment to the
Alliance no later than September 15, 2000; if 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.
2. If the contract is terminated prior to the contract end date of
September 30, 2000, then the provider must submit the final
request for payment to the Alliance no more than 45 days after the
contract is terminated; if 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.
2. Section III.,A. is hereby amended to read:
III. Provider and Alliance Mutually Agree:
A. Effective Date:
1. This contract shall begin on July 1, 1999 or on the date the
contract has been signed by both parties, whichever is later.
2. This contract shall end on September 30, 2000.
3. ATTACHMENT I, Section III, is hereby amended to include the following clause:
F. Contract Amendments
1. Transfer between budget categories: The provider may with
prior written approval by the Alliance's contract manager,
implement a budget transfer within the HCE case management
cost category and the HCE subsidies cost category.
AMENDMENT 002
CONTRACT # KH 972
Page 2
2. This contract is for services provided during the 1999/2000 State
Fiscal year beginning July 1, 1999 through June 30, 2000.
However, the contract is in effect through September 30, 2000 in
order to provide for maximization of resources and to allow for
greater flexibility to pay for the services rendered by June 30, 2000.
Services provided after June 30, 2000 can not be reimbursed
under this contract.
3. The provider will submit a draft closeout report by August 15, 2000.
Any contract amendments after August 15, 2000 determined
necessary by the Alliance will be based on the draft closeout
reports.
4. The final expenditure report and request for payment will be due to
the Alliance no later than September 15, 2000. No expenditure
reports or requests for payment will be accepted after
September 15, 2000.
4. Section IV, Paragraph E. is moved to Section III., Paragraph F.1.
5. ATTACHMENT II, Contract Report Calendar, is hereby deleted and replaced
with the revised copy, attached hereto.
6. This amendment shall begin on the date on which the amendment is signed by
both parties.
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 and the Master Agreement.
This amendment and all its attachments are hereby made a part of the contract.
AMENDfolENT 002
CONTRACT # KH 972
Page 3
IN WITNESS WHEREOF, the parties hereto have caused this 4 page amendment to be
executed by their officials thereunto duly authorized.
PROVIDER: MONROE COUNTY BOARD ALLIANCE FOR AGING, INC.
OF COMMISSIONERS FOR DADE AND MONROE COUNTIES
SIGNED SIGNED
BY: BY:
NAME: NAME: MARTY URRA
TITLE: TITLE: PRESIDENT
DATE: DATE:
FEDERAL ID NUMBER: 59-6000749
PROVIDER FISCAL YEAR ENDING DATE: 09/30
AMENDMENT 002
Report
Number
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Legend:
Note # 1:
Note # 2:
CONTRACT # KH 972
HOME CARE FOR THE ELDERLY PROGRAM
CONTRACT REPORT CALENDAR
ADVANCE BASIS CONTRACT
Month
Based On
July Advance*
August Advance*
September July Expenditure Report
October August Expenditure Report
November September Expenditure Report
December October Expenditure Report
January November Expenditure Report
February December Expenditure Report
March January Expenditure Report
April February Expenditure Report
May March Expenditure Report
June April Expendnure Report
July Adv. Recon.** May Expenditure Report
Aug. Adv. Recon.** June Expenditure Report
** Draft Closeout Report
** Final Expenditure and Request
for Payment Report
Final Closeout Report
*
Page 4
ATTACHMENT II
Submit to the
Alliance On This
Date
July 1
July 1
August 25
September 25
October 25
November 25
December 25
January 25
February 25
March 25
April 25
May 25
June 25
July 25
August 15
September 15
September 30
Advance based on projected cash need.
Submission of expenditure reports mayor may not generate a
payment request. If final expenditure report reflects funds due
back to the Alliance, payment is to accompany the report.
**
Report #1 for Advance Basis Contracts cannot be submitted to the
Alliance prior to July 1 or until the contract with the Alliance has
been executed. Actual submission of the vouchers to the DOEA is
dependent on the accuracy of the expenditure report.
The last two months of the provider's fiscal reports covering actual
expenditures should reflect an adjustment repaying advances for
the first two months of the contract.
