Item F06Meeting Date�, . . ..... .. 11-16-2011
Bulk Item: Yes No —
Department: Social Sem'ces/In-Home Services_
Staff Contact Person/Phone #--. Sheryl Graham/X45 10
. . ............... .... .. ..... .
AGENDA ITEM WORDING. Approval of Amendment 003 to the Community Living Program
(CLP) Contract CLP-MCSS-11 between the Alliance for Aging, Inc. (Area Agency on Aging for Miami* -
Dade and Monroe Counties) and the Monroe County Board of County Comnu"ssioners (Social
Ser"'ces/In-Home Services) for fiscal pen'od I / I / I I to 12/3 1 /11.
. ITEM BACKGROUND.* Approval of Amendment 003 to CLP-MCSS-11 will 'increase the allocation
under contract by $6,000.00. This is due to a couple of clients meeting the asset cn*teria set by the state
and therefore quaWng.
. ...... ............ : .. �:..---.---.--..-...--..-......................... . . . . ... .............. ... ........ ....... ------------------ -----
PREVIOUS RELEVANT BOCC ACTION: Prior approval granted to Contract CLP-MCSS-1-1 on
December2010
. . . ..... ..... ..... . .. . — -------- . . . ............ .......... ................... ... .. . . . .... ...........
........ . ......... ...... : ........... .. ..... ...... . . . . ... . ............ ..... ...
CONTRACT/AGREEMENT CHANGES.* An increase in allocation by $6,000.00
STAFF RECOMMENDATIONS: Approval
6 -1
TOTAL COST: $61YO00.00. INDIRECT COST* --0--BUDGETED: Yes Xt,o
COST TO COUNTY.
L6ftO.00 (10% Cash Match Regui SOURCE OF FUNDS: Ad -Valorem Taxes
And L600-00 (10% ln-KinLMat.�Ch
REVENUE PRODUCING: Yes No X— AMOUNT PER MONTH.. ear
Y
ut
1,57
APPROVF,D BY.* County Atty, X OMB/Purchasing X -RiskManagement
.......... .. ...... ....
DISPOSITION.
RMR�MM
AGENDA ITEM #
Contractwrith.- Alliance For Aging, Inc. Amendment 003 Contract CLP CLP-MCSS-11
Effective Date: 1/1/2011
Expiration Date: 12/31/2011
Approval of Amendment 003 to the Community Living Program (CLP) Contract
Contract Purpose/Description.
C -MCSS-11 will increase the allocation under contract by $6,000.00. This is due to a couple of client meeting
LP
the asset criteria set by the state and therefore qualifying.
Contract Manager: Sheryl GrAam
(Name)
For BOCC meeting 11/16/11
4510 Community Services/Stop I
(Ext.) (Department/Stop 9)
AgendaDeadline: mwwwm�11/1/11
CONTRACT COSTS
Total Dollar Value of Contract: (extension.) $6,000.00 Current Year Portion: $
Budgeted? Yes X No 0 Account Codes: 125-6153011-
C -$6000.00 .jrant.
County Match: $600. 00 (10% Cash Match Required
$600.00 10% In -Kind Match Total 20% Match
...... .......... . ....
ADDITIONAL COSTS
Estimated Ongoing Costs /Vr For:
tot included in dollar value a!!2ve) .. . . .. .... . ........................ . . ... .. ... (eg..- MairAenance, utiliti
Date in
Division Director
Cut
%sk Managem�nl
O.M.B./Purci�"
Mg
County Attorney
OMB Form Revised 2/27/01 MCP #2
janitorial, salaries, etc
W�
Changes Date Out
Rev* wer
Needed
Yes F] No [J-r k C
'c L
No Yes 0
Yes 0 No 0"
Amendment 003 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 Social Services.
The purpose of this amendment is to increase the allocation under contract by $6,OOO
The Budget Summary by Title for the whole fiscal year (January 1 -Decernber 31,
2011) is as follows:
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-.
I I
Maximum
I
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
$6,000
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.
r1% r1% &*"% I 11 rw% r� r-% -
Monroe Count y Social
Services#
SIGNED BY:
Heather Carruthers
NAME:
Mayor
TITLE:
11-16-2011
DATE:
MO.. OE COUNTY ATTORNEY
ROV AS R
a.
PEDRO I'vAl RCA'FV�l
ALLIANCE FOR AGING, INC.
Max B. Rothman, JD, LL.M.
NAME:
President & CEO
TITLE:
DATE:
........... .. ........ . ........ .............. .. ............. ................... . ..... .................. .......... ........ .. ......
Contract Cr ..,sP- 4CS S 1
ALLIANCE FOR AGING, INC.
STANDARD CONTRACTOLDER RICANS ACT PROCRAM TITLE III-B
COMMUNITY LIVING PROGRAM THIS CONTRACT is entered into between Y
the Alliance ce for Aging Inc. hereinafter referred "
Monty social services hereinafter referred to as :� ed to as the ,����, and Monroe
s the Con tractor", and collectively referred to
contractor for th i � purpose may des �n ate a vendor, :� as the �:Partiesr�, the term
��`��.���I��� III .�� � ub�rantee or sbrec spent, the status to befurther
m
� b1*t-2 as necessary. identified in
WITNESSETH THAT:
WHEREAS, the AAA has established throug
h the area Plan on Aging that it is �n need
herein,- and of certain services as described
WHEREAS, the contractor has demonstrated th
at it has the requisite expertise and ability to
as an independent contractor of the AAA, faithfilly perform Such services
NOW THEREFORE, in consideration of the services to be performed and payments to be made to
covenants and conditions hereinafter :set forth, the Parties ao gather with the nttial
Free as follows:
Ptr se of Contract
The purpose of this contract is to provide services ces in accordance with the terms and conditions
contract including all attachments and exhibits, which constitute specified in this
titt�te the contract document.
I.I Definitions
DOER means the Florida .Department of .Elder A
A.�.� means the Affairs.
Alliance for Aging, Inc.
PSA means the Planing and Service Area comes �'�
corresponding to iarni-.Dade and Conroe Counties.
2. Incorporation oration of Documents within
the Contract
The contract will incorporate the provider's application P in response to the 2010 Community un i
Invitation to negotiate (ITN), attachments ty diving Program
propo5al(s), state Ian s
handbooks, man��als or desk books, as an in p � �� rant agreements, relevant department
integral part of the contract, except to the extent t p
provides to the contrary. In the event of co n�l ict in that the contract expl icitl
language among any of the documents refer e
specific provisions and requirements of the contra anted above, the
Proposal(s) or other general contract document(s) shall prevail over inconsistent materials not specific to this contract document proviszon5 i�� the
t and identified attachments.
�. �'errr� of Contract
This contract shall begin on �a��r �o l 1 or
�e on the date on which the contract has been :si
required to sign it, Whichever is later. It shall end at �i fined by the last party
midnight, local time in Miami, Florida, on Dec
ember 3 ,-�o l 1.
4. Contract AMo int
The department agrees to pad' for contracted services according to the terms and conditions of this con
amount riot to exceed lo.00. or the rate .schedule subject tract n sir]
� to the availability labi l ity �ffunds . any costs or servicespaid
for under any ether contract or from any other so
rce are got eligible for payment ender this contract,
tract.
5. Renewals
. mutual agreement of the parties, in accordance with s. 2 .0-58(l l f , F.S., the AAA may renew
period got t exceed three ears, or the term :f the the contract for
c.r��ginal cotract, �=hichever is lor��er, `ale renewali..� .
method
for determining renewal price, is set forth i price. or
n the bid, proposal, or reply. �o ether costs for
be charged. any renewal is sub'act to the same the rc�� e �f� l may
�
me terns ����d conditions as the o��ignal c�.r���§ and a �,�:-�
satisfactory performance cv luations b the A�� an �.o tin('y t tIpo
d the �,��� il�bi l ity I ftinds.
l 6
.
JanUary 2011
Contract C LP- MCS S 11
6. Cora 1.1ance with Federal Law
6j. 1f this contract contains federal funds the following shall apply;
6.1.1 The provider shall comply with the provisions P of 45 CF 74 and/or 45 CFR 92., and other applicable icabl
PP e `egulations.
6.1.2 ff this contract contains federal
funds and is over S l oo,000.00, the contractor
standards orders or reg.�lations issred under �. hall comply with all applicable
o6 of the Clean Air Act as amended (42 U.S.C. 740 l �-
of the Federal dater Pollution. Control .Act as amended = et .se�.� �� �o�
dad � � U.S.C. �� et .seq.), Executive order
amended and where applicable Environmental Protection ��, as
Agency reg.lations �o +��� �o. The contractor shall r
any violations of the above to the .A.A. sport
6.1.3 The contractor, or went actin for the contract
or, tor, may not use any federal funds received in cone
contract to influence legislation or appropriationsndina before action with this
contract contains federal funding100,000.
� � re the Congress or any State legislature. �` this
� r� excess of � � oo,o�.00, the contractor rust, prior to contra the Certification Regarding Lobbying form, .�T"�'AP contract execution, complete 1�. All disclosure forms as required
Certification regarding Lobbying forte mint be completed � red by the
P tad and returned to the Contract Manager, prior to a
under this contract. P payment
6.1.4 That if this contract contains $ 10,000.00 or more
of federal funds, the contractor shall com 1 with �� . l l=, dal Employment opportunity, as amended b P y ecutive order
y Executive order 1 �"5 and others, and as supplemented
Department of Labor regulation 41 CF. 60 and 45 CF pp anted i n
�.�, if applicable.
6•1.5 That if this contract contains federal funds and r p oxides services to children up to age 18, the contractor
with the Pro -children Act of 1994 20 C .S.C. 6o8 shall comply
6•1.6 That a contract ward with an amount expected to .
not be made to P equal or exceed �?�,000.00 and certain other contract a� parties listed on the government --wide Excluded Parties ands shall
List System, in accordance with the OMB
guidelines at 2 CF. 180 that implement Executive Orders
rs 12549 and 12689 "Debarment and Suss erasion." Th
Excluded Pates fist System contains the nazres of anti P e
parties debarred, suspended, or otherwise excluded b
as well as parties declared ineligible under statutoryor regulatory y agencies,
contractor will comply �' latory authority other than Executive order 1 ���9.
P y with these provisions before doing business or enteringThe
finds pursuant to this contract. The contractor shall c into subcontracts receiving federal
complete and sign ATTACHMENT �Ii���'� prior to the exec
this contract. P execution of
6.2 The contractor shall not employ an unauthorized .
alien. The .AAA. shall consider the employment of
aliens a violation of the mrnigration and Nationality Act , R unauthorised
Act of 1986 8 U.S.C. y t U.S.C.�SC1 � a and the Immigration Reform and +C
� 1 l 01 S Bch violation shall be cause for unilateral � Control
cancellation of this contract by the .AAA.
�.� if the contractor is anon -profit pro��ider and is Subject to internal Revenue Service �5 tax. exam �
reporting requirements (filing a Porn 990 or Porgy 990- an Pt ors an�ation
with the filing requirements d has for
ts tax exempt status. revoked for failing to cots
q of the �00 Pension Protection .Act or pl and, other reason, the contractor must notify the
AAA n writing within thirty o days of receiving the R � � . 4
4.. S notice o revocation,
7. Compliance with. State Law
7.1. That this contract is e xec rued and entered into in
the State of Florida, and shall be construed. performed and enforcedin all respects in accordance with the Florida law, including Florida provisions for conflict of laws.
.20 Requirements of s, 1.87.o5 ffi F.S. -rs amended.
`96
M
January nary 20 11.
Contract CLP- MCS S 11
7.2.1 The contractor will provide units of deliverables, including v
ar o s .tent sereices, and in some instances may = incl d=
reports, find' ad drafts as specified in this contract, which the CY .
Contract gager nest receive and accept writing prior to payment in accordance with s. 2. l 5.q 1, F.S. 1 an
.2.2 the contractor will submit bills for fees or other compensation
for services or expenses sWic ient Meta i l for
proper pre --audit and post -audit.
7.2.3 If itenized payment for travel expenses is permitted in this
p contract, the contractor will submit bills for an tra��e
expenses in accordance with s. 1 12,061, F.S., or at such lower rates as ma Y
Y be provided in this contract.
7.2.4 The contractor will allow public access to all document.-
s, papers. letters, or other public records as defined in
subsection l l 9.0 l 1 1 2)). F.S., made or received b the contractor i
Y n Conjunction with this contract except for those
records which� are made confidential or exempt by lam. The contractor' c s refusal to comply with this provision :shall
constitute an Immediate breach of contract for which the AAA may unilaterally terminate the contract.
7.3 If clients are to be transported under this contract the contractor shall comply with the provisions of Chapter 427,
F.S., and RLIle 41 M-2, F. A. C.
7.4 Subcontractors who are on the discriminator vendor 1 fist
Y may not transact business mess with any public is ent it in
accordance with the provisions of s. 287.134, F.S. y
7.5 The contractor will comply with the provisions of s. 11,062, F.S., and s. 216.347. F.5., which prohibit the expenditure
of contract finds for the purpose of lobbying the legislature,judicial pbranch or a state agency.
