Item C22
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date:3/21-22/0 I
Division:Communitv Services
Bulk Item; Yes ---K- No
Department: Social Services
AGENDA ITEM WORDING:
Approval of Amendment 002 to Contract KS-0112 to Home and Community Based Medicaid Waiver
Spending Authority Between the Alliance For Aging, Inc., and the Monroe County Board of County
Commissioners/Monroe County Social Services (Monroe County In Home Service Program, The Case
Management Agency).
ITEM BACKGROUND:
The approval of this amendment will increase the present spending authority by $48,515.50 for the
Fiscal Year 2000-2001. The total spending authority amount through the Third Quarter of 200 I (1/1-
3/31/01) will be $145,546.50.
PREVIOUS REVELANT BOCC ACTION:
Approval
CONTRACT/AGREEMENT CHANGES:
Amendment increases the spending authority by an additional $48, 515.50. Total contract will
now be in the amount of $145,546.50.
STAFF RECOMMENDATIONS:
Approval
TOTAL COST: $145,546.50
COST TO COUNTY: -0-
BUDGETED: Yes ~ No
REVENUE PRODUCING: Yes ~ No
AMOUNT PER MONTH_ Year
APPROVED BY: County AttY----1L
OMB/Purchasing --1L- Risk Management _X_
/V\CtQQoeQ
James Malloch
DIVISION DIRECTOR APPROVAL:
DOCUMENTATION:
Included X
To Follow_
Not Required
DISPOSITION:
AGENDA ITEM #~l
Revised 2/27/01
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
CONTRACT SUMMARY
Contract #KS-0112 AMENDMENT 002
Contract with:Alliance for Aging, Inc. Effective Date:July 1, 2000
Expiration Date:June 30, 200 I
Contract Purpose/Description:Approval of of this amendment will increase the present spending
authority of the contract by $48,515.50 (Third Quarter Allocation), this will increase the total
spending authority to $145,546.50/
Contract Manager:Louis La T oere/tab! If ~
(Name) ! t~ (Ex!.)
Social Services / stop 1
(Department / Stop #)
for BOCC meeting on 3/21-22/01
Agenda Deadline: 3/7/01
CONTRACT COSTS
Total Dollar Value of Contract: $145,546.50 Current Year Portion: $
Budgeted?YeslS] NoD Account Codes: _-_-_-_
Grant: $145,546.50 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
Date In Needed /' ~""'_" ~~vJeJer I I (
Division Director '2,/, t/vl YesDNo~ ~.. ~.tt,t)
Risk Managem~nt L \~ \ \ c I YesO NoB' c., , L,) ckr'-'- ~t\-G-(:t,,,,<c l "Zl \ 01
'f!!j.Yurc-fasVngf:Zf.O( YeSONO~ O~~ ,,2-,J;?-O/
County Attorney "2-/2-- Jpr YesD NoGY ~!~~ )If
/
Comments:
OMB Form Revised 9/11195 Mep #2
, ,
AMENDMENT 002
Spending Authority Contract KS-0112
Page1
THIS AMENDMENT, entered into between the Alliance for Aging, Inc., hereafter referred to
as the "Alliance," and Monroe County Board of Commissioners, hereafter referred to as
the "provider," amends spending authority contract KS-0112.
The purpose of this amendment is to increase the Home qnd Community Based Medicaid Waiver
spending authority by $48,515.50 for the State Fiscal Year 2000-2001.
1. Section II. is hereby amended to read:
II. The Alliance Agrees:
Spending Authority
The Alliance authorizes payment in accordance with Attachment I to this agreement in
the amount of $145,546.50 for the Home and Community Based Medicaid Waiver
(HCBW) for SFY 00-01. Authorized spending authority contract allocations to date are
as follows:
QUARTER DATES HCBW ALW TOTAL COC
ALLOCA TED (CONTROL)
First 6/1-9/30/00 $70,152.00 0.00 $70,152.00 0.00
Second 10/1-12/31/00 $26,879.00 0.00 $26,879.00 0.00
Third 1/1-3/31/01 $48,515.50 0.00 $48,515.50 0.00
Fourth 4/1-6/30/01 0.00 0.00 0.00 0.00
.....> .... ......1'\1""\1""\ ..... ....>< ... ..
.>> TOTALS ......$145,546.50 '$145,546.50 0.00
...... ... .~, ~ ,
Service providers must not exceed allocated spending authority limits without first obtaining
written authorization from the Alliance and the Department of Elder Affairs. The provider is
responsible for continued monitoring of service providers to facilitate compliance with this
requirement.
':
AMENDMENT 002
Spending Authority Contract KS-0112
Page2
This amendment shall begin on the date on which the amendment has been signed by both
parties.
All provisions in the spending authority contract and any of its attachments which may be in
conflict with this AMENDMENT are hereby changed to conform with this AMENDMENT.
"
All provisions not in conflict with this AMENDMENT are still in effect, and are to be performed at
the level specified in the contract.
This AMENDMENT and all its attachment are hereby a part of the contract.
IN WITNESS THEREOF, 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.
FOR DADE AND MONROE COUNTIES
SIGNED
BY:
SIGNED
BY:
NAME:
NAME: KATE CALLAHAN, PH.D.