(
Amendment 001
AMENDMENT TO 1999-2000 HOME CARE FOR THE ELDERLY CONTRACT
THIS AMENDMENT, entered into between the Alliance for Aging, Inc. hereinafter
referred to as the "Alliance", and Monroe County Board of Commissioners, hereinafter
referred to as the "Provider", amends contract KH972.
1. Section II, Contract Amount, is hereby amended to read:
To pay for contracted services according to the conditions of this contract in an
amount not to exceed $18,129 subject to the availability of funds. The Alliance's
performance and obligation to pay under this contract are contingent upon an annual
appropriation by the Legislature. The costs of services paid under any other
contract or from any other source are not eligible for reimbursement under this
contract.
2. Section III, Paragraph A.2., is hereby amended to read:
This contract shall end on June 30, 2000.
3. Attachment /, Section // A, is hereby amended to read:
The approved Service Provider Application of Monroe County Board of
Commissioners for Home Care for the Elderly funds for July 1, 1999 to June 30,
2000, and any revisions thereto approved by the Alliance and located in the
contract manager's file, are incorporated by reference in this contract between the
Alliance and the provider, and prescribe the services to be rendered by the provider.
4. Attachment /, Section //B, is hereby amended to read:
The services will be provided in a manner consistent with and described in the
Service Provider Application for the Home Care for the Elderly funds for July 1,
1999 to June 30, 2000 of the Monroe County Board of Commissioners and the
Department of Elder Affairs Client Services Manual. In the event the manual is
revised, the contract will incorporate any such revision and the provider will be
given a copy of the revision.
5. Attachment /, Section /11, Paragraph E, is hereby amended to read:
The Alliance shall make payment to the provider for provision of services up to a
maximum number of units of service and at the rate(s) stated below:
Service to be
Provided
Unit of
Service
Unit
Rate
Maximum
Units
Maximum
Dollars
Case Management
1 client hour
$49.130081
369
$18.129
6.
This amendment shall begin on September 1, 1999 or on the date on which the
amendment has been signed by both parties, whichever is later.
All provisions in the contract and any attachments thereto in conflict with this amendment
shall be and are hereby changed to conform with this amendment.
All provisions not in conflict with this amendment are still in effect and are to be performed
at the level specified in the contract are hereby amended to conform with this amendment.
This amendment and all its attachments are hereby made a part of the contract.
IN WITNESS WHEREOF, the parties hereto have caused this 2 page amendment to be
executed by their undersigned officials as duly authorized.
PROVIDER: Monroe County
Board of Commissioners
ALLIANCE FOR AGING, INC.
---...... . - -r' .
SIGNED BY: ~'\".'-'-'~'"-'';SrGNED BY:<\") ~ .
. \\Gs'rn.~ t( - xrb.",
NAME: Lt"): \ ~'Q imino. t-ku.l'~ NAME: Ramona Frischman. Ed.D
TITLE: -1in ~ 1 ~ TITLE: PRESIDENT
DATE: ql9:Jq~ DATE: or/'2Gr q ,
ATTf\S-r. OANW: . ,..-...H^C~ CL,!;;~~ .
r;(~~~.~~
: . .'(..r-.:..) ~
.'
07/01/99
Contract Number KH972
HOME CARE FOR THE ELDERLY
STANDARD CONTRACT
TIDS CONTRACT is entered into between the Alliance for Aging, Inc., hereinafter refe~ to as
the "Alliance", and the Monroe County Board of Commissioners, hereinafter referred to as the
"provider". This contract is subject to all provisions contained in the MASTER AGREEMENT
executed between the Alliance and the Provider, Agreement No.. fA2.2, and its suc~essor,
incorporated herein by reference.
The parties agree:
I. Provider Agrees:
A. Services to be Provided:
To plan, develop, and accomplish the services delineated, or otherwise cause the planning,
development, and accomplishment of such services and activities, under the conditions
specified and in the manner prescribed in Attachment}t!of this agreement.
B. Requirements of Section 287.058, Florida Statutes:
These require~ents are herein incorporated by reference.
C. Final Request for Payment
1. The provider must submit the [mal request forpayment to the Alliance no more than
45 days after the contract ends or is terminated; if 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. Any payment due under the terms of this contract may
be withheld until all reports due from the provider, and necessary adjustments thereto,
have been approved by the Alliance.
