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Item C11BOARD OF COUNTY COMMISSIONERS AGENDA ITEM SUMMARY Meeting Date: 6-20-2012 Bulk Item: Yes X No Division: _County Administrator, Department: Social Services/In-Home Services Staff Contact PersonlPhone #: Sheryl Grp4am/X45 10 AGENDA ITEM WORDING: Approval of the Home Care for the Elderly (HCE) Contract KH-1272 between the Alliance for Aging, Inc. (Area Agency on Aging) and the Monroe County Board of County Commissioners (Social Services/In-Home Services) for fiscal year 7/1/12 to 6/30/13. ITEM BACKGROUND: Approval of the HCE Contract will enable Monroe County In -Home Services to continue providing services to Monroe County's elderly population under the Home Care for the Elderly Grant PREVIOUS RELEVANT BOCC ACTION: Prior approval granted to Amendment 005 of the Home Care for the Elderly (HCE) Grant Contract #KH-1 172 on 5-16-12. CONTRACT/AGREEMENT CHANGES: none STAFF RECOMMENDATIONS: Approval TOTAL COST: $12,694.00 INDIRECT COST: --O--BUDGETED: Yes X No COST TO COUNTY: $0 (No Cash Match Required) SOURCE OF FUNDS: REVENUE PRODUCING: Yes -i No X AMOUNT PER MONTH Year APPROVED BY: County A rvy'�Xlll OMB/Purchasing X Risk Management` DOCUMENTATION: DISPOSITION: Revised 1/09 Included X Not Required AGENDA ITEM # I �Gfflll 5111111111 WHOM= I ,410111L I I IL-11ILVI IN ITH-0 Contract with: Alliance for Aging, Inc. Contract # KH- 1272 Effective Date: July 1, 2012 Expiration Date: June 30, 2013 Contract Purpose/Description: Approval of the Home Care for the Elderly (HCE) Contract#KH-1272 will enable Monroe County In -Home Services to continue providing services to Monroe County's elderly population. Contract Manager: Sheryl Graham 4510 Social Services/Stop I (Name) (Ext.) (Department/Stop #) For BOCC meeting on 6/20/2012 Agenda Deadline: 6/5/2012 CONTRACT COSTS Total Dollar Value of Contract: $12,694.00 Current Year Portion: $ Budgeted? Yes X No 0 Account Codes: Grant: $12,694.00 (Fiscal Year) County Match: $0 (No Cash Match required) ADDITIONAL COSTS Estimated Ongoing Costs: $/yr For: (Not included in dollar value above) (eg. Maintenance, utilities, janitorial, salaries, etc) CONTRACT REVIEW Changes Date Out Division Director Pate In Needed Reviewer Yes 0 No t vrj( Risk Management r V Yes 0 Nou/ O.M.B./Pu asing Yes 0 No 1�1/ County Attorney Yes E N r f Z4 Comments: OMB Form Revised 2/27/01 MCP #2 Contract Number KH 1272 Page 1 HOME CAREFOR THE ELDERLYCONTRACT 2012-2013 THIS AGREEMENT is entered into between the Alliance for Aging, Inc., hereinafter referred to as the "Alliance" and "Monroe County Board of Commissioners.", hereinafter referred to as the "provider." THIS CONTRACT IS SUBJECT TO FURTHER MODIFICATION IN ORDER TO INCORPORATE CERTAIN PASS -THROUGH LANGUAGE REQUIRED BY THE STATE OF FLORIDA DEPARTMENT OF ELDER AFFAIRS. ALL SUBSEQUENT MODIFICATIONS WILL BE MADE THROUGH AMENDMENTS TO THIS CONTRACT. Attachment I, II, III, IV, V, VI, VH, VIII, IX, X and XI are integral to this Agreement 1. Recipient Agrees: A. Services to be Provided: The recipient's service provider application for state fiscal year 2011, and any revisions thereto approved by the Alliance and located in the contract manager's file, are incorporated by reference in this contract between the Alliance and the recipient, and prescribe the services to be rendered by the recipient. 2. Consumers may not be enrolled in a Department of Elder Affairs' state general revenue funded program, including HCE, who are also enrolled in a Medicaid capitated long term care health plan or program. These programs include the Frail Elder Program operated by United Health Care, the Channeling Program operated by Miami Jewish Home and Hospital for the Aged, the Long Term Care Community Diversion Program and the Program of All Inclusive Care for the Elderly (PACE) program scheduled to begin operation in the Miami -Dade County area. B. Manner of Service Provision: The services will be provided in a manner consistent with and described in the recipient's service provider application for state fiscal year 2011 and the 2011 Department of Elder Affairs Client Home And Community Based Services Handbook. In the event the manual is revised, such revision will automatically be incorporated into the contract and the recipient will be given a copy of the revisions. 11. The Alliance Agrees: A. Contract Amount: To pay for Case Management and Case Aide services in an amount not to exceed $12,694, subject to the availability of funds. As a matter of reference, the Alliance projects to process and pay the basic subsidy to qualified caregivers participating in the HCE program of approximately $16,628. At the time of execution of this contract, $9,504 are projected to be available for Special Subsidy i ! Specialized Medical Equipmentand Supplies —Vendorand Specialized Medical Equipmentand Supplies -Consumer reim Obligation to Pay: The Alliance's performance and obligation to pay under this contract is contingent upon an annual appropriation by the Legislature. B. Source of Funds: The costs of services paid under any other contract or from any other source are not eligible for reimbursement under this contract. The funds awarded to the recipient pursuant to this contract are in the state grants and aids appropriations. Program Title Year Funding Source CSFA# Fund Amounts Home Care for the Elderly 2012 General Revenue 65001 $12,694 TOTAL FUNDS CONTAINED IN THIS CONTRACT: $12,694 111. Recipient and Alliance Mutually Agree: A. Effective Date: 1. This contract shall begin on Julyl, 2012 or on the date the contract has been signed by both parties, whichever is later. 2. Delivery of services shall end on June 30, 2013. This contract shall end on July 15,2013. IN WITNESS WHEREOF, the parties hereto have caused this agreement to be executed by their undersigned officials as duly authorized. Monroe County Board of Commissioners. ALLIANCE FOR AGING, INC. SIGNED BY: SIGNED BY: David Rice NAME: NAME: Max B. Rothman, JD, LL.M. Mayor TITLE: TITLE: President & CEO 6-20-2012 DATE: DATE: MO#E C uN;� TTI NEY n M R D IVY 1ANT UNITY 10', .BEY 2 Date -4, Contract Number KH 1272 Page 3 ATTACHMENT I HOME CAREFOR THE ELDERLY• j The Home Care for the Elderly (HCE) Program encourages the provision of care in family - type living arrangements in private homes on a not for profit basis as an alternative to nursing home or other institutional care. A. Services: 1. The recipient's July 2011 application, and any revisions thereto approved by the Alliance and located in the contract manager's file, are incorporated by reference in this contract between the Alliance and the recipient, and prescribe the services to be rendered by the recipient. 2. Consumers may not be enrolled in a Department of Elder Affairs' state general revenue funded program, including HCE, who are also enrolled in a Medicaid capitated long-term care health plan or program. These programs include the Frail Elder Program operated by United Health Care, the Channeling Program operated by Miami Jewish Home and Hospital for the Aged, the Long Term Care Community Diversion Program and any other areas that may participate in the Long Term Care Community Diversion Program through expansion and the Program of All Inclusive Care for the Elderly (PACE) program. B. Manner of Service Provision: The services will be provided in a manner consistent with and described in the recipient's July 2011 application and the 2010 Department of Elder Affairs Home and Community -Based Services Handbook. In the event the handbook is revised, such revision will automatically be incorporated into the contract and the recipient will be given a copy of the revisions. A. The method of payment in this contract is based on a fixed rate reimbursement for approved services. The recipient must ensure fixed rates include only those costs that are in accordance with all applicable state and federal statutes and regulations and are based on audited historical costs in instances where an independent audit is required. All requests for payment and expenditure reports submitted to support requests for payment shall be on DOEA forms 106H and 105H. Duplication or replication of both forms via data processing equipment is permissible, provided all data elements are in the same format as included on department forms. B. Invoices must be submitted no later than 90 days after the end of the month on which the expense was incurred, except that invoices can not be submitted after close out report date (usually July 15th.) Invoices submitted late will not paid. Exceptions to this I Contract Number KH 1272 Page 4 rule are at the discretion ofthe Alliance, VOocase by case basis; such exceptions DlUot be requested prior to the 8Kp([8tkJD of the iOvOkjDg deadline. In making 8 determination Ofthe exceptionQthG/UU8n:evViUUO0siderwh8the[thediGrUoUoOkJthe billing cycle vY8sbeyond econtrol Qfthe provider, the frequency with which such exceptions are requested by the provider, and whether the Alliance can request reimbursement 8ta late date from D(]EA. C. The recipient shall maintain documentation 0osupport payment requests which shall bS available to the Comptroller, the Department of Elder Affairs, or the /U|ioOCe upon FeqU8gl. D. The