TITLE: PRESIDENT
TITLE:
DATE:
DATE:
FEDERAL ID
PROVIDER FISCAL YEAR END DATE
59-6000749
09/30
. ,
CLERKtsORIGINAL
AMENDMENT 001"
Spending Authority Contract KS0112
Page1
THIS AMENDMENT, entered into between the Alliance for Aging, Inc., hereafter referred to
as the "Alliance," and Monroe County Board of Commissioners, hereafter referred to as
the "provider," amends spending authority contract KS0112.
The purpose of this amendment is to increase the Home ~nd Community Based Medicaid Waiver
spending authority by $26,879.00 for the State Fiscal Year 2000-2001.
1. Section II. is hereby amended to read:
II. The Alliance Agrees:
Spending Authority
The Alliance authorizes payment in accordance with Attachment I to this agreement in
the amount of $97,031.00 for the Home and Community Based Medicaid Waiver
(HCBW) for SFY 00-01. Authorized spending authority contract allocations to date are as
follows:
QUARTE DATES HCBW ALW TOTAL CDC
R ALLOCA TED (CONTROL)
First 6/1-9/30/00 $70,152.00 0.00 $70,152.00 0.00
Second 10/1-12/31/00 26,879.00 0.00 26,879.00 0.00
Third 1/1-3/31/01 0.00 0.00 0.00 0.00
Fourth 4/1-6/30/01 0.00 0.00 0.00 0.00
TOTALS $97,031.00 0.00 $97,031.00 0.00
Service providers must not exceed allocated spending authority limits without first obtaining
written authorization from the Alliance and the Department of Elder Affairs. The provider is
responsible for continued monitoring of service providers to facilitate compliance with this
requirement.
AMENDMENT 001"
Spending Authority Contract KS0112
Page2
This amendment shall begin on the date on which the amendment has been signed by both
parties.
All provisions in the spending authority contract and any of its attachments which may be in
conflict with this AMENDMENT are hereby changed to conform with this AMENDMENT.
;'
All provisions not in conflict with this AMENDMENT are still in effect, and are to be performed at
the level specified in the contract.
This AMENDMENT and all its attachment are hereby a part of the contract.
IN WITNESS THEREOF, 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.
FOR DADE AND MONROE COUNTIES
,,( , '/1- .-J--
~~6-/? f-C~~\j ~~GN~~~
NAME: t:eDJe. If. /IJ~J~" I NAME: MARTIN URRA
TITLE: Ma..y_,,- TITLE: PRESIDENT
I
/lIz/laD
DATE:
DATE:
11- ~:J.. - ()()
59-6000749
09/30
,,---,
I
{-
, .
"
Contract No. KS0112
Medicaid Waiver Spending Authority Contract
CASE MANAGEMENT AGENCY
2000 - 2001
THIS CONTRACT is entered into between the Alliance for Aging, Inc., hereinafter referred to
as the "Alliance", and Monroe County Board of Commis:;;ioners, hereinafter referred to as
the "case management agency". "
The parties agree:
I. The Case Management Agency 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 I of this agreement.
B. Request for Payment
Service provider agencies should submit requests for payment (claims) to the
Medicaid fiscal agent within 60 days after services have been provided or document
reasons for delayed submission of claims which will be made available to the Alliance
or the Case Management Agency upon request; if the service provider fails to
submit claims within 60 days and fails to document reasons for delayed
submission as required, spending authority amounts may be adjusted to reflect
the most current claim (expenditure) information available. Future allocations
amounts may be contingent on timely submission of claims.
C. Conflict of Interest
The case management agency hereby agrees that it will develop and implement a
policy to ensure that its employees, board members, management, and service
providers, will avoid any conflict of interest or the appearance of a conflict of interest
when disbursing or using the funds described in this agreement or when contracting
with another entity which will be paid by the funds described in this agreement. A
conflict of interest includes, but is not limited to, receiving, or agreeing to receive, a
direct or indirect benefit, or anything of value from a service provider, c1ient,vendor, or
any person wishing to benefit from the use or disbursement of funds. To avoid a
conflict of interest, the case management agency must ensure that all individuals make
a disclosure to the Alliance of any relationship which may be a conflict of
interest, within thirty (30) days of an individual's original appointment or placement on
a board, or if the individual is serving as an incumbent, within thirty (30) days of the
1
-----
('
Contract No. KS0112
commencement of the contract.
D. Audits and Records
1. To maintain books, records, and documents (including electronic storage media) in
accordance with generally accepted accounting procedures and practices which
sufficiently and properly reflect all revenues ancl expenditures of funds provided by
the Alliance under all contracts under this agreement.
2. To assure these records shall be subject at all reasonable times to inspection,
review, audit, copy, or removal from premises by state personnel and other
personnel duly authorized by the Alliance, as well as by federal personnel, if
applicable. .
3. To maintain and file with the Alliance such progress, fiscal and inventory and other
reports as the Alliance may require within the period of this agreement. Such
reporting requirements must be reasonable given the scope and purpose of the
contracts incorporating this agreement by reference.
4. To include these aforementioned audit and record keeping requirements in all
approved agreements and assignments.
5. The case management agency agrees to respond to requests for client information
and statistical data for research and evaluative purposes when requested by the
Alliance.
E. Retention of Records:
1. To retain all client records, financial records, support documents, statistical records
and any other documents (including electronic storage media) pertinent to each
contract covered under this agreement for a period of five (5) years after
termination of the contract(s), or if an audit has been initiated and audit findings
have not been resolved at the e1!d of five (5) years, the records shall be retained
until resolution of the audit findings.