8. Background Screening
The contractor Shall ensure that, prior to providingservices all
persons having access to vulnerable elders and
children their 1 iving area, fends or personal property, 1� Y, or protected
d health information pertaining to such individuals,
shall pass a Level 11 criminal background screeningin accordance e with the requirements of s. 430.0402 and ch. 435,
F.5., as amended. These provisions shall apply to employees, :st�bco ntractors, consultants, direct :service providers and
volunteers. consequently, any commitment for employment,purchase
p of Services, or volunteer program participation
:shall be contingent upon the passing of a Level 11 background g check. The background screening Shall inclUde
employment history checks as provided in s. 435.03( 1), F.5. and both local and national criminal record checks
coordinated through law enforcement agencies.
8.1 For purposes of this section, the term "direct :service rov i �,
p der means a person 18 years of age or older who, Pursuant
to a program to provide services to the elderly, has direct. face-to-face conta
ct with. a client while providing services
to the client or has access to the. client's living areas or to the client's funds .
ends 0r personal property. This terms includes
coordinators, managers, and Supervisors of residential facilities and volunteers.
9. Grievance Procedure
The contractor :shall develop and implement, and ensure that its sub
contractors have established grievance procedures
to process and resolve client dissatisfaction with or denial of .sear ice -,s.
, and address co��plairts rc�g�rding t1e
termination. suspension or red cation of sere ices as required for receipt eipt of funds. these procedures, at � n�inint111,
should provide for once �f tfe grievance procedure and a � ; °
determnations.
p n opportunity for rc rev of the subcontractor's
o. Aud s4 ins ect ons Inve 4 a on:s Pnblic records and Retention
10, To establish and nt,intain books, records and documents c l d t electron'
oe media) Sufficient to reflect l lis , come and e pendit res of funds provided by the AAAUnder this contract,
3/96
. .
..........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
N
JanUary _'41.20 1. 1
E
Contract CLP- MCSS 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) vears after completion of the
contract or longer when required by law. In the event an audit is required bv this contract, records shall be retaine(
for a minimum period of six (6) years after the audit report Is issued or until resolution of any audit findings oi
litior4nationbased on the terms of this contract, at no additional cost to the AAA.
10.3 Upon demand, at no additional cost to the AAA, the contractor will facilitate the duplication and transfer of any
records or documents during the required retention period in Para-araph I �.
I.-- Z� 0. ?
10.4 To assure that the records described in Para raph 10 shall be subject at all reasonable times to inspection, review,,
9 1
copying, or audit by Federal, State, or other personnel duly authorized by the AAA.
low
At all reasonable times for as long as records are maintained, persons duly aL[thorized by the AAA, DOEA and
Federal auditors, pursuant to 45 CFR 92.36(i)(10), shall be allowed full access to and the right to examine any of the
contractor's contracts and related records and documents pertinent to this specific contract, regardless of the form in
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 by
the office of the Inspector General pursuant to s. 20.055, F. S.
11. Non!Liscrimination-Civil Rights Compliance
11.1 The contractor will execute assurances in ATTACHMENT VI that it will not d I scriminate against any person in the
provision of services or benefits under this contract or in employment because of age, race, religion, color, disability,
national origin, marital status or sex in compliance with state and federal law and regulations. The contractor further
assures that all contractors, subcontractors, subgrantees, or others with who it arranges to provide services or
benefits in connection with any of its programs and activities are not discriminating against clients or emloees
because of age, race, religion, color, disability, national origin, marital statLIS or sex. py
11.2 The contractor will retain, on file, during the term of this agreement a timely, complete and accurate Civil Rights
Compliance Checklist (ATTACHMENT B). Z:�
11.3 The contractor agrees to establish procedures pursuant to federal law to handle complaints of discrimination
involving services or benefits through this contract. These procedures shall include 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, its Successors, transferees, and assignees for the period
during which Such assistance is provided. The contractor further assures that all Subcontractors. vendors. or others
with whom it arranges to provide services or benefits to participants or employees in connection with I iny of its
programs and activities are not discriminating against those pat-6
icipants or employees in violation of the above
statutes, regulations, guidelines, and standards. In the event of failure to comply, the contractor understands that the
- Z�'
AAA may, at its discretiond seek a court order requiring compliance with the terms of this assur'ince or seek other
appropriate Judicial or administrative relief, Including but not limited to
to, terminati n of anddenial Of Et her
f,issistance.
12. Provision of Services
The contractor will provide, set -vices In the manner described in ATTACHINIENT I.
4/96
January `)0 11.
M
Contract CLP- MCSS 11
.13, Monitorina. b3: the AAA
The contractor will permit persons duly authorized by the AAA to inspect and copv any records. papers, dOCL1111C11tS,
facilities, izoods and services of the contractor which are relevant to this contract, and to interview any clients.
employees and Subcontractor employees of the contractor to aSSLIre the AAA of the sat Isfactory performance of the
terms and conditions of this contract. Following such review, the AAA will deliver to the contractor a written report
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,
14, Coordinated Monitorin with Other Agtncies
If the contractor receives funding from one or more of the State of Florida other human sery Ice agencies, in addition
to the Department of Elder Affairs, then a joint monitoring visit including such other agencies may be schedu led. For
the purposes of this contract, and pursuant to s. 287-0575, F.S. as amended, Florida's human sery Ice agencies 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 subseqUellt
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. Indernniffication
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. 768.2-8, F.S., or other Florida law, Paragraph 15 is not applicable to contracts
.k-
-i�-W
exeCLIted between the DOEA and state agencies or subdivisions defined in s. 768.118(1), F.S.
16. Insurance and Bondl!lg
16.1 To provide continuous 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 agency or subdivision as defined by SUbsection
768-28(2), F.S., the contractor accepts full responsibility for identifying and determining the type(s) and extent t 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 under 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 i-nay be
provided by a self-insurance program established and operating under the laws of the State of Florida. The AAA
reserves the right to require additional insurance as specified in this contract,
16.2 Throughout the term of this agreement, the contractor agrees to maintain ntain an insurance 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 i
z:1 - In
an amount commensurate with the funds handled, the degree of risk as determined by the insurance company and
consistent with good business practices.
.0
1.7. ConfidentialLti, of Information
The contractor shall not use or disclose tiny information concerning a recipient of services Linder this contract for Liny
purpose prohibited by state or federal law or regulations except with the written consent of 1 person legally
authorized to give that consent or when authorized by law.
184, Health Insurance Portabifi-tv and Accpunt ablit LAc
5/96
J anUary o l
■
Contract CLP- MOSS 11
Where, applicable, the contractor will comply with the Health Insurance Portabilit and Accountability �, f64).
rty �.�:t =�� �� �20d.. as well as all regulations promulgated thereunder 45 CFI. 160, I6?, and
19. Incident Reporting
19.1 The contractor shall notify the AAA Im ediately, but no later than fort -eicht 4� hours from, Y �,: �t, the contractor
awareness or discovery of conditions that may materially affect the contractor or subcontractor's ability 3 t � � to
the services required to be performed under this contract. SLIch notice shall be trade orallyto the contract .
telephone) with an email to immediately follow.
act manager I
19.2 To immediately report knowledge or reasonable suspicion of abuse, ne(ylect, or exploitation of a child
,
aged person,
disabled adult to the Florida Abuse Hotline on the statewide toll -free telephone number l--8o0-9
P � 6AB U SE.
required by Chapters 39 and 415, I.S., this provision is binding upon both the contractor and its employees.
20, New Contracts Re ortnN/A
The contractor shall notify the AAA within ten (l o) days of entering into a new contract with an of
Y the remainrn
four (4) state human service agencies. The notification shall include the following information: contracting star
agency; (2) contract name and number; (3) contract start and end dates; (4) contract amount; S) contract descrip
tio
and commodity or service; and (6) contract manager name and number. In complying with this pro
vision, are
pursuant to s. 287.0575, F.S. as amended, the contractor shall complete and provide the information i
ATTACHMENT D.
i. Bkru tc Notification
If, at any time during the terra of this contract, the contractor, its affiliates assignees, subcontractors or
� rates file-s, a
claim for bankruptcy, the contractor must immediately notify the AAA within ten (l o) days after not
anon, the
contractor must also provide the following information to the AAA: (l) the date of film of the bankruptcy
petition; (2) the case number; (3) the court name and the�
division in which the petition was filed (e. g., Northern
District of Florida, Tallahassee Division); and, (4) the name, address, and telephone number of the bankruptcy
P
attorney.
22. onsorshi anc Publicit
22A As required by s. 286.25, F.S., if the contractor is a non -governmental organization which sp
onsors ponsors a program
financed wholly or in part by state funds, including any funds obtained through this contract it shall i ' n publicizing
,�
a vertisinZ17a, or describing the sponsorship of the program, state: "Sponsored by (contractors name), The Alliance for
Aging, and the State of Florida, department of Elder Affairs." If the sponsorshipreference is in written material. terral, the
words "Alliance for Aging and "State of Florida, Department of Elder Affairs"` shall appear in at least the same size
letters or type as the name of the organization.
�
2.2 The contractor shall not use the words "'Alliance for Aging`, or "The State of Florida, Department of Elder Affairs"' t
indicate sponsorship of a program otherwise financed, unless, specific authorization has been obtained by the AAA
prior to LISe.
23.
an�en�
23.1 The contractor shall not assign the ri(..-h s and responsibilities Linder this Contract without the prior written approval of
the AAA, which shall riot be rnreasonably withheld. Any sublicense, assignment. or transfer otherwise � & g
her°�� iase rrrng
without prior written approval of the AAA. will constitute a material breac h � f the contract,
13. 'File State of Florida shall at all times be entitled to assign or transfer, in whole r art, its ritThts - .� ,
�- Florida, � , duties, r �1. l �rtrors
Under this contract to anot her cyove rnr e tal as ncy it). the State of ,FOr
Upon v i� nprior written notice �° i � ..
P �,.. � P o tile
6 96
. . . . . . . . .
..................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
■
Contract CLP- MOSS 11
contractor, In. the event the State of Florida approves transfer of the contractor's obli�ationts the contractor remap
responsible for all work performed and all expenses incurred in connection with the cont
ract.
t.
23.3 This contract shall remain bindinc upon the successors in interest of either the
1contractor or the AAA.
24, S bco"tracts
24.1 The contractor is responsible for all work performed and for all commo
dities produced pursuant to this contact,
whether actually furnished by the contractor or its subcontractors. AnySubcontracts is shall be evidenced by a writtendocument and subject to any conditions of approval the AAA deems necessary. the contractor ftrther agrees that the
AAA. shall not be 1 iable to the subcontractor in any moray or for an reason. The co
the AAA against any such claims.
Y contractor, at its expense, will defend
24.2 The contractor shall promptly pay any subcontractors upon receipt of
p p payment from the department or other
sponsoring agency. failure to mare payments to any subcontractor in accordance wi
th s. �.87.0585, l�`.5., unless
otherwise .stated in the contract between the contractor and subcontractor, will. resul
t in a penalty as provided by
statute.
25, Indc endent Ca ace of Contractor
t is the intent and understanding of the parties that the contractor, or an f its
y osubcontractors, are independent
contractors and are not employees of the AAA, and shall not hold themselves out as employees or
agents of the AAA
without specific authorization from the .AAA.. It is the further intent and understands ng of the parties that the AAA
does not control the employment practices of the contractor and shall not be
liable for any wage and hour,
employment discrimination, or other labor and employment claims a ainst the contra
ctor actor or its subcontractors. All
deductions for social security, withholding taxes, income taxes, contributions to une
mployment compensation funds
and all necessary insurance for the contractor shall be the sole responsibility it of the con
p Y tractor.
--- IIIIIIII�
Payments will be made to the contractor pursuant to s. 215.422, F.S., as services are rendered and invoiced by the
contractor. The AAA's Contract Manager will have final approval of the invoice for payment,
invoice for payment only if the contractor p Y � and will approve the
Y has met all terms and conditions of the contract, unless the bid
specifications, purchase order, or this contract specify otherwise. The approved invoice
AAA's fiscal section. for budgetary approval pp Dice will be s�ibmitted to thy.
Y pp a.l and processing. Disputes arising over invoicing and payments will be
resolved in accordance with the provisions of s. � 15.422 F.S. A Vendor p Y
om bt�dsman has been established within the
Department of Financial Services and may be contacted at (850) 4 l 3-5665.
27. Return of
The contractor will return to the AAA any overpayments due to unearned funds or � F
f� nds disallowed and any interest
attributable to such funds pursuant to the terns and conditions of this contract that we
re disbUrsed to the contractor by
the AAA. to the event that the contractor or its independent auditor discovers that ° ,.
a ��n overpayment has been jade,
the contractor shall repay said overpayment immediately without prior notification n from the AAA. to the event that
the AAA first discovers an overpayment has been made, the Contract Manager. on g behalf of the AAA, wl l notify the
contractor by letter of such findings. Should repayment not be made forthwith, the contra
ctor will be charged at the
lawful rate of interest on the outstanding balance pursuant to s, 55.03, l�.S.g after AA notification or contractor
discovery.
28. Data Into r tL and Safeguardl*aa Information
The contractor shall ins ure an
appropriate
level of data security for the informa
tion the contractor is collecting or
Using in the performance of this contract.. An appropriate level of security includes approving g � q �.
p � nc I�d�s �ppro� �� ��rd tr�cl��g ill
contractor employees that request system car information access and enSur na that � ms�r � � ��s � � � � � .