recipient may request amonthly advance for service costs based Onanticipated cash needs. Detailed documentation justifying cash needs for advances must be submitted with the signed contract, approved byth8A||i3OC8'3DdO0o(Ot8iOediOthe C0Otno{t nl8O3g8[`S file. All payment F8qu8GtS for the third through the OiO8 [O0DthS shall be based on the submission of monthly actual expenditure reports beginning with the first month of the contract. The schedule for submission of advance requests is ATTACHMENT UUtothis contract. Reconciliation and recouping ofadvances made under this contract are tobecompleted byJune 2O12reports. All advance payments one subject to the availability of funds. E. Advance funds may be temporarily invested by the recipient in an insured interest bearing account. All interest earned oncontract fund advances must bereturned tothe Alliance at the end ofthe first quarter ofthe contract period. � � Contingent upon the recipient's ability to maintain program expenditures within the assigned quarterly allocations and the availability of funds, the Alliance shall make payment tothe provider for provision of services at the rate(s)atated below: SERVICE TO BE UNIT MAXIMUM MAXIMUM PROVIDED RATE UNITS DOLLARS Case Management $50.48 251 $12.094 G. Anvpayment due bvthe Alliance under the terms 0fthis cOD�8(tn03yb8wKhh8|d }e'iDgthHn20giCt'ndGpproV3|bvthe/U|i8OCe0fc0mp|8te3Od8CCUr3te�OQO[j@|3nd ' rornnl��iC reports dU8f�>nl �h� recipient and any adjustments including any pn]Q p -^ ' disallowance not resolved. IV. REPORTING: The provider need to provide the Alliance with an expenditure plan by July 15 or two weeks after contract has been signed, a monthly update due on the 15 of each following month. The expenditure plan and updates must follow the format provided by the Alliance. A. State Laws and Regulations: 1. The recipient agrees to comply with applicable parts of Rule Chapter 58H-1^Florida Administrative Code pnJmOU|o3ted for administration of Sections 430.001 Ul[OVgh 430.808.F|Ohda Statutes, and the 2O1ODepartment 0fElder Affairs Home and Community Based Services Handbook. 2. The recipient agrees tOcomply with the provisions VfSections Q7.Q21and S7.058' Florida Sb]tuteG, and all [U|8S related thereto in the Florida Administrative Code. B. Assessment and Prioritization for Service Delivery for New Consumers: The following are the criteria k}prioritize new consumers for service delivery. |tksnot the intent ofthe Department ofElder Affairs k)remove existing clients from any program (norder toserve new clients being assessed and prioritized for service 1. Priority Criteria for Service Delivery: o\ Individuals (nnursing homes under Medicaid who could betransferred to the b\ Individuals innursing homes whose Medicare coverage (aexhausted and may be diverted to the community; d Individuals innursing homes which are closing and can bedischarged to the community; or d\ Individuals whose mental or physical health condition has deteriorated to the degree self care (anot possible, there ianocapable caregiver and institutional placement will occur within 72hours. 2. Priority Criteria for Other Assessed Individuals: The assessment and provision of services should always consider the most cost effective means of service delivery. Functional impairment shall b8determined through the department's consumer assessment form 8dnn(DiStHn8d to each 8pp|iC8OL The most frail iOd(VidU3|o not prioritized |Dgroups one, two 0rthree above, regardless Ofreferral source, will receive services t0 the extent funding is available. C. Consumer Information, Registration and Tracking System (CIRTS): 1.The recipient will ensure the collection and maintenance of Home Care for the Elderly (HCE) subsidies and case management information on a monthly basis from the Consumer Information, Registration and Tracking System (C|RTS). Maintenance includes valid exports and backups Of all data and systems according to department standards. Contract Number KH 1272 Page 6 2. The recipient must ensure all data for HCE subsidies are entered in the CIRTS by the 15th of each month. HCE subsidy data entered into the CIRTS by the 15th of the month will be for payments incurred between the 16th of the previous month and the 15th of the current month. Case management data entered into the CIRTS by the 15th of the month will be for units of service provided during the previous month from the 16th and up to and including the 15th of the current month or case management units of service may be entered according to the recipient schedule, in aggregate on the 31 st or daily, weekly or monthly. I The recipient will ensure data entry for HCE subsidies will cease on the 15th of the month and the CIRTS Monthly Service Utilization Report, by consumer and by worker identification is run. 4. The recipient will ensure the Monthly Utilization Report, by consumer and by worker identification is verified, corrected, certified no later than the 20th of the month in which the report is generated. 5. The recipient will ensure caregivers determined eligible for the HCE basic subsidy after the 15th of a month, will be processed to begin eligibility for the HCE basic subsidy on the 1 st day of the next month. 6. The Alliance will reconcile and verify the CIRTS data prior to payment for HCE basic and special subsidies and case management. 8. The Alliance will reconcile and verify the CIRTS data prior to payment for HCE basic and special subsidies and case management. I Contract Number KH 1272 Page 7 CONTRACT REPORT CALENDAR Report Number Based On Submit To The Alliance On This Date 1 July Advance *............................................................ 2 August Advance "........................................................ 3 July Expenditure Report ...1/12 Advance Reconciliation....... 4 August Expenditure Report ...1/12 Advance Reconciliation ... 5 September Expenditure Report 1/12 Advance Reconciliation 6 October Expenditure Report ...1/12 Advance Reconciliation .. 7 November Expenditure Report ... 1/12 Advance Reconciliation 8 December Expenditure Report ...1/12 Advance Reconciliation 9 January Expenditure Report ...1/12 Advance Reconciliation... 10 February Expenditure Report.. 1/12 Advance Reconciliation... 11 March Expenditure Report ..1/12 Advance Reconciliation .... 12 April Expenditure Report ...1/12 Advance Reconciliation .... 13 May Expenditure Report ... 1/12 Advance Reconciliation ....... 14 June Expenditure Report ... 1/12 Advance Reconciliation ...... 16 Final Expenditure and Closeout Report ........... July 1 July 1 August 15 September 15 October1 5 November 15 December 15 January1 5 February 15 March 15 April 15 May 15 June1 5 July 15 July 15 Legend * Advance based on projected cash need. Note # 1: Report #1 for Advance Basis Contracts cannot be submitted to the Alliance prior to July 1 or until the contract with the Alliance has been executed. Actual submission of the vouchers to the Department of Elder Affairs is dependent on the accuracy of the expenditure report. Contract Number KH 1272 ATTACHMENT III Issue: Screening, Triage, and Referral for Activation under the Community Care for the Elderly/Home Care for the Elderly Programs and for the Aging & Disabled Adults and the Assisted Living for the Elderly Medicaid Waivers. Policy: Referrals will be based on availability of funds, in accordance with prioritization requirements. Purpose: To ensure funding is spent expeditiously and consumers are referred into programs for appropriate services. Procedure for Monroe County: Roles and Responsibilities A. Alliance for Aging / Aging and Disability Resource Center ➢ Reconciles overall program and Lead Agency specific spending levels on a monthly basis to ensure the Lead Agency is operating within the funding allocation. ➢ Reviews the number of cases released for activation based on projected funding available. ➢ Screens consumers to link with appropriate resources and prioritize for DOEA-funded programs and services. ➢ Recommends potential cases for activation based upon projected funding available by Lead Agency. ➢ Selects consumers from the waiting list based on their prioritization score. Refers consumers from the waiting list to the Lead Agency in Monroe County for activation, based on availability of funds. Monitors compliance with service standards and outcome measures. ➢ Reviews care plans and files per the File Review Policies and Procedures. Reviews data in CIRTS. B. Case Management Agency ➢ Requests and accepts referrals from the Aging and Disability Resource Center, to serve an optimal caseload and to avoid surpluses or deficits in accordance with the AAA CCE/HCE Surplus/Deficit Analysis policy. Refers inquiries from consumers interested in services to the ADRC for Information and Referral to community resources, Screening, Triage, and Long -Term Care Options Counseling, as appropriate. The functions of Screening and Intake are outsourced to the Lead Agency. Screening and Intake may also be completed by the ADRC. ➢ Completes comprehensive assessments on new consumers and annual reassessment on existing consumers and develops care plans and reviews care plans semi-annually. Authorizes service delivery and enters data into