Item C30
,.~~~-
, Uluis La.Torre, SeniQr Director
Social ServicesJdru
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
MEETING OA TE: 6-15-2005
DIVISION: COMMUNITY SERVICES
BULK ITEM:
NO
DEPARTMENT: SOCIAL SERVICES
YES _X_
AGENDA ITEM WORDING: Approval of Alzheimer's Disease Initiative (ADI) Contract #KZ597 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, 2005 through June 30, 2006.
ITEM BACKGROUND: The approval of the Ant 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 DOCe ACTION:
June 162004.
CONfRACT! AGREEMENT CHANGES:
NIl\.
STAli(t RECOMM};NUATJON: Approval
TOT AL COST: $65,888.00
COST TO COUNTY: $8,708.00 (County Match)
REVENUE PRODUCING: YES_X_ NO__
BUDGETED: YES..1L NO_
SOURCE OF FUNDS: AD! Contact
For fiscal year 7/2005 thru 6/2006 for
For $65,888.00
AMT.PER MONTH_SSO.OO_ YEARj600,OO
APPROVED BY: COUNTY A TIY.l OMB/PurchasinglL RISK MAN~9EMENT -X
( '~\AJC>/
MES MALLOCH
DIVISJON DIRECTOR APPUOV AI,:
DOCUMENTATION:
L'\JCLUDED_eX ,~ TO FOLLOW __ NOT REQUIRED_
DISPOSITION:
AGENDA JTEM#:
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MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
CONTRACT SUMMARY
Contract
Effective Date: July I, 2005
Expiration Date: Junc 30,2006
Contract Purpose/Description: Approval of the Alzheimer's Disease Initiative (AD!) Contract #KZ597 between
the Alliance for Aging, Inc. and the Monroe County Board of County Commissioners (Monroe County Social
Servlccs/ln.Homc Services Program) for Fiscal yea{ July 1,2005 through June 30, 2006.
""IOri'~~;< 4589
(Name) (Ext.)
Contract w1th: Alliance For Aging, Jnc.
Contract Manager:
Social Services/Stop 1
(Department/Stop #)
For BOCC meeting on 6/15/2005
AQenda Deadlme:
513lJ2005
CONTRACT COSTS
Total Dollar Value of Contract:
Budgeted? Yes X No
Grant: $ 65,888.00
County Match: S $8,708.00
$65,888.00
Account Codes:
Current Year Portion: $
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Estimated Ongoing Costs: $_____,_w~iyr
(Not included In dollnr VOllw ahove}
ADDITfONAL COSTS
For:
(c.ce, M-;i~--i~~~.~,c"'t~'li~-e-;!~;;~i;;n~d, ~;ri~ etc}---
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CONTRACT REVIEW
LhvlSlon Director
~n )j{l S.'
Changes
Ncedefr ,. ,
Yes ~--
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Risk Management
O.M.B.iPur~g
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County Attomey
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Comments:
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OMB Form Revised 2/27/01 MCP #2
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07/01/2005
Contract Number KZ 597
ALZHEIMERS' DISEASE INITIATIVE CONTRACT
2005-2006
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. PA429, 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, 2006; 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,
2006, 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 falls 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:
07/01/2005
Contract Number KZ 597
Program Title Year Funding Source CSFA# Fund Amounts
AD I - Respite Services 2005 General Revenue 65004 $65,888.00
AD I - Model Day Care 2005 General Revenue 65002 $0.00
ADI - Alzheimer Special Proiects 2005 General Revenue 65002 $0.00
TOTAL FUNDS CO NT AINED IN THIS CONTRACT: $65,888.00
III. Recipient and Alliance Mutually Agree:
A. Effective Date:
1. This contract shall begin on July 1, 2005 or on the date the contract has been
signed by both parties, whichever is later.