'Lift b..en removed o d fro
ter inated employees, The c�: ntractor, o g other rc�cl ire e ts, E st a tics patc and prepare for the loss of
796
E
January '2-0 11
■
Contract CLP- MCSS 11
information processing capabilities. All data and software Must be routinely backed LIP to insure recovery frorn losses
or outages of the computer system. The security over the backed -Up data is to be as stringent as the protectforl
required of the primary systems. The contractor shall insure all Subcontractors maintain written procedures for
computer systern back Lip and recovery. The contractor shall complete and sign ATTACHMENT IV prior to the
execution of this contract.
29. Computer Use and Social Media Policy
The Department of Elder Affairs has implemented a new Social Media Policy, in addition to its Computer Us is
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 Aging and vendors. Any entit 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, Wlkis, RSS feeds, video sharing, social
networks like MySpace, Facebook and Twitter, as well as content sharing networks Such as flickr and YOUTLibe-
(ATTACHSENT E)
30, Conflict 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 organizational conflict of
interest or personal gain. No employee, officer or agent of the contractor or Subcontractor shall participate i'n
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 organization 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 . 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 with -in 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.
AM
31. Pubfic Entity Crime
Pursuant to s. 2.87.133, 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 lis-'t
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 conSLIltant
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. 187.01 7, F. S., for CATEGORY TWO fora period of 3 6 months fo I I ow i ng the date o f
being placed on the convicted vendor list. 4n
32. Pure
32.1 To procure any recycled products or materials, which are the subject of or are required to carry OLIt this contract. in
c 'iccordance with the provisions of s. 403.7065, F.S. .1 -
33. Patents, C2UK1*2ht-s Rola I t1"e S
..1. :
if any discovery, invention copyrightable material is developed or produced in the course of or as a reSLIft of work
tion or I
or services performed Linder this contract, the contractor shall refer the discovery, invention or material to the AAA to
he referred to the Department of State. Any and all patent rights or copyrights -cruina Under this contract are hereby
ights aC I 11� an -
=Z
E
January .1-0 11
E
Contract CLP- MCSS 11
reserved to the State of Florida in accordance with Chapter 286, F.S. Pursuant to s. 287.0571 -5) (k-) I and I 'is
amended. the only exceptions to this ;.w i,
contract. provision shall be those that are clearly expressed and reasonably valued ill the
33. t If the primary purpose of this contract is the creation of intellectual property, the state shall retain an unencumbered
right to use such property, notwithstandina any agreement made pursuant to Paragraph 33,
34. Em=ency Preparedness and Continulfty of Operations
..........
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. within
thirty (30) calendar days of the execution of this contract, submit to the Contract Manager verification of all
emergency preparedness plan. In the event of an emergency, the contractor shall notify the AAA of emergencv
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 continuity of operations withOLIt
interruption.
35. PUR 1000 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 shal I take precedence.
36. Use of State Funds to Purchase or I e Real Property
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 arnOLint 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, Disoute 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 minimum 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, refusing payment, withholding
payments Until deficiency IS cured, tendering only partial payments, and/or cancellation of contract and reacquiring
Z7
services from an alternate source. zr7
38.1 The contractor shall not be charged with financial consequences, when a failure to pet -form arises out of causes that
were the responsibility of the AAA.
39. No Waiver of Sover
elan Immunity
Nothing contained in this agreement is intended to serve as a waiver of sovereign ImMUnIty by any entitV to which
Z7 reement I
sovereign Immunity may be applicable.
40. Venue
If any dispute arises out of this contract, the venue Of SLIch le(yal recOUrse will be Leon COLInty, Florida.
t-
9/96
E
Jatttary 'o 1
E
Cotract CLP- MCSS 11
4 I. Entire Contract
. .. ...........
This contract contains all. the terms and conditions agreed upon by the parties. No oral agreements or representations
shall be valid or binding upon the AAA or the contractor unless expressly contained herein or by a written
amendment to this contract signed by both parties.
42, Force Ma `e,�e
Neither party shall be liable for any delays or failures in performance due to circumstances beyond its control,
provided the party experiencing the force majeure condition provides immediate written notification io the other
and tames all reasonable efforts to cure the condition.
party
43. Severabilily Clause
The parties acrree 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: Apl2ro2riations
The parties p
agree that the AAA's performance and obligation to pay Linder this contract is contingent upon an annual
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 to the PSA's best interest and reduced to a written amendment signed b both parties. The parties
Y p
shall negotiate compensation for any additional services added.
46, Waiver
The delay or failure by the .AAA to exercise or enforce any of its rights Linder this contract shall not constitute or be
deemed a waiver of the AAA's right thereafter to enforce those rights, nor shall any or single partial exercise of an
g p Y
such right preclude any other or further exercise thereof or the exercise of any other right.
47.orn�liance
-
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 regulations. The parties agree that failure 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 as specified in rap
Paragh 3.3.4. (date for final
request for payment) of ATTACHMENT I. If the contractor fails to submit final payment or f
re nest aY Y b 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 withheld until all reports due from
the contractor and necessary adjustments thereto have been approved by the AAA..
49. Renegotiations or Modifications
Modifications of the provisions of this contract shall be valid only when they have been reduced to writinil and dul
signed by both parties, The rate of payment and the total dollar amount may be adjusted retroactively to reflect price
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.
MW
50. Termination
o.l This contract ray he terminated by either party without cause Upon no less than thirty calendar days notice
writing to the other pa ty Unless a sooner time is Mutually agreed upon in writing. Said notice shall be delivered b -
v
I /96
January 2011 w:
g
Contract CLP- MCS S 11
U.S. Postal Service or any expedited delivery service that provides 'verification of deliver
y or by hand delivery to th
Contract ?tanager or the representative of the contractor responsible for administration 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 ()4 hours notice in writing to the contractor. Said notice shall be delivered
by U.S
Postal Service or any expedited delivery service that provides verification of delivery or by hand delivery to t b,
Contract Manager or the representative of the contractor responsible for administration f t p o he contract. The A.A�
shall be the final authority as to the availability and adequacy of funds. In the event of termination . e mtnatton of this contract
the contractor will be compensated for any work satisfactorily completed prior to the date of
p P termination.
50.3 This contract may be terminated for cause upon no less than twent -four 24 hours
y � � notice to writing to the
contractor. If applicable, the AAA may employ the default provisions in Rule f 0A- I.0{ 3 F
� �_ .A. C. Waiver o
breach of any provisions of this contract shall not be deemed to be a waiver of an othe
r er breach and shall not b�
construed to be a modification of the terms and conditions of this contract. The provisions herein
p do not limit the
AAA's or the contractor's rights to remedies at law or in equity.
50,4 Failure to have performed any contractual obligations with the AAA in a manner satisfac
tory to the AAA, will be a
sufficient cause for termination. To be terminated as a contractor under this provision, the
P contractor must have ()
previously failed to satisfactorily perform in a contract with the AAA, been notified b the AAA of
performance and failed to correct t y the unsatisfactory
he unsatisfactory performance to the satisfaction of the AAA; or (2) had a contract
terminated by the AAA for cause.
51. Official Payee and Representatives (Karnes, Addresses, and Telephone Numbers).-
�
The contractor name, as shown on page 1 of this
Monroe County Board of Fount Commissioners
y Commissioners/In-Home
a. contract, and mailing address of the official payee to
P �`
Services Program
whom the payment shall be made is:
1100 Simonton Street Ism 2-257
Key't est, FL 33040
The name of the contact person and street address
b. where financial and administrative records are
Sheryl Graham, Director , Monroe Count Social Services
y Ser �c.es
maintained is:
1100 Simonton Street, Rm. 2-257
Key 'Vest, FL 33040
305-292w4510
C. The name, address, and telephone number of the
Sheryl Graham, Director, Monroe Count Social i Services
representative of the contractor responsible for
1 100 Simonton Street, Rm. 2-257
administration of the program under this contract is:
Key rest, FL 33040
305-292-4510
The section and location within the AAA where
d
Anthony Coombs, Associate
��g'poom�.� ��'�'std�n
Requests for Payment and Receipt and Expenditure
J
760 NW 107th Avenue Suite 20 � ,
and 14
Corms are to be mailed is:
�
Miami, Florida 33172
e. The name, address, and telephone number of the
Maria Scotto
Contract ?'tanager for the AAA for this contract is:
760 N-W 1 7'hAve. #21.4
L_
Miami. F.. 3314
Upon change of representatives (names, addresses, telephone numbers) by either art notice � party, shall � provided in
writing to the other party and the notification attached to the originals of this contract.
Jan ary '20 11 Qj Contract CLP- MCSS 11
�2. All Terms and Conditions Included
This contract and its Attachments, I — X, A, Bft Ev, F, G and H. and any exhibits referenced in said attachments.
to ether with any documents incorporated by reference. contain all the terms and conditions aoreed on by the
parties. There are no provisions, terms, conditions, or obligations other than those contained herein, and this contract
shall Supersede all pre ion co m mun icat ions, representations or agreements, either written or verbal between the
parties.
By sianing this contract. the part'
ties 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. Z� Z:�
Contractor:
SIGNED BY:
Heath
NAME:
Mayor
TITLE:
DATE: 12-15-2010
ruthers
ALLIANCE FOR AGING, INC.
SIGNED BY:
NAME: MAX B. ROTH AN, JD, LL.M.
TITLE: PRESIDENT AND CEO
DATE:
1 ')/96
JanUary ?0 11.
Contract CLP- MCSS
ATTACHMENT
ATTACHMENTI
ATTACHMENT 11
ATTACHMENT 1.11,
EXHIB IT I
ATTACHMENT I 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 2
ATTACHMENT X,
EXHIBIT 3
ATTACHMENT A
ATTACHMENT B
ATTACHMENT E
ATTACHMENT F,,
EXHIBIT I
ATTACHMENT F,
EXHIBIT .
ATTCHMENT G
ATTACHMENT H
INDEX TO CONTRACT ATTACHIMENTS
ATTACHINIENT DESCRIPTION
STATEMENT OF WORK
CERTIFICATION REGARDING LOBBYING
FINANCIAL COMPLIANCE AUDIT ATTACHMENT
FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT 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 1, AND IIIC2
RECEIPTS AND EXPENDITURES, TITLE IIIE
DEPARTMENT OF ELDER AFFAIRS" PROGRAMS & SERVICES
HANDBOOK (ON CD)
DEPARTMENT OF ELDER AFFAIRS' CIVIL. RIGHTS COMPLIANCE
CHECKLIST AND INSTRUCTIONS
DEPARTMENT OF ELDER AFFA IRS' COMPUTER USE AND SOCIAL
MEDIA POLICY (ON CD)
DO A. 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 - -42 5
,�7 2
29-32
33
35
37
39
41-42
43
45
47
49-51
53-55
57-59
61
63-68
69
71
73
75-84
85-96
13/96
m
January '2.0 11
■
Contract CLP- MCSS
1.41196
JanUary -.,20 11
E
Contract CLP- MCSS 11
ALLIANCE FOR AGING, INC.
STATEMENT OF WORK
OLDER AMERICANS ACT PROGRAM TITLE III
SECTION I. SERVICES TO BE PROVIDED
1.1 DEFINITIONS OF TERMS AND ACRONYMS
IAA 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
CIRTS — Client Information and Registration Tracking System
FLAIRS — Florida Alliance of Information and Referral Services
I — Information and Referral
1ADL — Instrumental Activities of Daily Living
MOA — Memorandum of Agreement
MOU — Memorandum of Understanding
OAA —Older Americans Act
PSAs — Planning and Service Areas
WebDB — Web -based Database System
1J.2 PROGRAM SPECIFIC TERMS
ATTACHMENT I
ADI (Alzheimer's Disease Initiative) — Services targeted to individuals with Alzheimerl 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 -prof it entity
which is the single entry point for the aging service system within each established region of the state.
AIDS (Adult Protective Services) High Risk — The designation of an elder who needs immediate protection from
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 defivery
i system in its planning and service area in accordance with the Section 306 (42 U.S.C. 3026) of the Older Americans Ac"t
.W I
and department instructions.
Area Plan Update., A revision to the area plan wherein the area agency on aging enters OAA specific data in the
Z�
web -based database system (WebDB). 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 whom 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 client's, situation and makes recommendations concerning continuation of services after the initial short term
grant- t- fu tided crisis -resolving period. However in no case will services be C011tillLied on a long term basisbasisunder this
progra in
15/96
E
J anUary 20 11
E
Contract CLP- NICSS 11
CCE (Community Care for the Elderly) — Services offered to functionally impaired older persons to enable the t
%F I
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.
CIRTS (Client Information and Registration Tracking System) — The database of the Department of Elder
Affairs used by the aging network to manage client assessment data, register clients for services, plan client services
I %_� ices
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
manage 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 dall,
care needs. A fiscal/employer agent (F/EA) pays the workers and vendors according to the rates on the budget plan.
The REA also pays the required federal and state taxes and files the necessary tax forms.
Community Living Program — "Community Living Program" is a grant to the state of Florida from the federal
Administration on Aging. For persons meeting the project's functional and financial eligibility criteria, the arant
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 beat high risk
of either nursing home placement or continued stay in a nursing home. This program also manages consumer directed
care services provided to veterans. Z:�
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 - I i m i te d c 0 M M U n i ty- based services provided to address a client's I m med i a te 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 de 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 I ikelihood of recidivism or further patient deterioration where a permanent
nursing home placement is a likely sequel.
