Item C13
~
Loui L:Torre, Senior Director
Social Services/tabt
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
MEETING DATE: 11/20-21/01
DIVISION: COMMUNITY SERVICES
BULK ITEM:
YES X
NO
DEPARTMENT: SOCIAL SERVICES
AGENDA ITEM WORDING: Approval of Amendment 001 to Contract KS 212 of the 2nd Quarter Home and
Community Based Medicaid Waiver Spending Authority for Fiscal Year 7/1/01 thru 6/30/02 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 amendment to this contract will allow Monroe County In Home
Services to continue providing the necessary services without interruption to the clients that are eligible to
receive services under this spending authority and prevent premature institutionalization..
PREVIOUS RELEVANT BOCC ACTION:
Approval
CONTRACT/AGREEMENT CHANGES:
N/A
STAFF .lU.:COMMENDATION: Approval
TOTAL COST: $127,431.00 BUDGETED:YES---1L NO
COST TO COUNTY: $ -0-
REVENUE PRODUCING: YES
NO ---1L AMT.PER MONTH
YEAR
APPROVED BY: COUNTY A TTYl OMB/Purchasing l RISK MANAGEMENT -X
DOCUMENTATION:
INCLUDED
TO FOLLOW NOT REQUIRED_
AGENDA ITEM#: ./ ~^ :f
DIVISION DIRECTOR APPROVAL:
DISPOSITION:
Revised 2/27/0 I
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
CONTRACT SUMMARY
Contract with: Alliance For Aging, Inc, Contract #KS 212 Amendment 00 ]
Effective Date: July 1,2001
Expiration Date: June 30, 2002
Contract Purpose/Description: Approval of Amendment 00 I to Contract KS 212 for the 2nd Quarter Home and
Community Based Medicaid Waiver Spending Authority Contract for Fiscal Year 7/110 I thru 6/30/02 between
the Alliance For Aging Inc" and the Monroe County board of County CommissionerslMonroe County Social
Services (Monroe County In Home Service Program, The Case management Agency),
Contract Manager:
,.
~~r..~
Louis La Torre 'I/iv
(Name) AI
For BOCC meeting on 11/20-21/0 I
4573
(Ext.)
Social Services/Stop I
(Department/Stop #)
Agenda Deadline:
11/01/01
CONTRACT COSTS
Total Dollar Value of Contract: $127,431.00 I sl * 2nd Quarter Current Year Portion: $
Budgeted? Yes X No D Account Codes:
Grant: $ 127,431.00 (1 sf & 2nd Quarter)
County Match: $ -0-
/yr
ADDITIONAL COSTS
For:
(eg. Maintenance, utilities, janitorial, salaries, etc)
Estimated Ongoing Costs: $
(Not included in dollar value above)
CONTRACT REVIEW
Division Director
Date In
\C(IS(C(
t 0 ~~5 -c (
\0\\5\0\
101 z, '2-/0 I
Changes
Needed
YesD No~
Risk Management
Yes D No Q-
O,M,B.lPurchasing
YesD NoD
County Attorney
YesD No~
Comments:
OMB Form Revised 2/27/01 MCP #2
~~~~,
t~~
Date Out
10 I I
/ f!/d ~/O;
AMENDMENT #001
Spending Authority Contract KS 212
Page 1
THIS AMENDMENT, entered into between the Alliance for Aging, Inc" hereafter
referred to as the "Alliance" and the Monroe County Board of Commissioners, hereafter referred to as
the "recipient", amends spending authority contract KS 212,
The purpose of this amendment is to amend Section II of the Medicaid Waiver Spending Authority
adding the schedule of funds awarded to the recipient and increasing the Home and Community
Based Medicaid Waiver spending authority by $63,715,50, and increasing the Assisted Living
Medicaid Waiver spending authority by $0,00, for the State Fiscal Year 2001-2002,
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 $127,431.00 for the Home and Community Based Medicaid Waiver (HCBW) for SFY 01-02
and $0,00 for the Assisted Living Medicaid Waiver (ALW) for SFY 01-02, Authorized spending
authority contract allocations to date are as follows:
QUARTER DATES HCBW ALW TOTAL
ALLOCATED
First 7/1-9/30/01 $63,715,50 0,00 $63,715,50
Second 10/1-12/31/01 $63,715,50 0,00 $63,715,50
Third 1/1-3/31/02
Fourth 4/1-6/30/02
TOTALS $127,431,00 0,00 $127,431,00
The Alliance is responsible for allocating these spending authority amounts down to the service
provider level. The recipient must not exceed allocated spending authority limits without first
obtaining written authorization from the Alliance and/or the Department of Elder Affairs. The
Alliance is responsible for continued monitoring of recipients providers to facilitate compliance
with this requirement.
