Item F04# .. .. ....... .
# 10 1 W
am alk 111
Meeting Dates I I - 16-2011 Division: —County Admim*strator
Bulk Item.- Yes X No Department: So ial S ices/In-Home Services
ci ervi
Staff Contact Person/Phone # : Sheryl Grab 5 10
......... ...... ........ . . .........
.. .. ...........
PREVIOUS RELEVANT BOCC ACTION.* Prior approval granted to Contract CLP MC__S___
December 151, 20 10
CONTRACT/AGREEMENT CHANGES: A reduction of funds by $221 .38, which reduces the
contract CLP-MCSS-H from $15,000.00 to $14,,778.62.
STAFF RECOMMENDATIONS.* Approval
TOTAL COST: $145778..62 . . .......... INDIRECT COST* _-0-.BUDGETED: Yes X No
COST TO COUNTY, S14 .86
*71....J10% -Cash Match Requi I SOURCE OF FUNDS.* Ad -Valorem Taxes
And SIL477.86 (10% In -Kind MaLch)
REVENUE PRODUCINQ Yes No X AMOUNT PER MONTH.. Year
APPROVED BY.* County Att�,/ X OMB/Purchasing X Risk Management _X
ITOCUMENTATION3. Included X
v —
DISPOSITION.
Not Required.
AGENDA ITEM #
IIIIIIJ�I I I � I I 1 111 1111�
ws X-5 IN.
Contract with: Alliance For Aging, Inc. Amendment 00 1 Contract CLP # CLP-MOSS-II
Effective Date: 1/1/2011
Expiration Date: 12/31/2011
Contract Purpose/Description: Approval of Amendment 001 to the Community Living Program (CLP} Contract
CLP-MASS41 will reduce the contract by $221.38 from $15,000,00 to $14,778.62. This is due to an allocation
cut by the Florida Department of Elder Affairs (DC}EA}.
Contract Manager.- Sheryl Graham 4510 Community Services/Stop I
(Name) (Ext.) (Department/Stop #}
For BOCC meetiMon 11/16/11 Agenda Deadline: 11/1/11
L
CONTRACT COSTS
Total Dollar Value of Contract: (extension) $14,778.62 Current Year Portion:
Budgeted? Yes X No El Account Codes: 12 5 - 615 3 011 -
Grant: $ K1778.62
County Match.- $1,477.86 (10 % Cash Match Required
$1,477.86 10% In -Kind Match Total 20% Match
ADDITIONAL COSTS
Estimated OngoiLng Costs: $ /yr For:
Zot included in doflar value above) Maintenance, utilities, janitorial, salaries, etc)
DW In
Division Director
14
Risk M�wWement
cJkggg
O.M.B./Purc .. iing
County Attorney
MEN _
.. 0 0 4 #
1 it 1!
CONTRACT REVIEW
Changes
Needed
Yes 0 No
Yes 0 No 9/
Yes 0 No
f
Date Out
Amendment 001 Contract CLP- MOSS 11 Page 1
THIS AMENDMENT is entered into between the Alliance for Aging, Inc. hereinafter referred
to as the "Alliance", and Monroe County Socials Services.
The purpose of this amendment is to reflect the allocation reduction as a result of the
allocation cut by DOEA. The reduction by title is as follow. Title 11113 CLP is reduced by
$221.38 from $15,000 to $14,778.62. The reduction is recurrent.
The Budget Summary by Title for the whole fiscal year (January 1-December 31,
2011) is as follows:
Title III B (CFDA/CsF # 93.044): $14,778,62
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:
.
. .............
Maximum
Service Unit
Units of
Maximum
Service(s) to be Provided
Rate
Service*
..............
Dollars*
HOMEMAKER
$22.04:
TEED
T B D
PERSONAL CARE
$28.87
TBD
TBD
CASE MANAGEMENT
$38.03
TEED
TBD
Total Contract
$14,778,62
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.
IN WITNESS WHEREOF, the parties hereto have caused this amendment to be executed by their
undersigned officials as duly authorized.
1*1% V_% 01% % It 1 r"W& r- r-W&
Monroe Coun!j Social
Services.
ALLIANCE FOR AGING, INC.
Max B. Rothman, JD, LL.M.
President & CEO
.. ... .... ....... : ........... ....... .................... . ........... : .......................... ......... ...... ..................... .... .......... .................... .. .. : .......... ......... ...................... ...... ...... ................. ........................... ...... .................... ..... . ...... ............ ............ .. ..... .......... ...... ...... .... ........... : ............................ ......... .................... . .. . ...... ............. ....... ... .. :: .. .. .... ........ ...... .. ... . . .. .............. ..
Date
............... ......
....,
f4ntlary ? o
Contract CEP- MCSS 1
ALLIANCE FOR AGING INC.
STANDARD CONTRACTOLDER AMERICANS ACT PROGRAM TITL 11-B
COMMUNITY LIVING PROGRAM
THIS CONTRACT is entered into between the '
Alliance for A�rn 4 Inc hereinafter referred Count Social Services hereinafter referred �� d to as the "*AA .,'- and
to as the Contractor��, and collectively ref Monroe
contractor for this purpose gay designate ayendor referred to as the:Parties.=' The tern
���T�����l�T ��� ��� � subgrantee or subrecipient� the status to b bit-2 as necessary. et�rther identified In
WITNESSE TH THAT:
WHEREAS, the AAA has established through the Area Plan on ��� ng that it �:� i n need herein; sand of certain services as described
ribed
WHEREAS, � ,��.�� the contractor has demonstrated
that it has the requisite expertise and ability
Y
as an Independent contractor of the A. � to faithfully perform sLIch services
NOW THEREFORE, in consideration
t on of the services to be performed and
set forth, the Parties payments to be made, together with the mttral
covenants and conditions hereinafter
agree as follows.
1. Pu r .Sc of Contract
The pUrpose of this contract is to provide services P rvices in accordance with the terms and cond'
contract incl��ding all attachments and exhibits, whichconstitute the �trons specified in this
contract docLrrnert.
1.1
2.
3s
11
U
Deflnitlons
OEA means the Florida Department of Elder
Affairs.
AAA means the AlIlance for Aging, Inc.
PSG means the P � lann i ner and Service ,area corresponding to M i .
g Miami -Dade and Conroe CoUnties.
ncor oratlon of Dqcum nts within the Cont
ract
The contract will incorporate the provider's s application in response to the 2010 Community
Incitation to negotiate (ITN), attachments r�t�nity Living Program
proposals, state plan(s), grant agreements,
handbooks, .manLrals or desk books, as an irate � rats, relevant department
integral part of the contract, except to the extent t P
provides to the contrary. In the event of conflict ' that the contract explicitly
�n language among any of the documents r e
specific provisions and requirements of the cons referenced above, the
contract document(s) shall prevail over inconsistent
Proposals or other general materials t provisions
not specific to this contract document and IdentifiedrP In the
attachments.
Term of Contract
This contract shall begin on January I o I I
or on the date on which the contract has been signed
required to .sign it, whichever is later. t .Shall end gned by the Iasi art
at midnight, local time in Miami, Florida, on D2011.
party
ece �� ber � I �+� I I .
+Cotract Amount
The department agrees to pay for contracted services according to the terns and condition
amount riot to exceed S 15 0o0.�. or the rate schedule subject s of this contract i � an
sect to the availability of funds. Any - costs or service s
for rrnder any ether contract car from any other � Ord
er source are riot eligible for payment ender this contract. p act,
&.newals
By mutual agreement of the parties. in accordance with s. 2 7.058 I f , F.S., the AAA. may renew period not to exceed three °ears, or the term of the ° �� a contract, y � the contract for-
er-rrnl contract, whichever Is longer. The rer = $ .
method r dctermir it g r reve al price is set for e al rice, ()r
forth n the bid, proposal., or reply. No other .� � �w
be charged. Any r-c�ne��=�tl is scrb`ec�t to the s� costs for the renewal r�� �
same terms and conditions as the original contract E satisfactory performance evaluation s b ¢the �A r� ct and con tinuent r 0
A � nd the availability of funds, � P.11
16
January 2011
Contract CLP- MOSS 11
6, jance th Federal Law
C2M21* wi
6,1. If this contract contains federal funds the following shall apply:
6,1.1 The provider shall comply with the provisions of 45 Cam. 74 and/or 45 CFR 92, and other applicable re2tilations.
1
6.1.2 If this contract contains federal funds and is over $100,000.00, the contractor shall co standards, orders, or regulations issued Linder s. 306 oft Clean Air Act as m ly with all applicabit
%_ amended (42 U.S.C. 7401, et seq.), s. 50�
of the Federal Water Pollution Control Act as amended (33 U.&C. 1251., et seq.), Executive Order 11738,
amended, and where applicable Environmental Protection Agency regulations 40 CFR 30. The contractor shall reporl
any violations of the above to the AAA.
hall
The contractor, or agent acting for the contractor, may not use any federal funds received in connection with this
contract to influence legislation or appropriations pending before the Congress or any State legislature.
contract contains federal funding ' if this
in excess of $ 100.000.00, the contractor must, prior to contract execution, complete
the Certification Regarding Lobbying form, ATTACHMENT 11. All disclosure forms as required by the
Certification Regarding Lobbying form must be completed and returned to the Contract Manager, prior to payment
Linder this contract.
6.1.4 That If this contract contains $ 10,000.00 or more of federal funds, the contractor shall corn with Executive Order
11246, Equal Employment Opportunity, as amendeply d by Executive Order 11375 and others, and as supplemented in
Department of Labor regulation 41 CFR 60 and 45 CFR 92, if applicable.
6,1,5 That if this contract contains federal funds and provides services to children up to a18 the c,
with the Pro -Children Act of 1994 (20 U.S.C. 6081 ge oractor shall comply
6.1.6 That a contract award with an amount expected to equal or exceed $25,000.00 and certain other contract awards shall
not be made to parties listed on the government -wide Excluded Parties List System, in accordance with the OMB
guidelines at 2 CFR 180 that Implement Executive Orders 12549 and 126891 "'Debarment and Suspension." The
Excluded Parties List System contains the names of parties debarred, suspended, or otherwise excluded by agencies,
as well as parties declared ineligible under statutory or regulatory authority other than Executive Order 12549. The
. The contractor shall complete and sign ATTACHMENT V prior to the execution of
funds pursuant to this contract
contractor will comply with these provisions before doing business or entering into subcontracts receiving federal
th is contract.
6,2 The contractor shall not employ an unauthorized alien. The AAA shall consider the employment of unauthorized
aliens a violation of the Immigration and Nationality Act (8 US.C. 1314 a) and the Immigration Reform and Control
Act of 1986 (8 U.S.C. 1101). Such violation shall be cause for unilateral cancellation of this contract by the A.A.A.
6.3 If the contractor is anon -profit provider and IS Subject to Internal Revenue Service (IRS.) tax exempt ori!anization.
reporting requirements (filing a Form 990 or Form 990-N) and has its tax exempt status revoked for failing'io compiv
with the filing requirements of the 2006 and Protection Act or for an other reason, the contractor must notify the
AAA in writing within thirty (30) days of receivin the IRS notic
9 e of revocation.
7. L0manc with State Law
7.1 That this contract is executed and entered into in the State of Florida, 4'-ind shall be construed,
in all respects in accordance with the Florida lawperformed and enforcecl
, including Florida provisions for conflict of laws.
7.2 Requirements of s. 287-058, F,S. as amended.
_12/96
... . ...... . ..... .. ..... ......... .. ....... .. ..... ... . .. .. .... ...... . . ... .......... . ...... . . .. .... . . .
.. ........... .. .. .. .. ... .. .. . .. .... .. .... .. .1: . . . .......... . . . .... .. ... ... :: . ..... . ............ . ............. . .. ....... .
..... . . . . .... : ... . ..... . . .... . . ... . : . .. ...... .... ...
■
January 2011.
Contract CLP- MOSS 11
7.2.1 The contractor will provide units of deliverables, i n � � various � client . services, � w ,
�..Itrtdtn�, � artou5 �Itent sert�es� and in some Instances
reports, findings, and drafts, as specified in this Contract, which may i tic
the contract manager must receive and accept writing prior to payment in accordance with s. 215.971, F �.and(`)).p
A;_
7,2.2 The contractor will submit bills for fees or other -
compensation for services or expenses to sufficient detail for
proper pre -audit and post -audit.
7.2,3 If itemized payment for travel expenses is permitted
P P ed to this contract, the contractor will submit bills fora
expenses in accordance with s. 11 21W.0611 F.S., or at Such lower rates ny Ira . �.
as .may be provided in this contract.
7.2.4 The contractor will allow public access to all documents, papers, letters, or other public records as defined it
;subsection I .o I I(I 2)� F.S., made or received b the con .
y tractor In conjunction with this contract except for those
records which are made confidential or exempt b law. The c P . . P y contractor"s refusal to comply with this provision steal;
constitute an immediate breach of contract for which the .�,.,�,�, P
may unilaterally lateral ly terminate the contract.
7.3 If clients are to be transported under this contract t .
he contractor shall comply with the provisions of Chapter �
F.S., and Rule 41--2, F. A. C. pter - ��. ,
7.4 Subcontractors who are on the discriminatory vendor list may not transact business with an public ent
accordance with the provisions of s. 287.134, F.S. �' P ttyg in
7.5 The contractor will comply with the provisions of s. I P 11,061 .,, �'.5., and s. 216.347, F.5., which prohibit the expenditure
of contract fonds for the purpose of lobbying the legislature, p tore
g g , branch or a state agency.
S. Background Screenln
The contractor Shall ensure that, prior to providing
P g services, all persons having access to vulnerable elders and
children, their lining area, Funds or personal or r .
property, . P otected health information pertaining to such individuals
shall pass a Level 11 criminal background screeningin
accordance with the requirements of s. 430.0402 and ch. 435
F.5., as amended. These provisions :Shall apply to employees,
P y
subcontractors, consultants, direct service providers and
Volunteers. Consequently, any commitment for employment,,
:shall be contingent upon t II background check. The back purchase of services, or volunteer program participation
g p he passing of a Level P
ground screening shall Include
employment history checks as provided in s, 435,o
3� I � �.5.� and both local and national criminal record ch
coordinated through law enforcement agencies. ecks
8.1 for purposes of this Section, the term "direct service
provider �'means a person 18 years of age or older who, �IrsLtal�t
to a program to provide services to the elderly. has direct, face-to-facepursuant contact with a client while providing services
to the client or has access to the c I ient's living areas or to the � ' � � � �.Itent s funds or personal properly. This term includes
coordinators, managers, and supervisors of residential facilities and Volunteers.
9. Grievance Procedures
The contractor .shall develop and implement, and ensure that
Its subcontractors have established grievance procedIres
to process and resole client dissatisfaction with or denial of servi
termination, suspension r redaction o 5 ro Ices . and address complaInts regarding the
f services, .es, as required for receipt of funds. These procedures, z
should provide for notice of the grievance procedure � P �..dures� at � mini
determi nation (s). P e and an opportunity for review of the subs=otractor's
10. Audit Ins ect �ons" Ins est at o is. PtIblic Records• and ��tenion
E
January '20 11
Contract CLP- MMSS 11
10.2 To retain all client records, financial records,, Supporting documents, statistical records, and any other dOCUment
(inclUding electronic storage media) pertinent to this contract fora period of six (6) years after completion of th
contract or longer when required by law. In the event an audit is required by this contract, records shall be retainei
for a minimum period of six (6) years after the audit report is Issued or until resolution of any audit findina.,S 0 I itigation based on the terms of this contract, at no additional cost to the AAA. t-�
10.3 Upon demand, at no additional cost to the AAA. the contractor will ficilitate the duplication and transfer of aw
records or dOCLIments during the required retention period in Paraorraph 10.2.
Z�'
10.4 To assure that the records described In Paragraph 10 shall be subject at all reasonable times to inspection, review
copying. or audit by Federal, State, or other personnel duly authorized by the AAA.
1W
1.0 *Z� At all reasonable times for as long as records are maintained, persons duly authorized by the AAA, DOEA and
Federal auditors, pursuant to 45 CFR 92.36(1)(10), shall be all y
owed full access to and the right to examine anof the
contractor's contracts and related records and documents pertinent to this specific contract, regardless of the form which kept.
10,6 To provide a financial and compliance audit to the AAA as specified in this contract and in ATTACHMENT III and
to ensure that all related party transactions are disclosed to the auditor.
10,7 To comply and cooperate immediately with any inspections, reviews,, investigations, or audits deemed necessary b
the office of the Inspector General pursuant to s. '20.055, F.S. Y
Ill Nogdiser* * ati tvia 'min on -Civil -Rights Compl*
iance,
11.1 The contractor will execute assurances in ATTACHMENT VI that it will not discriminate against any person in the
prov sion of services or benefits under this contract or in employment because of age, race, religion, color, disability,
national origin, gin, marital status or sex in compliance with state and federal law and regulations. The contractor further
assures that all contractors, subcontractors, S'ubgrantees, or others with whom it arranges to provide services or
benefits in connection with any of its programs and activities are not discriminating against clients or employees -
because of age, race, religion, color, disability, national origin, marital status or sex.
1.1.2 The contractor will retain, on file, during the term of this agreement a timely, complete and accurate Civil Rights
Compliance Checklist (ATTACHMENT B).
11.3 The contractor agrees to I establish procedures purSUant to federal law to handle compla I nts of discrimination
i
involving services or benefits through this contract. These procedures shall I nclude notifying clients, employees, and
participants of the right to file a complaint with the appropriate federal or state entity.
11.4 If this contract contains federal funds, these assurances are a condition of continued receipt of or benefit from federal
financial assistance, and are binding upon the contractor it
sts successors,, transferees, and assignees for the per'od
during which such assistance is provided. The contractor further assures that all Subcontractors, vendors, or othlers
with whom it arranges to provide services or benefits to participants or employees in connection with an y of its
programs and activities are not discriminating against those participants or employees in violation of the above
statutes, regulations, guidelines, and standards. In the event of failure to corn
AAply. the contractor understands that the
AAA gay, at its discretion, seek a Court order reqi
uiring complance with the terms of this assurance or seek other
appropriate judicial or administrative relief, including but not limited to, termination of and denial of further
assistance.
120 Provision OrServ* Q
Ice"i
...
The contractor will provide services in the manner described In ATTACHMENT 1,
4/96
... .......... . .. .. . ........... . . ... ......... .. . .. .... . .. ... . . . .. . . .. ..... ....... . . ..... ..... ..... ...... ..... ... ... .. ... ...... .. ........ ... . .. ... ... .... ......... .............. ................................ .................... ..... .... .. ..... ......... . . . ...... ...... ...... ... . : ........... . . . . ... . . . .. . .. . . . . ... ....... ..... ..... : . .. . . . .. . . . .. . .. ... . .. . . . . ........ . ............. ..... ...... .. . . ... .... ......
N
January 2011
Contract CLP- MOSS 11
13. Monitori'M b the AAA
The contractor will permit persons duly authorized by the AAA to inspect and copy any records, papers, documents
facilities, moods and services of the contractor which are relevant to this contract, and to interview any clients
Z-7
employees and Subcontractor employees of the contractor to assure the AAA of the satisfactory performance of the
terms and conditions of this contract. Following such review, the AAA will deliver to the contractor a written repo
of Its findings and request for development, by the contractor,, a corrective action plan where appropriate. The
contractor hereby agrees to timely correct all deficiencies identified in the corrective action plan.
Z!�
14* Coordinated lonitorin with Other Aences
If the contractor receives funding from one or more of the State of Florida other human service agencies, in addition
to the Department of Elder Affairs, then a joint monitoring visit including such other agencies ray be scheduled. For
the purposes of this contract, and pursuant to s. 287.0575, F.S. as amended, Florida I s human service a(yencies shall
include the Department of Children and Families, the Department of Health, the Agency for Persons with' Disabilities,
the Department of Veterans Affairs, and the Department of Elder Affairs. Upon notification and the Subsequent
scheduling of such a visit by the designated agency's lead administrative coordinator, the contractor shall comply and
cooperate with all monitors, inspectors, and/or investigators.
15, Indemnification
The contractor shall indemnify, save, defend, and hold harmless the AAA and its agents and employees from any and
all claims, demands, actions, causes of action of whatever nature or character, arising out of or by reason of the
execution of this agreement or performance of the services provided for herein. It is understood and agreed that the
provider is not required to indemnify the AAA for claims, demands, actions or causes of action arising solely out of
the AAA" s negligence.
15.1 Except to the extent permitted by s. 768.28, F.S., or other Florida law, Paragraph 15 is not applicable to contracts
executed between the DOEA and state agencies or Subdivisions defined in s. 768-28(2), F.S.