Financial Eiigihiiity — To be financially eligible to receive services, other than assessment and referral, under this
project, the individual Must not be eligible for Medicaid under the Institutional Care Program (ICI') 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 under
the CCE and ADI programs. In addition lead i
agencies handle APS cases in with a DOEA established
protocol, L-11
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 grant period.
grant
11-1131, IUD, 111E (Older Americans Act Titles) — Title 11113 provides Supportive services to assist elders to live
independently in their community. Title HID provides disease -prevention and health -promotion services at senior
centers or alternative sites. Title ME provides services through the National Family Caregiver Support Program to
assist families, caring for frail oldem r men and to assist grandparents or older relatives who are caregivers for
I=
E
January 2011.
E
Contract CLP- MCSS 11
children who are Linder 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 management agencies,
hospitals, rehabilitation centers, home health agencies, physician assisted home based programs, and nursing hornes.
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 (Single Entry Point) — The CLP staff for the area where the individual is receiving services is the single entry
point into the aging service system.
Spend down to Medicaid — The use of personal resources to pay for services prior to the individLial'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.
Veterans Administration Consumer Directed Fare --A capitated consumer directed care program sponsored by
the Veterans Administration and operated through the Community Living Program. Also, see ConSLImer Directed
Care definition above. Zn
1,2 Alliance for Aging Mission
The Alliance For Aging Inc. mission id to promote and advocate for the I quality of life for older adults and
their families. t:� optima
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, where all can enjoy Florida's Z__
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 cfare
Z� tn -
expenditures. develop co -pay and financially sustainable .systems within the context of the Older Americans Act
network of AAA and providers, and to increase consul-ner choice and self-directioll.
1.3.2 Authority
The relevant references governing governing the OAA program are:
W Zn,
(1) Older Americans Act of "I'm2_00-6, as amended;
I=
E
January 20 11
E
Contract CLP- MCSS 11
(2) Rule 58A-1, Florida Administrative Code: and
(.3.) 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 officei
Memoranda. the following nierno
randa are provided for informational purposes and incorporated by reference:
(1) CFO Memo No. 02.- Release date, August 20, '2010-
Z71�
(2) CFO Memo No. 03: Release date. JUne.2.9. 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 in
ATTACHMENT G and its response to the 2.010 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),
Z:
1.3.4 Major Program Goals
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
have been identified as "critical pathways" to institutional long term care. Some of these "critical pathways"" include
Sudden caregiver burnout, depression, maInLitrition/dehydration and lack of proper follow LIP 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
1.4.1 Eligibility
Client Identification
I Individual is at least 60 years old.
1 Individual is a resident of Miami -Dade or Monroe Counties.
3. Financially unel igible for Medicaid and functional ly impaired.
4. Has Medicare or private health insurance.
Individual is not receiving hospice services.
Individual or caregivers in need of crisis resolving services and/or short term care, to avoid ret,idt-nission to a
i
hospital/rehab facility or a nursing home placement which Could lead to spend down to Medicaid. I d. Services are not
geared to resolve a long term care need. but to address a critical short term need that if left unresolved Would
precipitate a nursing or home placement or re -hospitalization
OAA Title 111, General
C011SUrners shall not be dually enrolled in an OAA program and a Medicaid capitated long-term care program.
Z11
N
J aiivary 2_0 I I
iD
Contract CLP- MOSS
income older individuals, including those that are low-income minorities, have limited En(llish proficiency, and
older individuals residing in rural areas. t
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 ill
Z� C�
ATTACHMENT G and the response to the 010 CLP program ITN contained in ATTACHMENT H
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.-
(1)
Adult Day Care/Adult Day Health Care-,
(17)
Legal Assistance,
(2)
Caregiver Training/Support,
(18)
Material Aid;
(3)
Case Aid/Case Management;
(10)
Occupational Therapy,
(4)
Chore Services;
(20)
Outreach;
(5)
Companionship:
(21)
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 ing/Assessment;
(1.1)
Home Health Aid;
(27)
Shopping Assistance;
(12)
Homemaker;
(28)
Skilled Nursing;
(13)
HOLIsinorZ:� Improvement*
1
(29)
Specialized Medical Equipment, Services, and
(14)
Information;
Supplies
05)
Intake;
(30)
1
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 coor d*i nation with
organizations that have experience in providing training. placement, and stipends for Volunteers or participants
such as organizations carrying out Federal service programs administered by the Corporation for Nliational and
Z� r Z�
Community Service.). in Community service settings.
2.1the Performance of Stibcontractors,
. N I
The contractor shall conduct at least one monitoring per year of each Subcontractor, The contractor shall pet -form
fiscal, cadministrative and programnitatic monitoring of each subcontractors to ensure contractLKII compliance, fiscal.
sm
(a
January 20 11
Contract UP- MOSS 11
accountability, programmatic performance, and compliance with applicable state and federal laws and reizulations
2.Z� 1, -. t
Use of Subcontractors
If this contract involves the use of a subcontractor or third party, then the contractor shall riot delay the
implementation of its agreement with the subcontractor. If any circumstances OCCUr that may result in a delay for a
period of 60 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
delay.
The contractor shall not permit a subcontractor to perform services related to this agreement withOLIt having a
binding subcontractor agreement exeCLIted. In accordance with Paragraph ?4.1 of the Standard Agreement, the
AAA 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 ellSLire they are available to provide services during hours responsive to client needs and during
those times which best meet the needs of the relevant service corn unity.
2.3 Equipment
2.3.1. Equipment means-.. (a) an article of nonexpendable, fe of more than one i
tangible personal property having a useful I Z=�
year and an acquisition cost which equals or exceeds the lesser of the capitalization level established by the
org
anization 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 $1,0W.00 or more per unit, and expected
useful life of at least one year; and hardback bound books not circulated to students or the general public, with a
value or cost of $250.00 or more [for state funds]. Z:�
2.3.2 Contractors and sub -contractors who are Institutions of Higher Education, Hospitals, and Other Non -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 Must be maintained on file and shall be provided to the AAA upon reqUest.
2.3.3 The contractor`s property management standards for equipment acquired with Federal funds and federally -owned
equipment shall. include accurately maintained equipment records with the following information:
(I) 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,
(,.5) Acquisition date or date received, if the equipment was furnished by the Federal Government) and cost.
(.6) 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 data the information was reported',
N20/6
January '20 1. 1 a
E
Contract CLP- MCSS 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 awardini! agencv for its share.
f.� -1
2.3.4 Equipment purchased with federal funds with an. acquisition cost over $5,000.00 and equipment purchased with
state funds with an acquisition cost over $ 1,000.00 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 in
the contractor, subject to the conditions of 2. CFR Part 215 Administrative Requirements (formerly OMB Circular
A-1 10.), Subpart C, Paragraph 34. Equipment purchased Linder these thresholds is considered Supplies andis [lot
subject to property standards. Equipment Purchased with funds identified in the budget attachments to agreements
covered by this contract, or identified in the sub -agreements with sub -contractors (not Included in a cost
methodo logy), is S L1bJ ect to the conditions of Chapter 273, F. S. and 60A- 1 .00 17, F. A. C. or T i t le 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 Manager. 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
120 days of the written request for disposition, the contractor is authorized to proceed as directed in 2 CFR Part 215 )
Administrative Requirements (formerly OMB CirCLIlar A-1 10).
23.7 Real property means land (including land improvements), buildings, structures and appurtenances thereto, but
excludes movable machinery and equipment. Real property may not be purchased with state or federal funds
through agreements covered tinder this contract withOLIt 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 outlay grants and aids appropriation and therefore are Subject to the provisions of s. 2 16.348, F. S.
4n
2.3.8 Any permanent storage devices hard drives, removable storage media) must be reformatted and tested prior to
(e.g.:Z:)
disposal to ensure no confidential information remains.
2 1. /96
Jate Uary'20 I I
Contract CLP- MCSS if.
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
Ho
2 REPORTS
�"he contractor is responsible for responding in a timely fashion to additional routine and/or special requests for
information and reports required by the AAA.
5 2-AM
.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 program. This report provides information for planning and negotiating unit rates.
Z:�
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 C0111PLIter
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
I
2.7o, I Outcomes
(1) The contractor shall timely submit to the AAA all reports described in ATTACHMENT 1, Paragraph 2.5
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 Linder 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.
Z:�
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-NonconforminLy Services
The contractor shall ensure that all participants served Linder 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 Cind
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 meeting the aforementioned
requirements shall not be eligible for reimbursement Linder this The costs associated with enrolling
"I is program. Z�l
training, reporting and/or managing the program shall be borne solely by the contractor. The AAA requires
ininnediate notice of any significant and/or systemic infractions that compromise the contractor's ability to provide
participant services, to achieve prmzrammatic performance or to provide sound financial nianage tTlent of the
program.
� 7
2.8 CONTRACTOR'S FINANCIAL OBII(,-I'AI IONS
2- . _2 /9 6
January '62-0 11
'left
I t
Co tract CLP- MOSS
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 through th'..
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, Ai
the end of the contract period, all OAA funds must be properly matched. The provider must comply with the "valLlt-
added'' provisions contained in Appendix
2.8.2 Consumer Contributions
(1) The contractor assures compliance with Section 31.5 of the Older Americans Act as amended in 1.006, in
regard to consumer contributions;
(2) Voluntary contributions are not to be used for cost sharing or matching,
(3) Accumulated voluntary contributions are to be used prior to requesting federal reimbLirsement; 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 list
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 accordinaly, as allowable Linder
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 2006, that funds
received under Title III will not be used to pay any part of a cost (ilICILiding 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.
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 III: METHOD OF PAYMENT
3.1 General Statement of Method of Payment
The method of payment for this contract includes advances, cost reimbursement 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
�N,.,here an independent audit is required. The contractor shall consolidate -till requests for payment from
subcontractors and expendiire reports that support requests for payment and sha-11 Submit to the AAA on fornis
106A (ATTACHMENT IX-, I 0.5AA (ATTACHMENT X-EXHIBIT t.), I 0_5A-S (ATTACHMENT X-EXHIBIT
2), and 105AE (ATTACHi'WENT X-EXHIBIT 3).
_)/96
1. If a
January 2-0 11 Clontract.. C AL 4. C
3.1.1 The contractor agrees to implement the distribution of funds as detailed in ATTACHMENT VII, Budget
Summary. An amendment is required to than the total amount of the contract.
3.2 Advance Payments
3.2. t The contractor may request LIP 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 describiniz how the funds will he
distributed,
3.2.2 The contractor's requests for advance require the approval of the AAA's Contract Manager. If sufficient budget is
available, the AAA will issue approved advance payments after January 1, '20 1. 1.
W
3-23 Requests for the first through the twelfth months shall be based on the submission of actual monthly expenditure
reports beginning with the first month of the contract. The schedule for Submission of advance requests, if avail -able
Z�
is shown on ATTACHMENT Vill of this contract.
3.2.4 All advanced payments made to the contractor shall be recouped in accordance with the Reporting Schedule,
ATTACHMENT Vill 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.
33 Invoice Submittal and Requests for Payment
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 reports beginning with the
first month of the contract. The schedule for Submission of advance requests (when available) and invoices is
ATTACHMENT Vill to this contract.
3.3.2 Any payment due by the AAA Linder the terms of this contract may be withheld pending 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. Z-"
3.3.3 Payment may be authorized only for allowable expenditures, which are in accordance with the lit -nits specified in
ATTACHMENT Vll, Budget Summary. Any changes in 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
-1 ,
The final request for payment w i I I be due to the AAA no later than Fe bruary 14, 20 12
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.
3.4.1 'rhe Contractor rnUSt enter all required data per the department's CIRTS Policy Guidelines for clients and services M
January 2.011
C
Lontract CLA1P - I.N
-V CSS 11
the CfRTS database. Data must be entered into CIRTS before the contractors submit their request for payment and
expenditure reports,
3.4.2 The contractor run monthly CIRIS reports and verify that client and service data in CIRTS is accurate. This report
must be submitted to the AAA with the monthly request for payment and expenditire report and MLIst be reviewed
by the AAA before the contractor"s reqUest can be approved by the AAA.
'.)5/96
J anuary 20 11 a
Contract Cl Css
mm
.3h
January Contract CLP- ASS 11
ATTACHMENT 11
CERTIFICATION REGARDING LOBBYING
CERTIFICATION FOR CONTRACTS, GRANTS, LOANS AND
AGREE.NMENTS
The Undersigned certifies, to the best of his or her knowledge and belief, that:
Z17
(1) No federal appropriated funds have been paid or will be paid, by or on behalf of the Undershyned, to any person for
influencing or attempting to influence an officer or employee of any state or federal agency, a 'member of conaress. an
Z7� Z� '7
officer or employee of congress, an employee of a member of congress, or an officer or employee of the state legislator,
in connection with the awarding of any federal grant, the making of any federal loan, the entering into of any cooperative
agreement, and the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or
cooperative agreement.
(2) If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or
attempting to influence an officer or employee of any agency, a member of congress, an officer or employee of congress,
gcontract, or an employee of a member of congress in connection with this federal
Zn ract, grant, loan, or cooperative agreement,
the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance
Z:!y
with its instructions.
(3) The undersigned shall require that the language of this certification be included in
Z!� Z� the award documents for all sub
awards at all tiers (including Subcontracts, sub -grants, and contracts Linder grants, loans and cooperative agreements) and
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 by
section 1.352, `Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penal ty
of not less than $ 10,000.00 and not more than $ 100,000.00 for each such failure.