Contract Amount
To pay for contracted services according to the conditions of Attachment I in an amount not to
exceed $127,431.00, subject to the availability of funds, The Alliance's performance and obligation
to pay under this contract is contingent upon an annual appropriation by the Legislature passed
through the Department of Elder Affairs, 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 recipient pursuant to this contract is not in a state grants and aids
appropriations and consists of the following:
AMENDMENT #001
Spending Authority Contract KS 212
Page 2
Program Title Year Funding Source CFDA# Fund Amounts
Medical 2001 CMS 93,778 $72,030,00
Assistance
2001 General Revenue NA $55,401,00
TOTAL FUNDS CONTAINED IN THIS CONTRACT: $127,431,00
2, 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,
RECIPIENT: MONROE COUNTY BOARD
OF COMMISSIONERS
ALLIANCE FOR AGING, INC,
BOARD PRESIDENT OR AUTHORIZED
DESIGNEE
SIGNED
BY:
SIGNED
BY:
NAME:
TITLE:
NAME: KATE CALLAHAN, PH,D,
TITLE: PRESIDENT
DATE:
DATE:
FEDERAL EMPLOYER 10 NUMBER
59-6000749
PROVIDER FISCAL YEAR END DATF
APPROVED AS TO FO~M
AND L GAL SUFFICI
09/30
CLERK'S ORIGINAL
07/01/01
Contract Number KS 212
Medicaid Waiver Spending Authority Contract
CASE MANAGEMENT AGENCY
2001-2002
THIS CONTRACT is entered into between the Alliance for Aging, Inc" hereinafter
referred to as the "Alliance", and the Monroe County Board of Commissioners,
hereinafter referred to as the "recipient", This contract is subject to all provisions
contained in the MASTER AGREEMENT executed between the Alliance and the
recipient, Agreement No, PA 129 , and its successor, incorporated herein by reference,
The parties agree:
I. Recipient 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 Department of Elder Affairs or the Area Agency on Aging 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.
II. The Alliance Agrees:
Spending Authority
The Alliance authorizes payment in accordance with Attachment I to this
agreement in the amount of $63,715.50 for the Home and Community Based
Medicaid Waiver for Aged and Disabled Adults for the first quarter of SFY 01-02
and $0.00 for the Assisted Living for the Frail Elderly Medicaid Waiver for the first
quarter of SFY 01-02, A portion of the funding for the Home and Community
Based Waiver for Aged and Disabled Adults may be designated by the
Department of Elder Affairs for expenditures under the Consumer Directed Care
program as provided for in the proviso language of the General Appropriations
Act for 2001-02,
Recipients must not exceed allocated spending authority limits without first
1
07/01/01
Contract Number KS 212
obtaining written authorization from the Department of Elder Affairs through
the Alliance, The Alliance will be responsible for continued monitoring of seNice
providers to facilitate compliance with this requirement.
III. Recipient and Alliance Mutually Agree:
A, Effective Date:
1, This contract shall begin on July 1, 2001 or on the date the contract has
been signed by both parties, whichever is later,
2, Delivery of seNices shall end on June 30, 2002,
B. Termination, Suspension, and/or Enforcement:
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. Recipient Responsibility:
Notwithstanding the pass through language contained in Section I.S,1, of the
Master Agreement, the recipient maintains responsibility for the performance of
all subrecipients in accordance with all applicable federal and state laws.