2. Persons duly authorized by the Alliance and federal auditors, pursuant to 45 CFR,
Part 92.42(e), (1), and (2), shall have full access to and the right to examine or
duplicate any of said records and documents during said retention period or as long
as records are retained, whichever is later.
F. Monitoring
1. To provide progress reports, including data reporting requirements as specified by
2
.'-"
, .
, ,
Contract No. KSO 112
the Alliance. These reports will be used for monitoring progress or performance of
the contractual services as specified in this agreement.
2. The case management agency agrees to coordinate meetings with the service
providers as requested by the Alliance when it becomes evident that spending
authority amounts are not being properly managed in accordance with this
agreement.
3. To permit persons duly authorized by the Alliance to inspect any records, papers,
documents, facilities, goods and services of the provider which are relevant to this
., agreement or the mission and statutory authority of the Alliance, and/or interview
any clients and employees of the case management agency to be assured of
satisfactory performance of the terms and conditions of the contract. Following
such inspection the Alliance will deliver to the case management agency a list of its
concerns with regard to the manner in which said goods or services are being
provided. The case management agency will rectify all noted deficiencies provided
by the Alliance within the time set forth by the Alliance, or provide the AllianGe with
a reasonable and acceptable justification for the provider's failure to correct the
noted shortcomings. The Alliance shall determine whether such failure is
reasonable and acceptable. The case management agency's failure to correct or
justify deficiencies within a reasonable time as specified by the Alliance may result
in the Alliance taking any of the actions identified in the Enforcement section, or the
Alliance deeming the case management agency's failure to be a breach of contract.
11. The Alliance Agrees:
Spending Authority
The Alliance authorizes payment in accordance with Attachment I to this agreement
in the amount of $ 70,152.00 for the Home and Community Based Medicaid
Waiver for the first quarter of SFY 00-01 and $ 0.00 for the Assisted Living
Medicaid Waiver for the first quarter of SFY 00-01.
Service providers must not exceed allocated spending authority limits
without first obtaining written authorization from the Alliance. Case
management agency is responsible for continued monitoring of service providers to
facilitate compliance with this requirement.
Ill. The Case Management Agency and Alliance Mutually Agree:
3
(
--.
Contract No. KS0112
A. Effective Date
1. This contract shall begin on July 1, 2000 or on the date the contract has been
signed by both parties, whichever is later.
2. This contract shall end on June 30, 2001.
B. Termination
1. Termination at Will
This agreement may be terminated by either party upon no less than thirty (30)
calendar days notice, without cause, unless a lesser time is mutually agreed upon
by both parties, in writing. Said notice shall be delivered by certified mail, return
receipt reque$ted, or in person with proof of delivery.
~'
2. Termination Because of Lack of Funds
In the event funds to finance this agreement become unavailable, the Alliance may
terminate this agreement upon no less than twenty-four (24) hours notice in writing
to the case management agency. Said notice shall be delivered by certified mail,
return receipt requested, or in person with proof of delivery. The Alliance shall be
the final authority as to the availability of funds.
3. Termination for Breach
Unless the case management agency's breach is waived by the Alliance in writing,
or the case management agency fails to cure the breach within the time specified
by the Alliance, the Alliance may, by written notice to the case management
agency, terminate this agreement upon no less than twenty-four (24) hours notice.
Said notice shall be delivered by certified mail, return receipt requested, or in
person with proof of delivery. If applicable, the Alliance may employ the default
provisions in Chapter 60A-1.006(3), Florida Administrative Code. The provisions
herein do not limit the Alliance's right to remedies at law or to damages.
4. The provisions herein do not limit the Alliance's right to remedies at law or to
damages, or to legal remedies of an equitable nature. If the Alliance engages any
of the enforcement provisions contained in part C below, the Alliance may in its
sole discretion determine if the termination of the contract is warranted.
C. Enforcement
The Alliance may in accordance with section 430.04, Florida Statutes, rescind
designation of the case management agency as a provider agency, or take immediate
action against the case management agency, including corrective action,
unannounced special monitoring, temporary assumption of the operation of one or
. .
4
"
Contract No. KS0112
more programs, placement of the case management agency on probationary status,
imposing a moratorium on case management agency action, imposing financial
penalties for non performance, or other administrative action pursuant to Chapter 120,
Florida Statutes if the Alliance finds that:
,
· An intentional or negligent act of the case management agency has materially
affected the health, welfare, or safety of clients, or substantially and negatively
affected the operation of an aging services program.
· The case management agency lacks financial stability sufficient to meet contractual
obligations or that contractual funds have been misappropriated.
· The case management agency has committed multiple or repeated violations of
legal and regulatory standards, regardless of whether such laws or regulations are
enforced by the Alliance, or the case management agency has committed repeated
violations of standards.
· The case management agency has failed to continue the provision or expansion of
services after the declaration of a state of emergency.
· The case management agency has failed to adhere to the terms of its contract with
the Alliance.
In making any determination under this provision, the Alliance may rely upon the
findings of another state or federal agency, or other regulatory body. Any claim for
breach of this contract is exempt from administrative proceedings and shall be brought
to the venue of Leon County in the appropriate court. Before the Alliance formally
rescinds the designation of the case management agency, initiates any intermediate
measure, or either party commences equitable or legal action of any sort, both parties
agree to engage in informal mediation through a meeting of each party's
representatives at a place and location designated by the Alliance.