2. Delivery of services shall end on June 30, 2006. This contract shall end on
September 30,2006. See Attachment I, Section IIJ.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
07/01/2005
Contract Number KZ 597
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
3
07/01/2005
Contract Number KZ 597
ATTACHMENT I
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
L 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 2005 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 2005 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 1062 and 1052. 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
05/24/2005 13:29 FAX 3056706534
ALLIANCE! AGING
liZlooJ.
07/01120&5 ' '
Coull d~t Hl.lmt:Jer KZ:'~
The recipient shall maintain documentation to support payment requests which shall be:
C.' The recipient. may request a--monl'h+y'~ for'servrc...-e cost!"'ior each-of ttre- ~
two months of the contract period, based on anticipated cash needs. Detailed ;
documefltatiofl justifying cash nGeds for-advances mtJ!t'Oe-'submitted Wtttt~
signed contract, approved by the Alliance, and maintained in the contract .
~~sf>>e-;' . A~paymern f~t~.for the third through the twelfth months ~
be based on the submission of monthly actual expenditure reports beginning with '
the,ftf&L rnOFtth of.tAe--COAtra€t.. The schedule for submission of advance'requ~
ATTACHMENT II to this contract ReconciliatIon and recouping of advances made
under tt'*s cootrad are t&.b& oom~'by the tifrl&-t~.frnat ~t is made:"'~
advance payments are subject to the availability of funds, i
I}.. . Advance funds.may-be lemporarUy invested-by th&"recipient-irran in5ll'f'ed int~
bearing account. Air interest earned on contract fund advances must be returned to
tt:le AI>>ance~'*the~fId of tke.ftrst'quat1erof the-eontract'periOO: '
E. The Alliance shaH make payment to the provider for provision of services up
to' it m~mJmber~umts of sen;Ge- al"rCt'at the rate(s)-Stated ~
Service
to-be-
~ided
Resptt~lln-Heme'
Unit of
~.n1iq
Unit Rate Maximum
umtI".
Maximum
OOlt~
~
1 hour"
$:H;23' 2,110'
$65,~
F. Contract Amendments:
1. The-recipient agrees to irnpJement me dmribution of-funds- tt detaited. jrr~
service provider application and the Budget Summary, ATTACHMENT III to this
oonvact.> Any chaflges. in. th&.emou~of fMt flfftd$ tdentified'on the Bttdi,et
Summary form require a contract amendment. '
2.,W4th trn.l~i()f)~.CaS& Management; tne-redpiem agrees to fmpl~a...
Modified Spending Authority. Recipient is to offer services based on clients' l
seEVice-plan-sand wiU-not Ml'e'!tf"tcte(t-to' providtng-the--servlces 9S' projected:-.,
Additional budget revisions/contract amendments will not be required to move
funding' among t~ ~~jwith the-&xceptiort of Case'Management: . ArTf--.\
changes in the total amount of the funds under contract require a formal
contrt:rct"mnemtment. '
3. This contract is for services provided during the 2005/2006 State Fiscal year
beginning. JUlY -1, 2005tl'lrougn ;)Ufl& 30; 2006;' however, . the contract. is Tl't eHeet,.
through September 30, 2006 in order to provide for maximization of resources .
and to.allow Jot g,eater flexjbility to pay for' the-service$ renderettby Jtm(t<J€h
2006 Services provided after June 30,2006 cannot be reimbursed under this
CCI'ft1act
5.
07/01/2005
Contract Number KZ 597
4. The recipient will submit a draft closeout report by August 15, 2006. Any
contract amendments after August is. 2006 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, 2006. No expenditure reports or requests for
payment will be accepted after September 15, 2006.
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 58D-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
07/01/2005
Contract Number KZ 597
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 5,2006.