16. Insurance and Bonding
16,1 To provide continLiOus adequate liability insurance coverage during the existence of this contract and any renewal(s)
and extension(s) of it. By execution of this contract, unless it is a state acrency or Subdivision as defined by subsection
768-228(2), F.S., the contractor accepts full responsib 1.1ity for identifying and determining the type(s) and extent of
I iability insurance necessary to provide reasonable financial protections for the contractor and the clients to be served
Linder this contract. The limits of coverage under each policy maintained by the contractor do not limit the
contractor's liability and obligations Linder this contract. The contractor shall ensure that the AAA has the most
current written verification of insurance coverage throughout the term of this contract. Such coverage may be
provided by a self-insurance program established and operating Linder the laws of the State of Florida. The AAA
reserves the right to require additional inSLirance as specified In this contract.
16.2 ThrOLIghOUt the term of this agreement, the contractor agrees to maintain an in Iurance bond from a responsible
commercial insurance company covering all officers, directors, employees and agents of the contractor authorized to
handle funds received or disbursed Linder all agreements and/or contracts incorporating this contract by reference - It
an amount commensurate with the funds handled, the degree of risk as determined by the insurance company and
consistent with good business practices. W
P It A,*
17. Con ride ntiaLi tv or intormation
The contractor shall not use or disclose any information concerning a recipient of services Linder this contract for ally
purpose prohibited by state or federal law or regulations except with the written consent of a person legli'fll'v
Z7
atithorized to a-i-ve that consent or when tRIthorized by law.
1.8. Health Insurance Portability and Accotintabill-ty Act
5/96
January 2-0 .
E
Contract CLP- MSS 11
Where applicable, the contractor will comply with. the Health insurance Po
rtability and AccoLintab i l sty Act 42 U
l 320d.), as well as all regulations promulgated thereunder (45 CFI. I60 162,
and 164,
19. Incident rtin
19.1 The contractor shall notify the AAA immediately, no later than forty-eight
- '
y forty e�ght 48) hors from, the contracto
awareness or discovery of conditions that may materially affect the contractor or subcor
the services required to be performed under this tractor � ability o perf�
p contract. Such notice shall be made orally to the contract manager
telephone) with an email to immediately follow. I
9.2 To immediately report knowledge or reasonable Suspicion of abuse, , neg �le�..t, or exploitation of a child, aged person,
disabled adult to the Florida Abuse Hotline on the statewide toll -free telephone number I-800-96ABUSE),
required by Chapters 39 and 415, F.S., this provision is binding upon both the �. p contractor and its employees,
20. New Contract .s Re ortin N/A)
The contractor shall notify the AAA within ten (l 0) days of entering into
y g a new contract with any of the re ma to i f
four 4) :state human service agencies. The notification shall include the following
0 owing information: � l ) contracting sta
agency; () contract name and number; (3 contract start and end dates; contract . � t amount, �>�� contract. descr�ptic
and commodity or service; and (6) contract manager name and Lim1 ber.
n complying with this provision, ar
pursuant to s. 287.0575, F.S. as amended, the contractor shall an
complete d roe'
ATTACHMENT D. p provide the information �
21. Bankru Notificati
tcon
If, at any time during the terra of this contract, the contractor, its assignees,
subcontractors or affiliates files- a
claim for bankruptcy, the contractor must immediately notifythe AAA Within
ten ( l 0) days after notification, the
contractor must also provide the following information to the AAA: (I) the date of fill
petition; �Z the case number; filing of the bankruptcy
p 3) the court name and the division in which the titian was filed
District of Florida, Tallahassee Division); and 4 '� �e • g•i northern
� the name, address, and telephone number of the bankruptcy
attorney. p y
22. Svonsorshand_ Pu blicit
22A As required by .s. 286.25, F.S., if the contractor is a non -governmental
financed wholly or i n g tal organization which sponsors a program.
' part by state funds, including any funds obtained through this contract it shall,
advertising, or describing the sponsorship of the program, - �� '1, �n publicizing,
P p p ogram, state. Sponsored by (contractors name), The .Alliance for
Aging, and the State of Florida, Department of Elder Affairs." if the sponsorship p ship reference is in written material, the
words "Alliance for Aging"' and "State of Florida, Department of Elder Affairs' Y
shall appear in at least the same size
letters or type as the name of the organization.
22.2 The contractor shall not use the words ""'Alliance for Aging"' or :The State Affairs"
g � to of Florida, L�epartrnent of Elder to
indicate sponsorship of a pr�ogran otherwise financed, unless, specific authori r has �tlon his been obtained by the �,
prior to use,
23.
IOiill I it ililments-
.IIwINWi
23.1 The contractor shall not assin the rights and res osibilities under this p Contract withoLt the prior written approval of
the AAA, which shall not be unreasonably withheld.. An sublicense assia� ,.�
y � � nn�ent, or transfer otherwise oc� err l
without prior written (,pproval of the AAA will constitute a material breach � � .� contract,�.
� the
January 2.o 11
Contract CL- MOSS 11
contractor. In the event the State of Florida approves transfer of the contractor's obligations,,� a
responsible for all word performed and all � the contractor rcr��
P expenses incurred in connection with the. contract.
3.3 This contract shall remain binding upon the successors in interest of eith
er the contractor or the AAA.
24, Subcontracts
24.1 The contractor is responsible for all work performed and for all commodities produced pursuant to this contract,
whether actually furnished by the contractor or its subcontractors. An subcontracts 3p
y ontracts :shall be evidenced by a written
document and subject to any conditions of approval the AAA deems necessary. ssary. The contractor further agrees that the
AAA :shall not be liable to the subcontractor in any way or for any reason. The contractor, at its expense, will defend
the AAA against any such claims.
24.2 The contractor Shall promptly pay any subcontractors upon receipt tpt of payment from the department or other
sponsoring agency, Failure to male payments to any subcontractor in accordant ?
otherwise stated to the contract be e with 4. A..,��.0585, F.S., unless
tween the contractor and subcontractor, will result in a penalty as provided b
statute.P rovY
25. fiadWendLnt.CaQacity of Contractor
t is the intent and understanding of the parties that the contractor, or any of its subcontractors, are independent
contractors and are not employees of the AAA and shall not hold themselves out as employees
without :specific authorization from the AAA. It is the further P oyees or agents of the AAA
and Understanding of the parties that the AAA
does not control the employment practices of the contractor and shall
not be liable for any wade and hour,
employment discrimination, or other labor and employment claims against the
� contractor or its sUbcontractors. All
deductions for social security, withholding taxes, income taxes, contributions to unemployment compensation funds
and all necessary insurance for the contractor shall be the sole responsibility P y of the contractor.
26. Payment
Payments will be made to the contractor pursuant to s. 715.422, F.S. as servi
ces are rendered and invoiced by the
contractor. The .AAA's Contract Manager will have final approval of the invoice. for
Payment, and will approve the
invoice for payment only if the contractor has met all terms and conditions of the contract, unless the bid
specifications, purchase order, or this contract specify otherwise. The approved pp oved invoice will be Submitted to the
AAA's fiscal section for budgetary approval and processing. Disputes arising v
� P � over Invoicing and payments will be
resolved in accordance with the provisions of s. 215.421 F.S. A Vendor Ombud
sman has been established within the
Department of Financial Services and may be contacted at (850) 413--5665.
27. Return of funds
The contractor will return to the AAA any overpayments due to unearned fund
s or funds disallowed and any interest
attributable to such funds pursuant to the terms and conditions of this contract
that were disbursed to the contractor by
the AAA. In the event that the contractor or its independent auditor discovers that an overpayment has been made,
the contractor shall repay said overpayment immediately withOLIt prior notification
� P canon from the AAA. In the event that
the AAA first discovers an overpayment has been made, the Contract Manager. on behalf of the AAA, will notify the
contractor by letter of :such. findings. Should repayment not be made forthwith the
lawful rate of interest on the o.tstandin - contractor will �e charged �t: the
� balance pursuant to s 55.w�, F.S. after AAA notification or contractor
discovery.
. Data Intean4v and Sate2uardin information
The contractor shall insure an appropriate level of data security for the information
ormaton the contractor is cllectn�
usingin the performance of this contract. ��n appropriate levelf security x
P includes 4pprong and tracl�irg ail
contractor employees that request system r information access and ensuring that User access ,ss his been removed try)
Cell terminated employees. The contractor, among other requirements, r tst anticipate a d prepare for
the loss of
76
January '20 11 a
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Contract CLP- MOSS 11
information processing capabilities. All data and software Must be routinely backed
up to insure recovery from losses
or Outages of the Computer system. The security over the backed -Up data is to be as stringent as the protection
required of the primary systems. The contractor shall insure all. subcontractors maintain written procedures for
computer system back tip and recovery. The contractor shall complete and sign ATTACHMENT IV prior to the
execution of this contract.
29, CoMputer Use and Social Medi
ia Po
The Department of.Elder Affairs has implemented a new Social Media Policy, in addition to its Computer Use Policy,,
which applies to all employees, contracted employees, consultants, OPS and volunteers, including all personnel
affiliated with third parties, such as, but not limited to, Area Agencies on Aor* r
,Yng and vendors. Any entity that uses the
Department's computer resource systems must comply with the Department"s policy regarding social media. Social
Media includes, but is not limited to blogs, podcasts", discussion forums, Wikis, ASS feeds, video sharing, social
networks like MySpace, Facebook and Twitter, as well as content sharing networks such as flickr and YouTube,
(ATTACHMENT E)
30. Conffi1
ct of Interest
The contractor will establish safeguards to prohibit employees, board members, management and Subcontractors from
using their positions for a purpose that constitutes or presents the appearance of personal or organ iIzatlonal conflict of
interest or personal gain. No employee, officer or agent of the contractor or Subcontractor shall participate in
selection, or in the award of an agreement supported by State or Federal funds if a conflict of interest, real or
apparent, would be involved. Such a conflict would arise when: (a) the employee, officer or agent- (b) any member of
his/her immediate family; (c) his or her partner, or- (d) an org�anization which employs, or is about to employ, any of
the above, has a financial or other interest in the firm selected for award. The contractor or subcontractor's officers,
employees or agents will neither solicit nor accept gratuities, favors or anything of monetary value from contractors,
potential contractors, or parties to Subcontracts. The contractor's board members and management must disclose to
the AAA any relationship which may be, or may be perceived to be, a conflict of interest within thirty (30) calendar
days of an individual's original appointment or placement in that position, or if the individual is serving as an
incumbent, within thirty (30) calendar days of the commencement of this contract. The contractor"s employees and
subcontractors must make the same disclosures described above to the contractor's board of directors. Compliance
with this provision will be monitored.
31. Public Emit 1 -v Crime
Pursuant to s. 287.133, F.S., the following restrictions are placed on the ability of persons convicted of public entity
crimes to transact business with the AAA. A person or affiliate who has been placed on the convicted vendor list
following a conviction for a public entity crime may not Submit a bid, proposal, or reply on a contract to provide any
goods or services to a public entity, may not submit a bid, proposal , or reply on a contract with a public entity for the
construction or repair of a public building or public work; may not submit bids, proposals, or replies on leases of real
property to a public entity; may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant
Linder a contract with any public entity; and may not transact business with any public entity in excess of the
threshold amount provided in s. 187.017, F.S., for CATEGORY TWO fora period of 36 months following the date of
being placed on the convicted vendor list..
32. Purc
32.1 To procure any recycled products or materials, which are the subject of or are required to carry out this contract. in
accordance with the provisions of s. 403.7065,, RS. f
33. Patents, C2pv .�.rig,htsRola.1ties
If any discovery, invention or copyrightable material is developed or produced in the course of or as a result Of W01-k-
or services performed tinder this contract, the contractor shall refer the discovery invention or material to the AAA to
be referred to the Department of State. Any and all patent rights or copyrights accruing under this contract are hereby
IN
January 20 11
Contract CLP- MCSS 11
reserved to the State of Florida in accordance with Chapter '186, F.S. Pursuant to s, '?87,0-")71 (5) (k) I and 1. a.s
amended. the only exceptions to this provision shall be those that are clearly expressed and reasonably valued in th%e
contract.
33. t If the primary purpose of this contract is the creation of intellectual property, the state shall retain an Unencumbered
W
right to use such property, notwithstandino, any agreement made pursuant to Paragraph 33.
34. EMergeMj Pre aredness and Continu*
JY of..O erations
p
34.1 If the tasks to be performed pursuant to this contract, include the physical care and control of clients, or the
administration and coordination of services necessary for client health, safety or welfare, the contractor shall I , within
thirty (30) calendar days of the execution of this contract, submit to the Contract Manager verification. of an
emergency preparedness plan. In the event of an emergency, the contractor shall notify the AAA of emergency
provisions.
34.2 In the event, a situation results in a cessation of services by a subcontractor, the contractor will retain responsibility
for performance under this contract and must follow procedures to ensure con
tinUity of operations without
interruption.
35. PUR 1.000 Form
The PUR 1000 Form is hereby incorporated by reference. In the event of any conflict between the PUR 1000 Form
and any terms or conditions of this contract the terms or conditions of this contract shall take precedence over the
PUR 1000 Form. However, if the conflicting terms or conditions in the PUR 1000 Form are required by any section
of the Florida Statutes, the terms or conditions contained in the PUR 1000 Form shall take precedence.
v
36. Use of State Funds to Purchase or Improve Real Propert,,
Any state funds provided for the purchase of or improvements to real property are contingent upon the contractor or
political subdivision granting to the state a security interest in the property at least to the amount of state funds
provided for at least 5 years from the date Of purchase or the completion of the improvements or as further required
by law.
37, Dispute Resolution
Any dispute concerning performance of the contract shall be decided by the Contract Manager, who shall reduce the
decision to writing and serve a copy on the contractor.
38, Financial Conseguences of Non -Performance
If the contractor fails to meet the minim.urn level of service or performance identified in this agreement, or that is
customary for the industry, then the AAA must apply financial consequences commensurate with the deficiency.
Financial consequences may include but are not limited to contract suspension, re using payment, withholding
payments until deficiency is cured, tendering only partial payments, and/or cancellation of contract and reacquiring
services from an alternate source. Z17
38.1 The contractor shall not be charged with financial consequences, when a failure to perform arises out of causes that
were the responsibility of the AAA.
39. N`o Waiver of Sovertign Immun"ty
Nothincr contained In this a(yreement is intended to serve as a waiver of sovereign Immunity by any ent1tv to which
Z� Zn 1.
sovereign immunity may be applicable.
Venue
If any dispute arises out of this contract,, the venue Of such legal recourse will be Leon COUnty. Florida.
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JanUary 2.0 11
E
Co trait CLP- MOSS H
41, Entire Contract
This contract contains all the terms and conditions agreed Upon by the parties. No oral agreements or representati
t� lolls
shall be valid or binding upon the AAA or the contractor unless expressly contained herein or by a written
amendment to this contract sigyned b both parties.
%� y
42, Force Majeure
Neither party shall be liable for any delays or failures in performance due to circumstances beyond its contral.
provided the party experiencing the force majeure condition provides immediate written notification to the other party
"i
and takes all reasonable efforts to cure the condition..
43. Severabil
i iLv Clause
The parties agree that if a court of competent jurisdiction deems any term or condition herein void or unenforceable,
the other provisions are severable to that void provision and shall remain in full force and effect.
44, Condition Precedent to Contract: A por2priat* ions
-
The parties agree that the AAA's performance and obligation to pay Linder this contract is contingent upon an annUl-cll
appropriation by the Legislature to DOEA.
45. Addition/Deletion
The parties agree that the AAA reserves the right to add or to delete any of the services required Linder this contract
when deemed to be in the PSA's best interest and reduced to a written amendment signed by both parties. The parties
shall negotiate compensation for an additional services added.
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46, Waiver
The delay or failure by the AAA to exercise or enforce any of its rights under this contract shall not constitute or he
deemed a waiver of the AAA's right thereafter to enforce those rights. nor shall any single or partial exercise of any
such right preclude any other or further exercise thereof or the exer�c" ise of any other right.
L.-
47. Cow PH iancek
-
The contractor agrees to abide by all applicable current federal statutes, laws, rules and regulations as well as
applicable current State statutes, laws, rules and recrZ7-
ulations. The parties agree that f,-1ilLire of the contractor to abide
by these laws shall be deemed an event of default of the contractor,, and subject the contract to immediate, unilateral
cancellation of the contract at the discretion of the AAA.
48. Final Invoice
The contractor shall submit the final invoice for payment to the AAA asspecified in Paragraph 3.3.4. (date for final
request for payment) of ATTACHMENT 1. If the contractor fails to submit final request for payment by the
deadline, then all rights to payment may be forfeited and the AAA may not honor any requests submitted after the
aforesaid time period. Any payment due Linder the terms of this contract may be w I thhel.d until all reports due from
the contractor and necessary adjustments thereto have been approved by the AAA.
49. EtneglItiations or Modifications
Modifications of the provisions of this contract shall be valid only when they have been reduced to writing and &1�,
Z!� -
signed by both parties. The rate of payment and the total dollar amount may be adjUsted retroactively to reflect price
1!n I
level increases and changes in the rate of payment when these have been established through the appropriations
process and subsequently identified in the AAA.'s operating budget.
50. 1 This contract may be terminated by either party without caLlSe Upon no less than thirty (30) c,ilendar days [IM-1ce M
w r't * ' -1
I lilt' to the other party Unless a sooner time g
W IS RlUtUially agreed LIP011 In writill.14. Said notice shall be delivered bv
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January ',2011
Contract CPw MC S S 11
U.S. Postal Service or any expedited delivery service that provides verification of delivery
P el ery or by hand delivery to th
Contract Manager or the representative of the contractor responsible for administration on of the contract.
50.2 In the event funds for payment pursuant to this contract become unavailable. the
AAA may terminate this contra
upon no less than twenty-four 24 hours notice in writing to the contractor. Said .notices ' shall be delivered v ered by U. �.
Postal Service or any expedited delivery service that provides verification of del iv ery or by hand delivery to th
Contract Manager or the representative of the contractor responsible for administration atior of the contract. The AA-i
shall be the final authority as to the availability and adequacy of funds. In the even
q y t of termination of this contraci
the contractor will be compensated for any work satisfactorily completed prior to the date of termination.
50.3 This contract may be terminated for cause upon no less than twenty-four 4
y hours notice in writing to the
contractor, If applicable, the AAA may employ the default provisions in Rule 60A-1.006.3
� , F.A.C. 'waiver o
breach of any provisions of this contract shall not be deemed to be a waiver of
any other breach and shall not b(
construed to be a modification of the terms and conditions of this contract. The provisions
AAA's or the contractor's rich p s herein do not limit the
is to remedies at law or in equity.
50.4 .Failure to have performed any contractual obligations with the AAA in a manne
r satisfactory to the AAA will be a
sufficient case for termination. To be terminated as a contractor under this provision, on, the contractor must have I
previously failed to satisfactorily performs in a contract with the AAA, been notified b the AAA
A of the unsatisfactorty
performance and failed to correct the unsatisfactory performance to the satisfaction oft he AAA, or (2..) had a contract
terminated by the AAA for cause.
51, Official Payee and Representatives (Names, Addresses, and Telephone Numbers):
).
The contractor name, as shown on page 1 of this
Monroe Count Board of Count Conn '
� �' Commissioners/In-Home
a. contract, and mailing address of the official payee to
p �
whom the payment shall be made is:
Services Program
1100 Simonton Street Ferri -
� .57
Key 'west, FL 33040
The name of the contact person and street address
b. where financial and administrative records are
Sheryl Grahams, Director , Monroe County Social Services
maintained is:
100 Simonton Street, Rm. 2-257
KeyWest FL 3304
� 0
305-292-4510
C. The name, address, and telephone number of the
representative of the contractor responsible for
Sheryl Graham, Director, Monroe County Social Services
administration of the program under this contract is:
1 1 Simonton Street, �. 2-�57
Key''west, FL 3304 0
305-292-4510
The section and location within the AAA where
d• Requests for Payment and Receipt and Expenditure
p�60
Anthonyoombs. Associate
y oc�ate ice President
forms are o be mailed is:
�� 1.0�th. Avenue, Suite �01 and 4
Miami, Flom da 33172
e. The name, address, and telephone number of the
Maria Scotto
Contract Manager for the AAA for this contract is:
760 NW 107'h Ave. #2)14
Miami, FL 33174
Upon change of representatives (names, addresses, telephone numbers b either �-
y party, notice shall be provided in
writing to the other party and the notification attached to the
originals of this contra
�. ct.