D. Notice and Contact Information
1. The name, address, and telephone number of the contract manager for the Alliance
for this contract is:
John L. Stokesberry
9500 South Oadeland Boulevard, Suite 400
Miami, Florida 33156
(305) 670-6500 SC 455-6500
5
~-
t .
, ,
Contract No. KS0112
2. The name, address, and telephone number of the representative of the case
management agency responsible for administration of the program under this
contract is:
Louis LaTorre
5100 College Road - Win~ III
Key West, Florida 33040
(305) 292-4573
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 vyriting to the other party and said notification attached to originals of this
contract.
IN WITNESS THEREOF, the parties hereto have caused this 21 page contract to be executed
by their undersigned officials as duly authorized.
CASE MANAGEMENT AGENCY:
Monroe County Board of Commissioners
ALLIANCE FOR AGING, INC.
FOR DADE AND MONROE COUNTIES
BOARD PRESIDENT OR
AUTHORIZED DESIGNEE
SIGNED
BY:
NAME:
TITLE:
DATE:
("if . .(---:,
'lo I .:; .__ ~/
(~) J.V(..,<..~i.-? j>L,~~.-'l.C..J/-'
Sh;v! Gi r::;.~~~
MA-LII'K
j/L--~ //--?
I
~~~NED~ ~
NAME: MARTY ~
TITLE: PRESIDENT
DATE: ~ - .l--.J-" !J LJ
59-6000749
9/30
6
.-..~ .
"
Contract No. KSO 112
ATTACHMENT I
A. Services to be Provided:
This agreement outlines the Medicaid Waiver spending authority for the case management
agency for SFY 00-01 and details the responsibilities and the expectations associated with this
agreement. i
1. The Alliance will execute an agreement for the Home and Community Based Waiver and
an agreement for the Assisted Living Waiver with its case management agencies which
outlines the case management agency's SFY 00-01 Medicaid Waiver spending authority
and the case management agency's corresponding responsibility to carefully manage
client care plans and program spending authority within allocated limits.
2. The Alliance will control service provider billings through the monitoring of care plans so
that case management agencies do not overspend budget allocations. The Alliance will
monitor service provider billings to ensure care plans are adhered to.
3. The Medicaid Waiver Specialist will work with the case management agencies to ensure
persons for which services are billed are in fact being entered into CIRTS, and otherwise
monitor expenditures for problems that could contribute to the case management agency
exceeding program spending authority.
4. Medicaid will furnish client data monthly on paid provider claims. DOEA will sort the data
by Planning and Service Area (PSA) and forvvard management reports to Medicaid
Waiver Specialists who vvill then utilize this data in working with service providers. These
reports will be helpful in identifying program spending patterns among waiver service
providers and will assist in the managing of program budgets.
5. The Alliance will ensure that multiple service providers are available for each service and
in sufficient quantities to meet demonstrated client needs by securing, enrolling and
entering into referral agreements [Attachments II and III(A) and III(B)] with service
providers.
B. Special Provisions:
1. The Department of Elder Affairs develops an allocation of Medicaid Waiver spending
authority by Planning and Service Area (PSA) each fiscal year using the original base
amount from the 1992 waiver budget allocation contained in the CCE appropriation
category, and by distribution of program Appropriations Act increases of new funds based
on each PSA's Proportion of the Medicaid eligible 60+ population. All appropriation
increases, since the establishment of the program base (which was shifted by each
7
J
i
, ,
Contract No. KSO 112
individual PSA from CCE) in 1992, are lumped together each year and reallocated (zero
based) according to each PSA's Medicaid eligible 60+ population. The allocation formula
for the Assisted Living Medicaid Waiver is based upon equal weight of the number of
medicaid eligibles, and number of assisted living facility beds in the PSA, and case
months (utilization) by PSA. Each PSA is allocated money through the area agencies on
aging to serve clients based upon this formula.
The department may alter the allocation formulas to avoid deficit spending, ensure
continuation of service to clients, and to ensure proper administration of the waiver
throughout the state.
2. Failure of the case management agency to remain within allocated authorized spending
authority limits may jeopardize future legislative program appropriations and may result
in enforcement sanctions. If, however, individual service providers within the PSA have
exceeded their spending authority but have demonstrated (1) the appropriate fiscal
restraint in keeping within their budget; (2) an increase in needs of clients; (3) a decrease
in the attrition of clients, then the case management agency's resulting deficit will be
reduced from the subsequent year's spending authority. The area agency on aging may
shift spending authority dollars among the service providers within the PSA's to avoid a
year-end deficit.
3. The Department of Elder Affairs is establishing criteria to prioritize new clients for service
delivery. It is not the intent of the department to remove existing clients from any
program in order to serve new clients being assessed and prioritized for service delivery.
a. The following assessment and prioritization for service delivery protocol will be used:
(1) Abuse, Neglect and Exploitation:
(a) the case management agency will ensure that pursuant to Section
430.205(5), Florida Statutes, those elderly persons who are
determined by adult protective services to be victims of abuse,
neglect, or exploitation who are in need of immediate services, will be
given primary consideration for receiving home and community-based
services. As used in this subjection, "primary consideration" means
that an assessment and services must commence within 72 hours
after referral to the department or as established in accordance "'lith
department contracts by local protocols developed between
department service providers and adult protective services.
