Item C30
~~~
Louis LaTorre, Senior Director
Social Services/dra
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
MEETING DATE: 6-18-2003
DIVISION: COMMUNITY SERVICES
BULK ITEM:
YES X
NO
DEPARTMENT: SOCIAL SERVICES
AGENDA ITEM WORDING: Approval of Renewal of Alzheimer's Disease Initiative (ADI) Contract
between the Alliance for Aging, Inc. and the Monroe County Board of County Commissioners (Monroe County
Social Services/In-Home Services Program) for Fiscal Year July 1,2003 through June 30,2004.
ITEM BACKGROUND: The approval of the ADI Contract will enable Monroe County In-Home Services
to continue providing Respite services to Monroe County's elderly population under the Alzheimer's Disease
Initiative (ADI) program.
PREVIOUS RELEVANT BOCC ACTION:
June 2002
N/A
CONTRACT/AGREEMENT CHANGES:
STAF.F RECOMMENDATION: Approval
REVENUE PRODUCING: YES X NO_
BUDGETED: YES X NO
SOURCE OF FUNDS: ADI Contact
For fiscal year 7/2003 thru 6/2004 for
For $65,888.00
AMT.PER MONTH_$50.00_YEARJ600.00
TOTAL COST: $65,888.00
COST TO COUNTY: $ -0-
APPROVED BY: COUNTY ATTY.~ OMB/(~aSing~ RI~:~7EMENT -X
DIVISION DIRECTOR APPROVAL: / r-Y
DOCUMENT A TION:
INCLUDED_
TO FOLLOW _X_NOT REQUIRED_
AGENDA ITEM#: CJ()
DISPOSITION:
Revised 1/03
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
CONTRACT SUMMARY
Contract with: Alliance For Aging, Inc. Contract
Effective Date: July I, 2003
Expiration Date: June 30, 2004-
Contract Purpose/Description: Approval of the Renewal of the Alzheimer's Disease Initiative (ADI) Contract
between the Alliance for Aging, Inc. and the Monroe County Board of County Commissioners (Monroe County
Social Services/In-Home Services Program) for Fiscal year July 1,2003 through June 30, 2004.
For BOCC meeting on
Deloris S~.~ so .
(Name) ~~
6/18/2003
4589
(Ext.)
Social Services/Stop I
(Department/Stop #)
Contract Manager:
Agenda Deadline:
6/3/2003
CONTRACT COSTS
Total Dollar Value of Contract:
Budgeted? Yes X No 0
Grant: $ 65,888.00
County Match: $ -0-
$65,888.00
Account Codes:
Current Year Portion: $
Estimated Ongoing Costs: $
(Not included in dollar value above)
/yr
ADDITIONAL COSTS
For:
(e.g. Maintenance, utilities, janitorial, salaries, etc)
CONTRACT REVIEW
Date In
Division Director t,,\ \~\ 03
Risk Management to /;3/63
O.M.BJPu,chas;ng (0113)03
County Attorney
Changes
Needed
YesD No~
Date Out
Yes 0 No [jJ./'
~1~\1).3
(lr3lc)
~
YesD No~
Yes 0 No 0
Comments:
OMB Form Revised 2/27/01 MCP #2
AGENDA ITEM WITH LATE DOCUMENTATION
DIVISION:
Community Services
DEPARTMENT: Social Services/In-Home Services Program
SUBJECT: Approval of the Renewal for the Alzheimer's Disease
Initiative (AD I) Contract for Fiscal Year 7/1/03 through 6/30/04.
DATE ITEM WILL BE AVAILABLE: 6-13-2003
AGENDA ITEM NUMBER
07/01/2003
Contract Number KZ 397
ALZHElMERS' DISEASE INITIATIVE CONTRACT
2003-2004
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. PA329, 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. Requirements of Section 287.058, Florida Statutes:
These requirements are herein incorporated by reference.
I. Final Request for Payment:
I. The recipient must submit the final request for payment to the Alliance no later
than September 15, 2004; if the recipient fails to do so, all right to payment is
forfeited, and the Alliance will not honor any requests submitted after the
aforesaid time period.
II. If the contract is terminated prior to the contract end date of September 15,
2004, then the recipient must submit the final request for payment to the Alliance no
more than 45 days after the contract is terminated; if the recipient fails to do so,
all right to payment is forfeited, and the Alliance will not honor any requests
submitted after the aforesaid time period.
II. The Alliance Agrees:
Contract Amount:
To pay for contracted services according to the conditions of Attachment I in an amount
not to exceed $65,888.00, 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. The costs of services paid under any other contract or from any other source
are not eligible for reimbursement under this contract. The funds awarded to the recipient
pursuant to this contract are in the state grants and aids appropriations and consists of the
following:
07/01/2003
Contract Number KZ 397
Program Title Year Funding Source CSFA# Fund Amounts
ADI - Respite Services 2003 General Revenue 65004 $65,888.00
ADI - Model Dav Care 2003 General Revenue 65002 $0.00
ADI - Alzheimer Special Projects 2003 General Revenue 65002 $0.00
TOTAL FUNDS CONTAINED IN THIS CONTRACT: $65,888.00
III. Recipient and Alliance Mutually Agree:
A. Effective Date:
1. This contract shall begin on July 1, 2003 or on the date the contract has been
signed by both parties, whichever is later.
2. Delivery of services shall end on June 30, 2004. This contract shall end on
September 30, 2004. See Attachment I, Section III.D.
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.
A. 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 sub-
recipients in accordance with all applicable federal and state laws.
D. Notice, Contact, and Payee Information:
A. 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 contract is:
Louis LaTorre
Gato Building - 1100 Simonton Street
Key West, Florida 33040
(305) 292-4573
2
Contract Number KZ 397
07/01/2003
3. In the event different representatives are designated by either party after execution
of this contract, notice of the name and address of the new representative will be
rendered in writing to the other party and said notification attached to originals of
this contract.
4. The name (recipient name as shown on page 1 of this contract) and mailing
address of the official payee to whom the payment shall be made:
Monroe County Board of Commissioners
Gato Building - 1100 Simonton Street
Key West, Florida 33040
IN WITNESS THEREOF, the parties hereto have caused this 10-page contract to be executed
by their undersigned officials as duly authorized.
PROVIDER:
MONROE COUNTY BOARD
OF COMMISSIONERS
ALLIANCE FOR AGING, INC.
FOR DADE & MONROE COUNTIES
SIGNED BY:
SIGNED BY:
NAME:
NAME:
Steven Weisberg, M. S.
TITLE:
TITLE:
President & CEO
DATE:
DATE:
FEDERAL 10 NUMBER:
PROVIDER FISCAL YEAR ENDING DATE:
59-6000749
09/30
i
3
07/01/2003
Contract Number KZ 397
ATTACHMENT I
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
I. STATEMENT OF PURPOSE
The Alzheimer's Disease Initiative (ADI) Program is focused on caring for persons 18 + with
memory disorders.
II. SERVICES TO BE PROVIDED
A. Services:
1. The recipient's service provider application for state fiscal year 2003 and any
revisions thereto approved by the Alliance and located in the contract manager's
file, are incorporated by reference in this contract between the Alliance and the
recipient, and prescribe the services to be rendered by the recipient.
2. Consumers may not be enrolled in a Department of Elder Affairs' state general
revenue funded program, including ADI, who are also enrolled in a Medicaid
capitated long-term care health plan or program. These programs include the Frail
Elder Program operated by United Health Care, the Channeling Program operated
by Miami Jewish Home and Hospital for the Aged, the Long Term Care Community
Diversion Program operating in Planning and Service Areas 7 and 9, and the
Program of All Inclusive Care for the Elderly (PACE) program scheduled to begin
operation in the Miami-Dade County area.
B. Manner of Service Provision:
The services will be provided in a manner consistent with and described in the
recipient's service provider application for state fiscal year 2003 and the
Department of Elder Affairs Home and Community Based Services Handbook
dated 01/03. In the event the manual is revised, such revision will automatically be
incorporated into the contract and the recipient will be given a copy of the revisions.