Signature
Name of Authorized Individual
Name and Address of Organization
DOEA Form 1 ()3
(Revised Nlov 2,,C)02)
Date
Application or Agreement Number
/96
Coact CLP- M.CSS
January 20 1 1.
Contract CLP- MCS S 11
FINANCIAL AND COMPLIANCE AUDIT
ATTACHMENT III
EXHIBIT t
The administration of resources awarded by the Department of Elder Affairs or the .Alliance for Aging to the provider may be
subject to audits and/or monitoring by the Department of Elder Affairs or the Alliance for Aging, as described in this sectiof .
MONITORING
In addition to reviews of audits conducted in accordance with OMB Circular A- 133, as revised, and Section 2 15.97, F.S., (see
"AUDITS" below), monitoring procedures may include, but not be limited to, on -site visits by 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.
PART 1: 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 prodder must have a
single or program -specific audit conducted in accordance with the provisions of OMB B circular A- 133, as revised. EXHIBIT
I to this agreement indicates Federal resources awarded through the Department of Elder affairs or the Alliance for Aging by
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- 133, 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.
n connection with the audit requirements addressed in Fart I, paragraph 1, the provider shall fulfill the requirements relative
to auditee responsibil ities 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- l 33 a:5 rep=isedt is not required. In the event that the provider expends less than. $500.000 in
Federal awards in its fiscal year and elects to have an audit conducted in accordance with the provisions of OMB Circular A-
1 33, 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 corldIcted in accordance with this part shall cover the entire organization for the organizations fiscal year.
Compliance findings related to agreementswith the �epart gent of Elder Affairs or the Alliance for aging shall be based on
the agreements regtrernerts,In
cltding any rules, regulations, or statutes referenced in the a�reeent. The financial
statements shall disclose whether or not the matching requirement was met for each applicable agreement. All questioned
costs and l iabi l it es 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 riot otherwise
disclosed as regt iced by Section Y3 10(b)(21.) of G IB Circular k -133, as revised, the schedule of expenditures of FederiIl
19/
96
J anu ary 2 0 11
W
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 ITI List 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 year end.
PART 11: STATE FUNDED
This part is applicable if the provider is a nonstate entity as defined by Section 2 1 5.97('2 )), Florida Statutes
In the event that the provider expends a total amount of state financial assistance equal to or in excess of %5,500.000 in. any
fiscal year of such provider (for fiscal years ending September 30. ")004 or thereafter), the provider must have a State sinizle
or project -specific audit for such fiscal year in accordance with Section. .2115.97, Florida Statutes: applicable rules of the
Department of Financial Services; and Chapters 10.550 (local governmental entities) or 10.6550 (nonprofit and for- profit
organizations), Rules of the Auditor General. EXHIBIT I to this agreement indicates state financial. assistance awarded
through the Department of Elder Affairs or the Alliance for Acing by this agreement. In determining the state 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 matching 9 requirements.
In connection with the audit requirements addressed in Part 11, paragraph 1; 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(2), 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,
.1.004 or thereafter), an audit conducted in accordance with the provisions of Section 215.97, 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 215.97, Florida Statutes, the cost of the audit must be paid from
the nonstate entity's resources (i.e., the cost of such an audit must be paid from the provider resources obtained from other
than State entities).
An audit conducted in accordance with this part shall cover the entire organization for the organizAtion'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 Acing in effect during the
Z:� Aging 11�
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 1.2 months after the provider's fiscal year end for local governmental entities. -Non-profit or forty
profit ororanizations 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 Call right and obligation to monitor and oversee the performance of this agreement as outlined
Z� Z-1
throughout 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
Z:�
-
PART I of this agreement shall be Submitted. when required by Section .3.2.13 0 (d), 0M.Circular A- 133 as revised, by or o"
behalf of the provider directly to each of the following:
The Alliance for aging, Inc,:
30/96
J antt ary 0 I I a
Contract CLP- MOSS 11
Alliance for Aging, Inc.
Attn.*. Horacio Soberon
760 NW 1.07 1h Ave.
Miami-, FL 33172
The Federal Audit Clearinghouse designated in OMB Circular A- 133, as revised (the nUrnber of copies required by Sections
320 (d)(1.) and (2.), OMB Circular A-133, as revised, should be SLibmitted to the Federal Audit Clearinghouse), at the
following address:
Federal Audit Clearinghouse
Bureau of the Census
1201 East 101h Street
Jeffersonville, IN 47132
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 .120(c), OMB Circular A-1-33, as revised, and any management letter issued by the auditor, to the
Department of Elder Affairs at each of the following addresses:
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 11 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:
Z:�
Alliance for Aging, Inc.
Attn: Horacio Soberon
760 NW 107 1h Ave.
Miami, FL 33172
The Department of Elder Affairs at each of the following addresses
Department of Elder Affairs
Attn.- Beverly Friedberg
4040 Esplanade Way Office 32.15B
Tallahassee, FL 32399-7000
The Auditor General"s Office at the following address. -
State of Florida Auditor General
Claude Pepper Building, Room.574
I I I West Madison Street
Tallahassee, Florida 323"- 14.15*0
Any reports. management letter. or other information required to be submitted to the Department of Elder Affairs PU rSUant to
this agreement shall be submitted timely in accordance with ONAB Circular A-1 33, Florida Statutes, and Chapters 10.550
(local governmental entities) or 10.650 (nonprofit and for -profit organizations), Rules of the Auditor General, -is applicable,
Providers. when subt-n-itting financial reporting packages to the Department of Elders ffairs for aUdits done ill accordance
5
with OMB Circular A-133 or Chapters 10,'50 (local governmental entities) or 10.650 (nonprofit and for -profit
UM
January '20 11.
Contract CLP- MCSS 11
organizations , Rules of the Auditor General, should indicate the date that the reporting package was delivered to the provider
in correspondence accompanyinefzn� the reporting package.
PART IV: RECORD RETENTION
The provider shall retain sufficient records demonstrating its compliance with the terms of this agreement for a period of six
Z"-
years from the date the audit report is issued, and shall allow the Department of Elder Affairs or its designee, the CFO or
'n
Auditor General access to Such records upon request. The provider shall ensure that audit working papers are made wail bl
to the Department of Elder Affairs, or its designee, CFO, or Auditor General Upon request for a period of six years from the
date the audit report is issued, unless extended in writing by the Department of Elder Affairs.
/96
January '20 11. Contract ALP- MOSS 11
ATTACHMENT III
EXHIBIT 2
I. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS AGREEMENT
CONSIST OF THE FOLLOWING:
PROGRAM TITLE
Older Americans Act Administration
Title 111B — SUpport Services
TOTAL FEDERAL AWARD
. . .. .........
........... . .
FUNDING SOURCE CFDA AMOUNT
...........
US, Health and Human Services 91044, $15,000
$15,000
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT TO
THIS AGREEMENT ARE AS FOLLOWS,
.13/196
C,ont ra ct C,..- Cs
ow
... ...... .
January 30 11
Contract CLP- MCSS 11
ATTACHMENT III
PART 1-0 AUDIT RELATIONSHIP DETERMINATION EXHIBIT 3
Providers who, receive state or federal. resources may or may not be subject to the audit requ ire me nts of OMB Circular A- 13 3, as revised.
and/or Section 22 15.97. Fla. Stat. Providers who are determined to be recipients or subrecipients of federal awards and/or state financial .
assistance may be subject to the audit requirements if the audit threshold requirements set forth in Part I and/or Part 11 of Exhibit I are rnet.
Providers who have been determined to be vendors are, not subject to the audit requirements of OMB Circular A- 133, as revised, and/or
Section 2 15.97, Fla. Stat. Retyardless of whether the audit requirements are met, providers who have been determined to be recipients or
subrecipients of Federal awards and/or state financial assistance, must comply with applicable programmatic and fiscal compliance
requirements. V
In accordance with Sec. 2 10 o f OMB C i re u I ar A- I.33 and/or Rule 691-5.006, FAC, pro vrider has been determined to be:
Vendor or exempt entity and not subject to OMB Circular A- 133 and/or Section 215.97, F.S.
Recipient/subrecipient subject to OMB Circular A- 133 and/or Section -2', 15-97. 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), FAC [state financial assistance] and
Section — .400 OMB Circular A- 13 3 (federal awards ] .
PART 11: 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 AND INDIAN TRIBES MUST FOLLOW:
2 CFR Part 12.5 Cost Principles for State, 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 Cast Principles for Non -Profit organizations (Formerly OMB Circular A--1 ?2 — Cost Principles)
2 CFR Part 215 Administrative Requirements (Formerly OMB Circular A- 1. 10 — Administrative Requirements)
Requirements)
OMB Circular A- 133 — Audit Requirements
Reference Guide for State 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 Part '2210 Cost Principles for Educational Institutions OMB (Formerly Circular A-21 — Cost Principles)*
2 CFR Part 215 Administrative Requirements (Formerly OMB Circular A- 110 — Administrative Requirements)
OMB Circular A- 133 — Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws. rules and regulations
*Some Federal programs may be exempted from compliance with the Cost Principles Circulars as noted in the OMB Circular A-
133 Compliance Supplement, Appendix 1.
STATE FINANCIAL ASSISTANCE. Providers who receive state financial assistance and who are determined to be a
recipient/SLibrecipient, must comply with the following fiscal laws. rules and regulations:
Section 2 1 5,97o Fla. Stat.
Chapter 691-5. Fla. Ad min. Code
State Projects Compliance Supplement
Reference G'ulde for State Expenditures
Other Fiscal requirements set Firth in program laws, rules and regulations
3_'5'/96
T
Contract CL - MCSS 11
6/96
January 2011 a
W
Contract CL.P- MOSS 11
ATTACHMENT IV
CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE
FOR AGREEMENTS, GRANTS, LOANS AND
COOPERATIVE AGREEMENTS
The undersigned., an. authorized representative of the contractor named in the contract or myreement to which this form is an
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, an Z7� W
-d complete disclosure of the financial results of each
grant -funded project or program in accordance with the prescribed reporting requirements' (2) the source and application of
funds for all agreement supported activities; and (3) the comparison of outlays with budgeted amounts for each award. The
Z�� i
inability to process information in accordance with these requirements Could result in a return of grant funds that have not
been accounted for properly.
Management Information Systems used by the contractor, sub-contractor(s), 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 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 -contractors} of services under 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.
The contractor shall require that the language of this certification be included in all subagreements, subgrants. and other
agreements and that all SLI b-con tractors shall certify compliance accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction wtts made or entered
into. Submission of this certification is a prerequisite for making or entering into this transaction '
imposed by OMB CirCUICars
A - 102 and 2 CFR Part 1. 15 (formerly OMB Circular A- I 10).
Name and Address of Contractor
Signature
Name of ALIthorized Signer
I M Rev I sed J i me Y �� 8.)
.............................
Title Date
-1
."7/96
1
January 2011
Comract CLP- MCSS 11
Um
January 20 11
Contract CLP- MOSS 11
ATTACHMENT V
CERTIFICATION REGARDING DEBARMENT,, SUSPENSION, INELIGIBILITY AND
VOLUNTARY EXCLUSION FOR LOWER TIER COVERED TRANSACTIONS
(1) The prospective contractor certifies, by signing principals this certification, neither it nor its pals are presently debarred,
I
suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this
transaction by any federal department or agency.
(41.) Where the prospective contractor is unable to certify to any of the staternens in this certification. such prospective
participant shall attach an explanation to this certification.
S t �natl.ire
%- Date
T itle Aorency/Organization
(Certification signature should be same as Contract signature,)
Instructions for Certiffirat ion
1. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction," "person,"
"primary covered transaction," and "voluntarily excluded," as used herein, have the meanings set out in the sections
of rules implementing Executive Order 12549. (2 CFR 180.5-180.1020, 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 cirCLImstances. 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 Recrardin9 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.
5a 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 C-ILIthorized
by the federal government.
6. If the contractor knowingly enters into a lower tier covered transaction with a person who
�.- .F IS SLIspended, debarred,
ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the
Z� participation I
federal �:tovernnient. the department may pursue available remedies. including suspension, and/or debarment.
The contractor may rely upon a certification of a prospective participant in a lower tier covered transaction that It is
not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, Unless It knows that the
certification is erroneOLIS.
(Revised June 1008)
H=
January 2011
Contract CLP- MCS S 11
EM
January
'2.0
Contract CLP- MCSS 11
ATTACHMENT V1
ASSURANCES —NON -CONSTRUCTION PROGRAMS
Public reporting burden for this collection of information is estimated to average 45 minutes per response, including . ... .. tine .. for reviekvi
Z� 91 n g
instrUCtions. searching existin(If data sources. ayatherincy and maintaining the data needed and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other aspect of this collection. of information, including suggestions for
reducing this burden, to the Office of Manaaernent and Budget. Paperwork Reduction Project (0348-0043). Washington, DC 220503,
. . . . ................................ .... . .
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET,
SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
Note.- Certain of these assurances may not be applicable to your project or program. If you have questions please contact the
awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If
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.
1 Will give the awarding agency, the Comptroller General of the United States, and if appropriate. the State. thrOLiah any authorized
In
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.
