Item C28
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Louis LaTorre, Senior Director
Social Services/tab
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
MEETING DATE: 10/16-17/02
DIVISION: COMMUNITY SERVICES
BULK ITEM:
YES X
NO
DEP ARTMENT: SOCIAL SERVICES
AGENDA ITEM WORDING: Approval for Monroe County Board of County Commissioners Mayor Charles
McCoy, to sign the Memorandum of Agreement for CARES Referrals between the Alliance For Aging, Area
Agency On Aging, United Home Care Services Inc., Douglas Gardens Community Care, First Quality Home
Care, the Community Care the Elderly Lead Agencies for Miami-Dade County, Monroe County Social Services,
the Community Care the the Elderly Lead Agency for Monroe County, and the Department of Elder Affairs-
CARES.
ITEM BACKGROUND: The approval for the Mayor to sign the attached document will promote the
development of a coordinated service delivery system to meet the needs of consumers who are referred by
CARES.
PREVIOUS RELEVANT BOCC ACTION: None
CONTRACT/AGREEMENT CHANGES: N/A
STA~'~' ~COMM.ENDATION: Approval
TOTAL COST: N/A BUDGETED: YES_ NO
COST TO COUNTY: N/A
REVENUE PRODUCING: YES
NO_ AMT.PER MONTH
YEAR
APPROVED BY:
COUNTY ATTY.l OMB/Purchasing l RISK MANAGEMENT -X
I
J
J
;/
DIVISION DIRECTOR APPROVAL:
DOCUMENTATION:
INCLUDED
~
TO FOLLOW
NOT REQUIRED_
DISPOSITION:
AGENDA ITEM#:
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Revised 2/27/0 J
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
CONTRACT SUMMARY
Contract with: See Below. Contract
Effective Date: July], 200.3-
Expiration Date: June 30, 2001'
Contract Purpose/Description: Approval for Monroe County Board of County Commissioners Mayor Charles
McCoy, to sign the Memorandum of Agreement for CARES Referrals between the Alliance For Aging, Area
Agency on Aging, United Home Care Services, Inc., Douglas Gardens Community Care, First Quality Home
Care, the Community Care for the Elderly Lead Agencies for Miami-Dade County, Monroe County Social
Services, the Community Care for the Elderly Lead Agency for Monroe County, and the Department of Elder
Affairs - CARES.
Contract Manager:
Louis La Torre
(Name)
For BOCC meeting on 10/16-17/02
4573
(Ext. )
Social Services/Stop]
(Department/Stop #)
Agenda Deadline:
] 0/02/2002
CONTRACT COSTS
Total Dollar Value of Contract:
Budgeted? Yes [J No 0
Grant: $ -0-
County Match: $ -0-
$-0-0
Account Codes:
Current Year Portion: $
Estimated Ongoing Costs: $
(Not included in dollar value above)
/yr
ADDITIONAL COSTS
For:
(eg. Maintenance. utilities, janitorial, salaries. etc)
CONTRACT REVIEW
Changes
Date In Needed ~"
Division Director t / (,3/~~ z.. Yes D No .
Risk Management ~ "J, ~;Dd-- Yes D Noc/
O.M.B./Purchasing '1\3~\UL Yes C NoV
County Attorney tf/~510~ Yes 0 No~
Comments:
OMB Form Revised 2/27/01 MCP #2
'~
Date Out
Cf/ZJjc'L-
AREA AGENCY ON AGING
DEPARTMENT OF ELDER AFFAIRS - CARES
COMMUNITY CARE FOR THE ELDERLY LEAD AGENCIES
MEMORANDUM OF AGREEMENT FOR CARES REFERRALS
This Memorandum of Agreement, made this 30th day of June, 2002, shall be in effect July 1,
2002, through June 30,2003, between the Alliance for Aging, the Area Agency on Aging for
Planning and Seryice - Area 11, United Home Care Services, Inc:, Douglas Gardens Community
Care, First Quality Horne Care, the Community Care for the Elderly Lead Agencies for Miami-
Dade County, Monroe County Social Services, the Community Care for the Elderly Lead Agency
for Monroe County, and the Department of Elder Affairs - CARES. The purpose of this
agreement is to promote the development of a coordinated service delivery system to meet the
needs of consumers who are referred by CARES.