8
i
"
Contract No. KS0112
(2) Pri.qrity Criteria for Service Delivery:
(a) individuals in nursing homes under Medicaid who could be transferred
to the community;
(b) individuals in nursing homes whose Medicare coverage is exhausted
and may be diverted to the comJT1unity;
(c) iridividuals in nursing homes which are closing and can be discharged
to the community;
(d) individuals whose mental or physical health condition has deteriorated
to the degree self care is not possible, there is no capable caregiver
and institutional placement will occur within 72 hours; and
(e) individuals who have been assessed and are pending enrollment in
the Long Term Care Community Diversion Project.
(3) Priority Criteria for Service Delivery for Other Assessed Individuals:
(a) The assessment and provision of services should always consider the
most cost effective means of service delivery. Functional impairment
shall be determined through the department's client assessment form
administered to each applicant. The most frail individuals not
prioritized in groups one or two above, regardless of referral source,
will receive services to the extent funding is available.
9
.._,
r
I
Contract No. KS0112
A TIACHMENT "
HOME AND COMMUNITY BASED WAIVER
REFERRAL AGREEMENT
This Referral Agreement, made this _ day of ,. 2000, shall be in effect for the
period of to between, the Area Agency
on Aging for Planning and Service Area ; and , the Service Provider
Agency. This Referral Agreement may be extended for a period of up to ninety (90) days upon
written notice by the Area Agency on Aging. One purpose of this agreement is to promote the
development of a coordinated service delivery system to meet the needs of the aged or
disabled adults who are at risk of premature institutionalization. Another purpose of this
agreement is to enable eligible elderly participants to receive Home and Community Based
Waiver Services from qualified providers with oversight of the quality of care by the Medicaid
Waiver Specialist employed by the Area Agency on Aging. These services are authorized in
order that the participant may remain in the least restrictive setting and avoid or delay
premature nursing home placement. Services and care are to be furnished in a way thqt
fosters the independence of each participant to facilitate aging in place. All parties agree that
routines of care provision and service delivery must be consumer driven to the maximum
exteClt possible. All parties agree to and will treat each participant with dignity and respect.
I. Objectives
A. To maintain a climate of cooperation and consultation with and between agencies, in
order to achieve maximum efficiency and effectiveness.
B. To participate together by means of shared information in the development and
expansion of services.
C. To promote programs and activities designed to prevent the premature
institutionalization of elders and disabled adults.
D. The parties of this Agreement will provide technical assistance and consultation to
each other on matters pertaining to actual service delivery and share appropriate
assessment information and care plans so duplication may not occur.
II. Under this Agreement, the Service Provider Agency agrees to the following:
A. To accept referrals for the 1915c Home and Community Based Service (HCBS)
Medicaid Waiver from the enrolled case management agency.
B. To provide quality service(s) to the waiver participant as specified in Section V.
Provision of service(s) is subject to quality monitoring and/or observation by the case
management agency and/or the Area Agency on Aging and/or the Department of
10
:"
Contract No. KS0112
Elder Affairs.
C. To provide only those services specifically outlined in the Plan of Care or service
authorization submitted by the enrolled case management agency.
D. To attach documentation regarding provider qualifications to this agreement; and to
provide, as requested, any information regarding ~edicaid Waiver billing, payment, or
waiver participant in'formation, to the case management agency or Area Agency on
Aging. Provider rate increases/decreases must be forwarded to the Area Agency on
Aging along with justification for any increase. If additional services are to be added to
this agreement, a written request to do so must be received by the Area Agency on
Aging and an amendment must be prepared by the Area Agency on Aging listing the
added service(s). The necessary documentation regarding provider qualifications for
the additional services will be signed, attached to the agreement and forwarded to the
Area Agency on Aging.
E. To maintain the waiver participant's confidentiality according to 42 CFR 431.301.
F. To immediately report any changes in the waiver participant's condition to the case
management agency.
G. To maintain enrolled provider status by renewing applicable licensure, certification,
contract, and/or referral agreements.
H. To include its name, unit rate, and other appropriate information on a list of all
enrolled providers which will be shown to recipient during development of an
individualized plan of care, understanding that the recipient reserves the right at all
times to a choice of enrolled providers.
/. To immediately notify the case management agency of staffing shortfalls which will
negatively impact provision of service to Medicaid Waiver recipients.
J. To submit claim data for billing to the Medicaid fiscal agent after delivery of services
has been accomplished. All services should be billed within 60 days after services
have been provided or document reasons for delayed submission of claims. Such
documentation shall be available for review by the area agency on agency or by the
Department of Elder Affairs, upon request.
K. To submit claims for billing to the Medicaid fiscal agent at the agency's usual and
customary rate. It is a violation of federal regulation to bill Medicaid more than the
agency's usual and customary rate.
L. To submit 081 void or adjustment claims no later than 45 days after the error has
been identified.
M. To develop and implement a policy to ensure that its employees, board members, and
11
,.......
r
, ,
Contract No. KSO 112
managemer:1t, will avoid any conflict of interest or the appearance of a conflict of
interest when disbursing or using the funds described in this agreement. A conflict of
interest includes, but is not limited to, receiving, or agreeing to receive, a direct or
indirect benefit, or anything of value from a service provider, client, vendor, or any
person wishing to benefit from the use or disbursement of funds. To avoid a conflict
of interest, the service provider agency must enst,lre that all individuals make a
disclosure to the Area Agency on Aging of any relationship which may be a conflict of
interest, within thirty (30) days of an individual's original appointment or placement on
a board, or if the individual is serving as an incumbent, within thirty (30) days of the
commencement of the contract.