CIRTS. Screens consumers for Medicaid Waiver eligibility. ➢ Bills in CIRTS and Medicaid as appropriate. ➢ Monitors care plans in an effort to keep costs down while sustaining the individuals in 8 Contract Number KH 1272 Page 9 the community. Il. Management of the Assessed Prioritized Consumer List (APCL). A. Referrals to the ADRC are routed to the Information and Referral Specialists or Intake Unit staff depending on the type of referral. Clients are provided information on community resources and programs available including private pay options. Persons are directed to those resources most capable of meeting the need they have expressed to ADRC staff. Cases presenting strong identifiers that indicate the consumer might benefit from publicly funded long term care services are screened, entered into CIRTS, triaged and provided options counseling. In Monroe County, the functions of Screening and Intake are outsourced to the Lead Agency. Screening and Intake may also be completed by the ADRC. DOEA prioritization requirements will be adhered to by both entities, as follows: APS High Risk Referrals (See section B) 2. Imminent Risk cases will be prioritized for activation after APS High Risk Referrals have been served. If budgetary constraints prevent opening new cases, clients will be placed on the APCL. ADRC staff will contact the client on a monthly basis to determine if there has been a change in the client's situation. 3. All other CARES referrals will be screened and prioritized in accordance with DOEA requirements. 4. Aging Out consumers will be referred by DCF for prioritization and/or activation in the corresponding aged program managed by the Alliance, as appropriate (See section IV). 5. Consumers applying for the Community Care for the Elderly (CCE) and/or Home Care for the Elderly (HCE) programs will be contacted and screened using the statewide assessment form developed by the Department of Elder Affairs for this purpose (Form 701A). If a consumer is being served through a DOEA-funded agency which enters their annual assessment into CIRTS, the Priority Score generated by that assessment will determine their ranking on the APCL. 6. Consumers referred for inclusion under the Assisted Living for the Elderly (ALE) Medicaid Waiver APCL will be interviewed and screened using the 701 A form. 7. Consumers referred for inclusion under the Aging and Disabled Adult (ADA) Medicaid Waiver APCL will be contacted and screened following the same procedure as the one described under Section 5. Individuals who appear as potentially eligible for other types of public assistance will be referred to the Economic Self - Sufficiency Unit at the Department of Children and Families. 8. All other referrals will be waitlisted and prioritized, during which time other community resources will be researched, including private pay/fee for services providers. Consumers on the waiting lists will be reassessed according to the 2011 Department of Elder Affairs Programs and Services Handbook, or any revisions made thereafter. B. t i forms will be sent to the consumerii ii Ir Contract Number KH 1272 0 Opening New Cases A. CCE1ADA/ALEIHCE Clients The Fiscal Department will monitor Lead Agency specific spending levels on a monthly basis to ensure each Lead Agency is operating within its spending authority. In addition, the fiscal department will analyze surplus/deficit projections, and share the information with the Lead Agency to assist in their determination of slot availability. The Lead Agency will request referrals directly from the ADRC. The Fiscal Department will be notified of the number of new cases being referred to the Lead Agency for activation. 2. Upon receipt of the request for referrals from the Lead Agency, the ADRC Intake Unit Supervisor will run the Prioritized Risk Report to identify the consumers on the APCL to be opened. 3. In response to the request for referrals, the ADRC Intake Unit Supervisor will refer wait listed clients to the Lead Agency for activation, in accordance with prioritization requirements. The Intake Unit will update the wait list enrollment using the appropriate code to terminate from the APCL. Upon receipt of referral, the Lead Agency will enter the APPL enrollment, and subsequent enrollments to reflect client status. B. APS Referrals APS Low and Intermediate Risk referrals will be screened and prioritized by the ADRC for services as per the DOEAIAPS Memorandum of Understanding. Low and Intermediate Risk referrals are also offered information and referral to additional community resources, including private pay as appropriate. 2. APS High Risk Referrals are not waitlisted. They are immediately referred for service from DCF in Monroe County to the Lead Agency. ARTT referrals will be forwarded directly the Lead Agency. APS cases are to be served for a maximum of 31 calendar days. If additional time is justified, the case management agency will staff the case with the Alliance to obtain the extension needed. 3. Upon receipt of the APS High Risk referral, the Lead Agency will coordinate services to begin within the 72 hour period mandated by statute. A comprehensive assessment will be done within 72 hours of the referral. Services required under the care plan will remain in place for a maximum of 31 days, unless an extension has been granted. 4. The Lead Agency will enter ACTV enrollment under their provider number in CIRTS. In addition, service codes will be entered by service date for all services provided. If a service(s) is not provided as required under the care plan, an NDP code will need to be entered in CIRTS and the case notes under the client file should document the reason for non -delivery of such service(s). A. All "Aging Out" consumers will be referred by DCF to the ADRC for enrollment into the corresponding .•-s program .•-• by Alliance. In, Contract Number KH 1272 Page 11 B. Consumers active in the CCDA and HCDA programs that are turning 60 and are eligible for CCE and/or HCE will be opened in the corresponding aged program managed by the Alliance if funding is available. if funding is available, these consumers will be made active. If funding is not available, they will be waitlisted for these programs but will be given priority for activation once funding is available. C. Consumers active in the ADA Medicaid Waiver, upon turning age 60, will continue to be eligible for and receive ADA Medicaid Waiver services. a Contract Number KH 1272 Page 12 ATTACHMENT IV CERTIFICATION REGARDING LOBBYING CERTIFICATION FOR CONTRACTS, GRANTS, LOANS AND AGREEMENTS The undersigned certifies, to the best of his or her knowledge and belief, that: (1)No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any state or federal agency, a member of congress, an officer or employee of congress, an employee of a member of congress, or an officer or employee of the 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, or an employee of a member of congress in connection with this federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. (3)The undersigned shall require that the language of this certification be included in the award documents for all sub -awards at all tiers (including subcontracts, sub -grants, and contracts under grants, loans and cooperative agreements) and that all subproviders 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 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000.00 and not more than $100,000.00 for each such failure. 6-20-2012 Signature Date _David Rice KH 1272 Name of Authorized Individual Application or Agreement Number Monroe County BOCC 1100 Simonton Street, Key West, FL 33040 Name and Address of Organization IN Contract Number KH 1272 Page 13 ATTACHMENT V FINANCIAL AND COMPLIANCE AUDIT The administration of resources awarded by the Alliance of Elder Affairs to the provider may- be subject to audits and/or monitoring by the Alliance of Elder Affairs, as described in this section. In addition to reviews of audits conducted in accordance with OMB Circular A-133, as revised, and Section 215.97, F.S., (see "AUDITS" below), monitoring procedures may include, but not be limited to, on -site visits by the Alliance 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 Alliance for Aging. In the event 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 Alliance to the provider regarding such audit. The provider further agrees to comply and cooperate with any inspections, reviews, investigations, or audits deemed necessary by any level of government. AUDITS PART I: FEDERALLY FUNDED This part is applicable if the provider is a State or local government or a non-profit organization as defined in OMB Circular A-133, as revised. In the event that the provider expends $500,000.00 or more in Federal awards during its fiscal year, the provider must have a single or program -specific audit conducted in accordance with the provisions of OMB Circular A- 133, as revised. EXHIBIT 1 to this agreement indicates Federal resources awarded through the Alliance of Elder Affairs 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 Alliance of Elder Affairs. 