Item C28
Revised 3/99
~~~
Louis LaTorre, Director
Social Services
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: 12/15-12/16/04
Bulk Item: Yes [gI No D
Division: Community Services
Department: Social Services/Bavshore
Manor
AGENDA ITEM WORDING: Approval of referral agreement between Alliance for Aging
and Monroe County to enable respite clients ro remain in the Aged and Disabled Adult
(ADA) Waiver program.
ITEM BACKGROUND: The Aged and Disabled Adult (ADA) Waiver program promotes
the development of a coordinated service delivery system to meet the needs of aged or
disabled adults who are at risk of premature institutionalization. Under this program,
clients are referred to Bayshore Manor for daytime facility respite.
PREVIOUS RELEVANT BOCC ACTION: The Monroe County Board of County
Commissioners authorized execution of the Home and Community Based Waiver
Referral Agreement between the Alliance for Aging, Inc. and Monroe County at a regular
meeting of the Board held on October 16, 2002.
STAFF RECOMMENDATION: Approval.
TOTAL COST:$16,623.00(Estimated)
COST TO COUNTY: ~
REVENUE PRODUCING: Yes [gI No 0
BUDGETED: Yes [gI No D
AMOUNT PER MONTH $1385.25
YEAR $16.623.00
APPROVED BY: COUNTY ATTY ~ OMS/PURCHASING ~ RISK MANAGEMENT ~
DIVISION DIRECTOR APPROVAL:
DIVISION DIRECTOR NAME: Jim Mall
DOCUMENTATION: INCLUDED: ~ TO FOLLOW: D NOT REQUIRED: D
DISPOSITION:
AGENDA ITEM #: C .-- d- ~.
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
CONTRACT SUMMARY
Contract with:
Alliance for Aging, Inc.
Contract #_
Effective Date:
Expiration Date:
7/1/04
Ongoing
Contract Purpose/Description:
To enable Monroe County Bayshore Manor to remain in the Aged and Disabled Adult
ADA WaiverPro
Contract Manager: Louis LaTorre
(Name)
Social Services
(Department/Stop #)
for BOCC meetin on 12/15-12/16/04
A enda Deadline: 11/30/04
CONTRACT COSTS
Total Dollar Value of Contract: $ 16,623.00 Current Year Portion: $ N/A
estimated
Budgeted? Yes[8J No 0 Account Codes:
Grant: $ -0-
County Match: $ None
ADDITIONAL COSTS
Estimated Ongoing Costs: Included in For: N/A
Operations Cost
(Not included in dollar value above) (ej?;. maintenance, utilities, ianitorial, salaries, etc.)
CONTRACT REVIEW
Division Director
Changes Date Out
Date In Needed Reviewer
YesDNoD
- 1l_%{){YesDNog -tf}. ~lWQ/ I
- YesDNo~ ~,42 //
/-
_ 1//2./0'{ YesD Nog----.. .
Risk Management
O.M.B./Purchasing
County Attorney
Comments:
HOME AND COMMUNITY BASED SERVICES
AGED AND DISABLED ADULT (ADA) MEDICAID WAIVER
REFERRAL AGREEMENT
This Referral Agreement between the Alliance for AGlna. Inc., the Area Agency on Aging (AAA) for
Planning and Service Area (PSA) 11 and lj a y ~ b 0 r 9 MaR 0 r ,
the Service Provider, shall begin on July 1, 2004 or on the date the agreement has been signed by both
parties, whichever is later. This referral agreement or is in effect for a period of time that is equal to the
Medicaid waiver provider's enrollment period with the State of Florida's Medicaid fiscal agent and is
contingent upon an annual appropriation by the Legislature. One purpose of this agreement is to
promote the development of a coordinated service delivery system to meet the needs of the aged or
disabled adults who are at risk of premature institutionalization. Another purpose of this agreement is to
enable eligible elderly participants to receive home and community based services from qualified
providers with oversight of the quality of care by the Medicaid Waiver Specialist employed by the AAA.
These services are authorized in order that the participant may remain in the least restrictive setting and
avoid or delay premature nursing home placement. Services and care are to be furnished in a way that
fosters the independence of each participant to facilitate aging in place. All parties agree that routines of
care provision and service delivery must be consumer driven to the maximum extent possible. All parties
agree to and will treat each participant with dignity and respect.
I. Objectives
A. To maintain a climate of cooperation and consultation with and between agencies, in order to
achieve maximum efficiency and effectiveness.
B. To promote programs and activities designed to prevent the premature institutionalization of
elders and disabled adults.
C. To require the parties of this Agreement to provide technical assistance and consultation to each
other on matters pertaining to actual service delivery and share appropriate assessment
information and care plans so duplication may not occur.
D. To establish an effective working relationship between the case management agency that is
responsible for the development of care plans and authorization of services available under the
waiver, the service provider that is responsible for the direct provision of those services to
consumers served under the waiver program, and the AAA that is responsible for management
and oversight of the waiver program.
II. Under this Agreement, the Service Provider agrees to the following:
A. To accept referrals for the 1915c Home and Community-Based Services - ADA Medicaid
Waiver from the enrolled case management agency.
B. To provide quality service(s) to the waiver participant as specified in Section IV., Provision of
service(s), subject to quality monitoring and/or observation by the case management agency
and/or the AAA and/or the Department of Elder Affairs (the "department").
C. To provide only those services specifically outlined in the Plan of Care and authorized by the
enrolled case management agency.