2. A final receipt and expenditure report as a closeout report will be forwarded to the
Alliance within sixty (60) days after the contract ends or is terminated. All monies
which have been paid to the provider which have not been used to retire outstanding
obligations of the contract being closed out must be refunded to the Alliance along with
the final receipt and expenditure report
n. The Alliance Agrees:
Contract Amount
To pay for contracted services according to the conditions of AttachmenrTI1 in an amount not to
exceed $9,064.50, subject to the availability offunds. The Alliance's peIformance and obligation
1
07/01/99
Contract Number KH972
to pay under this contract is contingent upon 3D. annual appropriation by the Legislature. The
costs of services paid under any other contract or from any other source are not eligible for
reimbursement under this contract. The schedule of funds awarded to the provider pursuant to
this contract is in state grants and aids appropriations and consists of the following:'
Program Title Year Funding Source . CFDA# Fund Amounts
Home Care for the 1999 General Revenue N/A $9,064.50
Elderly
TOTAL FUNDS CONTAINED IN THIS CONTRACT: $9,064.50
IlL Provider and Alliance Mutually Agree:
A. EffeCtive Date:
1. 1bis co~tract shall begin on Julv 1. 1999 or on the date the contract has been signed by
both parties, whichever isJater.
2. 1bis contract shall end on December 31. 1999.
B. Termination and Suspension
The causes and remedies for termination or suspension of this contract shall follow the same
procedures as outlined in Section III. B. And Section III. C. of the Master Agreement.
C. Notice, Contact, and Payee Information:
1. The name, address, and telephone number of the contract manager for the Alliance for
this contract is:
John L. Stokesbeny
Alliance for Aging, Inc.
9500 S. Dadeland Boulevard, Suite 400
Miami, Florida 33156
305-670-6500
2. The name, address, and telephone number of the representative of the provider
responsible for administration of the program under this contract is:
Louis La Torre
5100 College Road - Wing III
Key West, FL 33040
(305) 292-4420
2
07/01/99
Contract Number KH972
3. In the event different representatives are designated by either party after execution of this
contract, notice of the name and address of the new representative will be rendered in writing
to the other party and said notification attached to originals of this contract
4. The name (provider name as shown on page 1 of this contract) and mailing address of the
official payee to whom the payment shall be made:
Monroe County Board of Co~sioners
5.1 00 Collage Road - Wing ill
. Key West, FL 33040 .'
IN WIlNESS TIffiREOF, the parties hereto have caused this ~ page contract to be executed by their
undersigned officials as duly authorized.
PROVIDER: MONROE COUNTY BOARD
OF COM1vfISSIONERS
ALLIANCE FOR AGING, INC.
BOARD PRESIDENT OR
AUTHORIZED DESIGNEE
SIGNED ~~:iJ -yo, -: ___ <:;\-~:-,-.~-L...\r
BY: -~. -- ~.
SIGNED .
BY~'K'l11fn C\ d~~O"Y\
tJ IL fkLf'l lfUi- (iA-l2.VlC.-f
;v( 1-Y OF-
'7-~/- 99
FED~RAL ID NUMBER: 59-1523943 Sftf~lT1t-tr
PROVIDER FISCAL YEAR END DATE: .JJiae-30
NAME:
NAME: RAMONA FRISCHMAN, BdD
TITLE:
DATE:
TITLE: BOARD PRESIDENT
DATE: of t-i {q q
!:
(SEAL)
Arr~ST; OA' ,:--i" L KOLHACE. ,:LERK
8Y ~~I-::<--.c. ~~
DEi Ty CLERK
3
07/01/99
Contract Number KH972
AITACHMENT I
HOME CARE FOR THE ELDERLY PROGRAM
I. STATEMENT OF PURPOSE
Home Care for the Elderly (HCE) encourages the provision of care in family-type living
. arrangements in private homes on a not for profit basis as an alternative to nursing home or other
institutional care. .
II. SERVICES TO BE PROVIDED
A. 'Services:
'. . The approved Service Provider Application of Monroe County Board of Commissioners for
Home Care for the Elderly funds for July 1,.1999 to December 31, 1999, and any revisions
thereto approved by the Alliance and located in the contract manager's file, are incorporated by
reference in this contract between the Alliance and the provider, .and prescribe the services to be
rendered by the provider.