N. To adhere to the policies and procedures as outlined in the DOEA Client Services
Manual and the Aged/Disabled Adult Waiver Guidelines and the Medicaid Provider
Reimbursement Handbook (Non-Institutional 081) as well as any attachments or
updates.
III. In addition to the above provisions in Section 1/, the Case Management Agency
service provider agrees to the fol/owing:
A. Submit a written referral to the service provider agency with at least 24 hours notice.
The referral will contain, at a minimum:
1. Name
2. Address (with directions if not easily accessible)
3. Pertinent information regarding recipient's health or disabilities and living situation.
4. Detailed service authorization including frequency, duration, and specific tasks to
be performed.
B. Maintain case records in accordance with the Aged and Disabled Adult Medicaid
Waiver Coverage and Limitations Handbook.
C. Evaluate quality of services and service documentation as provided by service
provider agencies.
D. Accept financial responsibility for service claims found out of compliance if the non-
compliance was the result of a failure by the case management agency to update,
renew, or terminate the service authorization.
E. Monitor service provider agencies for adherence to authorized case plans and within
authorized rates.
12
.1'(""--:.....
t
"
Contract No. KS0112
IV. Under this Agre~ment, the Area Agency on Aging agrees to the following:
A. To facilitate the enrollment of providers with the Medicaid Fiscal Agent.
B. To provide technical assistance and training to Service Providers.
C. To notify the case management agency within 48 hours of any approved service
provider rate adjustment. ~'
D. To regularly monitor the Service Providers in accordance with requirements specified
by the Department of Elder Affairs.
V. Under this agreement, the following services will be delivered by the Service
Provider Agency if! accordance with the plan of care or service authorization:
Service
Unit Rate
County/Region Served
a.
b.
c.
d.
e.
VI. Termination
In the event this agreement is terminated, the case management agency and the service
provider agency agree to submit, at the time notice of intent to terminate is delivered, a plan
which identifies procedures to ensure services to clients will not be interrupted or suspended
by the termination.
A. Termination at Will
This agreement may be terminated by any party upon no less than thirty (30) calendar
days notice, without cause, unless a lesser time is mutually agreed upon by both
parties, in writing. Said notice shall be delivered by certified mail, return receipt
requested, or in person with proof of delivery.
B. Termination Because of Lack of Funds
In the event funds to finance this agreement become unavailable, the area agency
may terminate this agreement upon no less than twenty-four (24) hours notice in
writing to the other party. Said notice shall be delivered by certified mail, return
receipt requested, or in person with proof of delivery. The area agency shall be the
final authority as to the availability of funds.
13
....-.
r
Contract No. KS0112
C. Termination.for Breach
Unless a breach is waived by the area agency in writing, or the parties fail to cure the
breach within the time specified by the area agency, the area agency may, by written
notice to the parties, terminate the agreement upon no less than twenty-four (24)
hours notice. Said notice shall be delivered by cectified mail, return receipt requested,
or in person with proof of delivery. '
In witness whereof, the parties have caused this _ page agreement to be executed by their
undersigned officials as'duly authorized.
Area Agency on Aging
Service Provider Agency
signature
signature
print name
print name
title
title
date
date
14
, ,
Contract No. KSO 112
ATTACHMENT III(A)
ASSISTED LIVING MEDICAID WAIVER REFERRAL AGREEMENT
This Referral Agreement, made this _ day of ,2000, shall be in effect for the
period of to between , the Area Agency on
Aging for Planning and Servi.ce Area and )' , an
Assisted Living Facility. This Referral Agreement may be extended for a period of up to ninety
(90) days upon written notice by the Area Agency on Agir)g. The purpose of this agreement is
to enable eligible elderly participants to receive Assisted Living Waiver Services from qualified
providers with oversight of the quality of care by the Medicaid Waiver Specialist employed by
the Area Agency on Agi.ng. These services are authorized in order that the participant may
remain in the least restrictive setting and avoid or delay premature nursing home placement.
Services and care are to be furnished in a way that fosters the independence of each
participant to facilitate aging in place. All parties agree that routines of care provision and
service delivery must be consumer-driven to the maximum extent possible. All parties agree to
and will treat each participant with dignity and respect.
I. Objectives
A. To maintain a climate of cooperation and consultation with and between agencies, in
order to achieve maximum efficiency and effectiveness.
B. To participate together by means of shared information in the development of services.
C. To promote programs and activities designed to prevent the premature
institutionalization of elders who, but for the provision of Assisted Living Medicaid
Waiver services, would require nursing home placement.
D. All parties recognize that the recipient retains the right to assume risk, tempered only
by the individual's ability to assume responsibility for that risk.
E. All parties recognize that the recipient retains the right to choose which enrolled facility
he/she will reside in.
F. The parties of this Agreement will provide technical assistance and consultation to
each other on matters pertaining to actual service delivery and share appropriate
assessment information and care/service plans so duplication may not occur.
fl. Under this Agreement, the Assisted Living Facility (ALF) Provider Agency agrees to
the following:
A. To receive referrals for the Assisted Living Medicaid Waiver from the enrolled case
management agency.
B. To maintain required licensure status as follows:
15
........-....