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
07/01/2005
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 597
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 Requestfor 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 1 0
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
07/01/2005
Contract Number KZ 597
ATTACHMENT III
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
1. Respite.........................................................
2. Model Day Care ....... ............................ ...........
3. Total..... ......... ............ ...... ........... ........... .......
9
$65,888.00
$0.00
$65,888.00
07/01/2005
Contract Number KZ 597
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
Trainina Title:
Date:
Trainina Summary:
* * * * * *
10
01/01/2004
Contract Number KZ 497
ALZHEIMERS' DISEASE INITIATIVE CONTRACT
2004-2005
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. PA429, 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:
L The recipient must submit the final request for payment to the Alliance no later
than September 15, 2005; 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,
2005, 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.
fl. 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:
07/01/2004
Contract Number KZ 497
Program Title Year Funding Source CSFA# Fund Amounts
ADI ~ Respite Services 2004 General Revenue 65004 $65,888.00
ADI - Model Day Care 2004 General Revenue 65002 $0.00
ADI ~ Alzheimer Special Projects 2004 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, 2004 or on the date the contract has been
signed by both parties, whichever is later.
2. Delivery of services shall end on June 30, 2005. This contract shall end on
September 30,2005. 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 Ill. 8. And Section Ill. C. of the Master
Agreement.
A. Recipient Responsibility:
Notwithstanding the pass through language contained in Section l.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 Dade/and 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
07/01/2004
Contract Number KZ 497
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
.'''.?<" ".;
(-' /.c
;, ..... .j~'" C,,/;:'
t~'<:"L-~lGNED&=~~
NAME: Steven Weisberg, M. S.
SIGNED BY:/'><:l/. //Z../iLl
<"'~"~'_^'.ff
......, J
Murray E. Nelson
NAME:
TITLE:
Mayor/Chairman
TITLE:
President & CEO
,
, ( "8' I (f ~
DATE:
June 16, 2004
DATE:
FEDERAL 10 NUMBER:
PROVIDER FISCAL YEAR ENDING DATE:
~9-60007 49
09/30
{SEAl.}
rr:::.L~..CU:RK
..1~
'"- CLERK
3
01101/2004
Contract Number KZ 497
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 2004 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 2004 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 1062 and 105Z. Duplication or
replication of both forms via data processing equipment is permissible, provided all
data elements are in the same format as induded 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
07/01/2004
Contract Number KZ 497
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 2004/2005 State Fiscal year
beginning July 1, 2004 through June 30, 2005, however, the contract is in effect
through September 30,2005 in order to provide for maximization of resources
and to allow for greater flexibility to Day for the services rendered by June 30,
2005 Services provided after June 30, 2005 cannot be reimbursed under this
contract.
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07/01/2004
Contract Number KZ 497
4. The recipient will submit a draft closeout report by August 15, 2005. Any
contract amendments after August 15, 2005 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, 2005. No expenditure reports or requests for
payment will be accepted after September 15, 2005.
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.
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Contract Number KZ 497
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 5,2005.
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.
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Report
Number
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
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Leqend:
Note # 1:
Note # 2:
Contract Number KZ 497
ATTACHMENT II
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
CONTRACT REPORT CALENDAR
Based On
July Advance" ...............................................................
August Advance" ......................................... p................
July Expenditure Report....................................................
August Expenditure Report ................................................
September Expenditure Report ....... ..... ....... ...... ........ ..........
October Expenditure Report .......................................,.......
November Expenditure Report ....,... ........,.. ...... ......... ...... ..,.
December Expenditure Report ........ ..... ...... ....... ........ ..........
Jan uary Expenditure Report .............................. no. .. .. .. . .. . ...
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.
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07/01/2004
Contract Number KZ 497
ATTACHMENT III
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
1. Respite. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . .. . . . . . . . . . . . . . . . . . . . .
$65,888.00
$0.00
2. Model Day Care ..............................................
3. Total..... ...... ..... .... ....... ............. ........ .............
$65,888.00
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Contract Number KZ 497
ATTACHMENT IV
ANNUAL MODEL DAY CARE CENTER TRAINING REPORT
Model Day Care Center Name:
Date Executed
Printed Name of Person
Completing Report
Signature of Person
Completing Report
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) Hea Ith Care Social People
Professionals Services Trained
Trained Personnel
Trained
Training Title:
Date:
Training Summary:
* '* * "* * *
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