Z711
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 Linder one of the 19 statutes or regulations specified in Appendix A of OPM'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. 88-35.1.) 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 1973 " 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., 6101-6107), which prohibits discrimination on the basis of age; (e) the
Drug Abuse Office and Treatment Act of 19721 (P.L92-255)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). 523 and 527 of the Public Health Service Act of 191 (412
U.S.C., '290 dd-3 and 290 ee 39, as amended, relating to confidentiality of alcohol and drug abuse patient records-, (h) Title VIII of , the
Civil Rights Act of 1968 (4,12 U.S.C.601 et seq.),, as amended, relating to nondiscrimination in the sale, rental or (financinty of h0L1,Sjng,; i) any other nondiscrimination `:'
provisions in the specific statutes) Linder which application for Federal assistance is being made-, and (J.)
the requirements of any other nondiscrimination statutes} s) which may apply to the application.
7. Will complly, or has already complied, with the requirements of Titles 11 and III of the uniform Relocation Assistance and Real Property
Acquisition Policies Act of 19710 (P.L. 91-646) which provide for fair and equitable treatment of persons displaced or whose propertv is
acquired as a reSL11t of Federal or federally assisted programs, These requirements apply to all interests in real property acqUiredfor
project purposes regardless of Federal participation in purchases.
8. Will comply, as applicable, with the provisions of the Hatch Act (5) U.S.C. 1501-1508 and 7/324_7"*4?8)', which limit the poht'cal
activities of employees whose principal employment activities are funded in whole or in part with Federal funds,
9. Will comply, as applicable, with the provisions of the Davis -Bacon Act (40 U.S.C., 2-176a to :"76a-7). the Copeland Act (40 U.S.C. 276C
and 18 U,S.C- ' S74.) and the Contract Work Hours and Safety Standards Act (40 U,&C. 312.7-333), regarding labor standards fOr
federally assisted constrLIC6011 subagreements, t� 1:
sm
January 10 11
Contract C CSS 11
10. Will comply. if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 197'
(VL. 93-2341 which requires recipients in a special flood hazard area to participate in the progfram and to purchase flood inSLirance 1.
the total cost of inSLirable constrLICtion and acquisition is $ 10,000.00 or more.
11. Will comply with environmental standards which may be prescribed purAtant to the followincy* a) institutiom of environmental quality
.1 t"
control measures Linder the National Environmental Policy Act of 1969 P.L. 91-190-) and Executive Order (EO) 1 1514, (b) notificatior
of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards it
floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved State manacrement progran,
't� C
develoo'
ped Linder the Coastal Zone Manaement Act of 197 2W (16 U.S.C. 1451 et seq.): (f) conformity of Federal actions to State Clew
Air) Implementation Plans under Section I 76(c) of the Clear Air Act of 1955, as amended (4:2 U.S.C, 7401 et seq.); (g) protection oil
underground SOLirces of drinking water Linder the Safe Drinking Water Act of 1974, as amended, (P.L. 93-52.3): and (h) protection of
endangered species under the Endangered Species Act of 1973, as amended, (P.L. 93-205).
1.2) Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C.. 17 2 1 et seq.) related to protecting components or potential
components of the national wild and scenic rivers system.
13. Will assist the awarding aclency 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 (16 U.S.C.. 469a- 1. et seq.).
1.4. 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..2 131 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.
.f
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
42 / 9 6
January 2011
Contract CLP- MCSS 1.1
ATTACHMENT VII
BUDGET SUMMARY
Maximum
Service Unit
Units of
Maximum
Service(s) to be Provided
Rate
Serv]"ce*
Dollars*
HOMEMAKER
$22.04
TBD
TBD
PERSONAL CARE
$25.87
TBD
TBD
CASE MANAGEMENT
$38.03
TBD
TBD
Total Contract
$154000
i tic 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.
43/96
January 2.7011
Contract CLP- MCS
um
J antiary 2) 0 11 Contract CLP- MOSS 11
ATTACHMENT V111
CONTRACT REPORT CALENDAR
ADVANCE BASIS CONTRACT
Report Number
Based On
Submit to the Alliance
On This Date
January Advance*
J anUary 1, 20 11
February Advance*
January t, 2011
3
January Expenditure Report
February 5, 2011
4
February Expenditure Report
March 5, 20 .11
5
March Expenditure Report
April 5, 2011
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
1.0
August Expenditure Report
September 5, 2011
11
September Expenditure Report
October 5, 2011
1.2
October Expenditure Report"
November 5, 2011
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, 201.2
Legend.- Advance based on projected cash need.
** Recoupment of advance due with this report.
Note # 1: Report #1. for Advance Basis Agreements cannot be submitted to the Department of
Financial Services (DFS) Prior to January .1 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).
dote #3: Submission of expenditure reports may or may not Generate a payment request. If final
expenditure report reflects funds due back to the Department, payment is to accompanv the
report.
45/96
January 2011 a
Contract - MCSS It
mm
"EQUEST FOR PAYMENT
OLDER AMERICANS ACT
PROMIDER NAME, ADDRESS, PHONE AND FED 10 NUMBER
TYPE OF REPORT:
THIS REQUEST PERIOD:
Advance
Report 4
Reimbursement
Agreement 4:
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 abo\e agreement.
Prepared By:
Date.,
Approwd By:
Date:
PART A:
(1)
(2)
(3)
(4)
(7) (6)
BUDGET SUMMARY
ADMIN.
III B
111cl
IIIC2
Title II 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
0.00
3, Agreement Balance
0.00
0.00
0.00
0.00
0.00
0.00
4. Pre\hous Funds
REQUESTED and
Not Received.
0.00
0.00
0.00
0.00
0.00
a 00
5. Agreement Balance
0.00
0.00
0.00
0.00
0.00
0.00
PART B:
FUNDS REQUESTED
1. 1st-2nd Months
Request Only
0,00
0.00
0,00
0.00
0.00
0,00
2. Net Expenditures
For Month
0-00
0.00
0.00
0.00
0.00
0,00
3, Additional
.
Cash Needs (Attach Doc.)
0,00
0,00
0,00
om
0-00. 01
0-00
4. Total
0. 00
0,00
0.=
0.00
0,00
0,00
PART C:
NET FUNDS REQUESTED-
1. Less: Over -Advance
0,00
0.00
0.00
0,00
0. 00.r
0i 00
2, Agreement Funds are
Hereby Requested For
0,
0.00
0,00
0,00
0.00
0,00
'WEA FORM 106A -ev'sed SIO
RM
■
J anUary '20 1. 1
Con -tract CLP- GCS 11
sm
January 201, 1
Comract CLP- MCSS 11
ATTACHMENT X
EXHIBIr-f t
sm
January ',?..,,0 11
iD Contract CLP- MCSS 11
BLANK PAGE
mm
JanUary 2.0 11 Contract CLP- MCSS 11
RECEIPTS AND EXPENDITURE REPORT
OLDER AMERICAN ACT
PROVIDER NAME, ADDRESS, PHONE# AND FE1D,*
Program Funding Source
THIS REPORT PERIOD
FROW TO:
CONTRACT
Title III Admin,
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
Approd 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
I. Federal Funds
$0.00
$aoo
$0.00 %
2. State Funds
$0,00
$0.00
$0.00
3. Program Income
$0.00
$0.00
$0.00
4. Cash Match (CCE, HCE and Other)
$0.00
$0.00
WOO
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
PART B: EXPENDITURES
1. Approved
.. . .......... -
2. Expenditures
3. Expenditures 4. Percent of
Budget
For This Report
Year to Date Approved Budget
I. Administrative SeNces
$0.00
$0.00
$0.00
2. Travel
$0.00
$0.00
$0.00
3. TOTAL EXPENDITURES
$0,00
$0.00
MOO
PART C: OTHER EXPENDITURES
. . .. ..............
...........
(For tracking purposes only)
1. Match: CCE GR
$0,00
MOO
$0.00
HCE GR
$0.00
150,00
$0.00
Other and In -Kind
$0.00
$0-00
$0,00
2- Local Match
$0.00
MOO
$0.00
3- TOTAL
MOO
$0.00
S000
.. ..............
PART D :Other Revenue and E x nd it u res
Pe
--- ............... ...
11, Addition Cost Alternative Program Income
.. ............. ...........
111. Interest
1. Program Income (PI):
1. Approved Budget
I. Earned on GR Advance $
a.OAA Unbudgeted PI Receipts YTS
2- Received YTD
2. Return of GR Advance S
3. Expenditures
3. Other Earned
DOEA FORM 105aa re�,Ased 10/08
51/96
Contract CLP- MCSS 1.1
-96
January '2.0 11
Contract CLP- MOSS 1.1
ATTACHMENT X
EXHIBIT -2w
5 -1
3/96
January
Con -tract CLP- MCSS 11
BLANK PAGE
54/96
January 2011.
Contract C W-SS
RECEIPTS AND EXPENDITURE REPORT
OLDER AMERICAN ACT
PROVIDER NAME, ADDRESS, PHONE#--A----ND FEID#
................
Program Funding Source
THIS REPORT PERIOD
FRMI TO:
118
11I`C1
CONTRACT
111C2
PERIOD:
CONTRACT#
REPORT #
IPSA#
CER71FICAT10N 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. A pp roved
2. Actual Receipts
13. 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
MOO
%
3. Program Income
$aoo
$0.00
$0.00
%
4. Local Cash Match (ICE, HCE and Other)
MOO
$0.00
$0.00
%
5. SUBTOTAL: CASH RECEIPTS
$0�00
M 00
$0.00
%
6. Local In -Kind Match
$aoo
$0.00
$0.00
%
7. TOTAL RECEIPTS
$0.00
$0,00
$0.00
%
PART B: 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
$0.00
9/0
2. Service Subcontractor
$0.00
MOO
$a 00
%
3. Other
$0.00
$aoo
$0.00:
%
4. Indirect Cost
$0.00
$0,00
$0.00
%
5. TOTAL E)PENDITURES
MOO
$0.00
$a00
%
PART C : OTHER EXPENDITURES
(For Tracking Purposes only)
1. Match
a. Other and In -Kind
$0,00
$0,00
$0.00
%
b, Local Match
$0,00
$0.00
$0,00
%
2. USDA (Cash ReceiRd
$0.00
$0-00
$0.00
%
3. TOTAL OTHER
$0,00
$0,00
$0,00
PART D -1 0_111HER REVENUE AND E)PENDITURES
.. ...........
2- Addition Cost Alternative Program Income
3, Interest
1, Program Income (PI)
a. Approved Budget
a. Earned or, GR Ad�ances $
a. OAA Unbudgeted P1 Receipts YTD
b, Received YTD
b. Return of GR Advance
c. Expenditures
c, Other Earned
DOEA FORM 105as re4sed f 1/og
January '20-11 w
Contract CLP- MCSS 11
BLANK PAGE
56/96
January '20 11
Contract CLP- MCSS 11
REMAINDER OF PAGE BLANK
ATTACHMENT X
EXHIBIT 3
//96
January
Contract CLP- MCSS
BLANK PAGE
158/96
January 20 11
Contract CLP- MOSS 11
RECEIPTS AND EXPENDITURE REPORT
OLDER AMERICAN ACT
PROVIDER NAME, ADDRESS. PHONE# AND FEID#
Program Funding Source:
...........
THIS REPORT PERIOD
FROM: TO:
CONTRACT
Tittle [if E
PERIOD:
CONTRACT tf
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
$]-00
$0.00 %
2. State Funds
$0.00
$0.00
$0.00 %
3. Program income
$0,00
$0-00
$0.00 %
4. Local Cash Match
$0,00
S0,00
$0,00 %
5. SUBTOTAL: CASH RECEIPTS
$0.00
$&00
$0.00 %
F. Local In -Kind Match
$0.00
$0.00
$0.00 %
7. TOTAL RECEIPTS
$0.00
$0.00
$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 Services
1. Personnel
$0.00
$0.00
$a00 %
2. Travel
$0.00
$000
$0.00 %
3. Building Space
$0.00
$0.00
$0.00 %
4. Communication / Utilities
$0.00
$om
$0.00 %
5. Printing / Supplies
$0.00
$0.00
$0.00 %
6. Equipment
$0.00
$0.00
$0,00 %
7. Other
$0.00
$0.00
$0.00 %
B Agreement Services
B. 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
$0,00
$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
$O-00
$0.00 %
PART C : E>PENDFTURES ANALYSIS
2. Units of Services Year to Date
3. Number of People Served Year to Date
A- Expenditures by SerAces Year to Date:
1, infortnation. . $0,
2. Assistance.. ......... z ......... K _00
....... S0'W
.................. 0_00
3. counseling,......, .........
so,
,, L01
0'W
4, Respite, ........ ........... S0.00
---- 1_11111111_1. W11
...... I—— ---- 0,00
I-
.., Supplemental Ser-Aces, $0,00
....... W'00
................... 0-00
6, TOTAL ...... .................. $0,
Part B Line 11, column 3 should be equal to this total.
PART D ' GRANDPARENT SERVE CES freported bry Federal Piscal Year)
FFY
Match $
Mato $
Match $
DOE A FORM 105AE remsea
59/96
Contract C me s s �.
0/96
J anU ary 62 0 11
Con -tract CLP- MCS It
Department of Elder Affairs Programs & Services Handbook, provided on CD.
Z:�
Also, available at the Department's Intranet site Linder, "Publications".
ATTACHNIENT A
6 1 /96
Contract CLP- MCSS 11
66
J angry 2 0 11
Con -tract CLP- MCSS 11
ATTACHMENT B
STATE OF FLORIDA DEPARTMENT OF ELDER AFFAIRS
CIVIL RIGHTS COMPLIANCE CHECKLIST
Program/Facility Name
County AAA/Contractor
Address
Completed By
(City, State, Zip Code Date Telephone
PART 1.