D. Notice, Contact, and Payee Information:
1, The name, address, and telephone number of the contract manager for the
Alliance for this contract is:
Steven Weisberg
9500 South Dadeland Boulevard, Suite 400
Miami, Florida 33156
(305) 670-6500 SC 455-6500
2, The name, address, and telephone number of the representative of the
recipient responsible for administration of the program under this contact is:
Louis LaTorre
5100 College Road - Wing 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 writing to the other party and said
notification attached to originals of this contract.
2
07/01/01
Contract Number KS 212
IN WITNESS THEREOF, the parties hereto have caused this 22 page contract to be
executed by their undersigned officials as duly authorized,
RECIPIENT:
ALLIANCE FOR AGING, INC
MONROE COUNTY BOARD
OF COMMISSIONERS
BOARD PRESIDENT OR
AUTHORIZED DESIGNEE
~ ~,e Kt~(t-d
SIG~ -h
BY; {f/~)ja;.~) ~/r?j~~
d~)
NR:~: KATE CALLAHAN. PH,D,
NAME: elt 021:, t[ f\J ~U ?;t!'1 (
rVI /+yDL
7/iV/OI
TITLE: PRESIDENT
DATE: ~S f/O (') ,/
FEDERAL 10 NUMBER:
RECIPIENT FISCAL YEAR END DATE:
59-6000749
09/30
3
07/01/01
Contract Number KS 212
ATTACHMENT I
MEDICAID WAIVER SPENDING AUTHORITY
I. STATEMENT OF PURPOSE
The Home and Community Based Services Aged and Disabled Adult Medicaid
Waiver and Assisted Living for Frail Elderly Medicaid Waiver Programs provide
community-based services organized in a continuum of care to assist aged 60 +
elders at risk of nursing home placement to live in the least restrictive environment
suitable to their needs, This agreement outlines the Medicaid Waiver spending
authority for the case management agency for State fiscal year 2001-2002 and details
the responsibilities and the expectations associated with this agreement.
II. SERVICES TO BE PROVIDED
A. Services:
1, The Alliance will ensure that each case management agency carefully manages
consumer care plans and program spending authority within allocated limits,
2, The Alliance will control service provider billings through the monitoring of care
plans for the Aged and Disabled Adult Medicaid Waiver to ensure spending is
within budget allocations, The Alliance will monitor service provider billings to
ensure that they are for services included in care plans, The Alliance will control
service provider billings through managing the enrollment of consumers in the
Assisted Living for the Frail Elderly Waiver to maximize budget allocations,
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,
have been given a Level of Care (LaC) by CARES and otherwise monitor
expenditures for problems that could contribute to the case management agency
exceeding program spending authority,
4, Medicaid will furnish consumer data monthly on paid provider claims, DOEA will
sort the data by Planning and Service Area (PSA) and forward management
reports to Medicaid Waiver Specialists who will 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 consumer needs by
securing, enrolling and entering into referral agreements [Attachments II(A) and
II(B) and III(A) and III(B)] with service providers,
4
07/01/01
Contract Number KS 212
8. Manner of Service Provision:
The seNices will be provided in a manner consistent with and described in the
Department of Elder Affairs Client SeNices Manual dated 12/98, as well as the
following manuals published by the Agency for Health Care Administration: the
Aged and Disabled Adult Waiver Guidelines, the Assisted Living for the Frail
Elderly Guidelines, and the Medicaid Provider Reimbursement Handbook (Non-
Institutional 081) including any and all attachments or updates.