III. METHOD OF PAYMENT
A. The method of payment in this contract is based on a fixed rate reimbursement for
approved services. The recipient must ensure fixed rates include only those costs
which are in accordance with all applicable state and federal statutes and regulations
and are based on audited historical costs in instances where an independent audit is
required. All requests for payment and expenditure reports submitted to support
requests for payment shall be on DOEA forms 106Z and 105Z. Duplication or
replication of both forms via data processing equipment is permissible, provided all
data elements are in the same format as included on departmental forms.
B. The recipient shall maintain documentation to support payment requests which shall
be available to the Comptroller, the Department of Elder Affairs, or the Alliance upon
request.
4
07/01/2003
Contract Number KZ 397
The recipient shall maintain documentation to support payment requests which shall be:
C. The recipient may request a monthly advance for service costs for each of the first
two months of the contract period, based on anticipated cash needs. Detailed
documentation justifying cash needs for advances must be submitted with the
signed contract, approved by the Alliance, and maintained in the contract
manager's file. All payment requests for the third through the twelfth months shall
be based on the submission of monthly actual expenditure reports beginning with
the first month of the contract. The schedule for submission of advance requests is
ATTACHMENT II to this contract. Reconciliation and recouping of advances made
under this contract are to be completed by the time the final payment is made. All
advance payments are subject to the availability of funds.
D, Advance funds may be temporarily invested by the recipient in an insured interest
bearing account. All interest earned on contract fund advances must be returned to
the Alliance at the end of the first quarter of the contract period.
E. The Alliance shall make payment to the provider for provision of services up
to a maximum number of units of service and at the rate(s) stated below:
Service Unit of Unit Rate Maximum Maximum
to be Service Units Dollars
Provided
Respite /In-Home 1 hour $26.610662 2,476 $65,888
F. Contract Amendments:
1. The recipient agrees to implement the distribution of funds as detailed in the
service provider application and the Budget Summary, ATTACHMENT III to this
contract. Any changes in the amounts of the funds identified on the Budget
Summary form require a contract amendment.
2. With the exception of Case Management, the recipient agrees to implement a
Modified Spending Authority. Recipient is to offer services based on clients'
service plans and will not be restricted to providing the services as projected.
Additional budget revisions/contract amendments will not be required to move
funding among these services, with the exception of Case Management. Any
changes in the total amount of the funds under contract require a formal
contract amendment.
3. This contract is for services provided during the 2003/2004 State Fiscal year
beginning July 1, 2003 through June 30, 2004, however, the contract is in effect
through September 30, 2004 in order to provide for maximization of resources
and to allow for greater flexibility to pay for the services rendered by June 30,
2004 Services provided after June 30, 2004 cannot be reimbursed under this
contract.
5
07/01/2003
Contract Number KZ 397
4. The recipient will submit a draft closeout report by August 15, 2004. Any
contract amendments after August 15, 2004 determined necessary by the
Alliance will be based on the draft closeout reports.
5. The final expenditure report and request for payment will be due to the Alliance
no later than September 15, 2004. No expenditure reports or requests for
payment will be accepted after September 15, 2004.
G. Any payment due by the Alliance under the terms of this contract may be withheld
pending the receipt and approval by the Alliance of all financial and programmatic
reports due from the recipient and any adjustments thereto, including any
disallowance not resolved as outlined in Section I.T. of the Master Agreement.
IV. SPECIAL PROVISIONS
A. State Laws and Regulations:
The recipient agrees to comply with applicable parts of Rule 580-1, Florida
Administrative Code promulgated for administration of Sections 430.501 through
430.504, Florida Statutes, and the Department of Elder Affairs Client Services
Manual dated 12/98.
B. 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 of Elder Affairs to remove existing clients from any
program in order to serve new clients being assessed and prioritized for service
delivery.
1. Priority Criteria for Service Delivery:
1. individuals in nursing homes under Medicaid who could be transferred to
the community;
2. individuals in nursing homes whose Medicare coverage is exhausted
and may be diverted to the community;
3. individuals in nursing homes which are closing or in receivership and can
be discharged to the community; or
4. 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.
2. Priority Criteria 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 the group above,
regardless of referral source, will receive services to the extent funding is
available.
6
07/01/2003
Contract Number KZ 397
C. Co-payment Collections:
1. The recipient will establish annual co-payment goals. The Alliance also has the option
to withhold a portion of the recipient's Request for Payment if goals are not met
according to the Department of Elder Affairs' co-payment guidelines.
2. Co-payments include only the amounts assessed consumers or the amounts consumers
opt to contribute in lieu of an assessed co-payment. The contribution must be equal to
or greater than the assessed co-payment.
D. Evaluation, Statistics and Reports
The recipient agrees to respond to requests for evaluation information and statistical data
concerning its consumers based on information requirements of the Memory Disorder
Clinics and Brain Bank. The recipient will ensure Model Day Care Centers supported by
this contract develop innovative therapies and interventions which can be shared with other
Alzheimer's Disease Initiative health and social services personnel via training. Model Day
Care Centers supported by this contract must report to the provider all training activities
provided to health care and social service personnel and caregivers, as well as serve as a
natural laboratory for service related applied research by Memory Disorder Clinics. An
annual Model Day Care Center Training Report, ATTACHMENT IV, is due by July 5, 2004.
E. Collaboration with Memory Disorder Clinics:
Memory Disorder Clinics are required to provide four hours of in-service training to all
respite and model day care centers in their designated service areas. The recipient agrees
to collaborate with Memory Disorder Clinics to assist in this effort.
F. Service Cost Reports:
The recipient will submit semi-annual service cost reports which reflect actual costs of
providing each service by program. This report provides information for planning and
negotiating unit rates.
7
07/01/2003
Report
Number
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Leqend:
Note # 1 :
Note # 2:
Contract Number KZ 397
ATTACHMENT II
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
CONTRACT REPORT CALENDAR
Based On
July Advance * ...............................................................
August Advance * ...........................................................
July Expenditure Report....................................................
August Expenditure Report...... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
September Expenditure Report... ... ... ... ... ...... ... ...... ......... ....
October Expenditure Report...... ... ... ... ... ... ... ... ... ... ... ... ... ... ..
November Expenditure Report ......... ......... ......... ...... ...........
December Expenditure Report............................................
January Expenditure Report... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ..
February Expenditure Report... ... ... ... ... ... ......... ... ......... .......
March Expenditure Report... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ..
April Expenditure Report......... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .
May Expenditure Report/July Advance Reconciliation ** ...........
June Expenditure Report/August Advance Reconciliation ** ......
Draft Closeout Report... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ..
Final Expenditure and Request for Payment Report... ... ... ... ... ..
Closeout Report... ... ... ... ... ... ... ... ... '" '" ... ... ... ... ... ... ... ... ... ...
*
Advance based on projected cash need.
Submit
to the Alliance
on This Date
July 1
July 1
August 10
September 10
October 10
November 10
December 10
January 10
February 10
March 10
April 10
May 10
June 10
July 10
August 15
September 15
September 15
Submission of expenditure reports mayor may not generate a payment
request. If final expenditure report reflects funds due back to the Alliance,
payment is to accompany the report.
**
Report #1 for Advance Basis Contracts cannot be submitted to the Alliance pnor
to July 1 or until the contract with the Alliance has been executed. Actual
submission of the vouchers to the Department of Elder Affairs is dependent on
the accuracy of the expenditure report.
The last two months of the recipient's fiscal reports covering actual expenditures
should reflect an adjustment repaying advances for the first two months of the
contract.
8
07/01/2003
Contract Number KZ 397
ATTACHMENT IV
ANNUAL MODEL DAY CARE CENTER TRAINING REPORT
Model Day Care Center Name:
Printed Name of Person
Completing Report
Signature of Person
Completing Report
Date Executed
The purpose of each model day care program must be to provide service delivery to persons
suffering from Alzheimer's disease or a related memory disorder and training for health care
and social service personnel in the care of persons having Alzheimer's disease or related
memory disorders. This report documents the required training for the State Fiscal Year July
1 st through June 30th.