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January 2011 Contract CLP- MCSS 11
52. All Terms and Conditions Included
i nis contract and its Attachments,., I — X, A. B. Ej F., G and H, and any exhibits referenced in said attachments.
together with any documents
W incorporated by reference, contain all the terms and conditions aereed upon by the
parties. There are no provisions, terms, conditions, or obl'
igations other than those contained herein. and this contract
shall Supersede a -it previous COMMUnications, representations or agreements, either written verbal between the
parties. Z:� or ve
By signing this contract, the parties agree that they have read and agree to the entire contract.
IN WITNESS THEREOF, the parties hereto have caused this 63 page contract, to be executed by their undersigned officials as
duly authorized.
Contractor:
SIGNED BY:
Heather Ca/truthers
NAME:
V
Mayor
TITLE.-
.. . ..........
DATE.- 12-1 5-2010
5 il
Y ,0U' GE CLERK
ALLIANCE FOR AGING, INC.
SIGNED BY:
NAME: MAX B. ROTHMAN, JD, L.L.M.
TITLE: PRESIDENT AND CEO
J
DATE:— C
..............
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J allLtuy `2.0 11
(9
■
Contract CLP- MCSS 11
ATTACHMENT
ATTACHMENTI
ATTACHMENT 11
ATTACHMENT 111,
EXH1B IT I
ATTACHMENT III,
EXHIBIT 2
ATTACHMENT 1.11.
EXHIBIT 3
ATTACHMENT IV
ATTACHMENT V
ATTACHMENT VI
ATTACHMENT VII
ATTACHMENT
Vill
ATTACHMENT IX
ATTACHMENT X,
EXHIBIT I
ATTACHMENT X,
EXHIBIT I
ATTACHMENT X,
EXHIBIT 3
ATTACHMENT A
ATTACHMENT B
ATTACHMENT E
ATTACHMENT F.
EXHIBIT I
ATTACHMENT F.
EXHIBIT'
ATTCHMENT G
ATTACHMENT H
INDEX TO CONTRACT ATTACHMENTS
ATTACHMENT DESCRIPTION
STATEMENT OF WORK
CERTIFICATION REGARDING LOBBYING
FINANCIAL COMPLIANCE AUDIT ATTACHMENT
FEDERAL RESOURCES AWARDED TO THE St BRECIPIENT PURSUANT
TO THIS AGREEMENT
AUDIT RELATIONSHIP DETERMINATION &FISCAL COMPLIANCE
REQUIREMENTS
CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE
CERTIFICATION REGARDING DEBARMENT, SUSPENSION,
INELIGIBILITY AND VOLUNTARY EXCLUSION
ASSURANCES - NON -CONSTRUCTION PROGRAMS
OLDER AMERICANS ACT PROGRAM BUDGET SUMMARY
OLDER AMERICANS ACT CONTRACT REPORT CALENDAR
REQUEST FOR PAYMENT
RECEIPTS AND EXPENDITURES, TITLE III ADMINISTRATION
RECEIPTS AND EXPENDITURES, TITLE IIIB, IIIC I I AND IfIC22
RECEIPTS AND EXPENDITURES, TITLE IIIE
DEPARTMENT OF ELDER AFFAIRS' PROGRAMS & SERVICES
HANDBOOK (ON CD)
DEPARTMENT OF ELDER AFFA IRS' CIVIL RIGHTS COMPLIANCE
CHECKLIST AND INSTRUCTIONS
DEPARTMENT OF ELDER AFFAIRS' COMPUTER USE AND SOCIAL
MEDIA POLICY ON CD)
DOEA COST ANALYSIS FOR NON -COMPETITIVELY PROCURED
CONTRACTS IN EXCESS OF CATEGORY 11
INSTRUCTIONS: DOEA COST ANALYSIS FOR NON -COMPETITIVELY
PROCURED CONTRACTS IN EXCESS OF CATEGORY 11
CLP PROGRAMS PROTOCOLS
SERVICE -PROVIDER APPLICATION
PAGE
15--?5
17 2
2 9 - 3 2
33
35
37
39
41-42
43
45
47
49-51
53-55
57-59
61
63-68
69
71
73
7�11-84
85-96
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January 2011
Contract CLP- M.CSS 11
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January 2011.
Contract CLP- MCSS 11
ALLIANCE FOR AGING, INC.
STATEMENT OF WORK
OLDER AMERICANS ACT PROGRAM TITLE III
SECTION 1: SERVICES TO BE PROVIDED
III DEFINITIONS OF TERMS AND ACRONYMS
L I J CONTRACT ACRONYMS
ADL — Activities of Daily Living
APS — Adult Protective Services
AIRS —Alliance of Information & Referral Systems
ADA — Americans with Disabilities Act
AAA — Area Agency on Aging
APCL — Assessed Priority Consumer List
CIRIS — Client Information and Registration Tracking System
FLAIRS — Florida Alliance of Information and Referral Services
UR — Information and Referral
IADL — Instrumental Activities of Daily Living
MOA — Memorandum of Agreement
MOU — Memorandum of Understanding
OAA —Older Americans Act
PSAs — Planning and Service Areas
Z�
WebD.B — Web -based Database System
1.1.2 PROGRAM SPECIFIC TERMS
ATTACHMENT I
ADI (Alzheimer"s Disease Initiative) — Services targeted to individuals with Alzheimer's Disease or a similar
memory disorder, including respite, assessment, caregiver training, and other community -based services. These
services are funded through a specific state appropriation.
ADRC or ARC (Aging and Disability Resource Centers or Aging Resource Centers) — The not -for -profit entity
which is the single entry aging point for the ing service system within each established re ion of the state.
i Z:� 9
APS (Adult Protective Services) High Risk — The designation of an elder who needs immediate protection from
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further abuse, neglect or exploitation, which can be accomplished completely or in part through the provision of
home and community -based services.
Area Plan: A plan developed by the area agency on aging outlining a comprehensive and coordinated service delivery
Z:!
system in its planningZn and service area in accordance with the Section 306 (42 U.S.C. 3026) of the Older Americans Act
and department instructions.
Area Plan Update.- A revision to the area plan wherein the area agency on aging enters OAA specific data in the
web -based database system (WebD.13). An update may also include other revisions to the area plan as instructed by
the department.
Caregiver or Support System — For this project, the caregiver or Support system is one or more persons whore the
elder can depend on to provide care or to organize the provision of needed care.
Care Plan Review Team — For purposes of this project, a team of staff designated by the CLP staff, which reviews
the chent"s situation and makes recommendations concerning continuation of services after the initial short term
grant -funded crisis -resorting period. However in no case will services be continued on a long term basis tinder this
program.
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In
January 201.1
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Contract CLP- , CSS
CCE (Community Care for the Elderly) — Services offered to functionally impaired older persons to enable them
live in the least restrictive environment, including adult day care, consumable medical supplies, home delivered
meals, homemaker, personal care, respite, and other community -based services. These services are funded through a
specific state appropriation. Z
CIRTS (Client Information and Registration Tracking System) — The database of the Department of Elder
Affairs used by the aZ��crine network to manage client assessment data,
I register clients for services, plan client services
and maintain program waiting lists. Lead agency provider assessors also use CIRTS to evaluate client eligibility for
Medicaid services and to develop recommendations for client placement.
CDC (Consumer Directed Care) — A service option that gives elders, or their representatives, the opportunity to
manaue the elder's service delivery, including decisions about which services will be provided, by whom and how
often. With the assistance of a consultant, an elder develops a budget plan that identifies needed goods and services
and authorizes the elder to hire workers, who may be family members or friends, and select vendors to help with da'lI
care needs. A fiscal/employer agent (F/EA) pays the workers and vendors according to the rates on the budget plari.
The F/EA also pays the required federal and state taxes and files the necessary tax forms. Z:
Community Living Program — "Community Living Program" is a grant to the state of Florida from the federal
Zn
Administration on Aging. For persons meeting the project"s functional and financial eligibility criteria, the grant
provides crisis -resolving in -home services to address their immediate and temporary needs as they leave a hospital or
rehabilitation center or after a short-term nursing home stay. Without these services, the person Would be at high risk
of either nursing home placement or continued stay in a nursing home. This program also manages consumer directe(
care, services provided to veterans.
Cost Sharing — Payment by an individual for a portion of the monthly cost of the services he/she receives, based on
the individual's income and assets, and determined by the total monthly cost of the planned services.
Crisis -Resolving Services — T i me -1 i m i ted community -based services provided to address a client's immediate s ho rt-
term care needs. Possible services include, but are not I imited to: case management, personal care, homemaker,
transportation, meals. For the purposes of this program, a crisis is an episode that has a high probability of creating a
nursing home long term placement or a re -hospitalization. Examples of such crisis include caregiving situations, i.e, a
caregiver hospitalization that would cause the nursing home placement of the care recipient; it also includes
hospital/rehab discharges that have a high likelihood of recidivism or further patient deterioration where a permanent
nursing home placement is a likely sequel.
Financial Eligibility — To be financially eligible to receive services, other than assessment and referral, under this
project, the individual must not be eligible for Medicaid Linder the Institutional Care Program (ICP) rules.
Frail., When an older individual is unable to perform at least two activities of daily living (ADL) without substantial
human assistance, including verbal reminding, physical cueing or supervision; or due to cognitive or other mental
impairment, requires substantial supervision because the individual behaves in a manner that poses a serious health or
safety hazard to the individual or to another individual.
Lead Agency —A Community Care for the Elderly (CCE) designated agency. Lead agencies provide services un.. er
the CCE and ADI programs. In addition lead agencies handle APS cases in accordance with a DOER established
protoco 1.
Lead Service Provider —A provider of Older American Act Services that also provides case management Under this
project. The Case manager from the service provider will follow-up with those project participants referred by the
CLP staff to facilitate the provision of services during the grant period and to help plan for the person"s needs after
the tyrant period, 17
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OAA III-B, HID, IIIE (Older Americans Act Titles.) — Title 111B provides Supportive services to assist elders to I iv-,e
independently in their Community. Title 111D provides disease prevention and health- promot ion services at senior
centers or aftemative sites. Title 111.E provides services through the National Family Caregiver Support Program to
assist families caring for frail older members, and to assist grandparents or older re' Z�ft -v
Zn latives who are caregi fCrs for
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January 20 1. 1
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Contract CL.P- MCSS 11
children who are tinder 19 or are disabled.
Private Pay — Payment of the complete cost of services by an individual with sufficient income and assets to be ovC
the financial standards for receipt of state or grant funded services.
Referring Entity — An entity providing prov referrals to the single entry point. These include case management agencies
hospitals, rehabilitation centers, home health agencies, physician assisted home based prot.-Trams, and nursing homes
Individuals referred should appear to meet the eligibility criteria for this project. �
Self -declared —.For purposes of initial financial eligibility for the project, the individual's declaration of income aric
assets will not require verification.
SEP (Single Entry Point) — The CL.P staff for the area where the individual is receiving services is the single entry
i point into the aging service system.
Spend down to Medicaid — The use of personal resources to pay for services prior to the individual's resources
being reduced to the level of Medicaid eligibility.
Triage — The activity performed by CLP staff to prioritize an individual for service based on the criteria established
for publicly funded programs because he/she does not meet the eligibility criteria for this project.
Zn eligibility
Veterans Administration Consumer Directed Care —A. capitated consumer directed care program sponsored by
the Veterans Administration and operated through the Community Living Prourram. Also, see Consumer Directed
Care definition above. Zn
1.2 Alliance for Aging Mission
The Alliance For Aging Inc. mission id to promote and advocate for the optimal quality of I ife for older adults and
their families.
DOEA Mission Statement
The department's mission is to foster an optimal quality of life for elder Floridians. The department's vision and
shared values are to foster a social, economic and intellectual environment for all ages, and especially those age 60
.
and older, i der, where all can enjoy Florida's unparalleled amenities in order to thrive and prosper. Area agencies, lead
agencies and local service providers as partners and stakeholders in Florida's aging services network are expected
to Support the department's mission, vision, and program priorities.
1.2.2 Older Americans Act Program Mission Statement
The Older Americans Act (OAA) Program is a federal program initiative that provides assistance to older persons
and caregivers and is the only federal supportive services program directed solely toward improving the lives of
older people. The program provides a framework for a partnership among the different levels of government and
the public and private sectors with a common objective, improving the quality of life for all older individuals by
helping them to remain independent and productive.
1.3 GENERAL DESCRIPTION
General Statement
The goals Of COMMUnity Living Program Phase 11, for PSA I I are to reduce overall Medicaid long term care
expenditures, develop co -pay and financially Sustainable systems within the context of the Older Americans Act
network of AAA and providers., and to increase consumer choice and self -direction.
1.3.2 Authority
The relevant references authority governing the OAA program are:
Z7
1) Older Americans Act of 2_006, as amended,
1 7 '9 6
...... .... . .... .. ... ................... ............. ........ ...... ...................... ............ .... . ... ... ......................... .... ................. .... . .............................. ............ ............................ ......................................................................................................................................................................................................................................................................................................................... :..: .... .................... ....... .......... .......... .. ..... ...... ................ .... . ........... .......... ....... ....... ...... ........ ... ... ... ..................... .......................................... . ...... .............. .. ... .... .......... ..... .. ... . ..... .... . .. ......... .......... ... .............. . ........... .......... ... . .. ...... .... . .... . .. ........ . .. .. .. ..... ...... .. .... .
January 20 11
W
E
Contract CLP- MCSS 11
(2) Rule 58A-1, Florida Administrative Code; and
(13) Section 430.101, Florida Statutes.
1.3.2.1 Incorporation of Reference Memoranda
In accordance with Ch. 287 F.S., as amended and Department of Financial Services", Chief Financial Office
Memoranda, the following memoranda are provided for informational purposes and incorporated by reference.
(I) CFO Memo No. off : Release date, AL gust 20. ?010;
(2) CFO Memo No. 03: Release date, June 29,2010; and
(3) CFO Memo No. 06.- Release date, June 30,2010.
1.3.3 Scope of Service
The contractor is responsible for providing services in accordance with the CLP Program Protocols contained it
ATTACHMENT G and its response to the 2010 CLP program ITN contained in ATTACHMENT H. The
services shall be provided in a manner consistent with and described in the current contractor's area plan update and
the current Department of Elder Affairs Programs and Services Handbook (ATTACHMENT A).
1.3.4 Major Program Goals
The goals of Community Living Program Phase 11, for PSA 11. are to reduce overall Medicaid loner term care
expenditures, develop co -pay and financially sustainable systems within the context of the older Americans Act
network of AAA and providers, and to increase consumer choice and self -direction.
To achieve these goals PSA I I will focus its efforts in providing consumers with the means to resolve events that
have been identified as "critical pathways"' to institutional long term care. Some of these "critical pathways"' inclLide
SUdden caregiver burnout, depression, malnutrition/dehydration and lack of proper follow up with home and
community based services following hospital/rehab discharges. PSA I I will also manage a Veterans Administration
Consumer Directed Care.
1.4 INDIVIDUALS TO BE SERVED
1,4A Eligibility
Client Identification
1. Individual is at least 60 years old.
2. Individual is a resident of Miami -Dade or Monroe Counties.
3. Financially uneligible for Medicaid and functionally impaired.
4. Has Medicare or private health insurance.
Individual is not receiving hospice services.
Individual or caregiver is in need of crisis resolving services and/or short term care, to avoid readmission to a
hospital/rehab facility or a nursing home placement which could lead to spend down to Medicaid. Services are not
tyeared to resolve a long term care need, but to address a critical short term need that if left unresolved would
precipitate a nursing home placement or re -hospitalization
OAA Title 111, General
Consumers shall not be dually enrolled in an OAA pro-oram and a Medicaid capitated long-term care program,
I- zn Z�
1.4.2 Targeted Groups
Preference shall. he given to those with the greatest economic and social need, with particular attention to low-
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January 201.1
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Contract C CSS
income older individuals, including those that are low-income minorities, have limited English proficiency, and
older individuals residing in rLtral areas.
Z:�
SECTION 11 — MANNER OF SERVICE PROVISION
2.1 SERVICE TASKS
In order to achieve the goals of the OAA program, the contractor shall ensure that the protocols contained in
Z7
ATTACHMENT G and the response to the _20 10 CLP program ITN contained in. ATTACHiNIENT H
Z�
2.1-3.1 Supportive Services
Supportive services include a variety Of Community
-based
and home -delivered services that support the quality of
life for older individuals by helping them remain independent and productive. Services include the following-
4n,
(1)
Adult Day Care/Adult Day Health Care;
(17)
Legal Assistance;
(2)
Caregiver Training/Support;
(18)
Material Aid;
(3)
Case Aid/Case Management*
to
Occupational Therapy;
(4)
Chore Services;
(20)
Outreach;
(5)
Companionship,
(2.1)
Personal Care;
(6)
Counseling (Gerontological and Mental
(22)
Physical Therapy;
Health);
(7)
Education/Training-
1
(23)
Recreation;
(8)
Emergency Alert Response;'
(24)
Referral/Assistance;
(9)
Escort;
(25)
Respite Services;
(10)
Health Support,
(26)
Screen i ng/Assessment;
(11)
Home Health Aid;
(27)
Shopping Assistance;
(1-2)
Homemaker-,
(28)
Skilled Nursing;
(13)
Housing Improvement,
(29)
Specialized Medical Equipment, Services, and
(14)
Information;
Supplies
( 1.15)
Intake,;
(30)
Speech Therapy;
(16)
Interpreter Translating;
(31)
Telephone Reassurance: and
(.32)
Transportation
2.1.4 Use of Volunteers to Expand the Provision of Available Services
The contractor shall make use of trained Volunteers in providing direct services delivered to older individuals and
individuals with disabilities needing such services. If possible, the contractor shall work in coordination with
organizations that have experience in providing training, placement, and stipends for VOILinteers or participants
(such as organizations carr-yina, Out Federal service programs administered by the Corporation for National and
Community Service), in community service settings.
2. 1 Z5 IN'lonlitoring the Performance of Subcontractors
The contractor shall. conduct at least one monitorina, per year of each SUbcontractor, The contractor shall perform
fiscal, administrative and programmatic monitoring of each subcontractors to ensure contractUcell compliance, f1scal
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Contract C LP- :IMC S S
accountability, programmatic performance, and compliance with applicable state and federal lays and regulations
2.I = .1 Use of Subcontractors
If this contract involves the se of a subcontractor or third party, then the contractor shall not delay the
implementation of its agreement with the subcontractor. If any circumstances occur that may result in a delay for a
period of 0 days or more of the initiation of the subcontract or in the performance of the subcontractor, the
contractor shall notify the AAA s Contract Manager and the AAA's Chief Financial officer in writing of SLIch
clay.
The contractor shall not permit a subcontractor to perform services related to this agreement without having a
ending subcontractor agreement executed. In accordance with Paragraph 24.1 of the Standard Agreement, the
AA will not be responsible or liable for any obligations or claims resulting from such action.
2.2 SERVICE LOCATION AND EQUIPMENT
2.2.1 Service Times
The contractor shall ensure the provision of the services listed in the contract during normal business hours unless
other times are more appropriate to meet the performance requirements of the contract, and it shall monitor its
subcontractors to ensure they are available to provide services during hours responsive to client needs and during
those times ► h ich best meet the needs of the relevant service community.
23 Equipment
2.3.1 Equipment means: a an article of nonexpendable, tangible personal property having a useful 1 ife of more than one
year and an acquisition cost which equals or exceeds the lesser of the capitalization level established by the
organization for the financial statement purposes, or $5,000.00 for federal funds], or (b); nonexpendable, tangible
personal property of a nonconsumable nature with an acquisition cost of $1,000.00 or more per unit, and expected
useful life of at least one year; and hardback bound books not circulated to students or the public, ubl ic, with a
�
value or cost of $250.00 or more [for state funds].
2.3.2 Contractors and sub -contractors who are Institutions of Higher Education, Hospitals., and other Ion -Profit
Organizations shall have written property management standards in compliance with 2 CFR Part 215
Administrative Requirements (formerly OMB Circular A-1 10) that include: a) a property list with all the elements
identified in the circular; and, b) a procedure for conducting a physical inventory of equipment at least once every
two years. The property records roust be maintained on file and shall be provided to the AAA upon request.