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 % Female
3. STAFF CURRENTLY EMPLOYED. Effective date:
.......................
[:Total # E011/0 White % Black % Hispanic % Other % Female % Disabled
4. CLIENTS CURRENTLY ENROLLED OR REGISTERED Effective date:
................
% White % Black % Hispanic % Other % Female % Disabled % Over 40
Total # _ [ L
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
� El El
7. Compare the staff composition to the population. Is staff representative of the population? NA YES NO
If NA or NO, explain.
8. Compare the client composition to the population. Are race and sex characteristics representative NA YES NO
of the Population? If NA or NO, explain,
9. Are eligibility requirements for services applied to clients and applicants without regard to NA YES NO
race, color, national origin, sex, age, religion or disability? If NA or NO, explain.
January 20 11
Con -tract CLP- MCSS 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
F-1 1:1 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 F-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 El Poster El 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
❑ 11 0
PART III. THE FOLLOWING QUESTIONS APPLY TO PROGRAMS AND FACILITIES WITH Is 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 Comma ct CLP- MCSS 11
17. Is there and established grievance procedure that incorporates due process in the resolution of
complaints? If N. explain.
YES NO
F-1 0
YES NO
H F-1
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
PART IV. FOR PROGRAMS OR FACILITIES WITH 50 OR MORE EMPLOYEES AND FEDERAL CONTRACTS OF $50,000 OR MORE.
21. Do you have a written affirmative action plan? If NO, explain. YES NO
am
Fa.
January 201.
AAA USE ONLY
Reviewed By In Compliance.- YES 0 N* 0
'+g'm i *Notice o Corrective Action Seat
Date Telephony 1
. . . ..... ........
On -Site 11 Desk Review 0 Response Received
DOER Form 101- , Revised May 2008 Page 2 of 2
57
-6 6
Jativary 2011
Contract CLP- MCSS 11
INSTRUCTIONS FOR THE CIVIL RIGHTS CO.NMPLIANCE CHECKLIST
ATTACHMENT B
Describe the geographic service area such as a district, County, city or other localitv. If the prograrn/facility
serves a specific target population Such as adolescents, describe the target population.. Also, define the type of
service provided.
2. 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
i 'zn
containino, 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
I ist 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 DOER 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
population is Hispanic, is there a comparable percentage of Hispanic staff?
S. 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
programs 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 bLit were denied services or employment, 45 CFR 80.3 (a)
and 45 CFR 80.1 (b) ('I).
10. Participants or clients must be provided services Such as medical, nursing and dental care, laboratory services',
physical and recreational. therapies, COLInselinsz and social services without rectard to race, sex, color, national
origin. religion, age or disability. COLIrtesy titles, appointment scheduling and accuracy of record keeping must be
pplied Uniformly and without regard to race, sex, colon national origin. religion, age or disabilitv. Entrances.
waiting rooms. reception areas, restrooms and other facilities [11LISt also he equally available to all clients, 45 CFR
80,3 (b).
For in -patient services. residents ITI List be assigned to rooms, \,vards., etc,, without regard to race. color, national
origin or disability. Also, residents mLlSt [lot be asked whether they are willing to share accommodations with
persons of ca different race, color, national origin, or disability. 45 CFR W
W 'I (a).
I -�. . I
The prograrn1facility and all services must he accessible to participants and applicants, including those persons
Z7
�vho nicay not speak English. In (Yeogra-phic areas where a significant POPUlation of non -fir gush . speaki ty C Ifi g people
67/96
............. .... ... ... ............ ....... ...... .... .... ... .... .... .. . .. ... ........... ...... .. . .... ... ... .. .. ..... . .. . .. . .. .. ... ... ... ... ........ ...... ..... ... .. .. . .. .. .... ............ ... .... ........ .... ......... .................. ..... ... . .......... : ........... ......... : ................ : ................. ... ... ........... .... .......................... . . . .... . .. .. .. . . . .. . . .... ... . .... ..... ...... . . ... .. . ...... .. ............. ........ ........ ....... ..... ............. ... ...................... : ........... ...... .... : . . .............. ............ ........................... ........... : .... .......................................... ............. ......... .............. ........... ....... ..... :..: ............ .......... ............ . ..................... ..... .. ... . ..... ............................
January 20 1. 1
Contract CAP CS_' 11
ive, program accessibility may include the employment, of bil in9 ual staff. In other areas, it is sufficient to have a
.,F
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
HAS. 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 a�zain.st the program/facility. Indicate the basis, e.g., race, color,
creed, sex, ale, national origin, disabilit9
y, retaliation- the issues involved, e.g., services or employment,
Z:� -
placement, termination, etc. Indicate the civil rights law or 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, Linder 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
servincr I ines 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 1973 requires that a recipient of federal financial assistance conduct
a self -evaluation 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).
I& 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, Continuina 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
w hearings.
ads, and other a ppropri ate written co ni in u n i cat I on, 45 5 C FR 84,8 (a).
_10'
Programs facilities that employ 15 or more persons Must provide appropriate auxiliary aids to persons with
impaired sensory, manual or speaking skills where necessary. ALIXIliary aids may 111CILide, but are not limited to,
interpreters for hearing Impaired individuals, taped or Braille materials, or tiny alternative, resources that can be
used to provide equally effective services, (45 CFR 84.52 (d).
Prfacilities rai ns
fac 'es with iO or more employees and S450.000 in federal contracts must develop, impleman ent d
ocyI I
maintain a written affirmative action compliance program in accordance with ExeCLItIve Order 112146, 41. CFR 60
and Title VI of the Civil Rights Act of 1964. C's me tided.
Em
. ..... ....
J anuary 2011
a
Contract CLP- MCSS 11
ATTACHNIENT E
Department's Computer Use Policy and its Social Media Policy, provided on CD.
69/96
January 2011
Contract CLP- MCS
7 1
0/96
. . . . .....
JanUary 2.0 1. 1
Contract CLP- MCSS 11
ATTACHMENT F
EXHIBIT I
*OEA Cost Analysis For Non -Competitively Procured Contracts
In Excess Of Category 11
PROGRAM: CONTRACT PERIOD:
41
TYPE OF SERVICE.
1 2 Column 3 Column 4 Column 5 ....... ....
. . ..........
to be completed by the contractor)
(to be completed by the DOER.
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
0
loom
e.
Travel
f.
Printing & Supplies
E
g.
Other (Please list or attach details)
h.
Allocated Cost/Overhead
TOTAL
.............................
Client Services (Attach
details)
TOTAL
4)
tE
.. ........................................ .... - ----------
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
Signature Date
jF
`/t/96
Contract C LP- GCS
2 6
January 20. 1
Contract CLP- MOSS 11
ATTACHMENT T 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 -corn petiti ely 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 D OEA contract manager will:
1. Evaluate each separate line item to determine whether the cost is allowable, reasonable and necessary.
a. To be allocable, 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/1 form in the official
file for this contract at the Department of Elder Affairs.
(t) 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 therm 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 nonexpendable, 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 allowable for carrying out the project. Travel must
be in 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 diem 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.
l 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.
4 The allocation to the agreement will be calculated based on the cost by line item cost divided by the total
agreement amount.
/96
J anuarv20 1
Contract CLP- MCSS 11
6
... . . . .... ... ....
January '2 0 1. t IF Contract CAP- MCSS 11
ATTACHMENT G
CO.NFNIUNITY LIVING PROGRAM PROTOCOLS
Prram Overview
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::� Z�
have been identified as "critical. pathways" to institutional long term care. Borne of these "critical pathways"' include
sudden caregiver burnout, depression, malnutrition/dehydration and lack of proper follow up with home and
community based services following hospital/rehab discharges. PSG. 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 Lin -necessary
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 consurner's choice.
Acronyms and Definitions
AD I (Alzheinier"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 -Resource Centers or Aging Resource Centers) — The not -for -profit entity
which is the single entry point for the aging service system within each established region of the state.
APS (:Adult Protective Services) High Risk — The designation of an elder who needs immediate protection froni
further abuse, ne(4-Ylect or exploitation, which can be accomplished completelv or in part thr0Uic.,Jh the provision of home
ased services. and coninitillitY b, ,
75 / 9 6
January '20 11 a
Contract CLP- MMSS 11
Carecriver or Support Svstem — For this project', the careoriver or support system is one or more persons whom the
Z�_ - 4:�
elder can depend on to provide care or to orcyanize the provision of needed care.
C�
Care Plan - A comprehensive listing of all services, including Medicare, CCE, OAA, county, etc. that address
4_� zl�
the client's physical, mental, and home care needs to resolve the crisis condition(s), and accomplish the client's
personal goals. The Lead Sen,�ice 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 CLP staff, which reviews
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
program.
CCU (Community Care for the Elderly) — Services offered to functionally impaired older persons to enable there
to live in the least restrictive environment, including adult day care, consumable medical supplies, home delivered
Z:�
meals, homemaker, personal care, respite, and other community -based services,
CIRTS (Client Information and Registration Tracking System) — The database of the Department of Elder Affairs
used by the aging network to manage client assessment data, register clients for services, plan client services and
maintain program waiting lists. Lead agency provider assessors also use CIRTS to evaluate client eligibility for
Z:�
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
manage the elder's service delivery, including decisions about which services will be provided, by whom and how
Z�
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/EA) pays 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.
Community Living Program — "'Community Living Program" is a grant to the state of Florida from the federal
Administration on .aging. For persons meeting the pr 'ect"s functional and financial elimbility criteria, the grant01
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.
care services provided to veterans.
7 1
6/96
k *
MR
January 20 1. t
... .. ......
..... . ........
Contract CLP- MOSS 11
Cost Sharing — Pavment 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 — 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
caregiver hospitalization that would cause the nursing home placement of the care recipient; it also includes
hospitaUrehab 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 701A or 701B
Z�
assessment tool; with an option for imminent risk designation in accordance, to the DOER 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 $4,100. The
assets, excluding primary residence and vehicle, must be valued at a minimum of $25,000 with a maximum
Z:�
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
the client's situation meets all three of the criteria listed in the 3d) contract language:
1. The client's mental or physical condition has deteriorated to the degree that self care is not possible,
2. There is no capable caregiver, and
3. Institutional placement will occur within 72 h0Urs. it
Lead Auency—A ComMUnitv Care for the Elderly, (CCE) designated agency. Lead agencies provide services
4n W Z:� Z�
under the CCE and ADI programs. In addition lead agencies handle APS cases in accordance with a DOE,
established protocol.
Lead Service Pro rider provider of Older American Act Services that also provides case management Linder
this project. The Case manager from the service provider will follow-up with those project participants referred by
0J Zn I
the CL.P staff to facilitate the provision of services during the grant period and to help plan for the person"s needs
L1%
after therant period.
,/,96
January 2.0 11
Contract CLP- MCSS 11
OAA 111B, 1111). IIIE (Older Americans Act Titles) — Title 111B provides SLI-pportive services to assist elders to live
independently in their COMMUnitv. Title 111D provides disease -prevention and health -promotion, services at senior
centers or alternative sites. Title IIIE 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
children who are under 19 or are disabled.
Private Pay — Payment of the complete cost of services by an individual with SLIfficient income and assets to be
over the financial standards for receipt of state or grant funded services.
4--�
Referring Entity — An entity providing referrals to the single entry point. These include case management
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.
Z�
Self -declared — For purposes of initial financial eligibility for the project, the individual's declaration of income
and assets will not require verification.
SEP (Single Entry Point) — The CLP staff for the area where the individual is receiving services is the single entry
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
Z:)
established for publicly funded programs because he/she does not meet the eligibility criteria for this project.
Protocols
Client Identification
L The referring entity will use the following criteria to identify potentially appropriate project participants:
? I I IndMdUal is at least 60 years old.
3. Individual is a resident of Miami -Dade or Monroe COUnties,
4. Financially and functionally eligible.
L---
Has Medicare or private health insurance.
6. hidividual is not receiving hospice services.
1"hidividUal or caregiver ' Votic, ,( is in need of crisis resolving services andor slit ern areto
Um
January '2.0 t. I
49 Contract CLP- MCSS 11
avoid readmission to a hospital/rehab facility or a nursing home placement.
Z:!�
8. Not currently receiving any DOER sponsored services.
Z:�
Client Referral
The referring entity will make client referrals to the single entry point (SEP).
1. Each referring or entity will designate a Community Living Program contact to make referrals.
2. The SEP will designate an appointed staff to receive referrals.
C�
3. At the referring entity, staff will complete the Referral Checklist and the designated community -Living
Program, contact will transmit the Referral to the SEP.
o For individuals in a hospital or nursing home, the referral will be completed 24 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
tn
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.
tn
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
the discharge summary to the SEP staff.
Client Screening (Functional and Financial Eligibility)
1. Within '24 hours of receiving the referral, the SEP designated staff will determine client eligibility for project
%_1 9 .1
participation.
The SEP staff will conduct a CIRTS record check to determine if the individual is currently enrolled in CCE11'k
ADI, or is a high risk APS referral. If Such is the case, the SEP staff will refer to the individual's case
manaciernent agency of record for follow up The lead age cy will recommend crisis resolving services, if
needed, to SUPPlei-nent the existing care plan. If the individual. appears eligible for proJect participation, then
the SEP staff will authorize the lead aoency tO Update the 701 BR
Z=
79/96
January 20 11
Contract CLP- MCSS 11
If the client is not enrolled in CCE, AM or any other case managed program, or is not a high risk APS
C" 9
referral and is in need of a short term care intervention, then the SEP designated staff will determine client
eligibility for project participation. Screening Must take place within 48 hours from the time the referral was
C� Z"-n
received by the Sip.