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. Iri connection with the audit requirements addressed in Part I, paragraph 1, the provider shall fulfill the requirements relative to auditee responsibilities as provided in Subpart C of OMB Circular A-133, as revised. If the provider expends less than $500,000.00 in Federal awards in its fiscal year, an audit conducted in accordance with the provisions of OMB Circular A-133, as revised, is not required. In the event that the provider expends less than 5500,000.00 in Federal awards in its fiscal vear and elects to have an audit conducted in accordance with the provisions of OMB Circular A-133, as revised, the cost of the audit must be paid from non - Federal resources (i.e., the cost of such audit must be paid from provider resources obtained from other than Federal entities.) An audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal year. Compliance findings related to agreements with the Alliance of Elder Affairs shall be based on the agreement's requirements, including anv rules, regulations, or statutes referenced in the agreement. 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 Alliance of Elder Affairs shall be fully disclosed in the audit report with reference to the Alliance of Elder Affairs agreement involved. If not otherwise disclosed as required by Section .310(b)(2) of OMB Circular A-133, as revised, the schedule of expenditures of Federal awards shall identify in Contract Number KH 1272 Page 14 expenditures by agreement number for each agreement with the Alliance of Elder Affairs in effect during the audit period. Financial reporting packages required under this part must be submits 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. As an Alliance requirement the Statement of Functional Expenses need to be part of the Financial and Compliance Audit Report. PART II: STATE FUNDED This part is applicable if the provider is a nonstate entity as defined by Section 215.97(2), Florida Statutes. In the event that the provider expends a total amount of state financial assistance equal to or in excess of $500,000.00 in any fiscal year of such provider (for fiscal years ending September 30, 2004 or thereafter), the provider must have a State single or project -specific audit for such fiscal year in accordance with Section 215.97, Florida Statutes; applicable rules of the Alliance of Financial Services; and Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and for -profit organizations), Rules of the Auditor General. EXHIBIT I to this agreement indicates state financial assistance awarded through the Alliance of Elder Affairs 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 Alliance of Elder Affairs, 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 requirements. In connection with the audit requirements addressed in Part lI, 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 $500,000.00 in state financial assistance in its fiscal year (for fiscal years ending September 30, 2004 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 $500,000.00 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 Alliance of Elder Affairs 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 Alliance of Elder Affairs shall be fully disclosed in the audit report with reference to the Alliance of Elder Affairs 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 Alliance of Elder Affairs in effect during the audit period. Financial reporting packages required under this part must be submitted within 45 days after delivery of the audit report, but no later than 12 months after the provider's fiscal year end for local governmental entities, Non-profit or for -profit organizations are required to be submitted within 45 days after delivery of the audit report, but no later than 9 months after the provider's fiscal year end. Notwithstanding the applicability of this portion, the Alliance of Elder W, Contract Number KH 1272 Page 15 Affairs retains all right and obligation to monitor and oversee the performance of this agreement as outlined throughout this document and pursuant to law. As an Alliance requirement the Statement of Functional Expenses need to be part of the Financial and Compliance Audit Report. PART III: REPORT SUBMISSION Copies of reporting packages for audits conducted in accordance with OMB Circular A-133, as revised, and required by PART I of this agreement shall be submitted, when required by Section .320 (d), OMB Circular A-133, as revised, by or on behalf of the provider directly to each of the following: The Alliance for Aging, Inc. at the following address: Alliance for Aging, Inc. Attn: Carlos Lahitte 760 NW 107th Ave. Suite 214 Miami, FL 33172-3155 IR Contract Number KH 1272 Page 16 ATTACHMENT V Providers who receive state or federal resources may or may not be subject to the audit requirements of OMB Circular A-133, as revised, and/or Section 215.97, 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 1 are met. 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 215.97, Fla. Stat. Regardless 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. In accordance with Sec. 210 of OMB Circular A-133 and/or Rule 691-5.006, FAC, provider has been determined to be: Vendor or exempt entity and not subject to OMB Circular A-133 and/ or Section 215.97, F.S. X Recipient/ subrecipient subject to OMB Circular A-133 and/or Section 215.97, F.S. NOTE: If a provider is determined to be a recipient /subrecipient of federal and or state financial assistance and has been approved by the Alliance 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-133 [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 225 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 130 Cost Principles for Non -Profit Organizations (Formerly OMB Circular A-122 - 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 GOVERNMEN-I) MUST FOLLOW: in Contract Number KH 1272 Page 17 2 CFR Part 220 Cost Principles for Educational Institutions OMB (Formerly Circular A-21 - Cost Principles)* 2 CFR Part 215 Administrative Requirements (Formerly OMB Circular A -I 10 - Administrative Requirements) o-i\,IB 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/ subrecipient, must comply with the following fiscal laws, rules and regulations: Section 215.97, Fla. Stat. Chapter 691-5, Fla. Admin. Code State Projects Compliance Supplement Reference Guide for State Expenditures Other fiscal requirements set forth in program laws, rules and regulations M Contract Number KH 1272 Page 18 ATTACHMENT VI CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE FOR AGREEMENTS, GRANTS, LOANS AND COOPERATIVE AGREEMENTS The undersigned, an authorized representative of the provider named in the contract or agreement to which this form is an attachment, hereby certifies that: (I)The provider and any sub -providers of services under this contract have financial management systems capable of providing certain information, including: (1) accurate, current, and complete disclosure of the financial results of each grant- funded project or program in accordance with the prescribed reporting requirements; (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 inability to process information in accordance with these requirements could result in a return of grant funds that have not been accounted for properly. (2)Management Information Systems used by the provider, sub-provider(s), or any outside entity on which the provider 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, provider(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 provider (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 provider 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 provider and any sub-provider(s) 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 provider shall require that the language of this certification be included in all subagreements, subgrants, and other agreements and that all sub -providers shall certify compliance accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by OMB Circulars A- 102 and 2 CFR Part 215 (formerly OMB Circular A-1 10). Monroe County BOCC, 1100 Simonton Street, Key West, FL 33040 Name and Address of Provider —,Mayor-_ 6-20-2012 Signature Title David Rice Name of Authorized Signer (Revised June 2008) '--'r-PEQRQ ZXUNT"('Arr R'E. 18 C -7" Contract Number KH 1272 Page 19 ATTACHMENT VII CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION FOR LOWER TIER COVERED TRANSACTIONS (I)The prospective provider certifies, by signing this certification, neither it nor its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal Alliance or agency. Where the prospective provider is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this certification. Signature Title 6-20-2012 Date Monroe County Board of County Commissioners Agency/Organization (Certification signature should be same as Contract signature.) Instructions for Certification Pl- ST AA I G L 6 cj Ch-� I.The terms "covered transaction," "debarred," "suspended," "ffieligible," "%VL��cover4e- 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 provider knowingly rendered an erroneous certification, in addition to other remedies available to the federal government, the Alliance may pursue available remedies, including suspension and/or debarment. 