06/18/2003 Contract
Clerk ollbe
Circul coun
Danny L. Kolhage
Clerk of the Circuit Court
Phone: (305) 292-3550
FAX: (305) 295-3663
e-mail: phancock@monroe-clerk.com
Memnranlium
TO:
Louis Latorre, Director
Social Services Division
ATTN:
Dotti Albury
FROM:
Pamela G. Hanco~Ziv
Deputy Clerk \._Y
DATE:
June 24, 2003
At the June 18,2003, Board of County Commissioner's meeting the Board granted approval and
authorized execution of the following:
Home Care for the Elderly (HCE) Contract KH372 between the Alliance for Aging, Inc., and
Monroe County Social Services/In-Home Services Program for fiscal year July 1, 2003 through June 30,
2004.
Alzheimer's Disease Initiative (AD!) Contract KZ397 between the Alliance for Aging, Inc. and
Monroe County Social Services/In-Home Services Program for fiscal year July 1,2003 through June 30,
2004.
Community Care for the Elderly (CCE) Contract KC371 between the Alliance for Aging, Inc. and
Monroe County Social Services/In-Home Services Program for fiscal year July 1, 2003 through June 30,
2004.
/' Community Care for Disabled Adults (CCDA) Contract KG047 between the State of Florida,
Department of Children & Families and Monroe County Social Services/In-Home Services Program for
fiscal year July 1, 2003 through June 30, 2004.
Enclosed are four duplicate originals of each of the above-mentioned, executed on behalf of
Monroe County, for your handling. Please be sure that the fully executed "Monroe County Clerk's
Originals" and the "Monroe County Finance Department's Originals" are returned to our office as
soon as possible. Should you have any questions please do not hesitate to contact this office.
cc: County Administrator wlo documents
Finance wlo documents
County Attorney
File /
O,~~rY Ao~!!~~E
(305) 294-4641
BOARD OF COUNTY COMMISSIONERS
MAYOR Dixie Spehar, District 1
Mayor Pro Tern Murray E. Nelson, District 5
George Neugent, District 2
Charles "Sonny" McCoy, District 3
David P. Rice, District 4
r~..... -..---.-
MEMORANDUM
Belle DeSantis and/ or Pam Hancock, Monroe County Clerk's Office
Dotti Albury, Administrative Assistant, In-Home Services Program ~
7/7/2003
TO:
FROM:
DATE:
RE:
CCD A Contract
At the January 18, 2003, Board of County Commissioner's meeting the Board granted approval and authorized
execution of Contract #KG047 between the Florida Department of Children and Families and Monroe County
Board of Commissioners (Social Services/In-Home Services Program).
This document was received back today July 7, 2003 from the Department of Children and Families fully
executed. Please see enclosed the Clerk's Office Original and the Finance Division's Original.
Thank you both for all your help. If you have any questions please call me at 292-4583.
Enclosures
Monroe County Clerk's Offj-- Original
04/10/03
CFDA No.
FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES
STANDARD CONTRACT
Client I:8J Non-Client 0
Multi-District 0
THIS CONTRACT is entered into between the Florida Department of Children and Families, hereinafter. referred to as the
"department," and Monroe County (Monroe County In Home Services), hereinafter referred to as the "provider."
I. THE PROVIDER AGREES:
A. Contract Document
To provide services in accordance with the terms and conditions specified in this contract including all attachments and exhibits, which
constitute the contract document.
B. Requirements of Section 287.058 F.S.
To provide units of deliverables, including reports, findings, and drafts, as specified in this contract, which must be received and
accepted by the contract manager in writing prior to payment. To submit bills for fees or other compensation for services or expenses
in sufficient detail for a proper pre-audit and post-audit. Where itemized payment for travel expenses are permitted in this contract, to
submit bills for any travel expenses in accordance with section 112,061, F.S. or at such lower rates as may be provided in this
contract. To allow public access to all documents, papers, letters, or other public records as defined in subsection 119.011 (1), F.S"
made or received by the provider in conjunction with this contract except that public records which are made confidential by law must
be protected from disclosure. It is expressly understood that the provider's failure to comply with this provision shall constitute an
immediate breach of contract for which the department may unilaterally terminate the contract.
C. Governing Law
1. State of Florida Law
That this contract is executed and entered into in the State of Florida, and shall be construed, performed and enforced in all respects
in accordance with the Florida law including Florida provisions for conflict of laws.
2. Federal Law
a, That if this contract contains federal funds the provider shall comply with the provisions of 45 CFR, Part 74, and/or 45 CFR,
Part 92, and other applicable regulations.
b. That if this contract contains federal funds and is over $100,000, the provider shall comply with all applicable standards,
orders, or regulations issued under section 306 of the Clean Air Act, as amended (42 U.S.C. 7401 et seq,), section 508 of the Federal
Water Pollution Control Act as amended (33 U.S.C. 1251 et seq.), Executive Order 11738 as amended and where applicable, and
Environmental Protection Agency regulations (40 CFR, Part 30). The provider shall report any violations of the above to the
department.
c. That no federal funds received in connection with this contract may be used by the provider, or agent acting for the provider,
to influence legislation or appropriations pending before the Congress or any State legislature. If this contract contains federal funding
in excess of $100,000, the provider must, prior to contract execution, complete the Certification Regarding Lobbying form, Attachment
N/A. If a Disclosure of Lobbying Activities form, Standard Form LLL, is required, it may be obtained from the contract manager, All
disclosure forms as required by the Certification Regarding Lobbying form must be completed and returned to the contract manager,
prior to payment under this contract.