This document was used to formulate the following prerequisites:
I. Objectives -
A. To maintain a climate of cooperation between agencies in order to achieve
equitable delivery of services to frail and vulnerable elder Floridians.
B. To promote services and activities designed to serve clients in imminent risk of
nursing home placement and clients leaving the hospital or nursing home to
remain in the community.
C. To participate together by means of shared information in the development and
expansion of services.
D. To provide technical assistance and consultation to each other on matters
pertaining to actual service delivery and to share appropriate assessment
information and care plans.
II. Definitions-
A. Imminent Risk: Persons in the following categories, when identified or
referred by CARES, will be designated Imminent Risk: existing Medicaid
residents in nursing homes who can return to a community setting with services;
elderly individuals in nursing homes whose Medicare coverage is expiring who
can return to the community with services; elderly in nursing homes that are
closing and can be discharged to the community with services; elderly whose
mental or physical health condition has deteriorated to the degree that self care
is not possible, there is no capable caregiver and institutional placement will
occur within 72 hours; elderly assessed as appropriate and pending enrollment in
the Long Tern Care Community Diversion Project.
B. Upstreaming: A statewide program which outposts CARES staff in hospitals to
assess and identify elderly patients who are at risk on nursing home admission.
The purpose of the program is to successfully divert elderly patients from
nursing home care by linking them with home and community-based services,
whether they are publicly or privately funded.
1
C. Nursing Home Transition: Identifying and moving existing Medicaid
nursing home residents who's needs can be met safely in an Assisted
Living facility that participates in the Medicaid Waiver program.
III. Under this Agreement, the Service Provider Agency, the Department of Elder
Affairs and Area Agency on Aging agree to the following:
A. Referral Process:
1. CARES will provide choice counseling to the consumers explaining the
different programs.
"2. If a consumer chooses a program other than Community Care for the
Elderly,'Home and Community-Based Services/Aged and Disabled Adult
Medicaid Waiver, the Assisted Living Medicaid Waiver or the Consumer
Directed Care Waiver (e.g.: Channeling, PACE, Eldercare), CARES will
have the consumer sign a form indicating their choice and will make the
necessary referrals.
3. If a consumer chooses Community Care for the Elderly, Home and
Community-Based Services/Aged and Disabled Adult Medicaid Waiver,
the Assisted Living Medicaid Waiver or the Consumer Directed Care
Waiver, CARES wi1l have the consumer sign a form indicating their
choice and will refer the consumer to the Elder Helpline.
a) CARES will send the completed fax cover sheet that includes
the name and Social Security number of the client, Medicaid
number, the reason for the referral and service recommend-
ations to the Elder Helpline.
b) CARES will send the following documents along with the fax
cover sheet to the Elder Helpline: the Comprehensive
Assessment, the physician Form 3008, the informed consent
sheet, Form 603 indicating the client's level of care with a note
in the comment section that the client also meets the Medicaid
Waiver eligibility requirements, and Form 608, indicating the
consumer's choice of programs.
4. If a consumer is an Imminent Risk referral, the Elder Helpline will
prioritize this referral. Contingent on funding availability, the Elder
Helpline will offer the consumer the choice of three Dade County
Community Care for the Elderly Lead Agencies or the Monroe County
Lead Agency. Standard operating procedures for processing referrals will
be followed.
a) After offering consumer choice, the Elder Helpline will send
the same fax cover sheet and forward the attachments to the
selected Lead Agency.
b) The Lead Agency will complete the bottom portion of the fax
cover sheet and return it to the Elder Helpline. The Lead
Agency will indicate the services started and what services
were authorized.
c) The Elder Helpline will fax a copy of the returned cover sheet
to CARES. This is only to serve as feedback to CARES; this is
not to receive CARES approval. Lead Agencies will respond to
CARES referrals within one (1) week.