3.The provider will provide immediate written notice to the Contract Manager if at any time the provider learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. The provider 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 provider will include a "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transaction" in all its lower tier covered transactions and in all solicitations for lower tier covered transactions. 5.The provider agrees that it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, determined ineligible or voluntarily excluded from participation, unless otherwise authorized by the federal government. 6.If the provider knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the federal government, the Alliance may pursue available remedies, including suspension, and/or debarment. the provider may rely upon a certification of a prospective participant hi 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 erroneous. (Revised Tune 2(X)8) We Contract Number KH 1272 Page 20 ATTACHMENT VIII ASSURANCES —NON -CONSTRUCTION PROGRAMS Public repo tin burden for this collection information is estimated to average 45 minutes per r searching existing data sources, gathering and response, including for reviewing instructions, reviewing the collection of information. Send maintaining the Tattainneeded and completing and aspect of this collection of information, including comments re�garding the burden estimate or any other a suggestions for reducing this burden, to the Office of Management and Budget. Paperwork Reduction Pr9ject (0348 ), Washington, DC 20503. MPLEITD FORM TO THE OFFICE OF MANAGEMENT AND PLEASE Do NOT RETURN YOUR CO 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. 2.Will give the awarding agency, the Comptroller General of the United States, and if appropriate, the State, through any authorized representative, access to and the right to examine all records, books, papers, or documents related to the award; and will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives. 3.Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest, or personal gain. 4.Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency. 5.Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C.. 4728-4763) relating to prescribed standards for merit systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of 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. 88-352)'which prohibits discrimination on the basis of race, color or 685- national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C.. 1681-1683, and 1 X; Rehabilitation Act of 1973, as 1686), which prohibits discrimination on the basis of se, (c) Section 504 of the Reh 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 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation A523ct ofd 1970 an527 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g).identiality of of the Public Health Service Act of 1912 (42 U.S.C.. 290 dd-3 and 290 ee 3), as amended, relating to confi dentiality alcohol and drug abuse patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C.. 3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination provisions in the specific statute(s) under which application for Federal assistance is being made; and (j) the requirements of any other nondiscrimination statute(s) which may apply to the application. 7.Will comply, or has already complied, with the requirements of Titles 11 and III of the uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of persons displaced or whose property is acquired as a result of Federal or federally assisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of Federal participation in purchases. s Will comply, as applicable, with the provisions of the Hatch Act (3 U.S.C.- 1501-1508 and 7324-7328), which fin -lit the political 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..276a to 276a-7), the Copeland Act (40 U.S.C. 276c and 18 U.S.C. 874) and the Contract Work Hours and Safety Standards Act (40 U.S.C. 327-333), 20 Contract Number KH 1272 Page 21 regarding labor standards for federally assisted construction subagreements. 10.Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93-234) which requires recipients in a special flood hazard area to participate in the program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000.00 or more. II.Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved State management program developed under the Coastal Zone Management Act of 1972 (16 U.S.C.1451 et seq.); (f) conformity of Federal actions to State (Clear Air) Implementation Plans under Section 176(c) of the Clear Air Act of 1955, as amended (42 U.S.C..7401 et seq.); (g) protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as amended, (P.L. 93-523); and (h) protection of endangered species under the Endangered Species Act of 1973, as amended, (P.L. 93-205). 12 Will comply with the Wild and Scenic Rivers Act of 1968 components of the national wild and scenic rivers system. (16 U.S.C..1721 et seq.) related to protecting components or potential 13.Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as amended (16 U.S.C..470), EO 11593 (identification and protection of historic properties), and the Archaeological and Historic Preservation Act of 1974 (16 U.S.C..469a-I et seq.). 14.Will comply with P.L. 93-348 regarding the protection of human subjects involved in research, development, and related activities supported by this award of assistance. 15.Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.C..2131 et seq.) pertaining to the care, handling, and treatment of warm blooded animals held for research, teaching, or other activities supported by this award of assistance. 16.Will comply with the Lead -Based Paint Poisoning Prevention Act (42 U.S.C..4801 et seq.), which prohibits the use of lead- based paint in construction or rehabilitation of residence structures. 17.Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act Amendments of 1996 and OMB Circular No. A-133, Audits of States, Local Governments, and Non -Profit Organizations. 18.Will comply with all applicable requirements of all other Federal laws, executive orders, regulations and policies governing this program. T= Mayor AppucANT oRGA-NizAwN Monroe County Board of County DATE SUBMITTED 6-20-2012 Commissioners 1 p-T MOLAR (C 0 U %M� A PEDF� ASSISTANI 21 Contract Number KH 1272 Page 22 ATTACHMENT IX ALLIANCE / ELDER AFFAIRS CIVIL RIGHTS COMPLIANCE CHECKLIST Program/Facility Name H.C.E. Grant County Monroe Provider Monroe County BOCC Address 1100 Simonton Street Completed By Dotti Albury City, State, Zip Code Key Nest, FL 33040 Date 5-2212 Telephone 305-2924510 PART I. 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: The entire Florida Keys (Monroe County, approximately 120 miles) which are considered rural with some urban characteristics. Services MCIHS will provide with this grant are Basic and Special Subsidy. 2. POPULATION OF AREA SERVED. Source of data: Total# % White % Black % Hispanic % Other % Female 73,165 72.3)/0 5.7/u 19.6% 2.0% 46.60/o 3. STAFF CURRENTLY EMPLOYED. Effective date: 8-15-2011 Total# % White % Black % Hispanic % Other % Female % Disabled 20 70.(P/0 30.0)/0 1.0% 0.01/0 80.0% 00'% 4. CLIE 'TS CURRENTLY ENROLLED OR REGISTERED Effective date: 5-22-2012 Total# % White % Black % Hispanic % Other % Female % Disabled % Over 40 285 86.8% 1221% 16.0% 71.00/o 72% 100% 1000/0 5. ADVISORY OR GOVERNING BOARD, IF APPLICABLE. Total # % White % Black 0' Hispanic % Other % Female % Disabled 5 100.0/o 0.00 0 0.0 0 0.9)/o 60.0) o 0.0o PART IT. USE A SEPARATE SHEET OF PAPER FOR ANY EXPLANATIONS REQUIRING MORE SPACE 6. Is an Assurance of Compliance on file with the Alliance? If NA or NO explain NA ❑ YES M NO ❑ 7. Compare the staff composition to the population. Is staff representative of the population? If NA or NO, explain. NA ❑ YES rX NO El S.Compare the client composition to the population. Are race and sex characteristics representative of the Population? If NA or NO, explain. NA ❑ YES rX NO %..ontract INjumber r%r" 14, r-'OUW ALJ 9.Are eligibility requirements for services applied to clients and applicants without NAF] YES RX NO R I O.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. NAF-1 YES F-I NOZ All grants/progiams under the AAA that we provide services for are for people 60 and older. I I.For in -patient services, are room assignments made without regard to race, color, national origin or disability? If NA or NO, explain. NAMX YES ❑ NOF-1 We see and provide services to clients in their homes. 