23.3 The contractoris property Management standards for equipment acquired with Federal funds and federally -owned
equipment shall include accurately maintained equipment records with the following information:
1 A description of the equipment,
2 Manufacturer's serial number, model. number, Federal stock number, national stock number, or other
identification number;
(3) Source of the equipment, including the award number-
(4) Whether title vests in the contractor or the Federal Government;
.15 Acquisition gate or date received, if the equipment was furnished by the Federal Government) and cost:
Information from which one can calculate the percentage of Federal participation in the cost of the equipment
(not applicable to equipment furnished by the Federal Government):
(7) Location and condition of the equipment and the date the information was reported;
6
JanUary 20 11 Contract CLP- MOSS 11
(8) Unit acquisition cost; and
(9) Ultimate disposition data, Including date of disposal and sales price or the method used to determine current
fair market value where a contractor compensates the federal awarding agency for its share.
2.3.4 Equipment purchased with federal funds with an acquisition cost over $5,000.00 and equ I rent purchased witl
state funds with an acquisition cost over S1,000-00 that is specifically identified in the area plan approved by DOEA
is part of the cost of carrying out the activities and functions of the grant awards and Title (ownership) will vest ir
the contractor, subject to the conditions of 2 CFR Part 2215 Administrative Requirements (formerly OMB CirvLllai
A-1 1.0), Subpart C, Paragraph 34. Equipment purchased under these thresholds is considered supplies and is !101
subject to property standards. Equipment purchased with funds identified in the budget attachments to agreement,�
covered by this contract, or identified in the sub -agreements with sub -contractors (not included in a cost
methodology), is Subject to the conditions of Chapter 273, F. S. and 60A- 1 .00 17, F. A. C. or Title 45 CFR Part 74.
2.3,5 The contractor shall not dispose of any equipment or materials provided by the AAA, or purchased with funds
provided through this contract without first obtaining the approval of the AAA's Contract Manacrer. When
disposing of property or equipment the contractor must submit a written request for disposition instructions to the
respective Contract Manager. The request should include a brief description of the property, purchase price,
funding Source, percentage of state or federal participation, acquisition date and condition of the property. The
request should also indicate the contractor's proposed disposition (i.e., transfer or donation to another agency that
administers federal programs, offer the items for sale, destroy the items, etc.).
2.3.6 The AAA's Contract manager will issue disposition instructions. If disposition instructions are not received within
1.20 days of the written request for disposition, the contractor is authorized to proceed as directed in _2 CFR Part 2- 1. 5
Administrative Requirements (formerly OMB Circular A- I 10).
23.7 Real property means land (including land improvements), buildings, structures and appurtenances thereto, bLit
excludes movable machinery and equipment. Real property may not be purchased with state or federal funds
through agreements covered under this contract without the prior approval of the DOEA. Real property pUrchases
from Older Americans Act funds are subject to the provisions of Title 42, Chapter 35, Subchapter 111, Part A. Sec.
3030b United States Code (USC). Real property purchases from state funds can only be made through a fixed
capital OLItlay grants and aids appropriation and therefore are subject to the provisions of s. 1. 16.348, F. S.
Z:�
2.3.8 Any permanent storage devices (e.g.: hard drives, removable storage media) must be reformatted and tested prior to
disposal to ensure no confidential information remains.
January 2_01 I y.
Contract CLP- MOSS f I
2.4 DELIVERABLES
2.4.1. Service Unit
The contractor shall provide the services described In the contract in accordance with ATTACHMENTS A, G and
no
2.5 REPORTS
The contractor is responsible for responding in a timely fashion to additional routine and/or special requests for
information and reports required by the AAA.
2.5.1 Service Costs Reports
The contractors shall submit to the AAA semi-annual service cost reports, which reflect actual costs of providing
each service by proararn. This report provides information for planning and negotiating unit rates.
2.6.1 Each contractor and subcontractor, among other reqUirements, must anticipate and prepare for the loss of
information processing capabilities. The contractor shall maintain written policies and procedures for Computer
system backup and recovery and shall have the same requirement in its contracts and/or agreements with
subcontractors. These policies and procedures shall be made available to the AAA upon request.
2.7 PERFORMANCE SPECIFICATIONS
2o7o1 Outcomes
Am
(1) The contractor shall timely submit to the AAA all reports described in ATTACHMENT 1, Paragraph 2 "Z�
REPORTS,:
(2) The contractor shall timely Submit to the AAA all Information described in ATTACHMENT 1, Paragraph
2.6 RECORDS AND DOCUMENTATION,
(3) The contractor shall ensure services in this contract are in accordance with ATTACHMENT A.
2.7.3 Monitoring and Evaluation Methodology
The AAA will review and evaluate the performance of the contractor under the terms of this contract. Monitoring
shall be conducted through direct contact with the contractor through telephone, in writing, and/or an on -site visit.
The AAA's determination of acceptable performance shall be conclusive. The contractor agrees to cooperate with
the AAA in monitoring the progress of completion of the service tasks and deliverables.
2.7.4 Remedies- Nonconform 19 .gLServices
The contractor shall ensure that all. participants served under this agreement are eligible for the program. and that all
monthly and/or quarterly performance reports and financial records are maintained for each reporting period rind
submitted as stipulated in Paragraphs 1.4 - 1.4.2 and 2.1 - 2.1.6.
Any nonconforming program services, performance reports or financial records not ineetinof the aforementioned
requirements shall not be eligible for reimbursement under this program. The costs associated w'th enrolfill
traininal, reporting and/or managing the program shall be borne solely by the contractor. The AAA re Hires
immediate notice of any significant and/or systemic infractions that compromise the contractor's ability to provide
participant services, to achieve programmatic performance or to provide Sound financial management of the
program,
1,8 CONTRACTOR"S FINANCIAL OBLIG'ATIONS
ow
Jaiittary 2011 a
Contract CLP- MOSS 11
2,8.1 Matching, Level of Effort, and Earmarking Requirements
The contractor will fulfill a. match requirement of at least 10 percent of the cost for all services funded thrOLIgh thii
contract (i.e. 90 cents of grant funds must be matched with 10 cents from the contractor.) The subcontractor
match will be made in the form of cash and/or in -kind resources. Match must be reported by title each month. A
the end of the contract period. all OAA funds must be properly matched. The provider must comply with the valUt
added," prow sons contained In Appendix
2.8,2 Consumer Contributions
(1) The contractor assures compliance with Section 315 of the Older Americans Act as amended in 2006. ill
regard to consumer contributions,
Z:� I
Gf!) Voluntary contributions are not to be used for cost sharing or matching'
(3) Accumulated voluntary contributions are to be used prior to requesting federal reimbursement; and
(4) Voluntary contributions are to be used only to expand services.
2,8.3 Use of Service Dollars
The contractor is expected to spend all federal, state and other funds provided by the AAA for the purpose specified
in the contract. The contractor must manage the service dollars in such a manner so as to avoid having a wait 11-st
and a Surplus of funds at the end of the contract period, for each program managed by the contractor. If the AAA
determines that the contractor is not spending service funds accordingly, the AAA may transfer funds to other
providers during the contract period and/or adjust subsequent funding allocations accordingly, as allowable under
state and federal law.
2.8.4 Title III Funds
The contractor assures compliance with Section 306 of the Older Americans Act, as amended in 20063 that funds
received under Title III will not be used to pay any part of a cost (including an administrative cost) incurred by the
contractor to maintain a contractual or commercial relationship that is not carried out to implement Title 111.
2,9 AAA RESPONSIBILITIES
2.9.1 Program Guidance and Technical Assistance
The AAA will provide to the contractor guidance and technical assistance as needed to ensure the successful
fulfillment of the contract by the contractor,
0
2.9.2 Contract Monitoring
The AAA shall, at its own discretion, conduct monitoring concerning any aspect of the contractor's performance of
this contract.
SECTION Ill: METHOD OF PAYMENT
3.1 General Statement of Method of Payment
The method of payment for this contract includes advances,, cost reimbLirsement for administration costs, and fixed
rate for services. The contractor shall ensure fixed rates for services include only those costs that 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. The contractor shall consolidate all requests for payment from
Subcontractors and expenditure reports that SLIpport requests for payment and shall submit to the A.AA on fir
nis
106A (ATTACHMENT IX), 10,5AA (ATTACHMENT X-EXHIBIT 1), 105AS (.ArTACHMENT X-EXHiBrr
2-, and 105AE 'ATTACH.
MENT X-EXHIBIT 3).
21-3/96
41
Contract CL.P- MOSS 11
3,1.1 The contractor agrees to implement the distribution of funds as detailed in ATTACHiMENT VII Budget
Summary. An amendment is required to change the total amount of the contract.
3.2 Advance Payments
v
3.2.1 The contractor may request up to two months of advances at the start of the contract period, if available to cover
program administrative and service costs. The payment of an advance will be contingent upon the sufficiency and
amount of funds released to the AAA by the State of Florida "budget release"'). The contractor shall provide the
AAA's Contract Manager documentation ,justifying the need for an advance and describing how the funds will be
distributed.
3.2.2 The contractor's requests for advance require the approval of the AA.A.'s Contract Manager. If Sufficient budget is
available, the AAA will issue approved advance payments after January 1, 2011.
3.2.3 Requests for the first through the twelfth months shall be based on the submission of actual monthly expenditure
p
reports beginning with the first month of the contract. The schedule for submission of advance requests, if available
is shown on ATTACHMENT vIII of this contract.
3.2.4 All advanced payments made to the contractor shall be recouped in accordance with the Reporting Schedule
ATTACHMENT vIII of this contract.
3.2.5 Interest earned on advances must be identified separately by source of funds, state or federal. Contractors shall
maintain advances of federal funds in interest bearing accounts unless otherwise excepted in accordance with 45
CFR 74.22(k). Earned interest must be returned to the AAA at the end of each quarter.
3.3 Invoice Submittal and Requests for Payment
t
All requests for payment and expenditure reports submitted to support requests for payment shall be on DOEA
forms 106A (ATTACHMENT IX), 105AA. (ATTACHMENT X-EXHIBIT 1), 105AS ATTACHMENT X-
EXHIBIT 2), and 105AE (ATTACHMENT X-EXHIBIT 3).
3.3.1 All payment requests shall be based on the submission of actual monthly expenditure g
reports beginning with the
p g
first month of the contract.. The schedule for submission of advance requests (when available) and invoices is
ATTACHMENT vIII to this contract.
3.3.2 Any payment due by the AAA under the terms of this contract may be withheld pending p pp the receipt and approval of
all financial and programmatic reports due from the contractor and any adjustments thereto, including any
disallowance not resolved as outlined in Paragraph 26 of this contract.
3.3.3 Payment may be authorized only for allowable expenditures, which are in accordance with the limits specified in
ATTACHMENT '11, Budget Summary. An changes i p � y' y g n the amounts of federal or general revenue fUnds
identified on the budget Summary form require a contract amendment.
3.3.4 Date for Final Request for Payment
The final request for payment w it l be due to the AAA no l ater than February 14, 20 122.
3.4 Documentation for Payment
The contractor shall Maintain documentation to support payment requests that shall be available to the AAA or
authorized individuals, Such as Department of Financial Services. upon. request.
J an U ary 2 0 1. 1
Contract. CIL -
CSS
the CIRTS database. Data must be entered into CIRTS before the contractors submit their request for payinent an(
expenditure reports.
3.4.2 The contractor run monthly CIRTS reports and verify that client and service data in CIRTS is accurate. This repor",
must be submitted to the AAA with. the monthly request for payment and expenditure report and must be reviewec
by the AAA before the contractor's request can be approved by the AAA.
� � 0 .
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January ?011
Contract C LPMC S S 11
ATTACHMENT 11
CERTIFICATION REGARDING LOBBYING
CERTIFICATION FOR CONTRACTS, GRANTS, LOANS AND
AGREEMENTS
The Underskmed certifies, to the best of his or her knowledge and belief, that:
1 No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for
influencing or attempting to influence an officer or employee of any state or federal agency, a member of congress, an
officer or employee of congress, an employee of a member of congress, or an officer or employee of the Mate leori:slator,
in connection with the awarding of any federal grant, the making of any federal loan, the entering any coo into of erati e
p
agreement, and the extension, continuation, renewal, amendment, or codification of any federal contract, grant, loan or
cooperative agreement.
2 f any funds other than federal appropriated funds have been paid or will be paid to an person for influencing Y � g or
attempting to influence an officer or employee of any agency, a member of conorress, an officer or employee ofcongress,
or an employee of a member of congress in connection with this federal contract, gp
rant, loan, or cooperative agreement,
the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," ," in accordance
with its instructions.
p Y
(3) The undersigned shall require that the language of this certification be included in the award documents for all sub -
awards at all tiers (including Subcontracts, sub --grants, and contracts under grants, loans and
cooperative agreements)and
p
that all sub --contractors shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was made or
entered into. Submission of this certification. is a prerequisite for making or entering into this transaction imposed b
p Y
section l 35:2, Title 3 1, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty
. p Y
of not less than $10,000.00 and not more than $ l 00,000.00 for each such fail ure.
Signature Date
Name of authorized Individual
...............
Name and Address of organization
t OEA Form 103
(Revised Nov ? 2
Application or Agreement Number
96
January '2.WO 11. Contract CL. - MC 's
M.0
J anuary 201 1
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Contract CLP- MCS S rI
FINANCIAL AND COMPLIANCE AUDIT
ATTACHMENT III
EXHIBIT I
The administration of resources awarded by the Department of Elder {affairs or the Alliance for E ,�provider to the pro der maybe
subject to audits and/or monitoring b the Department of Elder affairs or the alliance for aging, as described in this section.
MONITORING
In addition to reviews of audits conducted in accordance with OMB Circular A- 133, as revised, and Section 215. 7, F.S., (see
"'AUDITS"' below), monitoring procedures may include, but not be limited to, on -Site visits by p the department of staff limited
scope audits as defined by OMB Circular a- 133, as revised, and/or other procedures. By entering into this agreement, the
provider agrees to comply and cooperate with any monitoring procedures/processes deemed appropriate by the Department of
Elder affairs or the .alliance for aging. In the event the Department of Elder affairs or the alliance for aging determines
that a limited scope audit of the provider is appropriate, the provider agrees to comply with any additional instructions
provided by the Department of Elder affairs or the alliance for .aging to the provider regarding such audit. The provider
further agrees to comply and cooperate with any inspections, reviews, investigations, or audits deemed necessary by the Chief
Financial officer (CFO) or auditor General.
AUDITS
PART I: FEDERALLY FUNDED
This part is applicable if the provider is a State or local government or a non --profit organization as defined in OMB Circular
A- 133, as revised.
In the event that the provider expends $500,000 or more in Federal awards during its fiscal year, the provider must have a
single or program -specific audit conducted in accordance with the provisions of OMB Circular a- 133, as revised. EXHIBIT
1 to this agreement indicates Federal resources awarded through the Department of Elder affairs or the .alliance fora in b
Aging y
this agreement. In determining the Federal awards expended in its fiscal year, the provider shall consider all sources of
Federal awards, including Federal resources received from the Department of Elder affairs or the alliance for .aging. The
determination of amounts of Federal awards expended should be in accordance with the guidelines established by OMB
Circular A-13 3, as revised. an audit of the provider conducted by the auditor General in accordance with the provisions of
OMB Circular A-133, as revised, will meet the requirements of this part.
In connection with the audit requirements addressed in Fart I, paragraph 1, the provider shall fulfill the requirements relative
to and tee responsibilities as provided in Subpart C of OMB Circular A- 133, as revised.
If the provider expends less than $500,000 in Federal awards in its fiscal year, an audit conducted in accordance with the
provisions of OMB Circular A- 133, as revised, is not required. In the event that the provider expends less than $500,00in
.Federal awards in its fiscal year and elects to have an audit conducted in accordance with the provisions of OMB Circular a-
133, as revised, the cost of the audit must be paid from non -Federal resources i.e., the cost of such audit must be paid from
provider resources obtained from other than Federal entities.)
An audit conducted in accordance with this part shall cover the entire organization for the organizations fiscal year.
Compliance findings related to agreements with the Department of Elder affairs or the alliance for aging shall be based on
the agreement"s requirements, including any rules, regulations, or statutes referenced in the agreement. The fir anti. l
statements shall disclose whether or not the matching requirement was met for each. applicable agreement, all q. t estio ed
costs and licabilities due to the Department of Elder Affairs or the alliance for aging shall be fully disclosed in the audit
report with reference to the Department of Elder affairs or the Alliance for Aging agrees ent involved. If not othcry se
disclosedas required by Section e310 b of OMB Circular a-133$ as revised, the schedule of expendit res of Federal
_29/96
January 2_01 I Contract CLP- MCSS 11
awards shall identify expenditures by agreement number for each agreement with the Department of Elder Affairs or the
Alliance for Aging in effect during the audit period. Financial reporting packages required Linder this part must be submitted
within the earlier of 30 days after receipt of the audit report or 9 months after the end of the provider"s fiscal vear end.
W
PART 11: STATE FUNDED
This part is applicable if the provider is a nonstate entity as defined by Section '215.97(2), Florida Statutes
In the event that the provider expends a total amount of state financial assistance equal to or in excess of $500,000 in any
fiscal year of such provider (for fiscal years ending September 30, 200-4 or thereafter), the provider must have a State single
or project -specific audit for such fiscal year in accordance with Section 215.97, Florida Statutes'; applicable rLdes of lthe
Department of Financial Services; and Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and for- prot . it
organizations), Rules of the Auditor General. EXHIBIT I to this agreement indicates state financial assistance awarded
through Aa
h the Department of Elder Affairs or the Alliance for aging by this agreement. In determining the state . %_1 t�l ate financial
assistance expended in its fiscal year, the provider shall consider all Sources of state financial assistance,, including state
financial assistance received from the Department of Elder Affairs or the Alliance for Aging, other state agencies, and other
nonstate entities. State financial assistance does not include Federal direct or pass -through awards and resources received by a
nonstate entity for Federal program matchincrZ:� requirements.
In ' connection with the audit requirements addressed In Part 11, paragraph I - the provider shall ensure that the audit complies
with the requirements of Section 215.97(8), Florida Statutes. This includes submission of a financial reporting package as
defined by Section 215.97(?), Florida Statutes, and Chapter 10.550 (local governmental entities) or 10.650 (nonprofit and for -
profit organizations), Rules of the Auditor General.
If the provider expends less than $500,000 in state financial assistance in its fiscal year (for fiscal years ending September 30,
'004 or thereafter), an audit conducted in accordance with the provisions of Section 2 15.97., Florida Statutes, is not required.
In the event that the provider expends less than $500,000 in state financial assistance in its fiscal year and elects to have an
audit conducted in accordance with the provisions of Section 2 15.97, Florida Statutes, the cost of the audit must be paid from
the nonstate entity's resources
"'o
(i.e., the cost of such an audit must be paid from the provider resources obtained from other
than State entities).
i
An audit conducted in accordance with this part shall cover the entire organization for the organizat Ion's fiscal year.
Compliance findings related to agreements with the Department of Elder Affairs or the Alliance for Aging shall be based on
the agreement's requirements, including any applicable rules, regulations, or statutes. The financial statements shall disclose
whether or not the matching requirement was met for each applicable agreement. All questioned costs and liabilities due to
the Department of Elder Affairs or the Alliance for Aging shall be fully disclosed in the audit report with reference to the
Department of Elder Affairs or the Alliance for Aging agreement involved. If not otherwise disclosed as required by Rule
691-5.003, Fla. Admin. Code, the schedule of expenditures of state financial assistance shall identify expenditures by
agreement number for each agreement with the Department of Elder Affairs or the Alliance for Aging in effect during the
audit period. Financial reporting packages required under this part must be submitted within 45 days after delivery of the
audit report. but no later than 12 months after the provider's fiscal year end for local governmental entities. Non-profit or for -
profit organizations are required to be submitted within 45 days after delivery of the audit report, but no later than 9 months
after the provider' s fiscal year end. Notwithstanding the applicability of this portion, the Department of Elder Affairs or the
Alliance for Aging retains all right and obligation to monitor and oversee the performance of this agreement as outlined
thrOUILYin out this document and pursuant to law.
PART III: REPORT SUBMISSION
Copies of reporting packages for audits conducted in accordance with. OMB Circular A-133, as revised, and required by
PART I of this agreement shall be submitted, when required by Section .320 (d.), OMB Circular A- 133, as revised, by or on
behalf of the provider directly to each of the followin
g:
The Alliance for Aging. Inc.:
aging, I
30/96
J aim ary
Contract CLP- MCSS 11
Alliance for A *n.g, Inc.