, ,
Contract No. KS0112
1. Hold a current Limited Nursing Service (LNS) or Extended Congregate Care (ECC)
license.
2. A copy of the current license and most recent licensure survey results are attached
to this agreement.
C. Provide copies of all licensure survey reports, plan~of corrective actions if citations
have occurred and license within 10 calendar days from receipt to the Area Agency on
Aging.
D. To provide enhanced services beyond those specified in the resident's contract with
the facility. Services will be specifically outlined in the Plan' of Care submitted by the
Case Management Agency. These services are subject to observation by the case
manager and quality assurance monitoring by the Medicaid Waiver Specialist and/or
the Department of Elder Affairs.
E. To provide and log service(s) as authorized in the waiver participant's service plan
which is developed by the facility based upon the recipient's care plan. The log must
be current and available for the Case Manager and Medicaid Waiver Specialist to
review.
F. To bill Medicaid the amount not to exceed the per diem minus the resident's patient
responsibility. (Patient responsibility is determined by Department of Children and
Families) .
G. To provide the Medicaid Waiver Specialist with documentation regarding provider
qualifications; and to provide, as requested, any information regarding Medicaid
Waiver billing, payment, or waiver participant information to the case management
agency.
H. To maintain the waiver participant's confidentiality.
I. To immediately report any changes in the waiver participant's condition to the case
management agency.
J. Participate in training arranged by the Area Agency on Aging, Department of Elder
Affairs, Department of Children and Families and/or Agency for Health Care
Administration.
K. Schedule resident staffing to include case management participation and allow case
management agency staff and area agency staff access to Assisted Living Medicaid
Waiver resident files.
L. To adhere to all policies and procedures as outlined in the Assisted Living Medicaid
Waiver Coverage and Limitations Handbook and Assisted Living Waiver Guidelines.
16
, -,
, ,
Contract No. KS0112
M. To provide the Area Agency on Aging with a monthly summary of amounts billed to the
Medicaid Fiscal Agent for Assisted Living Medicaid Waiver Services.
N. To submit claim data for billing to the Medicaid fiscal agent after delivery of services
has been accomplished. All services should be billed within 60 days after services
have been provided or document reasons for de~ayed submission of claims. Such
documentation shall be available for review by th'e area agency on agency or by the
Department of Elder Affairs, upon request.
O. To develop and implement a policy to ensure that its employees, board members, and
management, will avoid any conflict of interest or the appearance of a conflict of
interest when disbursing or using the funds described in this agreement or when
contracting with another entity which will be paid by the funds described in this
agreement. A conflict of interest includes, but is not limited to, receiving, or agreeing to
receive, a direct or indirect benefit, or anything of value from a service provider, client,
vendor, or any person wishing to benefit from the use or disbursement of funds. To
avoid a conflict of interest, the service provider agency must ensure that all individuals
make a disclosure to the Area Agency on Aging of any relationship which may be a
conflict of interest, within thirty (30) days of an individual's original appointment or
placement on a board, or if the individual is serving as an incumbent, within thirty (30)
days of the commencement of the contract.
P. To submit 081 void or adjustment claims no later than 45 days after the error has been
identified.
III. Under this Agreement, the Area Agency on Aging agrees to the foI/owing:
A. To facilitate the enrollment of providers with the Medicaid Fiscal Agent.
B. To provide technical assistance and training to ALFs and case management
agencies.
C. To provide on site monitoring of the ALF and case management agency at
least semi-annually.
D. To monitor and project Provider spending to assure spending authorities are
adhered to.
E. To regularly participate in mandated core training for ALF operators as
coordinated by DOEA Trainers located within each PSA providing information
pertinent to the Assisted Living Medicaid Waiver.
IV. Termination
In the event this agreement is terminated, the case management agency and the service
provider agency agree to submit, at the time notice of intent to terminate is delivered, a plan
17
r
Contract No. KSO 112
which identifies proE:,edures to ensure services to clients will not be interrupted or suspended by
the termination.
A. Termination at Will
This agreement may be terminated by either party upon no less than thirty (30)
calendar days notic~, without cause, unless a lesser time is mutually agreed upon by
both parties, in writing. Said notice shall be delivered by certified mail, return receipt
requested, or in person with proof of delivery.
B. Termination Because of Lack of Funds
In the event funds to finance this agreement become unavailable, the area agency
may terminate this agreement upon no less than twenty-four (24) hours notice in
writing to the other party. Said notice shall be delivered by certified mail, return receipt
requested, or in person with proof of delivery. The area agency shall be the final
authority as to the availability of funds.
C. Termination for Breach
Unless a breach is waived by the area agency in writing, or the parties fail to cure the
breach within the time specified by the area agency, the area agency may, by written
notice to the parties, terminate the agreement upon no less than twenty-four (24)
hours notice. Said notice shall be delivered by certified mail, return receipt requested,
or in person with proof of delivery.
In witness whereof, the parties have caused this _ page agreement to be executed by their
undersigned officials as duly authorized.