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 priority level
4-�
4 will be eligible if there are demonstrable circumstances that put such individual at high risk of nursing home
placement or re -hospitalization. These cases will be approved based on their particulars by the SEA' on an
exception basis. The SEE staff will notify the referring entity of the eligibility of the individual or, if
applicable, the reasons for denying eligibility, in accordance to DOER criteria.
4. If the individual does not appear eligible for project parficipation, then the Sip staff will triage
the individual
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 pors i bi'lit es:
Initial Client Assessment (701 B):
* 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.
0 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
Z��
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
.11
7 2 hOUrs of referral Lising form 70 1 B , in this latter instance, the CM will review the hospital discharge
C�
paperwork. The Lead Service Provider will enter data in CIRTS within the week of the assessment.
The Case manager (CM) will develop a care plan with the client and or caregiver/support system. based on the
assess -rent. and will initiate in-horne crisis resolving services within 72. hOUrs of receipt of referral.
The Case manaZ7� tyer CM'm ) will. inform the client that the Departent of Elder Affairs has contracted an
( -
M=
January '.2.0 11 W
Contract CLP- MOSS 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 Comin it n I tv Llying -Prog rain "' 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 manager 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
forms, and any other related information collected on behalf of the client/caregiver or required by the program.
0
Enrollment Authorization.
* The SEP staff will authorize enrollment of the individual in the project.
* 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
4:�
from the project.
On-Goinvbase Mannement ties ibilifies:
The Case manager (CM) will conduct on -going service coordination of home and community based services
and hospital, nursing home or rehabilitation center if applicable. The Case manager will verify the information and
coordinate services as needed.
Client contact service is as follows.
ThrOUahOUt the Bra period. the Case manaoer (CM) will discuss the following with the client and care giver issues
pertainincy to the cherit"s medical needs, nutritional needs. mental health needs, home care needs. recreational needs:
cS 1/96
January 20 1. 1.
Contract CLP- MCSS 11
Medication management iSSUes-, The Case manager Z:�i will encourage client and care aver to address
zn
medication managernent issues with primary physician.
Medical management: The Case manager will review primary physician appointments and encourage
tn
client and fami1v to maintain appointments accordingly. Encourage client and care giver to follow-up With
medical needs.
3. Nutrition mana(yement: The Case manager (CM) will make referrals for nutrition counseling and meals
z1_ C� -
programs, if needed. It will encourage client and caregiver to follow the instructions of the nutritionist
conduct referrals as needed.
4. Mental Health: The Case manager (CM) will monitor good mental health practice and encourage
C�
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.
-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
2. What services is the client receiving".)
3. Are specific services adequately addressing the client's needs?
4. What are additional needs?
How are those additional needs beina addressed"'
Periodic Follow-up
L One week after initiating services, the Case manager will visit the client to ascertain services planned
are being delivered and client needs are being imet.
Two weeks after service initiation', the case inanager will conduct telephone contact with the client to
determine if services are addressing -the client s needs.
Four weeks after service initiation the case rnanager will conduct telephone contact with the client to
determine if services are addressing the client"s needs.
S: -2) / 9 6
January 2011
Contract CL-P- MCSS 11
4. No less than 5 days prior to the end of project participation, the CLP Lead agency provider case
*11 conduct a face to face contact with the client and caregiver to review the care plan and
manager wi Z�
determine the Ind ividual"s continued need of crisis-resolvinor 11or services-. The tim.1nor 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 SEP staff of the followillcl* 4=*
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 deliveryafter crisis -resolving service. eriod ends
S The client has an option of continuing to receive services in a traditional manner (agency ordered and
delivered) continuing with a co -pay, subject to provider funding availability.(The share of cost is stated on the care
plan.)
8 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.
0
Funding Options.
The SEP staff must ens re the availability of OAA dollars to serve individuals at high risk of nursing home
placement and spend down to Medicaid by implementing assessment and screening tools, as well as care planning alid
case rnanaiyernent for Title HIB fundinor, Title HID and Title HIE funds Should be considered for the provision of
011� Z=�
services Such as medication management and caregiver Support services.
f� t�
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
am
January 2011
Contract CLP- MCSS 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.
CIRTS Data Entri:
Screening data for each referral based on the CLP Screenino, tool or 701 A or similar ins tniment will be entered
I= C�I
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.
o All services will be reported as client specific, including non -registered OAA services.
*- All services funded with CLP grant funds will be reported under the appropriate CLP service code.
* All services funded with other program funds (oAA, CCE, etc.) will be reported using the appropriate program's
service code.
84/96
January ',2.0 1. 1.
Con -tract CLP- MCSS 11
ATTACH-NMENT H
SERVICE PROVIDER APPLICATION
sm
r:
02
y
December �D t 0 Contract LP-MCS S
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
86/ J6
Decern-ber Ko
Contrzk't CLP-MCSS I
IMPLEMENTATION OF SERVICES STATEMENT OF READINESS
Deputy County Administrator do hereby Stipulate and
derick
agree that Monroe County Social Services/In-Ha to Services is ready to implement the services
mentioned in this Invitation to Negotiate (ITN)
Date-,,fd 1O
---
I=
... .. ... ... ...
December 2.0 10 Contract CLP-MCA I
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 30S-292-4S10 (phone)
q,ylvia 3. Murphy,, Mayor., Monroe County — Chief Executive Officel
M
Monroe County Ire -Home Services (MCIHS), a department within Monroe County Social
Services (MCSS), is well-equipped to handle service interventions for the short-term high risk
C�
individual. Due to Our extensive reach throughout all of Monroe County, there are no areas that
cannot be served. MCIHS is able to provide any manner of services throughout the entirety of
Monroe County. For example, MCI.HS already provides value-added services (aria a number of
non DOER 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. MCIES employs County staff,
as well as subcontracted staff, that are strategically positioned throughout all areas of Monroe
County.
In addition to all of the aforementioned services which are considered value-added services, for
the Community Living Program, we are able to per foun the following direct In -Horne Services*.
Z:!�
Homemaking - which will. allow clients to receive specific home management services SLIch as
general housekeeping, laundry, assistance with budgeting and paying bills, shopping assistance,
tneal preparation, etc. Personal Care — which will allow clients to receive assistance with
om
R
December 20 10 Contract CL-P-MC& I
significant eating, dressing, personal hygiene, and other nificant activities of daily living. Case
9 z4:7
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
tanagers are "gatekeepers" in the community care system and have vast knowledge in the
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 offeringthe services, to meet the client's needs. Case Managers are able to monitor
all services and referrals to ensure they are having 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
functionally impaired, high risk older person by providing care for the person in the home for a
pre -determined period of time.
Overall Coordl*nation -Monroe County Case Managers are able to coordinate all community
resources for lil(yh 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 1. If a consumer needed medication and could not afford it, MCSS
would be able to pay for that rmedication. This is just one example of the many value-added
services that MCSS already has in place. Another example would be the Monroe County
Disabilitv Counci-I which is sponsored and staffed by the Monroe County Board of County
W=
. . . ......
. . ....... .
y.
. ..... . .
December 20 10 Contract CLP-MCS5 I
Commissioners (BOCC). The Social Services Department has loner 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 fundiner
to Social Services organizations or of the County structure) following the counsel of the
Human Services Advisory Council (HSAB). The HSAB reviews applications and makes
fundina recommendations for programs in the followino, 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 zD non -governmental, agencies that offer essential services for C011SUniers. As
contractors for the BOCC, these agencies are willing and able partners with the MCIHS Case
Manacrers 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 1.00 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 Key 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. Moll -roe
oust is 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 thrMlahMlt the corrinlunities of the Keys to ensure that access to needed
90/96
December ?0 10 Contract CLP-Mc I.
services is available. Since MOBS is integrated into the Social Services department, Case
Managers work closely with Community Support Services (CSS) for Consumable Supplies
.1
(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
IV I
physical therapy centers, etc. Further, Case Managers in Monroe County continuously monitor
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 ally caregiver in need.
Z:�
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. MOSS currently provides
Homeless Prevention and Rapid Re -Housing Program (HPRP). This grant is horded by the American
Recovery and Reinvestment Act of 2009, 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
t_1
AFTER the temporary housin(y assistance ends. It generally provides rent for 3 months or less.
itn 4:�
Like the Community Living Program, HARP is not a long-tein-i assistance program. MCSS also
operates the Weatherization itssistan.ce Program (WAP). This grant through DCA provides Enerof y
zl� ZI: Z:�
Deducing Services to low income families to reduce energy cost., conserve energy. increase
zn 4n zn_ -
comfort in the home and improve safety and health standards. Some of the services that
,F
91196
December '2.0 10 Contract CLP-MCAS- I
are offered under this grant are threshold repairs, window and door replacement, insulation, and
installation of smok-e/fire/carbon monoxide detectors, etc. The Low Income Home Energy
Assistance Program (LIHEAP) is another service we are able to provide through the DCA.
C�
This grant assists low income households to receive financial assistance in paying for the cooling
and heating of their homes. As Visiting 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. (CCMII). These agencies have on staff a licensed mental
health counselor (PhD), and a certified addiction professional (MSW). 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
Agency for over the past three decades, MCIHS is able to ensure the coordination of services and
is able to coordinate all aspects of the orrant with the AAA. Monroe County has a close
Z--
relationship with the Aging Resource Center (ARC) and is able to receive and coordinate all
referrals for them. MCIHS are also able to work innovatively, since the Case Managers have a
Z:�
long-standing relationship with the local hospitals Discharge Planners. Staff are able to give
Z:�
these planners the ARC contact information and they call the ARC when a high risk consumer
is a-MU
olng to be released from. the hospital. Throughout Conroe COnty, these referrals will lead to
k-�
December 20 1. 0 Contract CLP-MC: I
intake and assessment. Intake and Assessment begins when a potential consumer, caregiver,
family member, friend, neighbor, or public or private agency seeks assistance for an individual
z:- 4n
by contactincr the Alliance for Aaincr's ARC. MCIES employs ten staff members who have been
Z� 4:7� C�
trained and certified to take referrals and administer the DOE. Assessment Forms in
accordance with the DOE A Assessment Instructions 701. A, 701 B, 701, 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. MCIHS
staff members conduct all assessments in accordance with the instructions for completion as
indicated in the aforementioned training sessions and the DOE A Assessment Instructions
(701A, 701-B, 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
(701.B) 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 discharge, will be served immediately. Case Managers
have the capability after administering the assessment (701B) 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 throuorZ7�hOUt the community for over
three decades.
Pro ram Success and Reportiniz Requirements and familiarity with reportina
........................ ........ ....... ....
-
requirements and service descriptions -As previously mentioned, MCIHS ernplovs ten staff
93/96
An
4R")
..... ....
December '201.0 Contract CLP-MCSS I
members who have been trained and certified to administer the DOER Assessment Forms in
accordance with the DOER Assessment Instructions (701A, 701B, 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
4-1
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 21.01-0 as Monroe
County being a CCE Lead Agency for the past 30 years.
t�
Additional Seryices /Resources at no charge to the Alliance for mini! - As pre viousiv
W
mentioned, MCIHS is a department within the MOSS. MOSS offers a wide array of services to
.i
94/96
December 2010 Contract CLP-M I
help Mon -roe 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
starting on page.
I
Self-sustaining 12ro ram when it is at the end of its lot --Monroe County is certain it will be
able to self -sustain the protyrarn 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 MCSSI and all non DOEA 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 County In -Home Services Technical Ca act --- to provide the pro used service
intervention - MCIIIS Case Manaorers have the knowledge, educational background,
it��
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 tjovernmental or private agencies before working for Monroe County and have a
background and wide ranging knowledge services and procedures. With this knowledere
Monroe County Case Managers are proficient in helping individuals with Medicaid applications
along with assisting them with their applications for Food Stamps online. Monroe County's Case
Managers have a tninilnUM Of _5 years experience in the Social Services field and as such as .w
years field experielice. Alomy with the Case Managers extensive experience. MCIHS has been a
9*V96
T ,
December 20 l "::r
Cotract CL'-MCSS
CCE lead agency for over 3o years and we have the knowledge and technical ability to Submit a � � o
data and reportzn
into the C RTS system, the knowledge of required reports, and the flexibility to handle requirements
ments Set forth by the
DOEA and the Alliance for Aging.
Statement of Readiness — _NICIHS is fully ready to implement services within the Community ' � �
�� ��n� l�ro�ram
immediately. All of the Services that we are proposing here are currently bein or performed by existing ' t staff. We have
the necessary infrastructure and financial resources necessary to begin servin referred clients imn
9 sedate 1.
Unit Rate — MCIHS has the commitment of the BOCC to meet the 0% cash match s a requirement S � set forth in the
ITN. In addition, MC HS has the capacitor to offer an additional 10 o in -kind match aria our existing in
zll
frastructure
(office and congregate meal site space). The combination of these two Sources of funds will equate
€� to an overall 20%
match. Value-added services are outlined and documented in this response, as well as the office and cong
regate meal
site space which are documented on the Knit Cost Methodology.
9696