91
Attn: Horaelo Soberon
760 NW 107'hAve,
Nliarni, FL 33172
The Federal Audit Clearinghouse designated in OMB Circular A- 133, as revised (the number of copies required by Sect' 111� Z:� lolls
.320 (d)(1) and (7), OMB Circular A-133, as revised, should be Submitted to the Federal Audit C fear] nahOU se), at the
4n
following address:
Federal Audit Clearinghouse
Bureau of the Census
1201 East tolh Street
Jeffersonville, IN 4702
Other Federal agencies and pass -through entities in accordance with Sections .320 (e) and (f), OMB Circular A-133, as
revised.
Pursuant to Sections .320(f), OMB Circular A-133, as revised, the provider shall Submit a copy of the reporting package
described in Section .320(c), OMB Circular A-133, as revised, and any management letter issued by the auditor, to the
Department of Elder Affairs at each of the following addresses:
Z_11�
Department of Elder Affairs
Attn: Beverly Friedberg
4040 Esplanade Way Office 325B
Tallahassee, FL 32399-7000
Additionally, copies of financial reporting packages required by Part 1.1 of this agreement shall be Submitted by or on behalf of
the provider directly to each of the following:
The Alliance for Aging, Inc. at each of the following addresses:
Alliance for Aging, Inc.
Attn: Horacio Soberon
760 NW 107 th Ave.
Miami, FL 33172
The Department of Elder Affairs at each of the following addresses
Department of Elder Affairs
Attu., Beverly Friedberg
4040 Esplanade Way Office 325B
Tallahassee, FL 32399-7000
The Auditor General's Office at the followink address. -
State of Florida Auditor General
Claude Pepper Building, Room 574
11 .1 West Madison Street
Tallahassee, Florida 32399-14.115*0
Any reports, management letter, or other information required to be submitted to the Department of Elder Affairs pursuant to
this alrreement shall be sub pitted timely in accordance with OMB Circular A-133, Florida Statutes. and Chapters 10,550
(local governmental entities) or 10,650 (nonprofit and for -profit organizations), RL11es of the Auditor General. as applicable.
Providers, when submitting financial reporting packages to the Department of Elder Affairs for audits done in accordance
with OMB Circular A-133 or Chapters 10_550 (foe -al governmental entities) or 10.650 (nonprofit and for -profit
31/96
JanUary 2.0 11
M
Contract CLP- CMS 11
organizations), Rules of the Auditor General., should indicate the date that the re porting orpaCkae was delivered to the provider
in correspondence accompanying the reporting package.
PART IV: RECORD RETENTION
The provider shall retain Sufficient records demonstrating its compliance with the terms of this aareement for a period of six
years
from the date the audit report is issued, and shall allow the Department of Elder Affairs 'or its designee, the CFO or
Auditor General access to such records upon request. The provider shall ensure that audit working papers a"r�e made available
to the Department of Elder Affairs, or its designee, CFO, or Auditor General upon request for a per
iod of six ears from the
date the audit report is issued, Unless extended Z- in writing by the Department of Elder Affairs.
Jamiary'201 I
r
,ontract CL.P- MCSS 11
ATTACHMENT III
EXHIBIT 2
I. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS AGREVIVIENT
0
CONSIST OF THE FOLLOWING,
PROGRAM TITLE
Older Americans Act Administration —
Title 111B — Support ServI0I.I.I.0.iz
TOTAL FEDERAL AWARD
FUNDING SOURCE
U& Health and Human Services
CFDA A-MOUN . T
9'3), 0 4 4/
$15,000
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT TO
THIS AGREEMENT ARE AS FOLLOWS:
33/96
.......... . .... ..... ..... ............ : ..................... : ............... ... ............. : ........ ... : ...... ............. ...... .............................. ......... ................. : .... ....... : . .... ...... ................. ............. ....................... ........................ .............. ................. .................
J anUary ',,?;.0 11 a
Contract
Css
4 96
January 2011
contract CAP MOSS 11
PART I: AUDIT RELATIONSHIP DETERMINATION
ATTACHMENT III
EXHIBIT 3
Providers who receive state or federal resources may or may not be subject to the audit requirements of OMB Circular A- 33. as revised, re �
and/or Section 2 15.g7, Fla. Stat. Providers who are determined to be recipients or subrecipients of federal awards and/or state �nan c ial
assistance may be subject to the audit requirements if the audit threshold requirements set forth in Part I and/or Part II of Exhibit I are m et,
Providers who have been determined to be vendors are not subject to the audit requirements of OMB Circular A- 133, as revised car
end/
Section 215,97, Fla. Stat. Regardless of whether the audit requirements are recipients met. providers who have been determined to be recip` or
SL brecip ents of Federal awards and/or state financial assistance, must comply with applicable programmatic and fiscal compliance
nce
requirements.
� p
In accordance with Sec. 210 of OMB Circular -1 33 and or Rule 691-5.006, FAC, provider has been determined to be:
Vendor or exempt entity and not subject to OMB Circular A- and/car Section '115.97, F.S.
Recipient/subrecipient subject to OMB Circular -133 and/or Section 215.97, F.S.
NOTE: If a provider is determined to be a recipient subrecipient of federal and or state financial assistance and has been approved by the
department to :subcontract, they must comply with Section 215.97(7), F.S., and Rule 691-.006 2 F to
� �� � estate financial assistance and
Section — .400 OMB Circular A--133 1 federal awards].
PART II: FISCAL COMPLIANCE REQUIREMENTS
FEDERAL AWARDS OR STATE MATCHING FUNDS ON FEDERAL AWARDS. Providers who receive Federal awards or state
matching Funds on Federal awards and who are determined to be a subrecipient, must comply with the following fiscal laws, rules and
regulations.
STATES.) LOCAL GOVERNMENTS ADD INDIA N TRIBES UST FOLLOW:
2 CFR. Part. 225 Cost Principles for Mate, Local and Indian Tribal Governments (Formerly OMB Circular A.-87)*
OMB Circular A- 102 — Administrative Requirements
OMB Circular A- 133 — audit .Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in. program laws, rules and regulations
NON-PROFIT ORGANIZATIONS MUST FOLLOW:
2 CFR Part 230 Cost Principles for Non -Profit organizations (Formerly OMB Circular A-122 — Cost Princ i P les)*
2 CFR Part 215 Administrative Requirements (Formerly OMB Circular A -I I0— Administrative Requirements)
Requirements)
OMB Circular A- 133 — audit Requirements
Reference Guide for ,Mate Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
EDUCATIONAL INSTITUTIONS (EVEN IF A►: PART of A STATE OR LOCAL GOVERNMENT) MUST FOLLOW:
2 CFR .fart 220 Cost Principles for Educational Institutions OMB (Formerly Circular A-2 I — Cost Principles)*
2 CFR Part 215 Administrative Requirements (Formerly OMB Circular A- 110 — Administrative Requirements)
OMB Circular .-1 33 — Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth. in program laws, rules and regulations
t"Sane Federal programs may be exempted from compliance with the Cost .Principles CirCLIlars as noted in the OMB Circular A—
1 33 Compliance Supplement, Appendix I.
STATE FINANCIAL CIS L ASSISTANCE. Providers who receive state financial assistance and who are determined to b
e a
rec. p ent subrecipient, must comply with the followincy fiscal laws, rules and regulations:
Section 2.1.5.97. Fla. Stat.
Chapter 691-5, Fla, Admin. Code
State Projects Compliance Supplement
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws, rules and regulations
/96
January 20 11 a
Ow
J an.uary '4_20 11
'511ft
Contract 'ALP- MOSS .11
ATTACHMENT IV
CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE
FOR AGREEMENTS, GRANTS, LOANS AND
COOPERATIVE AGREEMENTS
The tindersit2ned, an authorized representative of the contractor named in the contract or agreement to which this form is an
t_
attachment, hereby certifies that:
(1) The contractor and any sub -contractors of services under this contract have financial management systems capable of
providing certain information, including: (1) accurate, current, and complete disclosure of the financial results of each
grant -funded project or program in accordance with the prescribed reporting requirements. the source and application of
funds for all agreement SLIpported activities; and (3) the comparison. of outlays with budgeted aMOUntS for each award. The
inability to process information in accordance with these requirements could result in a return of grant funds that have not
been accounted for properly. ZI-)
(2) Management Information Systems used by the contractor, sub -contractors). or any outside entity on which the contractor
is dependent for data that is to be reported, transmitted or calculated, have been assessed and verified to be capable of
processing data accurately. including year -date dependent data. For those systems identified to be non -compliant,
contractor(s) will take immediate action to assure data integrity.
(3) If this contract includes the provision of hardware, software, firmware, microcode or imbedded chip technology, the
undersigned warrants that these products are capable 4n of processing year -date dependent data accurately. All versions of
these products offered by the contractor (represented by the undersigned) and purchased by the State will be verified for
accuracy and integrity of data prior to transfer.
In the event of any decrease in functionality related to time and date related codes and internal subroutines that impede the
hardware or software programs from operating properly, the contractor agrees to immediately make required corrections to
restore hardware and software programs to the same level of functionality as warranted herein, at no charge to the State,
and without interruption to the ongoing business of the state, time being of the essence.
(4) The contractor and any sub-contractor(s) of services Linder this contract warrant their policies and procedures include a
disaster plan to provide for service delivery to continue in case of an emergency including emergencies arising from data
integrity compliance issues. ZI-)
The contractor shall require that the language of this certification be included in all subagreements, subgrants, and other
agreements and that all sub -contractors shall certify compliance accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered
into. Submission of this certification is a prerequisite for making or entering Into this transaction imposed b OMB Circulars
A- 102 and 1. CFR Part 21 (formerly OMB Circular A- I 10). y
Name and Address of Contractor
Signature
Name of ALIthorized Signer
Revised J Line
..........--.--
Title Date
W=
January 0.11
Contract CLP- MCSS
8/ 9
January '20 1 t
Contract CLP- MCA S
ATTACHMENT V
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND
VOLUNTARY EXCLUSION FOR LOWER TIER COVERED TRANSACTIONS
1) The prospective contractor certifies, by signing this certification, neither it nor its principals are presently debarred,
suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this
transaction by any federal department or agency.
('12) Where the prospective contractor is unable to certify to any of the statements in this certification, such prospective
participant shall attach an explanation to this certification..
SienatUre
Date
Title Agency/organization
(.Certification signature should be same as Contract signature.)
Instructions for Certiffleat ion
1. The terms "covered transaction," "debarred," "suspended,,` "ineligible," "lower tier covered transaction," "p
"primary primary covered transaction,it and "voluntarily excluded," as used herein, have the meanings set out in the sections
of rules implementing Executive Order 12549. ( - :2 CFR 180.5-180.1.020, as supplemented by 2 CFR 376.10-
376.995). You may contact the Contract Manager for assistance in obtaining a copy of those regulations,
2. This certification is a material representation Of facts upon which reliance was placed when the parties entered into
this transaction. If it is later determined that the contractor knowingly rendered an erroneous certification, in
addition to other remedies available to the federal government, the department may pursue available remedies,
including suspension and/or debarment.
3. The contractor will provide immediate written notice to the Contract Manager if at any time the contractor learns that
its certification was erroneous when Submitted or has become erroneous by reason of changed circumstances. The
contractor may decide the method and frequency by which it determines the eligibility of its principals. Each
participant to a lower tier covered transaction may, but is not required to, check the Excluded Parties List System
(EPLS).
4. The contractor will include a "Certification Regarding Debarment, Suspension. Ineligibility and Voluntary Exclusion
- Lower Tier Covered Transaction" in all its lower tier covered transactions and in all solicitations for lower tier
covered transactions.
5x The contractor agrees that it shall not knowingly enter into any lower tier covered transaction with a person who is
debarred, suspended, determined ineligible or voluntarily excluded from participation, unless otherwise authorized
by the federal government.
6. If the contractor knowingly enters into a lower tier covered transaction with a person who is suspended, debarred',
1.� .1
ineligible, or voluntarily excluded from participation. in this transaction, in addition to other remedies avail . able to the
federal aovernment. the department may pursue available remedies, including SLI.spension, and/or debarment.
January 2011. Contract
_96
January 2011.
Contract CLP- MCSS I
ATTACHMENT V1
ASSURANCES —NON -CONSTRUCTION PROGRAMS
Public report-Ing burden for this collection of information is estimated to average 45 minutes per response, including time for reviewinc.
maintaininginst.rttctions, searching existing data sources, gathering and maintaining the data needed and completing and reviewzi:�n-g the collection of
information. Send comments regarding the burden estimate or any other aspect of this collection of information. including suggestions f0i
reducim"! this burden, to the Office of Management and Budget. Paperwork Reduction Project (0348-0043). Washington. DC 20503.
- zn
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET,
SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
.0
,Note,. Certain of these assurances may not he applicable to your project or program. If you have questions please contact tht
awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. 11
such is the case, you will be notified.
I Has the legal authority to apply for Federal assistance, and the institutional,, managerial and financial capability (including funds
sufficient to pay the non -Federal share of project cost) to ensure proper planning, management, and completion of the project described
in this application.
2. Will give the awarding agency, the Comptroller General of the United States,,, and if appropriate, the State, through any authorized
representative, access to and the right to examine all records, books, papers, or documents related to the award; and will establish a
proper accounting system in accordance with generally accepted accounting standards or agency directives.
3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of
personal or organizational conflict of interest, or personal gain.
4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency.
5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. , 4728-4763) relating to prescribed standards for merit
systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPT 's Standards for a Merit
System of Personnel Administration (5 C.F.R. 900, Subpart F).
6. Will comply with all Federal. statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil Rights
Act of 1964 P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin: (b) Title IX of the Education
Amendments of 1972, as amended (20 U.S.C.� 1681-1683, and 1685-1686), which prohibits discrimination on the basis of sex; (c)
Section 504 of the Rehabilitation Act of 1.973, as amended (29 U.S.C.. 794), which prohibits discrimination on. the basis of handicaps-.
(d) the Age Discrimination Act of 1975, as amended (42 U.S.C.. 61-01-6107). which prohibits discrimination on the basis of age; (e) the
Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255)1, as amended, relating to nondiscrimination on the basis of drug abuse; (f)
the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616). as amended.,
relating to nondiscrimination on the basis of alcohol abuse or alcoholism: (g) 5.213 and 527 of the Public Health Service Act of 1912 (42
U-S.C., 290 dd-3 and 290 ee 3). as amended, relating to confidentiality of alcohol and drug abuse patient records-, (h) Title VIII of the
Civil Rights Act of 1968 (42 U.S.C. 3601 et seq.). as amended, relating to nondiscrimination in the sale, rental or financing of hOUSinct:
(i) any other nondiscrimination provisions in the specific statutes) under which application for Federal assistance is being made- and (j)
the requirements of any other nondiscrimination statute(s) which may apply to the application.
Will comply, or has already complied, with the requirements of Titles 11 and III of the uniform Relocation Assistance and Real Property
AcqUiSitiOn Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of persons displaced or whose property 1s
acquired as a result of Federal or federally assisted pros-trarns. These requirements apply to all interests in real property acquired four
project purposes regardless of Federal participation in purchases.
8. Will comply, as capplicable, with the provisions of the Hatch Act (5 U.&C, 1501-1508 and 732.4-7328), which limit the political
activities of employees whose principal employment activities are Ended in kvh('�)Ie or in part with Federal funds,
9. Will comply. as applicable, with the provisions of the Davis -Bacon Act (40 U.S.C.. 276a to '2-76a-717). the Copeland Act (40 UAS,C, 276c
and 18 U,S-Ca ' 8774)- and the Contract Work Hours and Safety Standards Act (.40 U.S,C. 3,271-3.33). recrarding lab standards for
federally assisted constrLICtion subagreements,
41/96
January 2011
Contract CLP- MCSS 11
10. Will comply, if applicable, with flood insurance purchase requirements of Section I 0.21(a) of the Flood Disaster Protection Act of 19-71.
P.L. 93 234) which requires recipients in a special flood hazard area to participate in the program and to purchase flood insurance it
the total cost of insurable construction and acquisition is $ 10,000.00 or more.
Will comply with environmental standards which. may be prescribed pursuant to the followinw, -a' institution of environmental quall0v
control measures under the National Environmental Policy Act of 1.969 P.L. 91-190) and Executive Order (EO) 11514: (b) notification
of violating facilities pursuant to EO 11-738; (c) protection of wetlands pursuant to EO 11990; (.d) evaluation of flood hazards in
floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved State, management program
znl tn
developed Linder the Coastal Zone Management Act of 1972 ( 16 U.S.C.. 145 ) I et seq.); (f) conformity of Federal actions to State (Cleat
Air) Implementation Plans under Section 176(c) of the Clear Air Act of 1955. as amended '42 U.S.C, 7401 et seq.):
g) protection cat
underground sources of drinking water under the Safe Drinking Water Act of 1974, as amended, P.L. 93-5.23): and (h) protection of
Z� tn
endangered species under the Endangered Species Act of 1973, as amended, P.L. 93-205 )-).
%.1
12 Will comply with the Wild and Scenic Rivers Act of 1968 (16 U-S-C.� 1721 et seq.) related to protecting components or potential
components of the national wild and scenic rivers system.
11 Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966. as amended
(16 U.S.C.,470). EO 11593 (identification and protection of historic properties), and the Archaeological and Historic Preservation Act
of 1974 (1-6 U.S.C.. 469a- I et seq.).
14. Will comply with P.L. 93-348 regarding the protection of human subjects involved in research, development, and related activities
supported by this award of assistance.
15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.C.. 2131 et seq.) pertaining to the care,
handling, and treatment of warm blooded animals held for research, teaching, or other activities Supported by this award of assistance.
16. Will comply with the Lead -Based Paint Poisoning Prevention Act (42 U.S.C.. 4801 et seq.), which prohibits the use of lead- based paint
in construction or rehabilitation of residence structures.
17. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act Amendments of 1996
and OMB Circular No. A- 133, Audits of States, Local Governments, and Non -Profit Organizations.
18. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations and policies governing this
program.
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL TITLE
APPLICANT ORGANIZATION DATE SUBMITTED
4 42W / 96
January .1.011 Contract CLP- MCSS 11
ATTACHMENT III
BUDGET SUMMARY
Maximum
Service Unit
Units- of
Maximum
Service(s) to be Provided
Rate
Service*
Dollars*
HOMEMAKER
$22.04
TBD
TBD
PERSONAL CARE
$25-87
TBD
TBD
CASE MANAGEMENT
$38.03
TBD
TBD
Total Contract
:000
*The number Of units of service will be determined by the AAA authorizing
individual care plans for each CLP program participant. The total contract
amount will not be exceeded.
H=
T .
January 20 1
Contract CLP- MOSS 1
44 96
4R,
J anUary 70 11 Contract CLP- MCSS 11
ATTACHMENT V111
CONTRACT REPORT CALENDAR
ADVANCE BASIS CONTRACT
Report Number
Based On
Submit to the Alliance
On This Date
I
January Advance*
J . anuary 1, 20 11
2
February Advance*
January 1, 20 11
3
January Expenditure Report
February 5, 20 11
4
February Expenditure Report
March 5, 2011
5
March Expenditure Report
April 5, ' 20 11
6
April Expenditure Report
May 5, 2011
7
May Expenditure Report
June 5, 2011
8
June Expenditure Report
July 5, 2011
9
July Expenditure Report
August 5), 2011
10
August Expenditure Report
September 5, 20-11
1.1.
September Expenditure Report
October 5. 2011
t2
October Expenditure Report"
November 5, 20 1. 1
13
November Expenditure Report
December 5, 2011
14
December Expenditure Report
January 5, 2012
15
Final Expenditure and Request for Payment
February 14, 2012
16
Closeout Report
February 28, 2012
Legend: Advance based on projected cash need.
** Recoupment of advance due with this report.
Note # I: Report #1 for Advance Basis Aareements cannot be submitted to the Department of
Financial Services (DFS) prior to January I or until the agreement with the Department has
been executed and a copy sent to DFS. Actual submission of the Vouchers to DFS is
dependent on the accuracy of the expenditure report.
Note # 2: All advance payments made to the contractor shall be returned to the Department by the
submission date of report #12. The adjustment shall be recorded in Part C, I of the report
(ATTACHMENT IX).
Note #3-. Submission of expenditure reports ma v or rnav not generate a payment request. If final
expenditure report reflects funds due back to the Department, payment is to accompany the
report.
Um
Contract CLPMCSS 11
Hm
January '2. 0 1. 1
Contract CLP- MCSS 11.
ATTACH N,fF\'T IX
REQUEST FOR PAYMENT
OLDER AMERICANS ACT
PROMDER NAME. ADDRESS, PHONE AND FED 10 NUMBER
. ....
ITYPE OF REPORT-
.. .. .............