B. Manner of Service Provision:
The services will be provided in a manner consistent with and described in the Service Provider
Application for the Home Care for the Elderly funds for July 1, 1999 to December 31, 1999 of
the Monroe County Board of Commissioners and the Department of Elder Affairs Client
Services Manual. In the event the manual is revised, the contract will incorporate any such
revision and the provider will be given a copy of the revision.
ITI. METHOD OF PAYMENT
A. This is a fixed rate - advance funding contract.. All requests for payment and expenditure
reports submitted to support requests for payment shall be on DOEA forms 1 06H and 105H.
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 forms.
B. The provider may request a monthly advance fur each of the first three months of the contract
period, based on anticipated cash needs. Detailed documentation justifying cash needs for
advances must be maintained in the contract managers file. All payment req~ests for the fourth
through the twelve months shall be based on the submission of monthly actual expenditure
reports beginning with the first month of the contract. The schedule for submission of advance
requests is . ATTACHMENT II to this contract. Reconciliation and recouping of advances
made under this contract are to be completed by the time the final payment is made. All
advance payments are subject to the availabili1y of funds.
4
07/01/99
Contract Number KH972
C. Advance funds may be temporarily invested by the provider in an insured interest bearing
account. All interest earned on contract fund advances must be returned to the Alliance at the
end of the fIrst quarter of the contract period.
D. Any payment due by the Alliance under the terms of this contract may be withheld pending the
receipt and approval by the Alliance of all fmancial and programmatic reports due from the
provider and any adjustments thereto. .
E. The Alliance shall make payment to the provider for proVIsion of services up to a maximum
number of units of service and at the rate(s) stated below:
Service to be
Provided
Unit of
Service
Unit
Rate
Maximum
Units
Maximum
Dollars
Case Management
1 client hour
$49.130081
184.5
$9,064.50
IV. SPECIAL PROVISIONS
A. Program Income :
Program Income earned may be spent in the same year as earned. Any program income funds
not spent may be carried forward into the next fiscal year. Any prior year program income
carried forward must be spent in the following year.
B. State Laws and Regulations
The provider agrees to comply with applicable parts of Rule Chapter 58H-l, Florida
Administrative Code promulgated for administration of Sections 430.601 through 430.608,
Florida Statutes, and the Department of Elder Affairs Client Services Manual.
c. Comprehensive Assessment Review and Evaluation for Long Term Care Services (CARES)
Program
Those persons who are functionally assessed by the Comprehensive Assessment Review and
Evaluation for Long Term Care Services (CARES) Program to be at imminent risk of nursing
home placement and referred to the Home Care for the Elderly Program will have services
started immediately. The provider must shelter an adequate portion of funds to serve these
CARES referrals.
5
07/01/99
Contract Number KH972
D. Business Hours
The Provider must at a minimum maintain business hours from 8:00 AM to 5:00 PM daily,
Monday through Friday.
E. Transfer Between Budget Categories
The provider may with prior written approval by the Alliance's contract manager, implement a
r budget transfer within the HC.E case management cost category and the HCE subsidies cost
category. The provider may also with prior written approval by the Alliance's contract manager,
implement a budget transfer from the HCE administrative cost category to the HCE subsidies or
HCE case management cost categories.
F. Client Information, Registration and Tracking System (CIRTS)
1. Area agencies will ensure the collection and maintenance of Home Care for the Elderly
(HCE) subsidies and case management information on a monthly basis from the Client
Information and Registration Tracking System (CIRTS). Maintenance includes valid
exports and backups of all data and systems according to department standards.
2. Lead agencies must enter all data for HCE subsidies in the CIRTS by the 15th of each
month. HCE subsidy data entered into the CIRTS by the 15th of the month will be for
payments incurred between the 16th of the previous month and the 15th of the current
month. Case management data entered into the CIRTS by the 15th 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 month. Case management units of service may be entered according
to the agency schedule, in aggregate on the 31st or daily, weekly or monthly.
3. Lead agencies will cease data entry for HCE subsidies on th.e 15th of the month and run a
CIRTS Monthly Service Utilization Report, by client and by worker identification.