Number Number Total
Actual Training Event(s) Health Care Social People
Professionals Services Trained
Trained Personnel
Trained
Training Title:
Date:
Training Summary:
* * * * * *
10
Mooroe~~i~~
07/01/2002
Contract Number KZ 297
ALZHEIMERS' DISEASE INITIATIVE CONTRACT
2002-2003
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. PP329, 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. Requirements of Section 287.058, Florida Statutes:
These requirements are herein incorporated by reference.
C. Final Request for Payment:
1. The recipient must submit the final request for payment to the Alliance no later than
September 15, 2003; if the recipient fails to do so, all right to payment is
forfeited, and the Alliance will not honor any requests submitted after the
aforesaid time period.
2. If the contract is terminated prior to the contract end date of September 15, 2003,
then the recipient must submit the final request for payment to the Alliance no more
than 45 days after the contract is terminated; if the recipient fails to doso, all
right to payment is forfeited, and the Alliance will not honor any requests
submitted after the aforesaid time period.
II. The Alliance Agrees:
Contract Amount:
To pay for contracted services according to the conditions of Attachment I in an amount
not to exceed $65,888.00, 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. The costs of services paid under any other contract or from any other source
are not eligible for reimbursement under this contract. The funds awarded to the recipient
pursuant to this contract are in the state grants and aids appropriations and consists of the
following:
1
07/01/2002
Contract Number KZ 297
Program Title Year Funding Source CSFA#, Fund
Amounts
ADI - Respite 2002 General Revenue 65004 $65,888.00
Services
ADI - Model Day 2002 General Revenue 65002 $0.00
Care
ADI - Alzheimer 2002 General Revenue 65002 $0.00
Special Projects
TOTAL FUNDS CONTAINED IN THIS CONTRACT: $65,888.00
III. Recipient and Alliance Mutually Agree:
A. Effective Date:
1. This contract shall begin on July 1, 2002 or on the date the contract has been
signed by both parties, whichever is later.
2. Delivery of services shall end on June 30, 2003. This contract shall end on
September 30, 2003. See Attachment I, Section 111.0.
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
07/01/2002
Contract Number KZ 297
2. The name, address, and telephone number of the representative of the recipient
responsible for administration of the program under this contract is:
Louis LaTorre
Gato Building - 1100 Simonton Street
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.
4. The name (recipient name as shown on page 1 of this contract) and mailing
address of the official payee to whom the payment shall be made:
Monroe County Board of Commissioners
Gato Building - 1100 Simonton Street
Key West, Florida 33040
3
07/01/2002
Contract Number KZ 297
IN WITNESS THEREOF, the parties hereto have caused this 11 page contra(:t 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
SIGNED
BY:
NAME: C/1C<.v/e.S -S''')''''!' M'-C."'I
. ,
\....!.,t" ,i
S I G N E ~--- :;____ I. ::;_~
BY: ~----1-.:/' '^-- LI\.,.../-v~
-./ )
NAME: STEVEN WEISBERG, M.S.
TITLE: PRESIDENT/CEO
TITLE:
f0""-Jvv
/
7ft
i 7 z..." 2-
DATE:
r I ~/ ~ ~
v .
DATE:
FEDERAL 10 NUMBER:
RECIPIENT FISCAL YEAR END DATE:
59-6000749
09/30
<; '7/. _
- . ' ~"NYj t ;H;J!U ON
DATE ~-//-of~
<SEALl ~
.~~L _ ClERK 'C
DEPUTY'ClERK
4
07/01/2002
Contract Number KZ 297
ATTACHMENT I
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
I. STATEMENT OF PURPOSE
The Alzheimer's Disease Initiative (ADI) Program is focused on caring for persons 18 + with
memory disorders.
II. SERVICES TO BE PROVIDED
A. Services:
1. The recipient's service provider application for state fiscal year 2002, and any
revisions thereto approved by the Alliance and located in the contract manager's
file, are incorporated by reference in this contract between the Alliance and the
recipient, and prescribe the services to be rendered by the recipient.
2. Consumers may not be enrolled in a Department of Elder Affairs' state general
revenue funded program, including ADI, who are also enrolled in a Medicaid
capitated long term care health plan or program. These programs include the Frail
Elder Program operated by United Health Care, the Channeling Program operated
by Miami Jewish Home and Hospital for the Aged, the Long Term Care Community
Diversion Program operating in Planning and Service Areas 7 and 9, and the
Program of All Inclusive Care for the Elderly (PACE) program scheduled to begin
operation in the Miami-Dade County area.
B. Manner of Service Provision:
The services will be provided in a manner consistent with and described in the
recipient's service provider application for state fiscal year 2002 and the Department of
Elder Affairs Client Services Manual dated 12/98. In the event the manual is revised,
such revision will automatically be incorporated into the contract and the recipient will
be given a copy of the revisions.
III. METHOD OF PAYMENT
A. The method of payment in this contract is based on a fixed rate reimbursement for
approved services. The recipient must ensure fixed rates include only those costs
which are in accordance with all applicable state and federal statutes and regulations
and are based on audited historical costs in instances where an independent audit is
required. All requests for payment and expenditure reports submitted to support
requests for payment shall be on DOEA forms 106Z and 105Z. Duplication or
replication of both forms via data processing equipment is permissible, provided all
data elements are in the same format as included on departmental forms.
B. The recipient shall maintain documentation to support payment requests which shall be
5
07/01/2002
Contract Number KZ 297
available to the Comptroller, the Department of Elder Affairs, or the Alliance upon
request.
C. The recipient may request a monthly advance for service costs for each of the first two
months of the contract period, based on anticipated cash needs. Detailed
documentation justifying cash needs for advances must be submitted with the signed
contract, approved by the Alliance, and maintained in the contract manager's file. All
payment requests for the third through the twelfth months shall be based on the
submission of monthly actual expenditure reports beginning with the first month of the
contract. The schedule for submission of advance requests is ATTACHMENT II to this
contract. Reconciliation and recouping of advances made under this contract are to be
completed by the time the final payment is made. All advance payments are subject to
the availability of funds.
D. Advance funds may be temporarily invested by the recipient in an insured interest
bearing account. All interest earned on contract fund advances must be returned to the
Alliance at the end of the first quarter of the contract period.
E. The Alliance shall make payment to the provider for provision of services up to a
maximum number of units of service and at the rate(s) stated below:
Service to be
Provided
Unit of
Service
Unit
Rate
Maximum
Units
Maximum
Dollars
Respite/In-Home
1 client hour $28.955394
2,275.50
$65,888
F. Contract Amendments:
1. The recipient agrees to implement the distribution of funds as detailed in the service
provider application and the Budget Summary, ATTACHMENT III to this contract.
Any changes in the amounts of the funds identified on the Budget Summary form
require a contract amendment.
2. With the exception of Case Management, the recipient agrees to implement a
Modified Spending Authority. Recipient is to offer services based on clients' service
plans and will not be restricted to providing the services as projected. Additional
budget revisions/contract amendments will not be required to move funding among
these services, with the exception of Case Management. Any changes in the total
amount of the funds under contract require a formal contract amendment.
3. This contract is for services provided during the 2002/2003 State Fiscal year
beginning July 1, 2002 through June 30, 2003, however, the contract is in effect
through September 30, 2003 in order to provide for maximization of resources and
to allow for greater flexibility to pay for the services rendered by June 30, 2003.
Services provided after June 30, 2003 cannot be reimbursed under this contract.
6
07/01/2002
Contract Number KZ 297
4. The recipient will submit a draft closeout report by August 15, 2003. Any contract
amendments after August 15, 2003 determined necessary by the Alliance will be
based on the draft closeout reports. .