D. To attach documentation regarding the service provider's qualifications to this agreement; and to
provide, as requested, any information regarding Medicaid Waiver billing, payment, or waiver
participant information, to the case management agency or AAA. Provider rates shall not
exceed the approved negotiated rates that are at or below the service provider's usual and
customary rates. If additional services are to be added to this agreement, a written request to
do so must be received by the AAA. If approved, an amendment must be prepared by the AAA
indicating the service(s) to be added. The necessary documentation regarding provider
qualifications for the additional services must be attached to the agreement.
E. To maintain the waiver participant's confidentiality according to 42 CFR 431.301.
F. To immediately report any changes in the waiver participant's condition to the case
management agency.
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G. To maintain enrolled provider status by renewing applicable licensure, certificatbn, contract
and/or referral agreements and by maintaining all provider qualifications as contained in the
Aged and Disabled Adult Medicaid Waiver under which services are provided.
H. To include its name and other appropriate information on a list of all enrolled providers which
will be shown to consumers during development of an individualized plan of care,
understanding that the consumer reserves the right at all times to a choice of enrolled
providers.
I. To immediately notify the case management agency of staffing shortfalls that will negatively
impact provision of service to Medicaid Waiver consumers.
J. To submit claim data for billing to the Medicaid fiscal agent after delivery of services has been
accomplished. All services should be billed within 60 days after services have been provided or
document reasons for delayed submission of claims. Such documentation shall be available for
review by the area agency on agency or by the department, upon request.
K. To submit claims for billing to the Medicaid fiscal agent at the agency's contracted rate.
L. To submit void or adjustment claims no later than 45 days after either party has identified the
error. The provider's refusal to adjust or void erroneous claims may result in termination of this
agreement and/or referral to the department, and will be referred by the department to the
Agency for Health Care Administration for appropriate action.
M. To develop and implement a policy to ensure that its employees, board members, and
management, will avoid any conflict of interest or the appearance of a conflict of interest when
disbursing or using the funds described in this agreement. A conflict of interest includes, but is
not limited to, receiving, or agreeing to receive, a direct or indirect benefit, or anything of value
from a service provider, consumer, vendor, or any person wishing to benefit from the use or
disbursement of funds. To avoid a conflict of interest, the service provider must ensure that all
individuals make a disclosure to the AAA of any relationship which may be a conflict of interest,
within thirty (30) days of an individual's original appointment or placement on a board, or if the
individual is serving as an incumbent, within thirty (30) days of the commencement of the
agreement.
N. To adhere to the federal waiver requirements and the poliCies and procedures outlined in the
following manuals published by the Agency for Health Care Administration: the Aged/Disabled
Adult Waiver Guidelines and the Medicaid Provider Reimbursement Handbook (Non-
Institutional 081), including any and all attachments or updates.
O. If the Service Provider is enrolled as a home delivered meals vendor, the Area Agency will
retain the services of a registered dietitian to perform the following:
1. Conduct site inspections of all catering facilities. These may be unannounced.
2. Monitor meal delivery times and temperatures.
3. Review all menus submitted by the service provider and suggest changes as needed.
4. Work with the service provider to ensure that standardized recipes and computer-assisted
nutritional analyses are carried out.
P. The AAA may Impose department-approved sanctions for non-compllance with the
terms of this agreement.
III. Under this Agreement, the Area Agency on Aging agrees to the following:
A. To facilitate the enrollment of providers with the Medicaid Fiscal Agent.
B. To provide technical assistance and training to Service Providers.
C. To notify the case management agency within 48 hours of any approved service provider
rate adjustment.
D. To regularly monitor the Service Providers in accordance with requirements specified by the
department.
E. To complete a new referral agreement signed by all parties when unit rate changes are approved.
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.'
IV. Under this agreement, the following services will be delivered by the Service provider
In accordance with the plan of care or service authorization:
Service Unit Rate County/Region Served
A. Faci Ii t y Based Respi te $ 2.50,( 15 minutes Monroe County
B.
C.
D.
E.
V. Termination
In the event this agreement is terminated, the case management agency and the service provider agree
to submit, at the time notice of intent to terminate is delivered, a plan which identifies procedures to
ensure services to consumers will not be interrupted or suspended by the termination.
A. Termination at Will
This agreement may be terminated by any party upon no less than thirty (30) calendar days
notice, without cause, unless a lesser time is mutually agreed upon by both parties, in writing.
Said notice shall be delivered by certified mail, return receipt requested, or in person with proof
of delivery.
B. Termination Because of lack of Funds
In the event funds to finance this agreement become unavailable, the area agency may
terminate this agreement upon no less than twenty-four (24) hours notice in writing to the other
party. Said notice shall be delivered by certified mail, return receipt requested, or in person with
proof of delivery. The area agency shall be the final authority as to the availability of funds.
C. Termination for Breach
Unless a breach is waived by the area agency in writing, or the parties fail to cure the breach
within the time specified by the area agency, the area agency may, by written notice to the
parties, terminate the agreement upon no less than twenty-four (24) hours notice. Said notice
shall be delivered by certified mail, return receipt requested, or in person with proof of delivery.
In witness whereof, the parties have caused this ~ page agreement to be executed by their undersigned
officials as duly authorized.
Area Agency on Aging
Service provider
signature
signature
Steven Weisbera. M.S.
printneme
print name
President/CEO
tiUe
title
date
date
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