4. Lead agencies will verify, correct, and certify the Monthly Utilization Report, by client and
by worker identification, and submit this report to the area agency on aging by the 20th of
the month in which the report is generated. The area agency an aging may also require a
Request for Payment and Receipt and Expenditure Report for case management to
accompany this report.
5. Caregivers who are determined eligible for the HCE basic subsidy after the 15th of a month,
will be processed by lead agencies to begin eligibility for the HCE basic subsidy on the 1 st
day of the next month.
6
07/01/99
Contract Number KH972
6. The Alliance will reconcile and verify the CIRTS data prior to payment for HCE basic and
special subsidies and case management
7. The Alliance will process basic and special subsidy checks to caregivers by the 3rd of the
month following the month services are rendered.
G. Outcome Achievement
. 1. Area agencies will assign the provider legislatively approved outcome measures.
2. Area agencies will track outcome achievement on a monthly basis. Technical assistance will
be provided to service providers when achievement levels drop 1 % or more from the
assigned outcome measures. Corrective action will be required specifying actions the
providers will take to bring achievement levels up to assigned amount if achievement drops
2% or more.
3. The Alliance will monitor implementation of provider strategies toward achieving outcomes
as described in the Service Provider Application for Monroe County Social Services.
H. Care Plans
Care plans will be costed out for each client. Projected costs will be provided to fiscal offices to
manage resources and compare to actual expenditures for the agency.
7
07/01/99
HOME CARE FOR THE ELDERLY PROGRAM
CONTRACT REPORT CALENDAR
ADVANCE BASIS CONTRACT
Report
Numbe:r: Month
1 July
2 August
3 September
4 October
5 November
6 December
7 January
8 February
9 March
10 April
11 May ,
12 June
13 July Adv.
14 Aug. Adv.
15 Sep. Adv.
16, **
17 **
Legend: *
**
Note # 1:
Note # 2:
Note: # 3:
ContI3ct Number H901
ATTACHMENT II
Submit to Alliance
On This
Date
July 1.
July 1
August 1
August 15
September 15
October 15
November 15
December 15
January 15
February 15
March 15
April 15
May 15
June 15
July 15
August 14
August 29
Based On
Advance *
Advance *
Advance *
July Expenditure Report
August Expenditure'Report
September Expenditure Report
October Expenditure Report
November Expenditure Report
December Expenditure Report
January Expenditure Report
February Expenditure Report
March Expenditure Report
April Expenditure Report
May Expenditure Report
June Expenditure Report
Final Request for Payment
Closeout Report
Advance based on projected cash need.
Submission of expenditure reports mayor may not generate a
payment request. If final expenditure report reflects funds due
back to the Alliance, payment is to accompany the report.
Report #1 for Advance Basis Contracts cannot be submitted to
the Alliance prior to July 1 or until the contract with the
Alliance has been executed. Actual submission of the
vouchers to the DOEA is dependent on the accuracy of the
expenditure report.
Recon. **
Recon.**
Recon.**
A final request for payment may be submitted to the Alliance
by the provider up to 45 days after the contract has ended.
The last three months of the provider'S fiscal reports
covering actual expenditures should reflect an adjustment
repaying advances for the first three months of the
contract.
8
MEMORANDUM OF AGREEMENT
BETWEEN
THE ALLIANCE FOR AGING, 1Ne.
AND
MONROE COUNTY SOCIAL SERVICES
PERTAINING TO
HOME CARE FOR THE ELDERLY PROGRAM SPENDING AUTHORITY FOR.1998-99
This Memorandum of Agreement outlines the Home Care for the Elderly Subsidy Payment spending authority
for Monroe County Social Services, hereinafter referred to as the "Providern, for 1999-00 and details the responsibilities
and the .ex~ectations associated with this auth~rity. .
1. The Alliance For Aging has determined the total amount of Home Care for the Elderly subsidy payments available
to each Lead Agency within Planning and Service Area (PSA) 11 based on each county's proportion of the clients
enrolled in the Home Care for the Elderly Program as of June I, 1999.