5. The final expenditure report and request for payment will be due to the Alliance no
later than September 15, 2003. No expenditure reports or requests for payment will
be accepted after September 15, 2003.
G. Any payment due by the Alliance under the terms of this contract may be withheld
pending the receipt and approval by the Alliance of all financial and programmatic
reports due from the recipient and any adjustments thereto, including any disallowance
not resolved as outlined in Section I.T. of the Master Agreement.
IV. SPECIAL PROVISIONS
A. State Laws and Regulations:
The recipient agrees to comply with applicable parts of Rule 580-1, Florida
Administrative Code promulgated for administration of Sections 430.501 through
430.504, Florida Statutes, and the Department of Elder Affairs Client Services Manual
dated 12/98.
B. 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 of Elder Affairs to remove existing clients from any
program in order to serve new clients 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; or
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.
2. Priority Criteria 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 the group above, regardless of
7
07/01/2002
Contract Number KZ 297
referral source, will receive services to the extent funding is available.
C. Co-payment Collections:
1. The recipient will establish annual co-payment goals. The Alliance also has the
option to withhold a portion of the recipient's Request for Payment if goals are not
met according to the Department of Elder Affairs' co-payment guidelines.
2. Co-payments include only the amounts assessed consumers or the amounts
consumers opt to contribute in lieu of an assessed co-payment. The contribution
must be equal to or greater than the assessed co-payment.
D. Evaluation, Statistics and Reports:
The recipient agrees to respond to requests for evaluation information and statistical
data concerning its consumers based on information requirements of the Memory
Disorder Clinics and Brain Bank. The recipient will ensure Model Day Care Centers
supported by this contract develop innovative therapies and interventions which can be
shared with other Alzheimer's Disease Initiative health and social services personnel
via training. Model Day Care Centers supported by this contract must report to the
provider all training activities provided to health care and social service personnel and
caregivers, as well as serve as a natural laboratory for service related applied research
by Memory Disorder Clinics. An annual Model Day Care Center Training Report,
ATTACHMENT IV, is due by July 5, 2003.
E. Collaboration with Memory Disorder Clinics:
Memory Disorder Clinics are required to provide four hours of in-service training to all
respite and model day care centers in their designated service areas. The recipient
agrees to collaborate with Memory Disorder Clinics to assist in this effort.
F. Service Cost Reports:
The recipient will submit semi-annual service cost reports which reflect actual costs of
providing each service by program. This report provides information for planning and
negotiating unit rates.
8
07/01/2002
Report
Number
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Legend: *
**
Contract Number KZ 297
ATTACHMENT II
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
CONTRACT REPORT CALENDAR
Based On
July Advance*
August Advance*
July Expenditure Report
August Expenditure Report
September Expenditure Report
October Expenditure Report
November Expenditure Report
December Expenditure Report
January Expenditure Report
February Expenditure Report
March Expenditure Report
April Expenditure Report
May Expenditure Report/July Adv. Recon.**
June Expenditure Report/August Adv. Recon.**
Draft Closeout Report
Final Expenditure and Request for
Payment Report
Closeout Report
Advance based on projected cash need.
Submit to the
Alliance On
This Date
July 1
July 1
August 10
September 10
October 10
November 10
December 10
January 10
February 10
March 10
April 10
May 10
June 10
July 10
August 15
September 15
September 15
Submission of expenditure reports mayor may not generate a payment
request. If final expenditure report reflects funds due back to the Alliance,
payment is to accompany the report.
Note # 1: Report #1 for Advance Basis Contracts cannot be submitted to the Alliance prior to
July 1 or until the contract with the Alliance has been executed. Actual submission
of the vouchers to the Department of Elder Affairs is dependent on the accuracy of
the expenditure report.
Note # 2: The last two months of the recipient's fiscal reports covering actual expenditures
should reflect an adjustment repaying advances for the first two months of the
contract.
9
07/01/2002
Contract Number KZ 297
ATTACHMENT III
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
BUDGET SUMMARY
1. Respite
$ 65.888.00
3. Total
$ 0.00
$ 65.888.00
2. Model Day Care
10
07/01/2002
Contract Number KZ 297
ATTACHMENT IV
ANNUAL MODEL DAY CARE CENTER TRAINING REPORT
Model Day Care Center Name:
Print Name of Person completing report
Signature of Person completing report
Date
The purpose of each model day care program must be to provide service delivery to persons
suffering from Alzheimer's disease or a related memory disorder and training for health care
and social service personnel in the care of persons having Alzheimer's disease or related
memory disorders. This report documents the required training for the State Fiscal Year July
1 st through June 30th.
Actual Training Event(s) Number Health Number Total
Care Social People
Professionals Services Trained
Trained Personnel
Trained
Training Title:
Date:
Training summary:
11
Amendment 001
CONTRACT KZ 297
PAGE 1
THIS AMENDMENT, entered into between the Alliance for Aging, Inc. hereinafter referred to
as the "Alliance", and Monroe County Board of Commissioners, hereinafter referred to as the
"Recipient", amends contract KZ 297.
The purpose of this amendment is to change the approved unit rate(s) the recipient shall be
reimbursed under this contract based on the unit costing spreadsheets submitted by the recipient and
approved by the Alliance on December 6, 2002.
1. Attachment I, Section III, Paragraph E, Method of Payment, is hereby amended to read:
The Alliance shall make payment to the provider for provision of services up to a maximum
number of units of service and at the rate(s) stated below:
Service to be
Provided
Unit of
Service
Unit
Rate
Maximum
Units
Maximum
Dollars
Respite
1 hour
$26.789184
2,459.50
$65,888
2. This amendment shall begin on the date on which the amendment has been signed by both
parties. Rates shall be adjusted retroactively to July 1, 2002.
All provisions in the contract and any attachments thereto in conflict with this amendment shall
be and are hereby changed to conform with this amendment.
All provisions not in conflict with this amendment are still in effect and are to be performed at
the level specified in the contract are hereby amended to conform with this amendment.
This amendment and all its attachments are hereby made a part of the contract.
Amendment 001
CONTRACT KZ 297
PAGE 1
IN WITNESS WHEREOF, the parties hereto have caused this 2 page amendment to be executed by
their undersigned officials as duly authorized.
PROVIDER: MONROE COUNTY BOARD
OF COMMISSIONERS
SIGNED BY ~~, kcju.id-!)
NAME: Dixie Spehar
TITLE: Mayor
DATE:
January 15, 2003
FEDERAL 10 NUMBER:
~'i--:~t~::l-r~ :
PROVIDER FISC~}{B'tE:~~DING DATE:
t!(l~~~? <,-(0,"
/:::1 "'~~"'~ '-:\~~.
~"'"' - '.'
'........, / ~,. r
, .. . . ~~. ... .).;:.'
,I '\ ' .."~ / r,...~ ~5'-
\. '. /r.;~iS$J.;).:! -
\~~;~~~:~:L
ALLIANCE FOR AGING, INC.
FOR DADE AND MONROE COUNTIES
SIGNED .~ l..J-.:7~
NAME: STEVEN WEISBERG. M.S.
TITLE: PRESIDENT/CEO
DATE:
~~)!))
59-6000749
09/30
~~~
Louis LaTorre. Senior Director
Social Services/dra
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
MEETING DATE: 6-18-2003
DIVISION: COMMUNITY SERVICES
BULK ITEM:
YES X
NO
DEPARTMENT: SOCIAL SERVICES
AGENDA ITEM WORDING: Approval of Renewal of Alzheimer's Disease Initiative (ADI) Contract
between the Alliance for Aging, Inc. and the Monroe County Board of County Commissioners (Monroe County
Social Services/In-Home Services Program) for Fiscal Year July l, 2003 through June 30,2004.
ITEM BACKGROUND: The approval of the ADI Contract will enable Monroe County In-Home Services
to continue providing Respite services to Monroe County's elderly population under the Alzheimer's Disease
Initiative (ADI) program.