TES REQUEST PERIOD,
Advance
Report
Reimbursement
Agreement
Agreement Period:
PSA:
CERTIFICATION: I hereby certify to the best of my knowledge that this request conforms with the terms and the purposes set forth in the above agreement.
Prepared By: Date: Approved By - Date:
PART A.-
(2)
(3) (4) (7)
(6)
BUDGET SUMMARY
ADMIN.
III B
111cl IIIC2 Title IIIE
TOTAL
I. Approved
Agreement Amount.
0.00
0,00
0.00 0.00 0.00
0.00
2. Pre�ous Funds
RECEIVED for
Agreement period.
0.00
0.00
0.00 0.00 0.00
py 0.00
3. Agreement Balance
0.00
0.00
0.00 0,00 0.00
0.00
4. Previous Funds
REQUESTED and
Not Received.
0.00
0.00:
0.00: 000 0.00
0.00
5. Agreement Balance
0.00
0,00
om 0.00 0.00
0.00
PART 8-.
FUNDS REQUESTED
1. Ist-2nd Months
Request Only
0.00
0.00
0.00 0.00 0-00
0,00
Z Net Expenditures
For Month
0,00:
0,00
0.00 0.00 0.00.
00
3, Additional
Cash Needs (Attach Doc.)
0. 00
0,00
0.00 0-00 0.00:
V 0-00
.4. Total
0.00.
0.00:
0-00 0,00 0,00:
0-00
PART C'.
NET FUNDS REQUESTED-
1, Less., Over -Advance
0,00
0.00
. 01
0.00 0.00 0.00.
0.00
2. Agreement Funds are
hereby Reques ted For
0,00
&GO
0,00 0.00 0.00
0-00
47/96
January 2011
.
Contract CLP- MOSS 11
48 96
Janua.ry'.?.O I I a
Contract CLP- MCSS 11
ATTACHMENT X
EXHIBIT t
sm
January 2011
q9 Contract CL-P- MOSS 11
BLANK PAGE
50/96
yam
January 2011 Contract CLP- MCSS 11
RECEIPTS AND EXPENDITURE REPORT
OLDER AMERICAN ACT
.PROVIDER NAME, ADDRESS, PHONE4 AND FEID#
Program Funding Source
THIS REPORT PERIOD
FROM: TO:
CONTRACT
Title Ilf Admin,
PERIOD:
CONTRAC-'Ir'#
REPORT#
IPSA#
CERTIFICATION I certify to the best of my knowledge and belief that this report
is complete and all outlays herein are for purposes set forth
in the contract,
Prepared by Date
Approved by
Date
PART A . BUDGETED INCOME/ RECEIPTS
1. Approved
2. Actual Receipts
3. Total Receipts 4. Percent of
Budget
For This Report
Year to Date Approved Budget
1. Federal Funds
$0,00
$0.00
$0.00 %
2. State Funds
$0.00
MOO
$0.00 %
3. Program Income
$0.00
$0.00
$0.00
4. Cash Match (CCE, HCE and Other)
$&00
$0.00
$0.00
5. SUBTOTAL: CASH RECEIPTS
$0.00
$0.00
$0.00
6. Local In -Kind Match
$0.00
$0.00
$0.00 . . . .............. %
7, TOTAL RECEIPTS
. .. . . .. .........
$0.00
$0.00
$0.00 /0
PART B: EXPENDITURES
1, Approved
.............
2. Expenditures
............
3. Expenditures 4. Percent of
Budget
For This Report
Year to Date Approved Budget
1. Administrative Services
$0.00
$0.00
MOO
2. Travel
$0.00
$0.00
$0.00
3. TOTAL EXPENDITURES
$0.00
$0,00
$0.00
PART C: OTHER EXPENDITURES
. . .. ...........
(For tracking purposes only)
1, Match: CCE 1' GR
$0.00
$0.00
$0.00
HCEIGR
$0.00
S0.00
$0,00
Other and In -Kind
$0.00
$0.00
$a00
2. Local Match
MOO
$0.00
$0.00
3. TOTAL
$0.00
$0.00
PART D : Other Revenue and Expenditures
11. Addition Cost Alternative Program Income
Ill. Interest ..............
1. Program income (Pl):
1. Approved Budget
Earned on GR Advance $
a,OAA Unbudgeted PI Receipts YTD
2. Received YTD
2. Return of GR Ad,,ance $
3, Expenditures
3. Other Earned $
...............
DOEA FORM 105aa reAsed I =8
1 /96
€. a.
January '. )011 a
Contract CLP- MCSS 11
6
t: %
January 2011
Contract CLP- MOSS 11
ATTACHMENT X
EXHIBIT 2
mm
January 20 11
Contract CLP- MCSS 1.1
BLANK PAGE
am
January 2011 a
Contract CLP- MCSS 11
RECEIPTS AND EXPENDITURE REPORT
OLDER AMERICAS ACT
PROVIDER NAME, ADDRESS, PHONE # AND FEID#
Program Funding Source
THIS REPORT PERIOD
. ............ ..
�FROM: TO:
CONTRACT
111C2
PERIOD:
CONTRACT#
REPORT#
PSA#
CERTIFICATION: I certify to the best of my knowledge and belief that this report
is complete and all outlays herein are for purposes set forth
in the contract.
Prepared by Date
Approved by
Date
PART A BUDGETED INCOME/ RECEIPTS
1 Approved
.. . ..........
2. Actual Receipts
3. Total Receipts 4. Percent of
Budget
For This Report
Year to Date Approved Budget
1. Federal Funds
$0.00
$0,00
$0,00
2. State Funds
$0.00
$0.00
_11%
$a00
%
3. Program Income
$0.00
$0.00
$0.00
%
4. Local Cash Match (CCE, HCE and Other)
$0,00
$aoo
$0.00
%
5. SUBTOTAL: CASH RECEIPTS
$a00
$0.00
$0.00
%
6, Local in -Kind Match
$0.00
$0.00
$0,00
%
7. TOTAL RECEIPTS
$0,00
$0,00
MOO
%
PART 6 EXPENDITURES
.............
1. Approved
2. Expenditures
..............
3. Expenditures 4. Percent of
Budget
For This Report
Year to Date Approved Budget'
1. Meals / Meal Agreements
$0.00
$0.00
$a00
%
2. Service Subcontractor
$0.00
$aoo
$a 00
3. Other
MOO
$a00
-0/0
$0.00
%
4. Indirect Cost
$0,00
$0.00
$0.00 .. ..........
%
5. TOTAL EXPENDITURES
$aoo
$0.00
MOO
%
PART C: OTHER EXPEND17URES
. ..............
(For Tracking Purposes only)
1 . Match
a. Other and In -Kind
$0.00
$0.00
$0,00
0%
b. Local Matc h
$0,00
$0.
$0.00
%
2, USDA Cash Received
$0,00
$0,00
$0,00
%
3. TOTAL OTHER
$0.00
$0.00
$0,00
%
PART D: OTHER REVENUE AND EXPENDITURES
2. Addition Cost Alternative Program Income
3, Interest
I. Program Income (PI)
a. Approved Budget
a. Earned on GR Advances
a. OAA Unbudgeted P1 Receipts YTD
b. Received YTD
b. Return of GR Advance S
c- Expenditures
c. Other Earned
DOEA FORM 105as revised 11/09
am
January 20 11
Contract CLP- MOSS 11
BLANK PAGE
mm
January 201 a
Contract CLP- MCSS 11
REMAINDER OF PAGE BLANK
ATTACHMENT X
EXHIBIT 3
57/96
January 2.Of I
Contract CLP-.MCSS 11
BLANK PAGE
am
January 201. 1
Contract CLP- MCSS [I
RECEIPTS AND EXPENDITURE REPORT
OLDER ► MERiCAN ACT
PROVIDER NAME, ADDRESS, PHONE# AND FEID#
Program Funding Source :
THIS REPORT PERIOD
FRO% TO:
CONTRACT
Tide III E
PERIOD:
CONTRACT
REPORT
PSA
CERTIFICATION I certify to the best of my Knowledge and belief that this report is complete
and all outlays herein are for purposes set forth
in the contract.
Prepared by : Date '
Approved by:
Date
PART A: BUDGETED INCOME/ RECEIPTS
1. Approved 2, Actual Receipts
3. Total Receipts 4. Percent of
Budget For This
Report
Year to Date Approved Budget
1. Federal Funds
$0.00
$0.00
$0,00 a0
2. State Funds
$0.00
$0.00
$0.00 %
3. Program Income
$0.00
$0.00
$0.00 %
4. Local Cash Match
$0M
$0,00
$0.00 %
5. SUBTOTAL: CASH RECEIPTS
$0-00
$0.00
$0.00 %
8. Local In -Kind Match
$0.00
$0.00
$0.00 %
7. TOTAL RECEIPTS
$0,00
M00
$0.00 %
PART B - EXPENDITURES
1. Approved 2. Expenditures
3. Expenditures 4. Percent of
Budget For This
Report
Year to Date Approved Budget
A : Direct Seances
1. Personnel
$0,00
$0.00
$0,00. %
2. Travel
$0.00
$0,00
$0-00 %
3. Building Space
$0.00
$0.00
$0.D0 %
4. Communication 1 Utilities
$0.00
$0.00
$0.00 %
5. Printing / Supplies
$0.00
$0.00
$0.00 %
8. Equipment
$0.00
$0.00
$0,00 %
7. Other
$0.00
$0.00
$0.00 %
B : Agreement Services
8. Services Subcontracted
$0.00
$0.00
$0,00 %
9. TOTAL EXPENDITURES
$0.00
$0.00
$0.00 %
10. DEDUCTIONS
a. Total Local Match
$0,00
$a00
$0.00 %
b. Program Income Used
$0.00
$0.00
$0 00 %
c. TOTAL. DEDUCTIONS
$0.00
$0.00
$0.00 %
11, NET EXPENDITURES
$0.00
$€7,00
$0.00%
PART C : EXPENDITURES ANALYSIS
2. Knits of Services Year to Date
3. Number of People Served Year to Date
A. Expenditures by SeMces Year to Date:
I- information.-__... .......... 0, 00
.........
0,
2. Assistance,... ........ . ...... . .
C��-
��a.
3. Counseling ..................-.. �.�
y0.
��1
�^�
4a.tl�i
5. Supplemental Services, .-,° "'��0.0
....... •- •-....._..- �`�.�
........................ 0°�'
8. TOTAL. ..............._. �.£
Part B Line 11, column 3 should be equal to this total.
PART D : GRANDPARENT SERVICES freported by Federal Rscarf gear)
F F` _ _.w - � . _. F FY...__--
$. - - _ _
F FY
Match $
Match_----_���__ � ...._�-__. ._
Match
DE'A FORM 10 AE revised 12-0
o f
i
Contract C LP- MCS S 11
96
January 20 11
Contract CL MCSS
Department of Elder Affairs Programs & Services Handbook, provided on CD.
Also, available at the Department's Intranet site Linder, "Publications".
ATTACHMENT A
61/96
Contract CLP- MOSS 11
66
.... . ..... ..........
January 2011
Contract CLP- MCSS 11
; 1 .1 1111 07 Mi 6112HA p0j''ilil !1111, 111111 i:: -11 AK: : I ; 1�
PART 1.
ATTACHMENT B
READ THE ATTACHED INSTRUCTIONS FOR ILLUSTRATIVE INFORMATION WHICH
WILL HELP YOU IN THE COMPLETION OF THIS FORM,
1. Briefly describe the geographic area served by the program/facility and the type of service provided:
2.
POPULATION OF AREA SERVED. Source of data:
. . . . . . . . . . ...........
Total # % White % Black % Hispanic % Other I% Female
S.
STAFF CURRENTLY EMPLOYED. Effective date:
Total # % White % Black % Hispanic % Other % Female % Disabled
.......
4.
....
CLIENTS CURRENTLY ENROLLED OR REGISTERED Effective date:
. . . . ............
Total # % White % Black L % Hispanic % Other % Female % Disabled
% Over 40
5.
ADVISORY OR GOVERNING BOARD, IF APPLICABLE.
.........................................
Total # % White Black % Hispanic % Other % Female % Disabled
PART 11. USE A SEPARATE SHEET OF PAPER FOR ANY EXPLANATIONS REQUIRING MORE SPACE.
6.
Is an Assurance of Compliance on file with DOEA? If NA or NO, explain.
NA YES NO
0 � El
7.
Compare the staff composition to the population. Is staff representative of the population?
If NA or NO, explain.
NA YES NO
8.
Compare the client composition to the population. Are race and sex characteristics representative
of the Population? If NA or NO, explain.
NA YES NO
1:1 0 El
9.
Are eligibility requirements for services applied to clients and applicants without regard to
,race, color, national origin, sex, age, religion or disability? If NA or NO, explain,
NA YES NO
--1
..........
L El 0
January
Contract CLP- MOSS 11
10. Are all benefits, services and facilities available to applicants and participants in an equally effective manner regardless of
race, sex, color, age, national origin, religion or disability? If NA or NO, explain.
NA YES NO
El 0 El
11. For in -patient services, are room assignments made without regard to race, color, national origin or disability? If NA or
NO, explain.
NA YES NO
1:1 1:1 1:1
12. Is the program/facility accessible to non-English speaking clients? If NA or NO, explain.
13. Are employees, applicants and participants informed of their protection against discrimination.?
If yes, how? Verbal El Written � Poster 0 If NA or NO, explain.
14. Give the number and current status of any discrimination complaints regarding services or
employment filed against the program facility.
15. Is the program/facility physically accessible to mobility, hearing, and sight -impaired individuals? If NA or
NO, explain.
NA YES NO
1:1 1:1 0
PART III. THE FOLLOWING QUESTIONS APPLY TO PROGRAMS AND FACILITIES WITH 15 OR MORE EMPLOYEES
16. Has a self -evaluation been conducted to identify any barriers to serving disabled individuals, and to make any
necessary modifications? If NO, explain.
64/96
January '20 11 Contract CLP- MOSS 11
1T Is there and established grievance procedure that incorporates due process in the resolution of
complaints? If NO, explain.
YES NO
1:1 11
18. Has a person been designated to coordinate Section 504 compliance activities? If NO, explain.
YES NO
LJ El
19. Do recruitment and notification materials advise applicants, employees and participants of
nondiscrimination on the basis of disability? If NO, explain.
20. Are auxiliary aids available to assure accessibility of services to hearing and sight impaired
individuals? If NO, explain.
YES NO
1:1 El
PART IV. FOR PROGRAMS OR FACILITIES WITH 50 OR MORE EMPLOYEES AND FEDERAL CONTRACTS OF $509000 OR MORE.
21, Do you have a written affirmative action plan? If NO, explain. YES NO
F� 11
65/96
. n
V`
January'201 I Cotitract CLP- MOSS 11
AAA USE ONLY
Reviewed By In Compliance: YES 0 NO* cl
Pro
gram foe "'Notice of Corrective Action Sent
Date Telephone Response Due
On -Site C3 Desk Review ❑ Response Received l i
DOEA Form 101 A Revised May 2008 Page 2 of 2
51
66
January '.2.0 11 Contract CLP- M.CSS 1.
ATTACHMENT B
INSTRUCTIONS FOR THE CIVIL RIGHTS CONIPLIANCE CHECKLIST
Describe the geographic service area such as a district, county, city or other locality. If the program facility
zn
serves a specific target Population such as adolescents, describe the target POPUlation. Also, define the type of
service provided.
17 Enter the percent of the population served by race and sex. The population served includes persons in the
geographical area for which services are provided such as a city, county or other regional area. Population
statistics can be obtained from local chambers of commerce-, libraries, or any publication. from the 1980 Census
containing Florida population statistics. Include the source of your Population statistics. ("'Other" races include
Asian/Pacific Islanders and American Indian/Alaskan Natives.)
3. Enter the total number of full-time staff and their percent by race, sex and disability. Include the effective date of
your summary.
4. Enter the total number of clients who are enrolled, registered or Currently served by the program or facility, and
list their percent by race, sex and disability. Include the date that enrollment was counted.
5. Enter the total number of advisory board members and their percent by race, sex, and disability. If there is no
advisory or governing board, leave this section blank.
6. Each recipient of federal financial assistance must have on file an assurance that the program will be conducted in
compliance with all nondiscriminatory provisions as required in 45 CFR 80. This is usually a standard part of the
contract language for DOEA recipients and their sub -grantees, 45 CFR 80.4 (a).
7. Is the race, sex, and national origin of the staff reflective of the general population? For example, if 10% of the
Z:�
population is Hispanic, is there a comparable percentage of Hispanic staff?
8. Where there is a significant variation between the race, sex or ethnic composition of the clients and their availability
in the population, the program/facility has the responsibility to determine the reasons for such variation and take
whatever action may be necessary to correct any discrimination. Some legitimate disparities may exist when
prograrns are sanctioned to serve target populations such as elderly or disabled persons, 45 CFR
80.3 (b) (6).
9. Do eligibility requirements unlawfully exclude persons in protected groups from the provision of services or
employment? Evidence of such may be indicated in staff and client representation (Questions 3 and 4) and also
through on -site record analysis of persons who applied but were denied services or employment, 45 CFR 80.3 (a)
Z:� -
and 45 CFR 80.1 (b) (42).
10a Participants or clients must be provided services such as medical, nursing and dental care, laboratory services,
physical and recreational therapies, counseling and social services without regard to race, sex. color, national
origin, religion. ace or disability. Courtesy titles, appointment scheduling and accuracy of record keeping must be
zn Z� I *n IF
applied Uniformly and without regard to race, sex. color, national origin. religion. age or disability. Entrances,,
zn zn
waiting roonis, reception areas, restrooms and other facilities must also be equally available to all clients, 45 CFR
80,3 (b).
For in -patient services, residents must be assigned to rooms, wards, etc., without regard to race. color, national
origin or disability, Also, residents must riot be asked whether they are willing to share accommodations with
persons of a different race, Colon national origin, or disability, 45 CFR 80.3 (a).
2- The proaram/factlity and all services must be accessible to participants and applicants, including those persons
who may not speak English. In geographic areas here a significant population of non-Encyllsh speaking people
Z7 Z7 t�
W=
January '20 11 Contract CLP- MCSS 11
live., program accessibility may Include the employment of bilingual staff. fn other areas t is sufficient to have a
policy or plan for service, such as a current list of names and telephone numbers of bilingual individuals who
will assist in the provision of services, 45 CFR 80.3 (a).
13. Programs/facilities must make information regarding the nondiscriminatory provisions of Title VI available to
their participants, beneficiaries or any other interested parties. This should include information on their right to
file a complaint of discrimination with either the Florida Department of Elder Affairs or the U.S. Department of
HHS. The information may be supplied verbally or in writing to every individual, or may be supplied through the
Use of an equal opportunity policy poster displayed in a public area of the facility, 45 CFR 80.6 (d).
14. Report number of discrimination complaints filed against the progran-Vfacility. Indicate the basis, e.g., race, color,
creed, sex, age, national origin, disability, retaliation; the issues involved, e., g., services or employment,
w
placement, termination, etc. Indicate the civil rights laor policy alleged to have been violated along with the
name and address of the local, state or federal agency with whom the complaint has been filed. Indicate the
current status, e.g., settled, no reasonable cause found, failure to conciliate, failure to cooperate, under review, etc.
15. The progranAacility must be physically accessible to disabled individuals. Physical accessibility includes
designated parking areas, curb cuts or level approaches, ramps and adequate widths to entrances. The lobby,
public telephone, restroom facilities, water fountains, information and admissions offices should be accessible.
Door widths and traffic areas of administrative offices, cafeterias, restrooms, recreation areas, counters and
serving lines should be observed for accessibility. Elevators should be observed for door width, and Braille or
raised numbers. Switches and controls for light, heat, ventilation, fire alarms, and other essentials should be
installed at an appropriate height for mobility impaired individuals.
16. Section 504 of the Rehabilitation Act of 1.973 requires that a recipient of federal financial assistance conduct
a self-evalLiation to identify any accessibility barriers. Self -evaluation is a four step process:
With the assistance of a disabled individual/organization, evaluate current practices and policies which do not
comply with Section 504.
Modify policies and practices that do not meet Section 504 requirements.
Take remedial steps to eliminate any discrimination that has been identified.
Maintain self -evaluation on file. (This checklist may be used to satisfy this requirement if these four steps
have been followed.), 45 CFR 84.6.
17. Programs or facilities that employ 15 or more persons must adopt grievance procedures that incorporate
appropriate due process standards and provide for the prompt and equitable resolution of complaints alleging
any action prohibited by Section. 504.45 CFR 84.7 (b).
18. Programs or facilities that employ 15 or more persons must designate at least one person to coordinate efforts
to comply with Section 504.45 CFR 84.7 (a).