12.1s the program/ facility accessible to non-English speaking clients? If NA or NO, explain. NAE] YES rX -1 NOF-1 13. Are employees, applicants and participants informed of their protection against discrimination? If V'es, how? Verbal o Written o Poster o If NA or NO, explain. D 14. Give the number and current status of any discrimination complaints regarding services or employment filed against the program/facility. Zero 15. Is the prozram/facility physically accessible to mobility, hearing, and sight -impaired individuals? C If NA or 0, explain. M Contract Number KH 1272 Page 24 NAF-1 YES 0 No F-1 PART 111. THE FOLLOWING QUESTIONS APPLY TO PROGRAMS AND FACILITIES WITH 15 OR MORE EMPLOYEES D 0 16. Has a self -evaluation been conducted to identify any barriers to serving disabled individuals, and to make any necessary modifications? If NO, explain NAF-1 YES rX -1 NO 17. Is there and established grievance procedure that incorporates due process in the resolution of complaints? If NO, explain. NAE1 YES Z No El 18. Has a person been designated to coordinate Section 504 compliance activities? If NO, explain. NAF-] YES Z No El 19. Do recruitment and notification materials advise applicants, emqloyees and C participants of nondiscrimination on the basis of disability? If 0, explain. NAE] YES® No 0 19.Are auxiliary aids available to assure accessibility of services to hearing and sight impaired individuals? If NO, explain. NA [:] YES nX No 0 Contract Number KH 1272 Page 25 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. NAF-1 YES ZC NOF-1 DOEAUSE ONLY Reviewed By Incompliance: YES ❑ NO* Program Office *Notice of Corrective Action Sent Date Telephone Response Due On -Site n Desk Review n Response Received DOER Form 101-A, Revised May 2008 Page 2 of 2 ATTACHMENT IX INSTRUCTIONS FOR THE CIVIL RIGHTS COMPLIANCE CHECKLIST I.Describe the geographic service area such as a district, county, city or other locality. If the program/ 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 containing Florida population statistics. Include the source of your population statistics. ("Other" races include Asian/ Pacific Islanders and American Indian/ Alaskan Natives.) 3 Enter the total number of full-time staff and their percent by race, sex and disability. Include the effective date of your summary. 4.Enter the total number of clients who are enrolled, registered or currently served by the program or facility, and list their percent by race, sex and disability. Include the date that enrollment was counted. 5. Enter the total number of advisory board members and their percent by race, sex, and disability. If there is no advisory or governing board, leave this section blank. 6.Each recipient of federal financial assistance must have on file an assurance that the program will be conducted in compliance with all nondiscriminatory provisions as required in4,5 CFR 80. This is usually a standard part of the contract language for DOE recipients and their sub -grantees, 45 CFR 80.4 (a). W CONTRACT KH 1272 Page 26 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? 8.Where there is a significant variation between the race, sex or ethnic composition of the clients and their availability in the population, the program/facility has the responsibility to determine the reasons for such variation and take whatever action may be necessary to correct any discrimination. Some legitimate disparities may exist when 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 but were denied services or employment, 45 CFR 80.3 (a) and45CFR80.1 (b) (2). 1 O.Participants or clients must be provided services such as medical, nursing and dental care, laboratory services, physical and recreational therapies, counseling and social services without regard to race, sex, color, national origin, religion, age or disability. Courtesy titles, appointment scheduling and accuracy of record keeping must be applied uniformly and without regard to race, sex, color, national origin, religion, age or disability. Entrances, waiting rooms, reception areas, restrooms and other facilities must also be equally available to all clients, 45 CFR 80.3 (b). I I .For in -patient services, residents must be assigned to rooms, wards, etc., without regard to race, color, national origin or disability. Also, residents must not be asked whether they are willing to share accommodations with persons of a different race, color, national origin, or disability, 45 CFR 80.3 (a). 12.The program/facility and all services must be accessible to participants and applicants, including those persons who may not speak English. In geographic areas where a significant population of non- English speaking people live, program accessibility may include the employment of bilingual staff. In other areas, it is sufficient to have a policy or plan for service, such as a current list of names and telephone numbers of bilingual individuals who will assist in the provision of services, 45 CFR 80.3 (a). 13.Programs/facilities must make information regarding the nondiscriminatory provisions of Title VI available to their participants, beneficiaries or any other interested parties. This should include information on their right to file a complaint of discrimination with either the Florida Alliance of Elder Affairs or the U.S. Alliance of HHS. The information may be supplied verbally or in writing to every individual, or may be supplied through the use of an equal opportunity policy poster displayed in a public area of the facility, 45 CFR 80.6 (d). 14.Report number of discrimination complaints filed against the program/facility. Indicate the basis, e.g., race, color, creed, sex, age, national origin, disability, retaliation; the issues involved, e.g., services or employment, 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, under review, etc. 15.The program/facility must be physically accessible to disabled individuals. Physical accessibility includes designated parking areas, curb cuts or level approaches, ramps and adequate widths to entrances. The lobby, public telephone, restroom facilities, water fountains, information and admissions offices should be accessible. Door widths and traffic areas of administrative offices, cafeterias, restrooms, recreation areas, counters and serving Tines should m CONTRACT KH 1272 Page 27 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 identifv any accessibility barriers. Self -evaluation is a four step process: -With the assistance of a disabled individual/organization, evaluate current practices and policies which do not comply with Section 504. -Modify policies and practices that do not meet Section 504 requirements. -Take remedial steps to eliminate any discrimination that has been identified. -Maintain self -evaluation on file. (This checklist may be used to satisfy this requirement if these four steps have been followed.), 45 CFR 84.6. 17.Programs or facilities that employ 15 or more persons must adopt grievance procedures that incorporate appropriate due process standards and provide for the prompt and equitable resolution of complaints alleging any action prohibited by Section 504.45 CFR 84.7 (b). 18.Programs or facilities that employ 15 or more persons must designate at least one person to coordinate efforts to comply with Section 504.45 CFR 84.7 (a). 19.Continuing steps must be taken to notify employees and the public of the program/facility's policy of nondiscrimination on the basis of disability. This includes recruitment material, notices for hearings, newspaper ads, and other appropriate written communication, 45 CFR 84.8 (a). 20.Programs/facilities that employ 15 or more persons must provide appropriate auxiliary aids to persons with impaired sensory, manual or speaking skills where necessary. Auxiliary aids may include, but are not limited to, interpreters for hearing impaired individuals, taped or Braille materials, or any alternative resources that can be used to provide equally effective services, (45 CFR 84.52 (d). 21.Programs/facilities with 50 or more employees and $50,000 in federal contracts must develop, implement and maintain a written affirmative action compliance program in accordance with Executive Order 11246.41 CFR 60 and Title VI of the Civil Rights Act of 1964, as amended. M CONTRACT KH 1272 I L11 0 KCS so M I NI- Verification of Employment Status Certification As a condition of contracting with the Alliance for Aging, Inc., Monroe County Board of Commissioners, hereby referred to as contractor, certifies the use of the U.S. Department of Homeland Security's E-verify system to verify the employment eligibility of all new employees hired by Contractor during the contract term to perform employment duties pursuant to this Agreement and (b) that any subcontracts include an express requirement that subcontractors performing work or providing services pursuant to this Agreement utilize the E-verify system to verify the employment eligibility of all new employees hired by the subcontractor during the contract term. Signature (Same as contract signature) Title 6-20-2012 Date Monroe County Board of County Commissioners Company Name W CONTRACT KH 1272 Page 29 ATTACHMENT XI Alliance for Aging, Inc. Business Associate Agreement This Business Associate Agreement is dated , by the Alliance for Aging, Inc ("Covered Entity") and Monroe County Board of County Commissioners, ("Business Associate"), a not -far -profit Florida corporation. WMNNKEE3. . • 1.1 Covered Entity has entered into one or more contracts or agreements with Business Associate that involves the use of Protected Health Information (PHI). 1.2 Covered Entity, recognizes the requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and has indicated its intent to comply in the County's Policies and Procedures. 1.3 HIPAA regulations establish specific conditions on when and how covered entities may share information with contractors who perform functions for the Covered Entity. 