PREVIOUS RELEVANT BOCC ACTION:
June 2002
CONTRACT/AGREEMENT CHANGES:
N/A
STAJ:i'}' RECOMMENDATION: Approval
TOTAL COST: $65,888.00
COST TO COUNTY: $ -0-
BUDGETED: YES~ NO
SOURCE OF FUNDS: ADI Contact
For fiscal year 7/2003 thm 6/2004 for
For $65,888.00
AMT.PER MONTH_$50.00_YEARJ600.00
REVENUE PRODUCING: YES X NO_
APPROVED BY: COUNTY A TTYl OMB/Purchasing l RISK MANAGEMENT -X
DOCUMENTATION:
INCLUDED_
TO FOLLOW _X_NOT REQUIRED_
AGENDA ITEM#: ~...,,(?!?
DIVISION DIRECTOR APPROVAL:
DISPOSITION:
Revised 1/03
AGENDA ITEM WITH LATE DOCUMENTATION
DIVISION:
Community Services
DEPARTMENT: Social Services/In-Home Services Program
SUBJECT: Approval of the Renewal for the Alzheimer's Disease
Initiative (AD I) Contract for Fiscal Year 7/1103 through 6/30/04.
DATE ITEM WILL BE AVAILABLE: 6-13-2003
AGENDA ITEM NUMBER
~~~
Louis LaTorre. Senior Director
Social Services/dra
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
MEETING DATE: 6-18-2003
DIVISION: COMMUNITY SERVICES
BULK ITEM:
YES X
NO
DEPARTMENT: SOCIAL SERVICES
AGENDA ITEM WORDING: Approval of Renewal of Alzheimer's Disease Initiative (AD I) Contract
between the Alliance for Aging, Inc. and the Monroe County Board of County Commissioners (Monroe County
Social Services/In-Home Services Program) for Fiscal Year July 1, 2003 through June 30,2004.
ITEM BACKGROUND: The approval of the ADI Contract will enable Monroe County In-Home Services
to continue providing Respite services to Monroe County's elderly population under the Alzheimer's Disease
Initiative (ADI) program.
PREVIOUS RELEVANT BOCC ACTION:
June 2002
N/A
CONTRACT/AGREEMENT CHANGES:
STA}'}' RECOMMENDATION: Approval
REVENUE PRODUCING: YES X NO_
BUDGETED: YES~ NO
SOURCE OF FUNDS: ADI Contact
For fiscal year 7/2003 thru 6/2004 for
For $65,888.00
AMT.PER MONTH_$50.00_YEARJ600.00
TOTAL COST: $65,888.00
COST TO COUNTY: $ -0-
APPROVED BY: COUNTY A TTYl OMB/Purchasing l RISK MANAGEMENT -X
DIVISION DIRECTOR APPROVAL:
DOCUMENTATION:
INCLUDED_
TO FOLLOW _X_NOT REQUIRED_
DISPOSITION:
AGENDA ITEM#:
C.30
Revised 1/03
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
CONTRACT SUMMARY
Contract with: Alliance For Aging. Inc. Contract
Effective Date: July I, 2003
Expiration Date: June 30, 2004
Contract Purpose/Description: Approval of the Renewal of the Alzheimer's Disease Initiative (ADI) Contract
between the Alliance for Aging, Inc. and the Monroe County Board of County Commissioners (Monroe County
Social Services/In-Home Services Program) for Fiscal year July 1,2003 through June 30, 2004.
For BOCC meeting on
Deloris S'~Ir'~ SOl .
(Name) (f:l; ~
6/18/2003
4589
(Ext. )
Social Services/Stop 1
(Department/Stop #)
Contract Manager:
Agenda Deadline:
6/3/2003
CONTRACT COSTS
Total Dollar Value of Contract:
Budgeted? Yes X No C
Grant: $ 65,888.00
County Match: $ -0-
$65,888.00
Account Codes:
Current Year Portion: $
Estimated Ongoing Costs: $
(Not included in dollar value above)
/yr
ADDITIONAL COSTS
For:
(e.g. Maintenance, utilities, janitorial, salaries, etc)
CONTRACT REVIEW
Date In
Division Director l# \ \ =!.\ 03
Risk Management to ~3 /6.3
O.M.B./Purchasing G I !:;, ) 03
County Attorney
Changes
Needed
YesD No~
Date Out
Yes 0 No [il./
~,~\t)3
h Il3h 1,
~
YesD No~
Yes 0 No 0
Comments:
OMB Form Revised 2/27/01 MCP #2
AGENDA ITEM WITH LATE DOCUMENTATION
DIVISION:
Community Services
DEPARTMENT: Social Services/In-Home Services Program
SUBJECT: Approval of the Renewal for the Alzheimer's Disease
Initiative (AD I) Contract for Fiscal Year 7/1/03 through 6/30/04.
DATE ITEM WILL BE AVAILABLE: 6-13-2003
AGENDA ITEM NUMBER
07/01/2003
Contract Number KZ 397
ALZHEIMERS' DISEASE INITIATIVE CONTRACT
2003-2004
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. PA329, 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. Requirements of Section 287.058, Florida Statutes:
These requirements are herein incorporated by reference.
I. Final Request for Payment:
I. The recipient must submit the final request for payment to the Alliance no later
than September 15, 2004; if the recipient fails to do so, all right to payment is
forfeited, and the Alliance will not honor any requests submitted after the
aforesaid time period.
II. If the contract is terminated prior to the contract end date of September 15,
2004, then the recipient must submit the final request for payment to the Alliance no
more than 45 days after the contract is terminated; if the recipient fails to do so,
all right to payment is forfeited, and the Alliance will not honor any requests
submitted after the aforesaid time period.
II. The Alliance Agrees:
Contract Amount:
To pay for contracted services according to the conditions of Attachment I in an amount
not to exceed $65,888.00, 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. The costs of services paid under any other contract or from any other source
are not eligible for reimbursement under this contract The funds awarded to the recipient
pursuant to this contract are in the state grants and aids appropriations and consists of the
following:
07/01/2003
Contract Number KZ 397
Program Title Year Funding Source CSFA# Fund Amounts
ADI - Respite Services 2003 General Revenue 65004 $65,888.00
ADI - Model Dav Care 2003 General Revenue 65002 $0.00
ADI - Alzheimer Special Proiects 2003 General Revenue 65002 $0.00
TOTAL FUNDS CONTAINED IN THIS CONTRACT: $65,888.00
III. Recipient and Alliance Mutually Agree:
A. Effective Date:
1. This contract shall begin on July 1, 2003 or on the date the contract has been
signed by both parties, whichever is later.
2. Delivery of services shall end on June 30, 2004. This contract shall end on
September 30,2004. See Attachment I, Section 111.0.
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.
A. 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 sub-
recipients in accordance with all applicable federal and state laws.
D. Notice, Contact, and Payee Information:
A. 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 contract is:
Louis LaTorre
Gato Building - 1100 Simonton Street
Key West, Florida 33040
(305) 292-4573
2
Contract Number KZ 397
0710112003
3. In the event different representatives are designated by either party after execution
of this contract, notice of the name and address of the new representative will be
rendered in writing to the other party and said notification attached to originals of
this contract.
4. The name (recipient name as shown on page 1 of this contract) and mailing
address of the official payee to whom the payment shall be made:
Monroe County Board of Commissioners
Gato Building - 1100 Simonton Street
Key West, Florida 33040
IN WITNESS THEREOF, the parties hereto have caused this 10-page contract to be executed
by their undersigned officials as duly authorized.
PROVIDER:
MONROE COUNTY BOARD
OF COMMISSIONERS
ALLIANCE FOR AGING, INC.
FOR DADE & MONROE COUNTIES
SIGNED BY:
SIGNED BY:
NAME:
NAME:
Steven Weisberg, M. S.