III. METHOD OF PAYMENT
A. The Department of Elder Affairs develops an allocation of Medicaid Waiver
spending authority by Planning and SeNice 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 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
for the Frail Elderly 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 seNe consumers based upon this formula,
The department may alter the allocation formulas to avoid deficit spending,
ensure continuation of seNice to consumers, and to ensure proper administration
of the waiver throughout the state, The method of payment in this contract
includes fixed rate for seNices, The recipient must ensure fixed rates are based
on audited historical costs,
B. 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, the case management
agency has exceeded the spending authority but has demonstrated (1) the
appropriate fiscal restraint in keeping within their budget; (2) an increase in needs
of consumers; (3) a decrease in the attrition of consumers, then the case
managements agency's resulting deficit will be reduced from the subsequent
year's spending authority,
5
07/01/01
IV. SPECIAL PROVISIONS
Contract Number KS 212
A. Assessment and Prioritization for Service Delivery for New Consumers:
The following are the criteria to prioritize new consumers for service delivery, It
is not the intent of the department to remove existing consumers from any
program in order to serve new consumers being assessed and prioritized for
service delivery,
1, Priority 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 community;
c) individuals in nursing homes which are closing or in receivership 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; or,
e) individuals who. have been assessed and are pending enrollment in
the Long Term Care Community Diversion Project.
2, Priority Criteria for Service Delivery for Other Assessed Individuals:
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 consumer assessment form
administered to each applicant. The most frail individuals not prioritized in
group one above, regardless of referral source, will receive services to the
extent funding is available,
8. Consumer Directed Care
The case management agency will fully support Florida's Consumer Directed
Care Research Project in the areas in which it is operational. The Medicaid
Waiver Specialist at the Alliance will ensure all eligible Home and Consumer
Based Services Waiver consumers are offered the opportunity to participate in
this project upon enrollment and reassessment.
6
07/01/01
Contract Number KS 212
ATTACHMENT II(A)
HOME AND COMMUNITY BASED WAIVER
REFERRAL AGREEMENT
This Referral Agreement, made this_day of , 2001 shall be in effect for the
period of to between , the Area Agency on
Aging for Planning and Service Area ; and , the Service Provider.
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 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 and
expansion of services.
C. To promote programs and activities designed to prevent the premature
institutionalization of elders and disabled adults.
D. To require the parties of this Agreement to provide technical assistance and
consultation to each other on matters pertaining to actual service delivery and
share appropriate assessment information and care plans so duplication may not
occur.
E. To establish an effective working relationship between the case management
agency that is responsible for the development of care plans and authorization of
services available under the waiver, the service provider that is responsible for
the direct provision of those services to consumers served under the waiver
program, and the Area Agency on Aging that is responsible for management and
oversight of the waiver program.
II. Under this Agreement, the Service provider agrees to the following:
A. To accept referrals for the 1915c Home and Community Based Service (HCBS)
Medicaid Waiver from the enrolled case management agency.
07/01/01
Contract Number KS 212
B. To provide quality service(s) to the waiver participant as specified in Section IV.
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 Elder Affairs.
C. To provide only those services specifically outlined in the Plan of Care and
authorized by the enrolled case management agency.
D. To attach documentation regarding the service provider's qualifications to this
agreement; and to provide, as requested, any information regarding Medicaid
Waiver billing, payment, or waiver participant information, to the case
management agency or 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 must be attached to the agreement.
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 and by maintaining all provider
qualifications as contained in the Aged and Disabled Adult Medicaid Waiver
under which services are provided.
H. To include its name and other appropriate information on a list of all enrolled
providers which will be shown to consumer during development of an
individualized plan of care, understanding that the consumer reserves the right at
all times to a choice of enrolled providers.
I. To immediately notify the case management agency of staffing shortfalls which
will negatively impact provision of service to Medicaid Waiver consumers.
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 void or adjustment claims no later than 45 days after the error has
been identified by either party. Any error not adjusted or voided within 45 days
may be adjusted or voided by the Area Agency on Aging. The provider's refusal
to adjust or void erroneous claims will result in termination of this agreement.
07/01/01
Contract Number KS 212
M. To develop and implement a policy to ensure that its employees, board members,
and management, will avoid any conflict of interest or the appearance of a conflict
of interest when disbursing or using the funds described in this agreement. A
conflict of interest includes, but is not limited to, receiving, or agreeing to receive,
a direct or indirect benefit, or anything of value from a service provider,
consumer, vendor, or any person wishing to benefit from the use or disbursement
of funds. To avoid a conflict of interest, the service provider must ensure that all
individuals make a disclosure to the 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 as well as the following manuals published by the Agency for Health Care
Administration: the Aged/Disabled Adult Waiver Guidelines and the Medicaid
Provider Reimbursement Handbook (Non-Institutional 081), including any and all
attachments or updates.