1.4 HIPAA requires the Covered Entity and the Business Associate to enter into a contract or agreement containing specific requirements to protect the confidentiality and security of patients' PHI, as set forth in, but not limited to the Code of Federal Regulations (C.F.R.), specifically 45 C.F.R. §§ 164.502(e), 164.504(e), 164.308(b), and 164.314(a-b)(2010) (as may apply) and contained in this agreement. 1.5 The Health Information Technology for Economic and Clinical Health Act (2009), the American Recovery and Reinvestment Act (2009) and Part I — Improved Privacy Provisions and Security provisions located at 42 United States Code (U.S.C.) §§ 17931 and 17934 (2010) require business associates of covered entities to comply with the HIPAA Security Rule, as set forth in, but not limited to 45 C.F.R. §§ 164.308, 164.310, 164.312, and 164.316 (2009) and such sections shall apply to a business associate of a covered entity in the same manner that such sections apply to the covered entity. The parties therefore agree as follows: 2.0 Definitions. For purposes of this agreement, the following definitions apply: 2.1 Access. The ability or the means necessary to read, write, modify, or communicate data/information or otherwise use any system resource. 2.2 Administrative Safeguards. The administrative actions, and policies and procedures, to manage the selection, development, implementation, and maintenance of security measures to protect electronic Protected Health Information (ePHI) and to manage the conduct of the covered entity's workforce in relation to the protection of that information. 2.3 ARRA. The American Recovery and Reinvestment Act (2009) 2A Authentication. The corroboration that a person is the one claimed. 2.5 Availability. The property that data or information is accessible and useable upon demand by an authorized person. 2.6 Breach. The unauthorized acquisition, access, use, or disclosure of PHI which compromises the security or privacy of such information. 2.7 Compromises the Security. Posing a significant risk of financial, reputational, or other harm to individuals. W' CONTRACT KH 1272 Page 30 2.8 Confidentiality. The property that data orinformation kanot made available or disclosed bounauthorized persons orprocesses. 2.9 Electronic Protected Health !nfonnat|mn./ePHM Health information asspecified in45CFF{ §160.103(l)(i) or (1)(ii), limited to the information created or received by Business Associate from or on behalf of Covered Entity. 2.10 HITECH. The Health Information Technology for Economic and Clinical Health Act (2009) 2.11 Information System. An interconnected set ufinformation resources under the same direct management control that shares common functionality. Asystem normally includes hardware, software, information, data, applications, communications, and people. 2.12 Integrity. The property that data or information have not been altered or destroyed in an unauthorized manner. 2.13 Malicious software. Softwero, for example, a viruo, designed to damage urdisrupts a system. 2.14 Pnrti. Part I — Improved Privacy Provisions and Security provisions located at 42 United States Code (U.S.C.)§§17Q31 and 17Q34(2010). 2.15 Password. Confidential authentication information composed of a string of characters. 2.16 Physical Safeguards. The physical measures, policies, and procedures toprotect a covered entity's a|aotrunio information systems and related buildings and equipment, from natural and environmental hazardo, and unauthorized intrusion. 2.17 Privacy Rule. The Standards for Privacy of Individually Identifiable Health Information at 45 CFRPart 180and Part 104.subparts Aand E. 2.18 Protected Health Information. (PMi) Health information asdefined in45CFR §160.103. limited to the information created or received by Business Associate from or on behalf of Covered Entity. 2.19 Required By Law. Has the same meaning as the term "required by law" in 45 CFR § 164.103. 2�20 Secretary. The Secretary ofthe Department ufHealth and Human Services urhis orher designee. 2.21 Security incident. The attempted or successful unauthorized access, use, disclosure, modifimaUon, or destruction of information or interference with system operations in an information system. 2.22 Security or Security measures. All of the administrative, physical, and technical safeguards inaninformation system. 2.23 Security Rule. The Security Standards for the protection ofElectronic Protected Health Information a!45CFRpart 1G4.subpart C.and amendments thereto. Z24 Technical Safeguards. The technology and the policy and procedures for its use that protect electronic protected health information and control access toit. 2.25 Unsecured PHI, Protected health information that is not secured through the use of technology or methodology specified by the Secretary in guidance issued under 42 U.S.C. section 17932(h)(2)� 2,26 All other terms used, but not otherwise defined, in this Agreement shall have the same meaning amthose terms inthe Privacy Rule. 3,0. Obligations and Activities of Business Associate. ME CONTRACT KH 1272 3] Business Associate agrees to not use or disclose PHI other than as permitted or required by this agreement or as Required by Law. 32 Business Associate agrees to: (e) Implement policies and procedures tuprevent, detect, contain and correct Security violations inaccordance with 45CFR§1O4.306; (b) Prevent use or disclosure of the PHI other than as provided for by this Agreement or asrequired bylaw; (o) Reasonably and appropriately protect the ounfidentia|ity, integrity, and availability of the ePHI that the Business Associate creates, receives, maintains, or transmits on behalf of the Covered Entity; and (6) Comply with the Security Rule requirements including the Administrative Safeguards, Physical Safeguards, Technical Safeguards, and policies and procedures and documentation requirements set forth in45CFR §§1S4.308.1S4.310.184.312.and 1S4.31S. 3.3 Business Associate agrees to mitigata, to the extent praotioab|e, any harmful effect that is known to Business Associate of a use or disclosure of PHI by Business Associate in violation of the requirements of this Agreement. 3.4 Business Associate agrees to promptly report to Covered Entity any use or disclosure of the PHI not provided for by this Agreement of which it becomes aware. This includes any requests for inspection, copying or amendment of such information and including any security incident involving PHI. 3.5 Business Associate agrees to notify Covered Entity without unreasonable delay of any security breach pertaining to: (a) Identification of any individual whose unsecured PHI has been, or is reasonably believed by the Business Associate to have been, accessed, acquired, or disclosed during such security breach; and (b) All information required for the Notice to the Secretary ofH/f3ofBreach of Unsecured Protected Health Information. 3.6 Business Associate agrees to ensure that any agent, including a subcontractor, to whom it provides PHI received from, or created or received by Business Associate on behalf of Covered Entity, agrees to the same restrictions and conditions that apply through this Agreement to Business Associate with respect tosuch information. 37 IfBusiness Associate has PHI inaDesignated Record Set: (o) Business Associate agrees hoprovide access, atthe request ofCovered Entity during regular business hours, to PHI in a Designated Record Set, to Covered Entity or, as directed by Covered Entity, to an individual in order to meet the requirements under 45 CFR §164.524; and (b) Business Associate agrees tomake any amendmmnt(s)toPHI inoDesignated Record Set that the Covered Entity directs or agrees to pursuant to 45 CFR § 164.526 at the request of Covered Entity or an Individual within 10 business days of receiving the request. 3.9 Business Associate agrees to document such disclosures of PHI and information related t* such disclosures as would be required for Covered Entity to respond to a request by an individual for an accounting of disclosures of PHI in accordance with 45 CFR § 164.528, M CO� ��e 32 Page �� ���� 310 Business Associate agrees toprovide 0oCovered E"� uronindividual, upon request, information collected to permit C overed Entity to respond to a request by an Individual for an accounting«f 4GCFR�104528�ndAR�AG134U4. d�au|oeur�sofPH\in�uonrdanoevv with , � _ 3.11 Business Associate specifically agrees touse security measures thatreaaonaby and appropriately protect the confidentiality, \nhagrih/'and availability ofPHI in electronic orany other form, tha t it oreateo, repe\vao, maintains, or transmits on behalf of the Covered Entity. 3-12 Business Associate agrees tuimplement security measures t»secure passwords used to ma\nta\»s.ortransmits espo�ofthis Agreement hnmmalicious software and acueae*pH\thatitooceaeeo' \ erabi|itiestomsnurotheovaUobUity. integrity, and confidentiality ufsuch other man-made and natural vu \nformatiom 313 BueinonsAosooiedoagro*stoimp)ementsoouritymoaouroob�aafeguardePH\�h�t�adaand � �� mhoaopadofthis agroementfrom malicious software =and .._n — a««eonae'mai»taino'»r »sradn*avaUobU�yn-mintagr�y.andoun�den�ia|�yofouoU/r�urmarm � notuna\vu|nenabUiUao�oaosu . 