TITLE:
TITLE:
President & CEO
DATE:
DATE:
FEDERAL ID NUMBER:
PROVIDER FISCAL YEAR ENDING DATE:
59-6000749
09/30
3
07/01/2003
Contract Number KZ 397
ATTACHMENT I
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
I. STATEMENT OF PURPOSE
The Alzheimer's Disease Initiative (ADI) Program is focused on caring for persons 18 + with
memory disorders.
II. SERVICES TO BE PROVIDED
A. Services:
1. The recipient's service provider application for state fiscal year 2003 and any
revisions thereto approved by the Alliance and located in the contract manager's
file, are incorporated by reference in this contract between the Alliance and the
recipient, and prescribe the services to be rendered by the recipient
2. Consumers may not be enrolled in a Department of Elder Affairs' state general
revenue funded program, including ADI, who are also enrolled in a Medicaid
capitated long-term care health plan or program. These programs include the Frail
Elder Program operated by United Health Care, the Channeling Program operated
by Miami Jewish Home and Hospital for the Aged, the Long Term Care Community
Diversion Program operating in Planning and Service Areas 7 and 9, and the
Program of All Inclusive Care for the Elderly (PACE) program scheduled to begin
operation in the Miami-Dade County area.
B. Manner of Service Provision:
The services will be provided in a manner consistent with and described in the
recipient's service provider application for state fiscal year 2003 and the
Department of Elder Affairs Home and Community Based Services Handbook
dated 01/03. In the event the manual is revised, such revision will automatically be
incorporated into the contract and the recipient will be given a copy of the revisions.
III. METHOD OF PAYMENT
A. The method of payment in this contract is based on a fixed rate reimbursement for
approved services. The recipient must ensure fixed rates include only those costs
which are in accordance with all applicable state and federal statutes and regulations
and are based on audited historical costs in instances where an independent audit is
required. All requests for payment and expenditure reports submitted to support
requests for payment shall be on DOEA forms 106Z and 105Z. Duplication or
replication of both forms via data processing equipment is permissible, provided all
data elements are in the same format as included on departmental forms.
B. The recipient shall maintain documentation to support payment requests which shall
be available to the Comptroller, the Department of Elder Affairs, or the Alliance upon
request
4
07/01/2003
Contract Number KZ 397
The recipient shall maintain documentation to support payment requests which shall be:
C. The recipient may request a monthly advance for service costs for each of the first
two months of the contract period, based on anticipated cash needs. Detailed
documentation justifying cash needs for advances must be submitted with the
signed contract, approved by the Alliance, and maintained in the contract
manager's file. All payment requests for the third through the twelfth months shall
be based on the submission of monthly actual expenditure reports beginning with
the first month of the contract. The schedule for submission of advance requests is
ATTACHMENT II to this contract. Reconciliation and recouping of advances made
under this contract are to be completed by the time the final payment is made. All
advance payments are subject to the availability of funds.
D. Advance funds may be temporarily invested by the recipient in an insured interest
bearing account. All interest earned on contract fund advances must be returned to
the Alliance at the end of the first quarter of the contract period.
E. The Alliance shall make payment to the provider for provision of services up
to a maximum number of units of service and at the rate(s) stated below:
Service Unit of Unit Rate Maximum Maximum
to be Service Units Dollars
Provided
Respite /In-Home 1 hour $26.610662 2,476 $65,888
F. Contract Amendments:
1. The recipient agrees to implement the distribution of funds as detailed in the
service provider application and the Budget Summary, ATTACHMENT III to this
contract. Any changes in the amounts of the funds identified on the Budget
Summary form require a contract amendment.
2. With the exception of Case Management, the recipient agrees to implement a
Modified Spending Authority. Recipient is to offer services based on clients'
service plans and will not be restricted to providing the services as projected.
Additional budget revisions/contract amendments will not be required to move
funding among these services, with the exception of Case Management. Any
changes in the total amount of the funds under contract require a formal
contract amendment.
3. This contract is for services provided during the 2003/2004 State Fiscal year
beginning July 1, 2003 through June 30, 2004, however, the contract is in effect
through September 30, 2004 in order to provide for maximization of resources
and to allow for greater flexibility to pay for the services rendered by June 30,
2004 Services provided after June 30, 2004 cannot be reimbursed under this
contract.
5
07/01/2003
Contract Number KZ 397
4. The recipient will submit a draft closeout report by August 15, 2004. Any
contract amendments after August 15, 2004 determined necessary by the
Alliance will be based on the draft closeout reports.
5. The final expenditure report and request for payment will be due to the Alliance
no later than September 15, 2004. No expenditure reports or requests for
payment will be accepted after September 15, 2004.
G. Any payment due by the Alliance under the terms of this contract may be withheld
pending the receipt and approval by the Alliance of all financial and programmatic
reports due from the recipient and any adjustments thereto, including any
disallowance not resolved as outlined in Section IT of the Master Agreement.
IV. SPECIAL PROVISIONS
A. State Laws and Regulations:
The recipient agrees to comply with applicable parts of Rule 580-1, Florida
Administrative Code promulgated for administration of Sections 430.501 through
430.504, Florida Statutes, and the Department of Elder Affairs Client Services
Manual dated 12/98.
B. 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 of Elder Affairs to remove existing clients from any
program in order to serve new clients being assessed and prioritized for service
delivery.
1. Priority Criteria for Service Delivery:
1. individuals in nursing homes under Medicaid who could be transferred to
the community;
2. individuals in nursing homes whose Medicare coverage is exhausted
and may be diverted to the community;
3. individuals in nursing homes which are closing or in receivership and can
be discharged to the community; or
4. 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.
2. Priority Criteria 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 the group above,
regardless of referral source, will receive services to the extent funding is
available.
6
07/01/2003
Contract Number KZ 397
C. Co-payment Collections:
1. The recipient will establish annual co-payment goals. The Alliance also has the option
to withhold a portion of the recipient's Request for Payment if goals are .not met
according to the Department of Elder Affairs' co-payment guidelines.
2. Co-payments include only the amounts assessed consumers or the amounts consumers
opt to contribute in lieu of an assessed co-payment. The contribution must be equal to
or greater than the assessed co-payment.
D. Evaluation, Statistics and Reports
The recipient agrees to respond to requests for evaluation information and statistical data
concerning its consumers based on information requirements of the Memory Disorder
Clinics and Brain Bank. The recipient will ensure Model Day Care Centers supported by
this contract develop innovative therapies and interventions which can be shared with other
Alzheimer's Disease Initiative health and social services personnel via training. Model Day
Care Centers supported by this contract must report to the provider all training activities
provided to health care and social service personnel and caregivers, as well as serve as a
natural laboratory for service related applied research by Memory Disorder Clinics. An
annual Model Day Care Center Training Report, ATTACHMENT IV, is due by July 5, 2004.
E. Collaboration with Memory Disorder Clinics:
Memory Disorder Clinics are required to provide four hours of in-service training to all
respite and model day care centers in their designated service areas. The recipient agrees
to collaborate with Memory Disorder Clinics to assist in this effort.
F. Service Cost Reports:
The recipient will submit semi-annual service cost reports which reflect actual costs of
providing each service by program. This report provides information for planning and
negotiating unit rates.
7
07/01/2003
Report
Number
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Leqend:
Note # 1 :
Note # 2:
Contract Number KZ 397
ATTACHMENT II
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
CONTRACT REPORT CALENDAR
Based On
July Advance * ... ... ... ... ... ... .,. ... ... ... ... ... ... ... ... ... .,. ... ... ... ...
August Advance * ........................ ...................................
July Expenditure Report... ... ... ... ...... ... ...... ... ... ... ... ... ... ... ....
August Expenditure Report...... ... ...... ... ......... ... ... ... ... ... ... ...
September Expenditure Report ...... ... ... ... ......... ...... ... ... ... ....
October Expenditure Report ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..
November Expenditure Report ... ... ...... ... ... ... ... ... ...... ... ... .....
December Expenditure Report ............................................
January Expenditure Report... ... ...... ...... ... ...... ...... ............ ..