2
5. If a consumer is not an Imminent Risk referral and is an Upsteaming or
Nursing Home Diversion referral and funding is available, the Elder
Helpline will follow the standard operating procedures for processing
referrals.
a) After offering consumer choice, the Elder Helpline will send
the same fax cover sheet and forward the attachments to the
selected Lead Agency.
b) The Lead Agency will complete the bottom portion of the fax
cover sheet and return it to the Elder Helpline. The Lead
Agency will indicate the date services started and what
services were authorized.
c) The Elder Helpline will fax a copy of the returned cover sheet
to CARES. This is only to serve as feedback to CARES; this
is not to receive CARES approval. Lead Agencies will
respond to CARES referrals within one (1) week.
6. If a consumer is not an Imminent Risk referral and is an Upstreaming or
Nursing Home Transition referral and funding is not available, the Elder
Helpline will place the consumer on the waiting list and make referrals to
other agencies and programs. The Elder Helpline will then notify
CARES.
7. CARES will send copies of the Imminent Risk referral logs to the Lead
Agencies and the Alliance for Aging to review and reconcile any
discrepancies prior to forwarding the logs to DOEA.
8. If the Lead Agency conducts an assessment and the client refuses
services, the Lead Agency should open the case and close it the next day
in CIRTS (termination code is client refused co-payor client placed in
nursing home after case management had already started, etc.) CARES
will enter the client on the referral log. The Lead Agency will enter the
information CARES completed on the 701A form into CIRTS.
9. If a referred client dies before an assessment is conducted by the Lead
Agency, CARES will not place the client on the referral log and the Lead
Agency will not enter the client in CIRTS.
B. Basic Understandings
1. New Consumers: A 3008 form is valid for up to one (I) year, unless
there is some medical change, upon which a new 3008 form may be
requested. A need for a new 3008 form would be determined by a
CARES physician or supervisor and would be done on an exception
basis. The case management agency should attach a brief narrative
addressing any changes related to the client's health.
2. Reassessments: For currently active consumers, there is no expiration
date for 3008 forms, if reassessments by the Lead Agencies are done and
submitted to CARES in a timely manner (for example: between the 11th
and the 13th month on the Level of CARE expiration date). Iflater than
that, CARES will request a new 3008 form prior to issuing a new Level
of Care.
3. In cases where the expiration date of the assessment does not coincide
with the expiration date of the Level of Care, the renewal request will be
made between the 11th and the 13th month of the Level of Care expiration
date. The case manager will include a note indicating whether there have
..,
.)
been any changes in the consumer's health condition and that the
assessment information has been updated.
4. Since consumers must have a Level of Care in order to be on the Assisted
Living Medicaid Waiver waiting list, CARES wi\1 issue Levels of Care to
consumers on the waiting list, regardless if those consumers are active or
wait listed for other programs.
5. A Level of Care may be shared among the Lead Agencies as long as the
client remains in the same funding program. If the client changes funding
programs, a new Level of Care would need to be reissued.
6. CARES is permitted by Medicaid rules to issue Levels of Care retroactive
for up to ninety (90) days prior to the date of application for waiver
services, providing that the condition of the client is certified and dated
by the private physician as qualifying for Medicaid Waiver services. This
criteria applies to all provider agencies participating in Medicaid Waiver
programs.
7. Copies of the 3008 forms will be accepted by CARES.
8. When a CARES referred consumer becomes active in a program, the
Elder Helpline will fax a copy of the referral form to CARES. If a
CARES referred consumer changes case management agency, the Elder
Helpline will fax a copy of the transfer form to CARES.
ALLIANCE FOR AGING, INe.
DEPARTMENT OF ELDER AFFAIRS - CARES
Signature
Signature
Title
Title
Date
Date
ES, INC.
Title
cer-u
if t7JL
Date
Date
~T :-7t~ME CARE
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MONROE OOUNTY SOCIAL SERVICES
Signat,u1e
M<iljf.(:n:: - M<...nrl""'le r'Ol1nt-y 'R1""'l.=trr1 of
T~~ C;unty Commissioners
~ -~,.
Date
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