19. Continuing steps must be taken to notify employees and the public of the program/facility's policy of
nondiscrimination on the basis of disability. This includes recruitment material, notices for hearings, newspaper
-ids, and other appropriate written communication, 45 CFR 84,8 (a).
0. Programs/facilities i I i ties that employ 1-5 or more persons MUSt provide appropriate auxiliary aids to persons with
t� W
impaired sensory, manual or speaking skills where necessary. Auxiliary aids may include, but are not limited to,
interpreters for hearing impaired individuals, taped or Braille materials, or an alternative resources that can be
Used to provide equally effective services, 45 CFR 84-5`2 (d).
W -
P roaramsI
acilities with 50 or more employees and S50,000 in federal contracts MUSt develop. Implement and /f, 1
maintain a written affirmative action compliance program in accordance with EXCCUt-lVe Order 11246, 41 CFR 60
and Title VI of the Civil Rights Act of 1964, as camended,
68/96
. . ........... . ............... ........... . ... .. .. ....... .. .............. ....... .. .... ... ............ . .... ........ .... ... .... ..... ................... ........... ... ... ............. ..... ........... .... ... .... . ... .......... .. ..... ...... . ... ........... ... ........ . .... ..... .................. ................... .. ............. ... .... ....... ......... .. .......... . ......... .... ................ .... ......... .... ........ ... . . .. . .............. . ..... . ....... ... .......... . ..... ........... .. ....... .... .. ... .... . .... . .. . . ..... . . .. ..... .................... . ...... .. ....... .... .................... .. .... . . ..... ... ...... ............... .... ...... .. ............. ... ... . ........... ...... ...... .. . ........... ... .. . . . .... . ......... ..... ....... ........ ... .. . ... .. .. ... ....... .......... ..... ........ ............. .... ............... ....... .............. ........... .................... .. ........ ......................... . ............. . . ... . . . ... .
.. . .. . . .. ... .. .
January 2011.
.2,
Co `race CLP- MOSS 11
ATTACHMENT E
Department's Computer Use Policy and its Social Media Policy, provided on CD.
Em
IN
January 2011.
Contract CLP- MOSS 11
hm
January "',20 1
Contract CLP- MCSS 11
DOEA Cost Analysis For Non -Competitively Procured Contracts
In Excess Of Category 11
ATTACHMENT F
EXHIBIT I
PROGRAW-
CONTRACT PERIOD:
TYPE OF SERVICE-.
2
Column 3 ..........................
.............
Column 4
Column 5 . ..... ....
bF
................. . ... .. ..........
to be completed by the contractor) (to. be completedby the DOEA�.
Contract Manager:
Budget
Line Item Amount % Allocated Allowable Reasonable Necessary
Category
Budget Category to this
Agreement
a.
Salaries ............ . ... -
b.
Fringe Benefits . . ....... .. ...... .
0
C.
Equipment
d.
....... ....
Telephone & Utilities
e.
. . .. ............... ----
Travel
E
f.
Printing & Supplies
g.
Other (Please list or attach details)
h.
Allocated CostlOverhead . .. .. ...... . ... .. .............
TOTAL . . . ....... ----...................
Client Services (Attache
Q
details)
•
>
1,TOTAL
W
..... . ... . ................
....................
CERTIFICATION (to be signed by DOEA Contract Manager)
I certify that the cost for each line item budget category has been evaluated and determined to be allowable, reasonable, and
necessary as required by Section 216.3475, Florida Statutes.
Name Title WWWWONNOWWWAWAW000
Signature Date
um
J anu ary 27 0 11.
Contract CLP- MOSS 11
1 '4�/96
January 20 11 Contract CLP- MCSS 11
ATTACHMENT F
EXHIBIT 2
INSTRUCTIONS:
COST ANALYSIS FOR NON-COMPETIVELY PROCURED CONTRACTS
IN EXCESS OF CATEGORY 11
The purpose of the ATTACHMENT F, Exhibit 1, is to document that costs in non -competitively procured contracts in
excess of $35,000 are allowable, reasonable and necessary. This form is required to be submitted by the contractor to
the contract manager within 30 days of the contract execution date.
Upon receipt of the form, the DOEA contract manager will-,
1. Evaluate each separate line item to determine whether the cost is allowable, reasonable and necessary.
a. To be allowable, a cost must be allowable pursuant to state and federal expenditure laws, rules and
regulations and authorized by the agreement between the state and the contractor.
b. To be reasonable, a cost must be evaluated to determine that the amount does not exceed what a prudent
person would incur given the specific circumstances.
c. To be necessary, a cost must be essential to the successful completion of the program.
d. Allocated costs/overhead should be evaluated to determine that the rate is reasonable.
2. Place the Cost Analysis for Non -Competitively Procured Agreements in Excess of Category// form in the official
file for this contract at the Department of Elder Affairs.
(1) In accordance with the following instructions, the contractor must complete COLUMNS 3, 4 AND 5 of the
DOEA Cost Analysis For Non -Competitively Procured Contracts In Excess Of Category 11 worksheet
(ATTACHMENT F, EXHIBIT 1) for the original contract and any amendment that affects the amount of
compensation and/or the level of services provided.
(2) Definition of Administrative Costs —
a. Salaries/Wages: Are the charges to directly hire someone and put them on payroll.
b. Fringe Benefits: Are the costs of health insurance, Social Security, Medicare, unemployment and other
benefits paid on behalf of each employee. If fringe benefits will be based on a specified percentage, rather
than the actual cost of fringe benefits, then the calculation for the fringe benefits amount must be shown.
c. Equipment: Equipment means an article of nonexpenclable, tangible personal property generally having a
useful life of more than one year and an acquisition cost that equals or exceeds the lesser of the
established capitalization level of $5,000 (federal funds) or $1,000 or hardback bound books not
circulated, with a value of $250.00 or more (state funds).
d. Telephone and Utilities: Are items such as utilities and telephone service costs.
e. Travel; Are those that are necessary, reasonable and allocable for carrying out the project. Travel must
i be n accordance with Section 112.061, Florida Statutes, which includes submission of the claim on the
approved State travel voucher or electronic means and at the authorized meal, per them and state
mileage reimbursement rates.
f. Printing and Supplies: Are items such as office supplies, postage, and printing.
g. Other Costs or Miscellaneous, Please explain/justify. Support documentation for other direct costs may
include copies of published rates, copies of expense vouchers, and/or invoices. Support documentation
for other costs or fees may include copies of published catalog prices, or copies of expense vouchers.
h, Allocated Costs or Overhead: The contractor should attach a copy of the computation schedule
supporting the allocated cost rate. Support documentation for allocated costs may be a federally -
negotiated allocated cost rate agreement. If the contractor does not have a rate agreement, (1) sufficient
information should be attached indicating how the rate used was determined and (2) if the rate was
accepted and paid previously by either a federal agency or agency of the State of Florida, documentation
to that affect should be provided.
(3) Client Service costs should be documented via Area Agency on Aging Area Plans, Unit Cost information input
into WebDB, or some other form of documentation to support the cost analysis.
(41) The allocation to the agreement will be calculated based on the cost by line item cost divided by the total
agreement amount.
73/96
... .... ........... ....... ........ ............. ...... ..... ... ... .................. .... .................. ...... ..... ......... . .. : ............. .............. : ........ ............ .. .... ............ ...... ...... . .. ...... ...... .... .... . . ....... ............... . .... .... : .... ... ........ ....... ..... .... .... ........ . .. : .... ....... ..... ....... .......... ....... .. ..... ..... .... ..... .... ........... ..... . : ... ............ ..... ...... ... ................. ...... ... .. ... ...... ..... . ....... .. . .... ... .... .. .. .... .. .. ..... .......... .... .. ... .. . . . . :...:..: .. .. ..... .. .......... ........ . . . .. .. . ..... ..... ... ....... . .... .. : ... ........ : .... ................. : . ........ ........... .. ................. ... ........... . . ................ .............. ............ . .. ............ . .... ..... ........... . ........ ........ .... . . ... . ... ........ ....... ... .... ........ . .... ..... .... ... .... ....
January 2011
Contract +ALP- .MCSS 1
Nm
January 20 11
Contract CLP- MCSS 11
ATTACHMENT G
COMMUNITY LIVING PROGRAM PROTOCOLS
E.roizram Qyerview
The goals of Community Living Program. Phase 11, for PSA I I are to reduce overall Medicaid long term care
expenditures, develop co -pay and financially Sustainable systems within the context of the Older Americans Act
network of AAA and providers, and to increase consumer choice and self -direction.
To achieve these goals PSA I I will focus its efforts in providing consumers with the means to resolve events that
Z"_ C�
have been identified as `critical pathways" to institutional long term care. Some of these "critical pathwaysil include
sudden caregiver burnout depression, malnutrition/dehydration and lack of proper follow up with home and
community based services following hospital/rehab discharges. PSA I I will also manage a Veterans Administration
Consumer Directed Care.
In particular, PSA I I will provide short term, cost effective, interventions, to individuals at high risk of nursing
home placement or hospital re -admission, using a Holistic Social Work model utilizing a motivational empowerment
case management approach focus on monitoring client follow-up in the community with medical needs, nutritional
needs, mental health, home care needs, and recreational needs in order to reduce re -admission and nursing home
placements. A Case Manager will utilize an interdisciplinary managed team approach whose major role is to
coordinate community based services to enable the client's independence and prevent premature or unnecessary
institutional ization.
The proposed model has three characteristics: Timely, short term sponsored interventions using Older Americans
Act services, intensive case management and, the possibility of long term continuation. of services on a cost -shared
basis at the consumer's choice.
Acronyms and Derinitions
ADI (Alzheimer" s Disease Initiative) — Services targeted to individuals with Alzheimer"s Disease or a similar
memory disorder, including respite, assessment,, caregiver.training, and other Community- based services.
ADRC or ARC (.Aging and Disability ReSOLirce Centers or Aging Resource Centers) — The not -for -profit entity
_7 C
which is the single entry point for the aging service system within each established region of the state.
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APS (Adult Protective Services) High Risk — The designation of an elder who needs immediate protection from
611,
further abuse, neglect or exploitation, which can be accomplished completely or in part thrOLIcyh the provision of home
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and community- based services.
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J anuary 2 0 11
Contract CLP- MCSS 11
Caregiver or Support System — For this project, the caregiver or support system is one or more persons whom the
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elder can depend on to provide care or to organize the provision of needed care.
I
Care Plan - A comprehensive listing of all services, including Medicare.
Z� t� I CCE, OAA, county, etc. that address
the client's physical, mental, and home care needs to resolve the crisis condition(s), and accomplish the client"s
personal goals. The Lead Service Provider would coordinate all services and evaluate their outcomes in conjunction
with the client.
Care Plan Review Team — For purposes of this project, a team of staff designated by the Clap staff, which reviews
%_1
the client's situation and makes recommendations concerning continuation of services after the initial short term
grant -funded crisis -resolving period. However in no case will services be continued on a long term basis under this
pro gram.
CCE (Community Care for the Elderly) — Services offered to functionally impaired older persons to enable them
to live in the least restrictive environmem, including adult day care, consumable medical supplies, home delivered
meals, homemaker, personal care, respite, and other cornunity-based services.
CIRTS (Client Information and Registration Tracking System) — The database of the Department of Elder Affairs
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used by the aging network to manaae client assessment data register clients for services, plan client services and
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maintain program waiting lists. Lead agency provider assessors also use CIRTS to evaluate client eligibility for
Medicaid services and to develop recommendations for client placement.
CDC (Consumer Directed Care) — A service option that gives elders, or their representatives, the opportunity to
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manage the elder's service delivery, including decisions about which services will be provided, by whom and how
4 lt�
often. With the assistance of a consultant, an elder develops a budget plan that identifies needed goods and services
and authorizes the elder to hire workers, who may be family members or friends, and select vendors to help with daily
care needs. A fiscal/employer agent (F/EApays the workers and vendors according to the rates on the budget plan..
The F/EA also pays the required federal and state taxes and files the necessary tax forms.
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Community Living Program —"Cominunity Living Program"' is acyrant to the state of Florida from the federal
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Administration on Acrincr. For persons meeting the pro ject's functional and financial eligibility criteria, the grant
provides crisis -resolving in -home services to address their immediate and temporary needs as they leave a hospital or
rehabilitation center or after a short-term nursing home stay. Without these services, the person Would be at high risk
of either nursing home placement or Continued stay in a nursing home. This program also manages Consumer directed
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care services provided to vet eran.s.
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January 2011
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Contract CLP- MCSS 11
Cost Sharing — Payment by an individual for a portion of the monthly cost of the services he/she receives, based
on the individLial" s income and assets, and determined by the total monthly cost of the planned services.
Crisis -Resolving Services — Time -limited community -based services provided to address a client's immediate
short-term care needs. Possible services include, but are not limited to: case management, personal. care, homemaker,
transportation, meals. For the purposes of this program, a crisis is an episode that has a high probability of creating a
nursing home long term placement or a re -hospitalization. Examples Of Such crisis include caregiving situations', i.e. a
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caregiver hospitalization that would cause the nursing home placement of the care recipient: it also includes
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hospital/rehab discharges that have a high likelihood of recidivism. or further patient deterioration where a permanent
nursing home placement is a likely sequel.
Functional Eligibility — The priority rank of 4 or higher (priority score of > 40) is based on the 70 1 A or 701.B
assessment tool; with an option for imminent risk designation in accordance,, to the DOE A policy. APS High Risk
Referrals (priority rank 8) are not eligible.
Financial Eligibility.-
* For a single person, the gross monthly income must be a minimum of $700 and a maximum of S4, 100. The
assets, excluding primary residence and vehicle, must be valued at a minimum of $25,000 with a maximum
cap of $179,999.
* For a couple, the gross monthly income must be a minimum of $900 and a maximum of $5,500. The assets,
excluding primary residence and vehicle, must be valued at a minimum of $25,000 with a maximum cap of
$249,999.
Imminent Risk -'"In designating an individual imminent risk, the case manager must document in the client file how
4:�
the client's situation meets all three of the criteria listed in the 3d) contract language:
I. The client's mental or physical condition has deteriorated to the degree that self care is not possible,,
A
There is no capable caregiver, and
3. Institutional placement will occur within 72 hours."
Lead Agency Community Care for the Elderly (CCE) designated agency. Lead agencies provide services
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under the CCE and ADI programs. In addition lead agencies handle APS cases in accordance with a DOER
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established protocol.
Lead Service Provider —A provider of Older American Act Services that also provides case mana(YeMent Linder
�11 t_1
this prQ'ect. The Case manager from the service provider will follow-up with those project participants referred by
the CLP staff to facilitate the provision of services during the grant period and to help plan for the person"s needs
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after the grant period.
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Janua-ry2w.0 I I
(a Contract CLP- MOSS 11
OAS. 111B, 111D, IIIE (Older Americans Act Titles) — Title 111B provides supportive services to assist elders to live
independently in their community. Title 111D provides disease -prevention and health -promotion services at senior
centers or alternative sites. Title 111E provides services through the National Family Caregiver Support Program to
assist families caring for frail older members, and to assist grandparents or older relatives who are caregivers, for
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children who are under 19 or are disabled.
Private Pay — Payment of the complete cost of services by an individual with sufficient income and assets to be
over the financial standards for receipt of state or grant funded services.
Referring Entity — An entity providing referrals to the single entry point. These include case managZ."-
ement
agencies, hospitals, rehabilitation centers, home health agencies, physician assisted home based programs, and
nursing homes. Individuals referred should appear to meet the eligibility criteria for this project.
Self -declared — For purposes of initial financial eligibility for the project, the individual"s declaration of income
and assets will not require verification.
SEP (Sinale Entry Point) — The CLP staff for the area where the individual is receiving services is the *
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point into the aging service system.
I
Spend down to Medicaid — The use of personal resources to pay for services prior to the individual's resources
being reduced to the level of Medicaid eligibility.
Triage — The activity performed by CLP staff to prioritize an individual for service ba'sed on the criteria
established for publicly funded programs because he/she does not meet the eligibility criteria for this project.
Protocols
Client Identification
1. The referring entity Will use the following criteria to identify potentially appropriate project participants:
2. Individual is at least 60 years old.
3. Individual is a resident of Miami -Dade or Monroe Counties.
4. Financially and functionally eligible.
5. Has Medicare or private health insurance.
6. Individual is not receiving hospice services.
7. Individual or caregiver is in need of crisis resolving services and/or short term care. to
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J anu ary 20 1. 1
Contract CLP- MOSS 11
avoid readmission to a hospital/rehab facility or a nursing home placement.
8. Not currently receiving any DOER sponsored services.
Client Referral
The referring entity will make client referrals to the single entry point (SEP).
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1. Each referring entity will designate a Community Living Program contact to make referrals,
2. The SEP will designate an appointed staff to receive referrals.
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3. At the referring entity, staff will complete the Referral Checklist and the designated Community Living
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Program., contact will transmit the Referral to the SEP.
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o For individuals in a hospital or nursing home, the referral will be completed '42,4 to 48 hours prior to
discharge, excluding weekends or holidays. Individuals in the community may be referred to the
project during any time deemed to be in crisis or in need of short term intervention to avoid
readmission and or nursing home placement.
o SEP will work with the discharge planner, in the case of a facility discharge, to identify emergency
services that wrap -around other benefits for which the client may be eligible, such as Medicare home
health benefits, to authorize services prior to discharge and in -home assessment.
o The SEP designated staff will confirm receipt of the referral to the referring entity and log in and
assign the case for screening and intake on the date received.
4. To conclude the referral process from a hospital or nursing home, the referring entity will transmit a copy of
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the discharge summary to the SEP staff.
Client Screening (Functional and Financial Eligibility)
L Within 24 hours of receiving the referral. the SEP designated staff will determine client eligibility for project
participation.
A. The SEP staff will conduct a CIRTS record check to determine if the individual is currently enrolled in. CCE,
ADI, or is a high risk APS referral. If such is the case, the SEP staff will refer to the individual's case
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management agency of record for fOl1OW Up The lead agency will. recommend crisis resolving services, In
needed, to SLIPPIenleflt the existimz care plan. If the individual. appears eligible for project participation., then
January 2011 a
Contract CLP- MCSS 11
If th-e client is not enrolled in CCE, ADI, or any other case managed program, or is not a high risk APS
referral and is in need of a short term care intervention, then the SEP designated staff will determine client
elicribility for project participation. Screening Must take place within 48 hours from the time the referral was
received by the SEP.
3. Individuals scoring as priority levels 4 or 5 on the CLP screen, that also meet self -declared income and asset
criteria will be eligible for referral to the Lead Service Provider. Individuals that score less than a priorit . Y level.
4 will be eligible if there are demonstrable circumstances that put such individual at liicFh risk of nursing home
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placement or re -hospitalization. These cases will be approved based on their particulars by the SEP on an
exception basis. The SEP staff will notify the referring entity of the eligibility of the individual or, if
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applicable, the reasons for denying eligibility, in accordance to DOEA criteria.
4. If the individual does not appear eligible for project participation, then the SEP staff will triage the individual
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to the ARC/ADRC for follow-up options counseling to provide assistance with referrals to other OAA
programs and services which may aid in their situation.
Lead Service Provider Res ponsinffities:
Initial Client Assessment (701 B)1-R
The Case manager (CM) will have contact, within 24 hrs of referral, with client and/or caregiver to introduce
services and program. The CM will reach out to individuals referred by the SEP to assess the situation.
■ The Case manager (CM) will provide information, including brochures and pamphlets regarding the project.
The Case manager (CM) will begin discussing cost sharing, private pay, and consumer directed care service
options should services be needed beyond the short term crisis resolving intervention. The financial worksheet
will be completed.
* The Case Manager will conduct the comprehensive assessment in the client's home, or medical facility within
72) hours of referral using form 70 1 B, in this latter instance, the CM will review the hospital discharcre
In
paperwork. The Lead Service Provider will enter data in CIRTS within the week of the assessment.
0 The Case manaaer (CM) will develop a care plan with the client and or caregiver/support system, m., based on the
assessment, and will initiate in -home crisis resolving services within 72 hours of receipt of referral.
The Case manager (CM) will inform the client that the Department of Elder Affairs has contracted an
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January 2.0 1. 1
ry Contract CLP- MCSS 11
evaluator that will be calling to conduct a five-minute survey about the quality and effectiveness of the
services the client receives as part of the "Communini Living Prograin program. The case manager should
assure the client that services will not be affected in any way whether the client participates or not in the
survey or by how the client answers any of the questions. The case mazer should report to the SEP staff if
the client requests not to be surveyed.