February Expenditure Report... ... ... ... ... ... ... ... ...... ......... .......
March Expenditure Report... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ..
April Expenditure Report... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .
May Expenditure Report/July Advance Reconciliation ** ...........
June Expenditure Report/August Advance Reconciliation ** ......
Draft Closeout Report... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ..
Final Expenditure and Request for Payment Report...... ... ........
Closeout Report... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
*
Advance based on projected cash need.
Submit
to the Alliance
on This Date
July 1
July 1
August 10
September 10
October 10
November 10
December 10
January 10
February 10
March 10
April 10
May 10
June 10
July 10
August 15
September 15
September 15
Submission of expenditure reports mayor may not generate a payment
request. If final expenditure report reflects funds due back to the Alliance,
payment is to accompany the report.
**
Report #1 for Advance Basis Contracts cannot be submitted to the Alliance prior
to July 1 or until the contract with the Alliance has been executed. Actual
submission of the vouchers to the Department of Elder Affairs is dependent on
the accuracy of the expenditure report.
The last two months of the recipient's fiscal reports covering actual expenditures
should reflect an adjustment repaying advances for the first two months of the
contract.
8
07/01/2003
Contract Number KZ 397
ATTACHMENT IV
ANNUAL MODEL DAY CARE CENTER TRAINING REPORT
Model Day Care Center Name:
Printed Name of Person
Completing Report
Signature of Person
Completing Report
Date Executed
The purpose of each model day care program must be to provide service delivery to persons
suffering from Alzheimer's disease or a related memory disorder and training for health care
and social service personnel in the care of persons having Alzheimer's disease or related
memory disorders. This report documents the required training for the State Fiscal Year July
1 st through June 30th.
Number Number Total
Actual Training Event(s) Health Care Social People
Professionals Services Trained
Trained Personnel
Trained
Training Title:
Date:
Training Summary:
* * * * * *
10
Monroe CouyCbfl's ~~
07/01/2002
Contract Number KZ 297
ALZHEIMERS' DISEASE INITIATIVE CONTRACT
2002-2003
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. PP329, 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. Requirements of Section 287.058, Florida Statutes:
These requirements are herein incorporated by reference.
C. Final Request for Payment:
1. The recipient must submit the final request for payment to the Alliance no later than
September 15, 2003; if the recipient fails to do so, all right to payment is
forfeited, and the Alliance will not honor any requests submitted after the
aforesaid time period.
2. If the contract is terminated prior to the contract end date of September 15, 2003,
then the recipient must submit the final request for payment to the Alliance no more
than 45 days after the contract is terminated; if the recipient fails to doso, all
right to payment is forfeited, and the Alliance will not honor any requests
submitted after the aforesaid time period.
II. The Alliance Agrees:
Contract Amount:
To pay for contracted services according to the conditions of Attachment I in an amount
not to exceed $65,888.00, 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. The costs of services paid under any other contract or from any other source
are not eligible for reimbursement under this contract. The funds awarded to the recipient
pursuant to this contract are in the state grants and aids appropriations and consists of the
following:
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07/01/2002
Contract Number KZ 297
Program Title Year Funding Source CSFA#. Fund
Amounts
ADI - Respite 2002 General Revenue 65004 $65,888.00
Services
ADI - Model Day 2002 General Revenue 65002 $0.00
Care
ADI - Alzheimer 2002 General Revenue 65002 $0.00
Special Projects
TOTAL FUNDS CONTAINED IN THIS CONTRACT: $65,888.00
III. Recipient and Alliance Mutually Agree:
A. Effective Date:
1. This contract shall begin on July 1, 2002 or on the date the contract has been
signed by both parties, whichever is later.
2. Delivery of services shall end on June 30, 2003. This contract shall end on
September 30, 2003. See Attachment I, Section 111.0.
8. 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
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07/01/2002
Contract Number KZ 297
2. The name, address, and telephone number of the representative of the recipient
responsible for administration of the program under this contract, is:
Louis LaTorre
Gato Building - 1100 Simonton Street
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.
4. The name (recipient name as shown on page 1 of this contract) and mailing
address of the official payee to whom the payment shall be made:
Monroe County Board of Commissioners
Gato Building - 1100 Simonton Street
Key West, Florida 33040
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07/01/2002
Contract Number KZ 297
IN WITNESS THEREOF, the parties hereto have caused this 11 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
SIGNED
BY:
i
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SIGNE~--- "/~_
BY: ~. ''^-
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NAME: STEVEN WEISBERG, M.S.
NAME:
C/1C('v/~S IS".)._"!. M'-C~f
M"'--Juv
I
V7 17 2",2-
TITLE: PRESIDENT/CEO
TITLE:
DATE:
DATE:
:-/~J~~
FEDERAL ID NUMBER:
RECIPIENT FISCAL YEAR END DATE:
59-6000749
09/30
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DEPUTY At<
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07/01/2002
Contract Number KZ 297
ATTACHMENT I
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
I. S1 A TEMENT OF PURPOSE
The Alzheimer's Disease Initiative (ADI) Program is focused on caring for persons 18 + with
memory disorders.
II. SERVICES TO BE PROVIDED
A. Services:
1. The recipient's service provider application for state fiscal year 2002, and any
revisions thereto approved by the Alliance and located in the contract manager's
file, are incorporated by reference in this contract between the Alliance and the
recipient, and prescribe the services to berendered by the recipient.
2. Consumers may not be enrolled in a Department of Elder Affairs' state general
revenue funded program, including ADI, who are also enrolled in a Medicaid
capitated long term care health plan or program. These programs include the Frail
Elder Program operated by United Health Care, the Channeling Program operated
by Miami Jewish Home and Hospital for the Aged, the Long Term Care Community
Diversion Program operating in Planning and Service Areas 7 and 9, and the
Program of All Inclusive Care for the Elderly (PACE) program scheduled to begin
operation in the Miami-Dade County area.
B. Manner of Service Provision:
The services will be provided in a manner consistent with and described in the
recipient's service provider application for state fiscal year 2002 and the Department of
Elder Affairs Client Services Manual dated 12/98. In the event the manual is revised,
such revision will automatically be incorporated into the contract and the recipient will
be given a copy of the revisions.
III. METHOD OF PAYMENT
A. The method of payment in this contract is based on a fixed rate reimbursement for
approved services. The recipient must ensure fixed rates include only those costs
which are in accordance with all applicable state and federal statutes and regulations
and are based on audited historical costs in instances where an independent audit is
required. All requests for payment and expenditure reports submitted to support
requests for payment shall be on DOEA forms 106Z and 105Z. Duplication or
replication of both forms via data processing equipment is permissible, provided all
data elements are in the same format as included on departmental forms.
B. The recipient shall maintain documentation to support payment requests which shall be
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07/01/2002
Contract Number KZ 297
available to the Comptroller, the Department of Elder Affairs, or the Alliance upon
request.
C. The recipient may request a monthly advance for service costs for each of the first two
months of the contract period, based on anticipated cash needs. Detailed
documentation justifying cash needs for advances must be submitted with the signed
contract, approved by the Alliance, and maintained in the contract manager's file. All
payment requests for the third through the twelfth months shall be based on the
submission of monthly actual expenditure reports beginning with the first month of the
contract. The schedule for submission of advance requests is A TT ACHMENT II to this
contract. Reconciliation and recouping of advances made under this contract are to be
completed by the time the final payment is made. All advance payments are subject to
the availability of funds.
D. Advance funds may be temporarily invested by the recipient in an insured interest
bearing account. All interest earned on contract fund advances must be returned to the
Alliance at the end of the first quarter of the contract period.
E. The Alliance shall make payment to the provider for provision of services up to a
maximum number of units of service and at the rate(s) stated below:
Service to be
Provided
Unit of
Service
Unit
Rate
Maximum
Units
Maximum
Dollars
Respite/ln-Home
1 client hour $28.955394
2,275.50
$65,888
F. Contract Amendments:
1. The recipient agrees to implement the distribution of funds as detailed in the service
provider application and the Budget Summary, ATTACHMENT III to this contract.