2. The 1999-00 Home Care for the Elderly Subsidy Payment spending authority for the Provider is $31,472.00. Under
no '!ircumstances must the Provider exceed the allocated spending authority limits. To that effect, the Provider
agrees to do the following:
a. The Provider wiH establish, house and maintain a client voucher file for each client enrolled in the HCE
Program. Client voucher files shall be intended to establish a proper audit trail of services authorized and
provided to clien~ enroUed in the. HCE program.
b. Client voucher files will contain a separate service paymentlutilizatio" record (DOEA Form 133) for each
month that the client is enrolled in the nCE program. DOEA Form 133 establishes a payment trail, by
client, of services authorized for payment. It further serves as the instrument for data entry of service
utilization information in the Client Information, Registration and Tracking System (CIRTS).
c. All items/services purchased by a caregiver in support of a client shall require prior authorization from the
case manager who shall so indicate in the client care plan/case record. A receipt, signed by the caregiver,
must be presented to the case manager and attached to DOEA Form 133 in order to authorize payment.
Receipts for all authorized items/services must be present in the client voucher ftle in support of all caregiver
reimbursements.
d.. For services provided by vendors, including the Lead Agency, case managers will be responsible for
indicating the Provider IDlLocation Code and Service Type on DOEA Form 133. Service payment amount
information shall be entered on DOEA Form 133 by the Lead Agency utilizing vendor invoices which clearly
indicate the client served, services received, date of service and payment information. Prior authorization
by the case manager is required before a service is received. The authorization for the client to receive these
services shall be the case manager's entry into the client care plan/case record as well as the case manager's
entry on DOEA Form 133 to indicate Provider ID/Location, Service Code and payment information.
e. The Provider will enter all data for HCE Basic and Special Subsidies in CIRTS by the 15th of each month
for payments incurred between the 16th of the previous month and the 15th of the current month.
MEMORANDUM OF AGREEMENT
Monroe County Social Services
& The Alliance For Aging
Page Two
f. The Provider will run a CIRTS Monthly Utilization' Report. The. Provider wiii vemy, correct and certify the
Monthly Utilization Report and submit this. report to the AJIiance by the 20th of the month in which the
report is generated. The Alliance may also require a Request for Payment and Rec~ipt and Expenditure
Report to accompany this report. ' .
g. Caregivers who are determined eligible for the HCE Basic Subsidy after the 15th of a ~onth, will be
processed by the Provider to begin eligibility for the HCE Basic Subsidy in the"first day of the following
month.
'h. The Provider is' responsible for continued monitoring of all vendors with which it holds agreements for the
provision of services to be reimbursed as Special Subsidies. Said agreements must be approved by the
Alliance, outline the vendor's responsibility.to carefully follow clients' care plans/service authorizations and
adhere to spending limits.
3. The Alliance agrees to do the following:
a. The Alliance will verify and process the CIR'TS data prior to payment for HCE Basic and Special Subsidies.
b. Provided the monthly report is received from the Case Management agency by the due date, the Alliance will
process Basic and Special, Subsidy checks to caregivers- by the third of the month following the month
services are rendered.
c. The Alliance will supply the Provider with a list of the amou~t paid each month to each caregiver, the date
the payment was made and the check number.
:Ibis Memorandum' of Agreement will be in effect for the period June 1, 1999 through December 31, 1999 or until
otherwise revised or terminated.
PROVIDER: MONROE COUNTY BOARD
OF COMMISSIONERS
ALLIANCE FOR AGING, INC.
BOARD PRESIDENT OR
AU1HORIZED DESIGNEE
SIGNED'~~~~-: _ _ . d~_'~,,".-LJ
BY: ""--- -- ..-----......-. . , . . . 'r
SIGNED
BY:\\~mC\ ~~""
'NAME:, iJfLfk-LMfNA- NA2\ILt(
TITLE: Jv\ A-L/ 6 t~
NAME:RAMONA FRISCHMAN. EdD
TITI..E:President
'7-.;2/-99
DATE: '3/~ /9 q.
. DATE:
FEDERAL ID NUMBER: 59-6000749
. PROVIDER FISCAL YEAR ENDING DA TE:...2QQ.
(SEAl)
ArrEST: DANNY L KOtHAG~ OERK
8~~ c!. Jlu.~/?-td
DEPUTY CL!RIC /