III. 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 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.
IV. Under this agreement, the following services will be delivered by the Service
provider in accordance with the plan of care or service authorization:
Service
Unit Rate
County/Region Served
A.
B.
C.
D.
E.
V. Termination
In the event this agreement is terminated, the case management agency and the service
provider agree to submit, at the time notice of intent to terminate is delivered, a plan
which identifies procedures to ensure services to consumers will not be interrupted or
suspended by the termination.
07/01/01
Contract Number KS 212
A. Termination at Will
This agreement may be terminated by any party upon no less than thirty (30)
calendar days notice, without cause, unless a lesser time is mutually agreed upon
by both parties, in writing. Said notice shall be delivered by certified mail, return
receipt requested, or in person with proof of delivery.
B. Termination Because of Lack of Funds
In the event funds to finance this agreement become unavailable, the area
agency may terminate this agreement upon no less than twenty-four (24) hours
notice in writing to the other party. Said notice shall be delivered by certified mail,
return receipt requested, or in person with proof of delivery. The area agency
shall be the final authority as to the availability of funds.
C. Termination for Breach
Unless a breach is waived by the area agency in writing, or the parties fail to cure
the breach within the time specified by the area agency, the area agency may, by
written notice to the parties, terminate the agreement upon no less than twenty-
four (24) hours notice. Said notice shall be delivered by certified mail, return
receipt requested, or in person with proof of delivery.
In witness whereof, the parties have caused this _ page agreement to be executed by
their undersigned officials as duly authorized.
Area Agency on Aging
Service provider
signature
signature
print name
print name
title
title
date
date
07/01/01
Contract Number KS 212
ATTACHMENT 11(8)
HOME AND COMMUNITY BASED WAIVER
CASE MANAGEMENT REFERRAL AGREEMENT
This Referral Agreement, made this _ day of ,2001 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 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 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.
E. To establish an effective working relationship between the case management
agency that is responsible for the development of care plans and authorization of
services available under the waiver, the service provider that is responsible for
the direct provision of those services to consumers served under the waiver
program, and the Area Agency on Aging that is responsible for management and
oversight of the waiver program.
II. Under this Agreement, the Area Agency on Aging agrees to the following:
A. To facilitate the enrollment of providers with the Medicaid Fiscal Agent.
B. To 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.
07/01/01
Contract Number KS 212
D. To monitor and project Provider expenditures to assure spending is maintained
within spending authority.
III. Under this Agreement, the Case Management Agency agrees to the following:
A. Assign qualified case managers as contained in the Aged and Disabled Adult
Medicaid Waiver to provide case management under the Medicaid Home and
Community Based Waiver for Aged and Disabled Adults.
B. Develop and implement the Plan of Care specifically outlining the service(s) to be
delivered which must be signed by the consumer.
C. Reevaluate the Plan of care at least every six months or more frequently if
changes in the consumers condition or the services being received have changed
significantly, and make changes to authorized services and/or service providers
as needed.
D. Adhere to the policies and procedures as outlined in the following manuals
published by the Agency for Health Care Administration: Aged and Disabled Adult
Waiver Guidelines and the Medicaid Provider Reimbursement Handbook (Non-
Institutional 081), including any and all attachments or updates.
E. Provide to the Area Agency on Aging a monthly summary of Aged and Disabled
Adult Medicaid Waiver expenditures billed and accrued.
F. Refer consumers to any qualified Service Provider as selected by the consumer.
G. Issue written service authorizations to the service provider with at least 24 hours
notice. The referral will contain at a minimum:
1. Name
2. Address (with directions if not easily accessible)
3. Pertinent information regarding consumer's health or disabilities and living
situation
4. Detailed service description including frequency, duration and specific tasks to
be performed
H. Evaluate quality of services and service documentation by the service provider.
I. 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.
J. Monitor service providers for adherence to authorized care plans and authorized
reimbursement rates.