Any changes in the amounts of the funds identified on the Budget Summary form
require a contract amendment.
2. With the exception of Case Management, the recipient agrees to implement a
Modified Spending Authority. Recipient is to offer services based on clients' service
plans and will not be restricted to providing the services as projected. Additional
budget revisions/contract amendments will not be required to move funding among
these services, with the exception of Case Management. Any changes in the total
amount of the funds under contract require a formal contract amendment.
3. This contract is for services provided during the 2002/2003 State Fiscal year
beginning July 1, 2002 through June 30, 2003, however, the contract is in effect
through September 30, 2003 in order to provide for maximization of resources and
to allow for greater flexibility to pay for the services rendered by June 30, 2003.
Services provided after June 30, 2003 cannot be reimbursed under this contract.
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07/01/2002
Contract Number KZ 297
4. The recipient will submit a draft closeout report by August 15, 2003. Any contract
amendments after August 15, 2003 determined necessary by the Alliance will be
based on the draft closeout reports. .
5. The final expenditure report and request for payment will be due to the Alliance no
later than September 15, 2003. No expenditure reports or requests for payment will
be accepted after September 15, 2003.
G. Any payment due by the Alliance under the terms of this contract may be withheld
pending the receipt and approval by the Alliance of all financial and programmatic
reports due from the recipient and any adjustments thereto, including any disallowance
not resolved as outlined in Section I.T. of the Master Agreement
IV. SPECIAL PROVISIONS
A. State Laws and Regulations:
The recipient agrees to comply with applicable parts of Rule 580-1, Florida
Administrative Code promulgated for administration of Sections 430.501 through
430.504, Florida Statutes, and the Department of Elder Affairs Client Services Manual
dated 12/98.
B. 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 of Elder Affairs to remove existing clients from any
program in order to serve new clients 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; or
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.
2. Priority Criteria 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 the group above, regardless of
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07/01/2002
Contract Number KZ 297
referral source, will receive services to the extent funding is available.
C. Co-payment Collections:
1. The recipient will establish annual co-payment goals. The Alliance also has the
option to withhold a portion of the recipient's Request for Payment if goals are not
met according to the Department of Elder Affairs' co-payment guidelines.
2. Co-payments include only the amounts assessed consumers or the amounts
consumers opt to contribute in lieu of an assessed co-payment The contribution
must be equal to or greater than the assessed co-payment
D. Evaluation, Statistics and Reports:
The recipient agrees to respond to requests for evaluation information and statistical
data concerning its consumers based on information requirements of the Memory
Disorder Clinics and Brain Bank. The recipient will ensure Model Day Care Centers
supported by this contract develop innovative therapies and interventions which can be
shared with other Alzheimer's Disease Initiative health and social services personnel
via training. Model Day Care Centers supported by this contract must report to the
provider all training activities provided to health care and social service personnel and
caregivers, as well as serve as a natural laboratory for service related applied research
by Memory Disorder Clinics. An annual Model Day Care Center Training Report,
ATTACHMENT IV, is due by July 5,2003.
E. Collaboration with Memory Disorder Clinics:
Memory Disorder Clinics are required to provide four hours of in-service training to all
respite and model day care centers in their designated service areas. The recipient
agrees to collaborate with Memory Disorder Clinics to assist in this effort.
F. Service Cost Reports:
The recipient will submit semi-annual service cost reports which reflect actual costs of
providing each service by program. This report provides information for planning and
negotiating unit rates.
8
07/01/2002
Report
Number
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Legend: *
**
Contract Number KZ 297
ATTACHMENT II
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
CONTRACT REPORT CALENDAR
Based On
July Advance*
August Advance*
July Expenditure Report
August Expenditure Report
September Expenditure Report
October Expenditure Report
November Expenditure Report
December Expenditure Report
January Expenditure Report
February Expenditure Report
March Expenditure Report
April Expenditure Report
May Expenditure Report/July Adv. Recon.**
June Expenditure Report/August Adv. Recon.**
Draft Closeout Report
Final Expenditure and Request for
Payment Report
Closeout Report
Advance based on projected cash need.
Submit to the
Alliance On
This Date
July 1
July 1
August 10
September 10
October 10
November 10
December 10
January 10
February 10
March 10
April 10
May 10
June 10
July 10
August 15
September 15
September 15
Submission of expenditure reports mayor may not generate a payment
request. If final expenditure report reflects funds due back to the Alliance,
payment is to accompany the report.
Note # 1: Report #1 for Advance Basis Contracts cannot be submitted to the Alliance prior to
July 1 or until the contract with the Alliance has been executed. Actual submission
of the vouchers to the Department of Elder Affairs is dependent on the accuracy of
the expenditure report.
Note # 2: The last two months of the recipient's fiscal reports covering actual expenditures
should reflect an adjustment repaying advances for the first two months of the
contract.
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07/01/2002
Contract Number KZ 297
ATTACHMENT III
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
BUDGET SUMMARY
1. Respite
$ 65.888.00
2. Model Day Care
$ 0.00
3. Total
$ 65.888.00
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07/01/2002
Contract Number KZ 297
ATTACHMENT IV
ANNUAL MODEL DAY CARE CENTER TRAINING REPORT
Model Day Care Center Name:
Print Name of Person completing report
Signature of Person completing report
Date
The purpose of each model day care program must be to provide service delivery to persons
suffering from Alzheimer's disease or a related memory disorder and training for health care
and social service personnel in the care of persons having Alzheimer's disease or related
memory disorders. This report documents the required training for the State Fiscal Year July
1 st through June 30th.
Actual Training Event(s) Number Health Number Total
Care Social People
Professionals Services Trained
Trained Personnel
Trained
Training Title:
Date:
Training summary:
11
Amendment 001
CONTRACT KZ 297
PAGE 1
THIS AMENDMENT, entered into between the Alliance for Aging, Inc. hereinafter referred to
as the "Alliance", and Monroe County Board of Commissioners, hereinafter referred to as the
"Recipient", amends contract KZ 297.
The purpose of this amendment is to change the approved unit rate(s) the recipient shall be
reimbursed under this contract based on the unit costing spreadsheets submitted by the recipient and
approved by the Alliance on December 6, 2002.
1. Attachment I, Section III, Paragraph E, Method of Payment, is hereby amended to read:
The Alliance shall make payment to the provider for provision of services up to a maximum
number of units of service and at the rate(s) stated below:
Service to be
Provided
Unit of
Service
Unit
Rate
Maximum
Units
Maximum
Dollars
Respite
1 hour
$26.789184
2,459.50
$65,888
2. This amendment shall begin on the date on which the amendment has been signed by both
parties. Rates shall be adjusted retroactively to July 1, 2002.
All provisions in the contract and any attachments thereto in conflict with this amendment shall
be and are hereby changed to conform with this amendment.
All provisions not in conflict with this amendment are still in effect and are to be performed at
the level specified in the contract are hereby amended to conform with this amendment.
This amendment and all its attachments are hereby made a part of the contract.
Amendment 001
CONTRACT KZ 297
PAGE 1
IN WITNESS WHEREOF, the parties hereto have caused this 2 page amendment to be executed by
their undersigned officials as duly authorized.
PROVIDER: MONROE COUNTY BOARD
OF COMMISSIONERS
ALLIANCE FOR AGING, INC.
FOR DADE AND MONROE COUNTIES
SIGNED BY ~~, kcju.id..!)
SIGN ED ~'-:;r;:::.. l..J-.:7~
NAME: Dixie Spehar
NAME: STEVEN WEISBERG. M.S.
TITLE: Mayor
TITLE: PRESIDENT/CEO
DATE:
January 15, 2003
DATE:
~~)!))
FEDERAL 10 NUMBER: 59-6000749
PROVIDER FISC~~{~~DING DATE: 09/30
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