* The Case manager (CM) will maintain a client file, including: care plan, financial worksheet, referral
information, assessments, a summary of each contact with or on behalf of the client and caregiver, project
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forms, and any other related information collected on behalf of the client caregiver or required by the program®
Enrollment Authorization.
0 The SEP staff will authorize enrollment of the individual in the project.
0 The SEP staff will refer the individual to the CLP lead agency provider for Case Management and crisis
resolving services.
0 If after initial enrollment the client is determined to be ineligible for financial reasons, the individual will
continue to receive the services being provided up to the crisis -resolving service period.
o The CLP lead service provider will notify the SEP.
o The SEP staff will contact the individual.
o Transition will be made as possible to other appropriate programs.
o The SEP staff will notify the CLP lead agency provider of the action to take regarding termination
from the project.
On-Goi`ase Mana,(Yement Res pq.n.sibifities:
The Case manager (CM) will. conduct on -going service coordination of home and community based services
and hospital, IlUrsing home or rehabilitation center if applicable. The Case manager will verify the information and
coordinate services as needed.
Client contact service is as follows.
ThroughOUt the grant period, the Case manager (CM) will diSCLISS the following with the client and caregiver iSSLIeS
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pertaininfa to the client"s medical needs. flUtritional needs, mental health needs, home care needs, recreational needs:
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January 20 11
Contract CLP- MCSS 11
1. Medication management issues: The Case manager will encourage client and care giver to address
medication management issues with primary physician.
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Medical management.- The Case manager will review primary physician appointments and encourage
client and family to maintain appointments accordingly. Encourage client and care giver to follow-up with
Z"11
medical needs.
3. Nutrition management.- The Case manager (CM) will make referrals for nutrition counseling and meals
proarams, if needed. It will encourage client and caregiver to follow the instructions of the nutritionist
Z111 Zt
conduct referrals as needed.
4. Mental Health.-r The Case manager (CM) will monitor good mental health practice and encourage
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appropriate follow-up as needed for mental health need and conduct referrals and placement of services as
needed.
5. Home Care needs: The Case manager (CM) will assess and monitor home care needs and conduct referrals
and placement of services as needed
6. Recreational needs: The Case manager (CM) will assess and monitor recreational needs and encourage
good recreational practices for both client and caregiver. CM will conduct referrals for services as needed.
4
-The Case Manager will document the review in the client's case notes
L -Satisfaction with services delivered during 45-day crisis resolving service period
What services is the client receiving.
3. Are specific services adequately addressing the client"s needs".)
4. What are additional needs?
5. How are those additional needs being addressed?
Periodic Follow-up
One week after initiating services, the base manager will visit the client to ascertain services planned
are being delivered and client needs are being net.
Two weeks after service initiation., the case manager will conduct telephone contact with the client to
detemilne if services are address iZ:�-11CY the client" s needs.
3. Four weeks after service initiative the case manager will conduct telephone contact with the client to
determine if services are addressina. the client's needs.
January 12.0 1. 1.
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Contract CLP- MOSS 11
4. No less than 5 days prior to the end of project participation, the CLP Lead agency provider case
manager will conduct a face to face contact with the client and care(jiver to review the care plan and
determine the individual"s continued need of crisis -resolving services. The timing of this contact will
be at the discretion of the Case manager prior to the discharge determination date.
Termination of Services
The Case manager will advise the SEA' staff of the following:
o The crisis is resolved and the client may be terminated from the project.
o The client is not stabilized and continues to need crisis resolving services. -Detail will be
provided as to the recommended services, frequency and duration.
o The crisis is resolved, but the client will need on -going in -home services. Detail will be
provided as to the recommended services, frequency and duration. Also whether client is
continuing with co -pays and consumer directed care.
Method of service delivery after crisismresolvinu service period ends
■ The client has an option of continuiner to receive services in a traditional manner (agency ordered and
:-I'D
delivered) continuing with a co -pay, subject to provider funding avai'lability.(The share of cost is stated on the care
plan.)
a The client has an option of participating in consumer directed care (consumer determines service provision),
as a private pay client, however the provider will charge the consumer rates that are not higher than the lowest rates
the provider receives from the Alliance.
a The client can afford the cost of private pay services.
Funding OptioRs
The SEP staff must ensure the availability of OAA dollars to serve individuals at high risk of nursing home
placement and spend down to Medicaid by implementinor assessment and screening tools, as well as care planning and
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case in-anai-Tement for Title IIIB funding. Title HID and Title HIE funds ShOLIld be considered for the provision of
services such as medication management and caregiver support services.
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The Alzheimer"s disease Demonstration Grant funding should be coordinated as appropriate to expand services to
clients in Miami -Dade County. This will include individuals with Alzheimer's disease or Related Disorders, who are
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January 20 11
Contract CLP- MOSS 11
not eligible for Medicaid but are at imminent risk of nursing home placement and spend down, to remain in the
community and avoid or delay nursing home placement.
CLRTS Data Ent
Screening data for each referral based on the CLP Screening toot or 701 A or similar instrument will be entered
into CIRTS. The Lead Service Provider will enter 701B assessment data promptly entered into CIRTS. All clients
authorized for CLP services will be enrolled in CIRTS, under the CLP program enrollment code. For all services
received by CLP clients, the case management agency will report the service units and unit cost data in CIRTS.
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* All services will be reported as client specific, including non -registered OAA services.
* I All services funded with CLP grant funds will be reported under the appropriate CLP service code. - Z:�
* All services funded with other program funds (OAA, CCE, etc.) will be reported using the appropriate program's
service code.
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January 20 11 Contract CLP- MCSS 11
ATTACHMENT H
SERVICE PROVIDER APPLICATION
mm
December 20 10 F ContracP-mc5s I
INVITATION TO NEGOTIATE
COMMUNITY LIVING PROGRAM
OLDER AMERICANS ACT
TITLE III-B
SUBMITTED BY:
MONROE COUNTY BOARD OF COUNTY
COMMISSIONERS
SOCIAL SERVICES
IN -HOME SERVICES PROGRAM
SYLVIA J. MURPHY, MAYOR, MONROE COUNTY
HISTORIC GATO BUILDING
1100 SIMONTON STREET RM. 2-257
KEY WEST, FL 33040
PHONE: (305) 292-4510
FAX: (305) 295-4359
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Contra'Pt CLP-MOSS I
...........
F
Deputy County Administrator do hereby stipulate and
&e���rederick
agree that Monroe County Social Serviceslln-Home Services is ready to implement the services
mentioned in this Invitation to Negotiate (ITN)
Date: %1 /C?
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December '41.0 10 Contract CLP-NICSS I
11111q� 1111111
���11111 1 1 ij�
Submitted by: Monroe County In -Home Services (MCIHS)
Monroe County Board of County Commissioners
Monroe County Social Services
1100 Simonton Street 2-257
Key West, FL 33040 305-292-4510 (phone)
aylvia 3, Murphy,. Mayor, Monroe County — Chief Executive Officer
Monroe County In -Home Services (MCIHS), a department within Monroe County Social
Services (MCSS), is well-equipped to handle service interventions for the short-term high risk
individual. Due to our extensive reach throughout all of Monroe County, there are no areas that
cannot be served. NICIHS is able to provide any manner of services throughout the entirety of
Monroe County. For example, MCIHS already provides value-added services (via a number of
non DOEA sources) such as, case management, homemaking, personal care" in -home respite,
facility -based respite, nutrition services for in -home and congregate clients, prescription
assistance, pauper burials, transportation assistance, shelter, energy cost assistance,
weatherization services, and many more. The funding for the Community Living Program will
allow MOBS to provide the following short-term services to the ARC referred high -risk
individuals: homemaking, personal care, and case management. MCIHS employs County staff,
as well as subcontracted staff, that are strategically positioned throughout all areas of Monroe
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County.
In addition to all of the aforementioned services which are considered value-added services, for
the Community Living Program, we are able to perfoun the following direct In. -Home Services.*
flornemaking - which will allow clients to receive specific home management services Such as
general 11OLIsekeepin(ly, laundry, assistance with bUd(Yeting and paying bills, shopping assistance,,
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ineal preparation, etc. Personal Care — which will allow clients to receive assistance with
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December 2.0 10 Contract CLP-MC I
eating, dressing, personal hygiene, and other significant activities of daily living. Case
Management - Monroe County has qualified and experienced Case Managers. Our Case
Managers are able to assist clients in. identifying physical and emotional needs and problems
through an interview and assessment process. Case Managers are able to discuss and develop a
care plan for services for these short-term clients to remove them from being high risk. Our Case
Managers are "gatekeepers" in the community care system and have vast knowledge in the
:_n C�
different resources available in our Community. Monroe County's Case Managers have many
years of experience and are fully able to coordinate and link clients and caregivers with
appropriate resources in the health care and delivery systems regardless of the agency or
organization offering the services, to meet the client's needs. Case Managers are able to monitor
all services and referrals to ensure they are havinor a positive impact on the problems that have
caused the client to become high risk. Respite Care -- as a value-added service — will provide
relief or rest for a primary caregiver from the constant, continued supervision and care of a
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functionally impaired, high risk older person by providing care for the person in the home for a
pre -determined period of time.
Overall Coordination -Monroe County Case Managers are able to coordinate all community
resources for high risk clients via a community care service that comprises health and
community resources. As part of a government agency MCIHS has access to a myriad of social
service programs available within our own offices, such as funding for prescription drugs and
the others referenced on page I - If a consumer needed medication and could not afford it., MCSS
would be able to pay for that medication. This is just one example of the many value-added
services that MOSS already has in place. Another example Would be the )Vlonroe County
Disability Council which is sponsored and staffed by the Monroe County Board Of COUMV
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December '20 10 Contract CLP- Mcss I
Commissioners (BOCC). The Social Services Department has long been the liaison for the
BOCC with this advisory council. At present time one of our Case Manager Supervisors is
Liaison and Secretary/Treasurer. The Council seeks to improve access, to, services for all
residents of our community. As a governmental agency. the BOCC provides additional funding
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to Social Services organizations (outside of the County structure) following the counsel of the
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Human Services Advisory Council (HSAB). The HSAB reviews applications and makes
01
funding recommendations for programs in the following service categories.. primary and
behavioral health care, core services, and quality of life services. The recommendations of
HSAB are presented to the BOCC for approval. Once approved, the BOCC enters into contracts
funding over 25 non -governmental, agencies that offer essential services for consumers. As
contractors for the BOCC, these agencies are willing and able partners with the MCIHS Case
Managers and Social Services staff to help meet the needs of consumers within the County.
Monroe County Transit (MCT), a program within the Social Services Department, is a partner
with In -Home Services providers. The MCT vehicle fleet is 100 percent accessible to the
physically disabled and provides door-to-door transportation for anyone who is transportation
disadvantaged throughout the entire length and breadth of the Keys. MCT coordinates closely
with the local COMMUnity Transportation Coordinator and Medicaid Transportation Coordinator
— the Guidance Care Center. All local transit providers are members of the Local Coordinating
Board, including the City of Kev West that provides bus routes in Key West and Stock Island
and the Lower Keys Shuttle that operates a fixed route from Marathon to Key West. Monroe
County is an equal financial partner with the Cities of Key West and Marathon in the operation
of the Lower Keys Shuttle. MCIHS Case Managers actively coordinate with available
transportation providers thrOLI(YLnI10LIt the communities of the Kevs to ensure that access to needed
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December '._20 10 Contract CLP-M I
services is available. Since MOBS is integrated into the Social Services department, Case
manage
rs work closely with Community Support Services (CSS) for Consumable Supplies
(value-added service). The Case Managers also work very closely with the health care
providers in the Keys and CSS to provide a link to ensure individuals who are low income
receive the supplies they need, This requires the involvement of local physicians, hospitals,
physical therapy centers, etc. Further, Case Manaorers, in Monroe County continuously monitor
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the quality, appropriateness, and cost of services that are delivered to consumers to ensm that
the most appropriate and cost-effective service is being received. Referrals are often made for
value-added services to the Helpline of the Florida Keys for clients who need Telephone
Reassurance. This service is designed to allow staff to check on the consumer daily and if
needed call to remind them to take their medication® Caregiver Support is also offered through
Helpline and they hold support groups throughout the Florida Keys for any caregiver in need.
Often caregivers are in crisis and this gives them an opportunity to discuss their situation and
obtain some advice and assistance relative to their loved one. MCSS currently provides
Homeless Prevention and Rapid Re -Housing Program (HPRP). This grant is funded by the American
Recovery and Reinvestment Act of J'2W 0 0 9, through the Department of
Homelessness/DCF and assists eligible Monroe County households with the prevention of
homelessness. The intent of this funding is to help persons who can remain stably housed
AFTER the temporary housing assistance ends. It generally provides rent for 3 months or less.
Like the COMMUnity Living Program, HPR.P is not a long-teint assistance program. MCSS also
operates the WeatherizationiVssistance Program (WAP). This grant through DCA provides Energy
Reducing Services to low income families to reduce energy cost. conserve energy, increase
comfort in the home and improve safety and health standards. Some of the services that
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December '20 10 Contract CLP-M f
are offered under this grant are threshold repairs, window and door replacement, insulation, and
installation of smoke/fire/carbon monoxide detectors, etc. The Low Income Home Energy
Assistance Program (LIHEAP) is another service we are able to provide through the DCA.
This errant assists low income households to receive financial assistance in paying for the cooling
and heating of their homes. As Vist*ting Nurse Association (VNA) currently sub -contracts with
MCIHS for the provision of direct services to our clients, we have developed a close alliance
with them and are able to make referrals to them for services outside of direct services. One of
the services that we often refer to VNA for is Bereavement Counseling. Often consumers are
very distraught after losing a loved one, such as a spouse, and are in dire need of professional
services. VNA offers this service with licensed counselors free of charge. Along with VNA,
Case Managers also refer for counseling services to the Guidance Care Center and the Care
Center for Mental Health, Inc. (CC TII . These agencies have on staff a licensed mental
health counselor (PhD), and a certified addiction professional (MSS"). A wide range of
Gerontological Counseling Services are also available to clients who are referred to these
agencies.
Service Coordination/Assessment, Coordination with the AAA - As Monroe County's Lead
fluency for over the past three decades, MCIHS is able to ensure the coordination of services and
is able to coordinate all aspects of the grant with the AAA. Monroe County has a close
relationship with the Aulna Resource Center (ARC) and is able to receive and coordinate all
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referrals for them. MCIHS are also able to work innovatively, since the Case Managers have a
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long-standing relationship with the local hospitals Discharge Planners. Staff are able to give
these planners the ARC contact information and the v call the ARC when a hiorh risk consumer
W Z7
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December 20 10 Contract CLP-M I
intake and assessment. Intake and Assessment begins when a potential consumer, care jiver,
family member, friend, neighbor, or public or private agency seeks assistance for an individual
by contacting the Alliance for Aging's ARC. MCIHS employs ten staff members who have been
trained and certified to take referrals and administer the DOEA Assessment Forms in
accordance with the DOEA Assessment Instructions (70 1 A,. 701 B, 70 1 C) Manual. Training and
certification was completed for MCIHS staff by the AAA in Miami during August 2007 and
August 2008 and staff continue to receive updated information and training as needed. NICIHS
staff members conduct all assessments in accordance with the instructions for completion as
indicated in the aforementioned training sessions and the DOEA Assessment Instructions
(701A, 701B., 701C) Manual. The ARC determines when persons are approved for services
from MCIHS and will send the referrals accordingly. After the referral is received, MCIHS
conducts a home visit with the consumer in order to perform a comprehensive assessment
(701B) and develop a care plan in accordance with the DOEA. Referrals from the ARC for high
risk individuals who are at imminent risk of institutional placement, such as individuals
awaiting hospital or emergency room discharcre, will be served immediately. Case Managers
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have the capability after administering the assessment (701-13) to communicate with other
agencies to ensure that all needs for the consumer are adequately addressed and keep the
individual from staying high --risk. This is due to the fact that MCIHS enjoys a high level of
coordination and commitment from community partners countywide. The success of MCIHS as
well as the high level of countywide coordination and service linkage is due in a large part to
the exceptional working relationship MOBS has maintained throughout the community for over
three decades.
Program Success and Rel2orting Re_guirements and farni'liaritl with reporti
requirements and service descriptions -As previously mentioned, MCIHS ei-n-plovs ten staff
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December 20 10 Contract CLP-M I
members who have been trained and certified to administer the DOEA Assessment Forms in
accordance with the DOER Assessment Instructions (701A, 701-B, 701C) Manual. Two MCIHS
administrative staff members are responsible for the upkeep and maintenance of the CIRTS data
entry. Both staff members are full trained on the CIRTS application. While one clerical staff
member serves as the primary CIRTS data entry worker, the other administrative staff member
serves as a backup, thus ensuring that CIRTS data entry is completed timely. Monthly, quarterly,
and annual reporting requirements are fulfilled by a full time Sr. Grants Coordinator employed
by MOSS. The Sr. Grants Coordinator maintains a chart of reports including due dates,
submission requirements, standards for completion, etc. Additionally, the Sr. Grants Coordinator
reviews and coordinates all reporting with the Director of Social Services. This ensures that
multiple staff members are aware of each report, progress being made on the report, when it is
due, and what the requirements for completion are. The Sr. Grants Coordinator maintains
electronic copies and printed copies of each report. Working papers and substantiating backup
documentation are maintained in the printed copy files and stored in locked filing cabinets,
inside locked offices., in a secure building. Daily backups of electronic data occur through
routine Monroe County Technical Services operations. Since Monroe County implemented the
position of Sr. Grants Coordinator, all reports have been submitted timely and accuracy and
continuity has been ensured. Further, there is now one central person that the Alliance for Aging
can contact if there are questions about reporting. Monroe County's staff is very familiar with
the Service Descriptions as identified in the DOER Handbook issued July 2-01-0 as Monroe
County being a CCE Lead Agency for the past 30 years.
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Additional Sere ices /Resources at no charge to the Alliance for - As pre viouslv
mentioned, MCIHS is a department within the MCSS. MOSS offers a wide array of services to
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December ',201.0 Contract CLP-M I
help Monroe County's citizens and MCIFIS has full access to all services and funds. Some of
these services include but are not limited to the services outlined under Overall Coordination
startinor on page 2.
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Self-sustaining prog am when it is at the end of its ii t --Monroe County is certain it will be
able to self -sustain the program when it is at the end of its pilot time allotment. All of the
aforementioned services are able to be provided, on a limited basis, through Our Case Managers,
the MASS, and all non DOER funding. While some of these services are paid for with grants
from DCF and DCA, many of these services are paid for through General Funds (County tax
dollars) and is provided annually from Monroe County. Once the Community Living Program
pilot ends our Case Managers will continue referring and coordinating services (as mentioned
above) between the clients and other entities to provide the needed services for our citizens.
Monroe CounjjIn-Home Services Technical Caaciy to provide the . 4M --pro nsed service
intervention - MCIIIS Case Managers have the knowledge, educational background,
experience, and skills to coordinate the most beneficial and least restrictive services and
community resources for consumers throughout the community. Along with experience and
training in the In -Home Services field, our Case Managers have many years and extensive
training in the Social Services field. Several of our Case Managers have worked for DCF or
other governmental or private agencies before working for Monroe County and have a
background and wide ranging know ledge services and procedures. With this knowledge,Zn 4t� Zn
Monroe County. Case Managers are proficient in helping individuals with Medicaid applications
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along with assistincr Zn
them with their applications for Food Stamps online. Conroe County's Case
Managers have a mininIUM of 5 years experience in the Social Services field and as much as
years field experience. Along with the Case Managers extensive experience, MC.IHS has been a
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December 20 10 Contract CLP-MCSS I
CCE lead atyencv for over 30 years and we have the knowledore and technical ability to submit all data and report inor
into the CIRTS system, the knowledge of required reports, and the flexibility to handle requirements set forth by the
DOEA and the Alliance for Aging.
Statement of Readi*ness MC is fully ready to implement services wi•thin the COMMUnity Living Program
immediately. All of the services that we are proposing here are currently being performed by existing staff. We have
the necessary infrastructure and financial resources necessary to begin serving referred clients immediately.
Unit Rate — MCIHS has the commitment of the BOCC to meet the 10% cash match requirement as set forth in the
ITN. In addition, MCIHS has the capacity to offer an additional 10 o in -kind match via our existina infrastructure
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(office and congregate meal site space). The combination of these two sources off
ands will equate to an overall 20%
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match. Value-added services are outlined and documented in this response, as well as the office and congregate meal
site space which are documented on the Unit Cost Methodolo4cry.
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