K. 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
07/01/01
Contract Number KS 212
agreeing to receive, a direct or indirect benefit, or anything of value from a service
provider, consumer, vendor, or any person wishing to benefit from the use or
disbursement of funds. To avoid a conflict of interest, the case management
agency must ensure that all individuals make a disclosure to the 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.
L. To submit void or adjustment claims no later than 45 days after the error has been
identified by either party. Any error not adjusted or voided within 45 days may be
adjusted or voided by the Area Agency on Aging. The provider's refusal to adjust
or void erroneous claims will result in termination of this agreement.
IV. Under this agreement, the following services will be delivered by the Service
provider in accordance with the plan of care or service authorization:
Service
Unit Rate
County/Region Served
A.
B.
C.
D.
E.
V. Termination
In the event this agreement is terminated, the case management agency agrees to
submit, at the time notice of intent to terminate is delivered, a plan which identifies
procedures to ensure services to consumers will not be interrupted or suspended by the
termination.
A. Termination at Will
This agreement may be terminated by either party upon no less than thirty (30)
calendar days notice, without cause, unless a lesser time is mutually agreed upon
by both parties, in writing. Said notice shall be delivered by certified mail, return
receipt requested, or in person with proof of delivery.
B. Termination Because of Lack of Funds
In the event funds to finance this agreement become unavailable, the area agency
may terminate this agreement upon no less than twenty-four (24) hours notice in
writing to the other party. Said notice shall be delivered by certified mail, return
receipt requested, or in person with proof of delivery. The area agency shall be
the final authority as to the availability of funds.
07/01/01
Contract Number KS 212
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
signature
print name
print name
title
title
date
date
07/01/01
Contract Number KS 212
ATTACHMENT III(A)
ASSISTED LIVING FOR THE FRAIL ELDERLY MEDICAID WAIVER
REFERRAL AGREEMENT
This Referral Agreement, made this _day of
period of to , between
on Aging for Planning and Service 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 Aging. The purpose of this
agreement is to enable eligible elderly participants to receive Assisted Living for the Frail
Elderly Medicaid 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 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
,2001 shall be in effect for the
, the Area Agency
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 for the Frail
Elderly Medicaid Waiver services, would require nursing home placement.
D. All parties recognize that the consumer retains the right to assume risk, tempered
only by the individual's ability to assume responsibility for that risk.
E. All parties recognize that the consumer retains the right to choose which enrolled
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.
G. To establish an effective working relationship between the case management
agency that is responsible for the development of care plans and authorization of
services available under the waiver, the Assisted Living Facility that is responsible
for the direct provision of those services to consumers served under the waiver
program, and the Area Agency on Aging that is responsible for management and
oversight of the waiver program.
07/01/01
Contract Number KS 212
II. Under this Agreement, the Assisted Living Facility (ALF) Provider Agency agrees
to the following:
A. To receive referrals for the Assisted Living for the Frail Elderly Medicaid Waiver
from the enrol/ed case management agency.
B. To maintain required licensure status as follows:
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 aI/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 consumer'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 consumer'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 for
the Frail Elderly Medicaid Waiver resident files.
L. To adhere to all policies and procedures as outlined in the following manuals
published by the Agency for Health Care Administration: Assisted Living Waiver
07/01/01
Contract Number KS 212
Guidelines and the Medicaid Provider Reimbursement Handbook (Non-Institutional
081), including any and all attachments or updates.
M. To provide the Area Agency on Aging with a monthly summary of amounts billed to
the Medicaid Fiscal Agent for and accrued for Assisted Living for the Frail Elderly
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 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.
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, consumer, vendor, or any person wishing to benefit from the use or
disbursement of funds. To avoid a conflict of interest, the service provider must
ensure that all individuals make a disclosure to the 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 void or adjustment claims no later than 45 days after the error has been
identified. Errors not voided or adjusted within 45 days may be voided or adjusted
by the Area Agency on Aging. Refusal by the provider to adjust or void erroneous
billings will result in the termination of this agreement.