314 8uoinassAsouoimtoagr000tnonmp(ywith: � )� (a) A[�RA§13404(Application ofKnowledge BamentoAssociated with Cuntracts'. (b) ARRA § 13405 (Restrictions on Certain Disclosures and Sales of Health Information); and (o) ARRA § 13406 (Conditions on Certain Contacts as Part of Health Care Operations). 40 �amm|ttedUsasan�D)so\�sunaub�BusinmssAesoobte. Except aouthenw�oUmdodinform . . related BuoinooeAaaooia�/moyusou/u/�^","^. ..t_,-��hCuverad dhk�Agraam*r�»rany b*ha�u�'--'redEndtyaoopeo�edinany and aocu/wu«s�" En0tyur�h* activities, »","'|dnutvinlate the phvaoyRule �done UYL�«»*nn« Endtyprovided that such use ordisclosure vvouth (�ovar*dEn�ity minimum necessary policies and procedures (f e . 5.0 Specific Use and Disclosure Provisions. tBusiness Associate 51 Except aauthamv\selimited inthis agreement orany related agraamon. may use 'H|for the proper management and administradonufthe Business Associate " rtucarry out the ' responsibilities of |mga|roopons ent! Business Associate ouoia te 52 Except aaotherwise limited in this agreement «rany related aQraam may disclose PHI for the proper management and administration of the Business Associate, provided that eRa�uirad�YLa�.nrBuoineseAssociate btainoreasonable assurances from the person to d)ao|usuraear��na\ondueedurfu�herdioo|ooedon\Yao »homtheinfVrmadoniadio«|«oedthatitwi||remam««neperson notifies the purposefor which itwas disclosed tthe person, ondth Required ByLaw orfor the stances ofwhich \\isaware lnwhich the confidentiality ofthe information has Business Associate nfany in been breached. �so�\ he ayuse PHI toprovide data aggregation services tuCove red Endtyau 5.3 Business )' only when spec�\caUyauthorized byCovered EnUh/� permi0edby45CFR§184.5O4( )(2)(i)(B r\ateFederal and State 54 BusinessAe000iabamayusePH\torepn�vio\ationsof\ovvtoapprop � authorities, oonsa i tentvvith45CFR§104.5O2(j)(1)� 60 Obligations ofCovered Entity. Aaaoc)m�eofany|)mitot\on(a)\nitsnoh«e»fpr\»auy 61 CoveredEni\h/sha\|n»tifyBus\nesa ' tothe exte nt that such limitation may affect practices ofCovered Entity \naccordance with 45CFR§164.52U Business Associate's use urdisclosure ofPHI, byPro»\dinA ocopy ufthe most current Notice ofPrivacy esAssooi��ea�AdaohmentX|hath\mAgreement� Future Notices and/or pract\ces(NPp)toBusine� modUioedionsbmtheNPPshaUbepoahagonCoveredEndt/svebsea CONTRACTKH 1272 Page 33 62 Covered Entity shall notify Business Associate of any restriction to the use or disclosure of PHI that Covered Entity has agreed to in accordance with 45 CFR § 164.522, to the extent that such restriction may affect Business Associate's use ordisclosure nfPHI. 7.0 Permissible Requests byCovered Entity. Except for data aggregation ormanagement and administrative activities of Business Associate, Covered Entity shall not request Business Associate to use or disclose PHI in any manner that would not be permissible under the Privacy Rule ifdone byCovered Entity. 8.0 Effective Date and Termination. 81 The Parties hereby agree that this agreement amends, restates and replaces any other Business Associate Agreement currently in effect between Covered Entity and Business Associate and that the provisions ufthis agreement shall beeffective aofollows: (a) These Business Associate Agreement provisions, with the exception of the electronic security provisions and the provisions mandated by ARRA, HITECH and Part I shall be effective upon the later ofApril 14. 2003. orthe effective date ofthe earliest contract entered into between Business Associate and Covered Entity that involves the use ofPHI; (b) The electronic security provisions hereof shall be effective the later of April 21, 2005 or the effective date of the earliest contract entered into between Business Associate and Covered Entity that involves the use ofPHI; and (o) Provisions hereof mandated by ARRA, HITECH and/or Part I shall be effective the later ufFebruary 17. 2010 orthe effective date ofthe earliest contract entered into between covered entity and business associate that involves the use ufPHI oraPH|. 8.2 Termination for Cause. Upon Covered Entity's knowledge nfamaterial breach byBusiness Associate, Covered Entity shall either: (a) Provide an opportunity for Business Associate to cure the breach or end the violation and terminate this agreement if Business Associate does not cure the breach or end the violation within the time specified byCovered Entity; (b) Immediately terminate this agreement if Business Associate has breached a material term ofthis Agreement and cure is not possible; or (o) |fneither termination nor cure is feasible, Covered Entity shall report the violation to the Secretary. 8.3 Effect of Termination. Except as provided in subparagraph (b) of this soction, upon termination of this agreement, for any reason, Business Associate shall return all PHI and ePHI received from Covered Entity, or created or received by Business Associate on behalf of Covered Entity. (o) This provision shall apply to PHI and ePHI that is in the possession of subcontractors oragents ofBusiness Associate. Business Associate shall retain nocopies ofthe PHI and ePH|. (b) In the event that Business Associate or Covered Entity determines that returning the PHI or ePHI is infeasible, notification of the conditions that make return of PHI or ePHI infeasible shall be provided tothe other party. Business Associate shall extend the protections ofthis Agreement tosuch retained PHI and ePHI and limit further uses and disclosures of such retained PHI and ePHI, for a minimum of six years and so long as Business Associate maintains such PHI and ePHI, but no less than six (6) years after the termination ofthis agreement. 9,0 Regulatory References. Areferenoe in this agreement tnu section in the Privacy Rule or Security Rule means the section then in effect or as may be amended in the future, 1O�D Amendment. The Parties agree totake such action asisnecessary toamend this agreement from time to time as is necessary for Covered Entity to comply with the requirements of the CONTRACT KH 1272 Page 34 Privacy Rule, the Security Rule and the Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191. 11.0 Survival. Any term, condition, covenant or obligation which requires performance by either party hereto subsequent to the termination of this agreement shall remain enforceable against such party subsequent to such termination. 12.0 Interpretation. Any ambiguity in this agreement shall be resolved to permit Covered Entity to comply with the Privacy Rule and Security Rule. 13.0 Incorporation by reference. Any future new requirement(s), changes or deletion(s) enacted in federal law which create new or different obligations with respect to HIPAA privacy and/or security, shall be automatically incorporated by reference to this Business Associate Agreement on the respective effective date(s). 14.0 Notices. All notices and communications required, necessary or desired to be given pursuant to this agreement, including a change of address for purposes of such notices and communications, shall be in writing and delivered personally to the other party or sent by express 24-hour guaranteed courier or delivery service, or by certified mail of the United States Postal Service, postage prepaid and return receipt requested, addressed to the other party as follows (or to such other place as any party may by notice to the others specify): To Covered Entity: Alliance for Aging, Inc. Attention: Max Rothman 760 NW 107 Avenue Miami, Florida 33172 To Business Associate: Monroe County Board of County Commissioners Social Services/In-Home Services Program 1100 Simonton Street, Key West, FL 33040 Any such notice shall be deemed delivered upon actual receipt. If any notice cannot be delivered or delivery thereof is refused, delivery will be deemed to have occurred on the date such delivery was attempted. 15.0 Governing Law. The laws of the State of Florida, without giving effect to principles of conflict of laws, govern all matters arising under this agreement. 16.0 Severability. If any provision in this agreement is unenforceable to any extent, the remainder of this agreement, or application of that provision to any persons or circumstances other than those as to which it is held unenforceable, will not be affected by that unenforceability and will be enforceable to the fullest extent permitted by law. 17.0 Successors. Any successor to Business Associate (whether by direct or indirect or by purchase, merger, consolidation, or otherwise) is required to assume Business Associate's obligations under this agreement and agree to perform them in the same manner and to the same extent that Business Associate would have been required to if that succession had not taken place. This assumption by the successor of the Business Associate's obligations shall be by written agreement satisfactory to Covered Entity. 1 &0 Entire Agreement. This agreement constitutes the entire agreement of the parties relat' to the subject matter of this agreement and supersedes all other oral or written agreements or poli lati g thereto, except that this agreement does not limit the amendment of this agreement in accordance i section 10.0 of this agreement. Covered Entity: • to z Date: cc P Business Associate: Monroe County Board of County Commissioners D in 34CD