Area Agency on Aging
Assisted Living Facility
sign.Jcure
sign~cur=
prim nJme
prim nJm:
title
title
dJte
dale
18
, ,
Contract No. KS0112
ATTACHMENT II/(B)
ASSISTED LIVING MEDICAID WAIVER REFERRAL AGREEMENT
This Referral Agreement, made this day of ,2000, shall be in effect for the period of
to between , ' the Area Agency on Aging for Planning
and Service Area and " a case management agency. This
Referral Agreement may be extended for a period of up to ninety (90) days upon written notice by the
Area Agency on Aging. The purpose of this agreement is to enable eligible elderly participants to receive
case management services from qualified providers with oversight of the quality of care by the Medicaid
Waiver Specialist employed by the Area Agency on Aging. These services are authorized in order that
the participant may remain i,n the least restrictive setting and avoid or d,elay premature nursing home
Jlacement. Services and care are to be furnished in a way that fosters the independence of each
Jarticipant to facilitate aging in place. All parties agree that routines of care provision and service
jelivery must be consumer-driven to the maximum extent possible. All parties agree to and will treat
:=ach participant with dignity and respect.
Objectives
F. To maintain a climate of cooperation and consultation with and between agencies, in order to
achieve maximum efficiency and effectiveness.
G. To participate together by means of shared information in the development and expansion of
services.
H. To promote programs and activities designed to prevent the premature institutionalization of
elders and disabled adults.
/. The parties of this Agreement will provide technical assistance and consultation to each other on
matters pertaining to actual service delivery and share appropriate assessment information and
care plans so duplication may not occur.
Under this Agreement, the Area Agency on Aging agrees to the following:
A. To facilitate the enrollment of providers with the Medicaid Fiscal Agent.
B. To provide technical assistance and training to the case management agencies.
C. To provide on site monitoring of the case management agency at least semi-annually.
D. To monitor and project Provider spending to assure spending authorities are adhered to.
E. To regularly participate in mandated core training for ALF operators as coordinated by DOEA
Trainers located within each PSA providing information pertinent to the Assisted Living Medicaid
Waiver.
19
Contract No. KS0112
III. Under this Agreem.~nt, the Case Management Agency agrees to the following:
A. Assign qualified case managers who have successfully completed core training to provide caSe
management under the Assisted Living Medicaid Waiver. Case managers must complete sUch
training within six months of being assigned to the Assisted Living Waiver.
F. Develop and implement the Plan of Care specifically oytlining the service(s) to be delivered Which
'must be signed by the resident, ALF administrator or representative of ALF's nursing staff, and
the Case Manager and provided to the ALF for their files.
G. Be available to the ALF for case staffing of the referred case and provide narratives describing the
contents of such staffing for the case record.
H. Provide on site case 'management activities with the resident and the ALF staff monthly and note
the resident's progress and receipt of services as evidenced by the facility Service Activity Plan
and resident log entries; changes in the residents Activities of Daily Living, Instrumental Activities
of Daily Living; and certify continuing participation in the program based on the observations. A
case file must be maintained at the case management agency describing the case management
activities.
l. Review the Care Plan quarterly with the resident, his/her family if applicable, and the ALF facility
staff.
J. Provide the assisted living facility with a copy of the Comprehensive Resident Assessment and
subsequent Reassessments.
K. Adhere to the policies and procedures as outlined in the Assisted Living Medicaid Waiver
Coverage and Limitations Handbook.
L. Provide to the Area Agency on Aging a monthly summary of Assisted Living Case Management
expenditures.
/. Refer clients to any qualified Service Provider Agency.
J. Agrees that it will develop and implement a policy to ensure that its employees, board members,
and management, will avoid any conflict of interest or the appearance of a conflict of interest
when disbursing or using the funds described in this agreement or when contracting with another
entity which will be paid by the funds described in this agreement. A conflict of interest includes,
but is not limited to, receiving, or agreeing to receive, a direct or indirect benefit, or anything of
value from a service provider, client, vendor, or any person wishing to benefit from the use or
disbursement of funds. To avoid a conflict of interest, the case management agency must ensure
that all individuals make a disclosure to the Area Agency on Aging of any relationship which may
be a conflict of interest, within thirty (30) days of an individual's original appointment or placement
on a board, or if the individual is serving as an incumbent, within thirty (30) days of the
commencement of the contract.
20
..-..
-'
(
\
"
Contract No. KS0112
III. Termination
In the event this agreement is terminated, the case management agency and the service provider
agency agree to submit, at the time notice of intent to terminate is delivered, a plan which identifies
procedures to ensure services to clients will not be interrupted or suspended by the termination.
A. Termination at Will
"
-
This agreement may be terminated by either party upon no less than thirty (30) calendar days
notice, without cause, unless a lesser time is mutually agreed upon by both parties, in writing.
Said notice shalf be delivered by certified mail, return receipt requested, or in person with proof of
delivery.
B. Termination Because of Lack of Funds
In the event funds to finance this agreement become unavailable, the area agency may terminate
this agreement upon no less than twenty-four (24) hours notice'in writing to the other party. Said
notice shall be delivered by certified mail, return receipt requested, or in person with proof of
delivery. The area agency shall be the final authority as to the availability of funds. ~
C. Termination for Breach
Unless a breach is waived by the area agency in writing, or the parties fail to cure the breach
within the time specified by the area agency, the area agency may, by written notice to the
parties, terminate the agreement upon no less than twenty-four (24) hours notice. Said notice
shall be delivered by certified mail, return receipt requested, or in person with proof of delivery.
In witness whereof, the parties have caused this _ page agreement to be executed by their
undersigned officials as duly authorized.
Area Agency on Aging Case Management Agency
signature
signatl..:r:
prim name
prim name
ti:le
title
date
date
21