Under this Agreement, the Area Agency on Aging agrees to the following:
To facilitate the enrollment of providers with the Medicaid Fiscal Agent.
To provide technical assistance and training to ALFs and case management
agencies.
To provide on site monitoring of the ALF and case management agency.
To monitor and project Provider expenditures to assure spending is maintained
within spending authority.
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 for the Frail Elderly Medicaid Waiver.
IV. Termination
In the event this agreement is terminated, the case management agency and the service
provider agree to submit, at the time notice of intent to terminate is delivered, a plan
III.
A.
B.
C.
D.
E.
07/01/01
Contract Number KS 212
which identifies procedures to ensure services to consumers will not be interrupted or
suspended by the termination.
A. Termination at Will
This agreement may be terminated by either party upon no less than thirty (30)
calendar days notice, without cause, unless a lesser time is mutually agreed upon
by both parties. in writing. Said notice shall be delivered by certified mail, return
receipt requested, or in person with proof of delivery.
B. Termination Because of Lack of Funds
In the event funds to finance this agreement become unavailable, the area agency
may terminate this agreement upon no less than twenty-four (24) hours notice in
writing to the other party. Said notice shall be delivered by certified mail, return
receipt requested, or in person with proof of delivery. The area agency shall be
the final authority as to the availability of funds.
C. Termination for Breach
Unless a breach is waived by the area agency in writing, or the parties fail to cure
the breach within the time specified by the area agency, the area agency may, by
written notice to the parties, terminate the agreement upon no less than twenty-
four (24) hours notice. Said notice shall be delivered by certified mail, return
receipt requested, or in person with proof of delivery.
In witness whereof, the parties have caused this _ page agreement to be executed by
their undersigned officials as duly authorized.
Area Agency on Aging
Assisted Living Facility
signature
signature
print name
print name
lIt1e
title
date
date
07/01/01
Contract Number KS 212
ATTACHMENT III(B)
ASSISTED LIVING FOR THE FRAIL ELDERLY MEDICAID WAIVER
CASE MANAGEMENT REFERRAL AGREEMENT
This Referral Agreement, made this_ day of , 2001, 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 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.
J. 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.
E. To establish an effective working relationship between the case management
agency that is responsible for the development of care plans and authorization of
services available under the waiver, the Assisted Living Facility that is responsible
for the direct provision of those services to consumers served under the waiver
program, and the Area Agency on Aging that is responsible for management and
oversight of the waiver program.
II. Under this Agreement, the Area Agency on Aging agrees to the following:
A. To facilitate the enrollment of providers with the Medicaid Fiscal Agent.
B. To 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.
07/01/01
Contract Number KS 212
D. Monitor and project Provider expenditures to assure spending is maintained within
spending authority.
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 for the Frail Elderly Medicaid Waiver.
III.Under this Agreement, 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 for the Frail Elderly Medicaid
Waiver and meet the minimum qualifications as contained in the Assisted Living
for the Frail Elderly Medicaid Waiver. Case managers must complete such training
within six months of being assigned to the Assisted Living for the Frail Elderly
Medicaid Waiver.
B. Develop and implement the Plan of Care specifically outlining 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.
C. 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.
D. 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.
E. Review the Care Plan quarterly with the resident, his/her family if applicable, and
the ALF facility staff.
F. Provide the assisted living facility with a copy of the Comprehensive Resident
Assessment, any subsequent Reassessments and Plans of Care.
G. Adhere to the policies and procedures as outlined in the following manuals
published by the Agency for Health Care Administration: Assisted Living Medicaid
Waiver Guidelines and the Medicaid Provider Reimbursement Handbook (Non-
Institutional 081), including any and all attachments or updates.
H. Provide to the Area Agency on Aging a monthly summary of Assisted Living Case
Management expenditures billed and accrued.
I. Provide consumers with a list of all qualified Service providers.
J. 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