d. That unauthorized aliens shall not be employed. The department shall consider the employment of unauthorized aliens a
violation of section 274A(e) of the Immigration and Nationality Act (8 U.S.C. 1324 a). Such violation shall be cause for unilateral
cancellation of this contract by the department.
e. That if this contract contains $10,000 or more of federal funds, the provider shall comply with Executive Order 11246, Equal
Employment Opportunity, as amended by Executive Order 11375 and others, and as supplemented in Department of Labor regulation
41 CFR, Part 60 and 45 CFR, Part 92, if applicable,
f. That if this contract contains federal funds and provides services to children up to age 18, the provider shall comply with the
Pro-Children Act of 1994 (20 U.S.C. 6081). Failure to comply with the provisions of the law may result in the imposition of a civil
monetary penalty of up to $1,000 for each violation and/or the imposition of an administrative compliance order on the responsible
entity. This clause is applicable to all subcontracts.
D. Audits, Inspections, Investigations, Records and Retention
1. To establish and maintain books, records and documents (including electronic storage media) sufficient to reflect all income
and expenditures of funds provided by the department under this contract.
2. To retain all client records, financial records, supporting documents, statistical records, and any other documents (including
electronic storage media) pertinent to this contract for a period of six (6) years after completion of the contract, or if an audit has been
initiated and audit findings have not been resolved at the end of six (6) years, the records shall be retained until resolution of the audit
CONTRACT # KG047
04/10/03
findings or any litigation which may be based on the terms of this contract, at no additional cost to the department.
3, Upon demand, at no additional cost to the department, the provider will facilitate the duplication and transfer of any records or
documents during the required retention period in Subsection I, Paragraph 0,2.
4, To assure that these records shall be subject at all reasonable times to inspection, review, copying, or audit by Federal, State,
or other personnel duly authorized by the department.
5. At all reasonable times for as long as records are maintained, persons duly authorized by the department and Federal auditors,
pursuant to 45 CFR, Section 92.36(i) (10), shall be allowed full access to and the right to examine any of the provider's contracts and
related records and documents, regardless of the form in which kept.
6. To provide a financial and compliance audit to the department as specified in this contract and in Attachment l.! and to ensure
that all related party transactions are disclosed to the auditor.
7. To comply and cooperate immediately with any inspections, reviews, investigations, or audits deemed necessary by the office
of The Inspector General (Section 20,055, Florida Statutes).
8. To include the aforementioned audit, inspections, investigations and record keeping requirements in all subcontracts and
assignments,
E. Monitoring by the Department
To permit persons duly authorized by the department to inspect and copy any records, papers, documents, facilities, goods and
services of the provider which are relevant to this contract, and to interview any clients, employees and subcontractor employees of
the provider to assure the department of the satisfactory performance of the terms and conditions of this contract. Following such
review, the department will deliver to the provider a written report of its findings and request for development, by the provider of a
corrective action plan where appropriate. The provider hereby agrees to timely correct all deficiencies identified in the corrective
action plan,
F. Indemnification
NOTE: Except to the extent permitted by s.768.28, F.S., or other applicable Florida Law, Paragraph I.F.1. and 2. are not applicable to
contracts executed between state agencies or subdivisions, as defined in subsection 768.28(2), F.S.
1. To be liable for and indemnify, defend, and hold the department and all of its officers, agents, and employees harmless from all
claims, suits, judgments, or damages, including attorneys' fees and costs, arising out of any act, actions, neglect, or omissions by the
provider, its agents, or employees during the performance or operation of this contract or any subsequent modifications thereof.
2. That its inability to evaluate its liability or its evaluation of liability shall not excuse the provider's duty to defend and to indemnify
within seven (7) days after notice by the department by certified mail. After the highest appeal taken is exhausted, only an adjudication
or judgment specifically finding the provider not liable shall excuse performance of this provision. The provider shall pay all costs and
fees including attorneys' fees related to these obligations and their enforcement by the department. The department's failure to notify
the provider of a claim shall not release the provider from these duties. The provider shall not be liable for the sole negligent acts of
the department,
G. Insurance
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 provider
accepts full responsibility for identifying and determining the type(s) and extent of liability insurance necessary to provide reasonable
financial protections for the provider and the clients to be served under this contract. Upon the execution of this contract, the provider
shall furnish the department written verification supporting both the determination and existence of such insurance coverage, Such
coverage may be provided by a self-insurance program established and operating under the laws of the State of Florida, The
department reserves the right to require additional insurance as specified in this contract.
H. Confidentiality of Client Information
Not to use or disclose any information concerning a recipient of services under this contract for any purpose prohibited by state or
federal law or regulations (except with the written consent of a person legally authorized to give that consent or when authorized by
law),
I. Assignments and Subcontracts
1. To neither assign the responsibility for this contract to another party nor subcontract for any of the work contemplated under
this contract without prior written approval of the department which shall not be unreasonably withheld. Any sublicense, assignment,
or transfer otherwise occurring without prior approval of the department shall be null and void,
2, To be responsible for all work performed and for all commodities produced pursuant to this contract whether actually furnished
by the provider or its subcontractors, Any subcontracts shall be evidenced by a written document. The provider further agrees that
the department shall not be liable to the subcontractor in any way or for any reason, The provider, at its expense. will defend the
department against such claims,
3. To make payments to any subcontractor within seven (7) working days after receipt of full or partial payments from the
department in accordance with section 287.0585, F.S., unless otherwise stated in the contract between the provider and
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CONTRACT # KG047
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subcontractor. Failure to pay within seven (7) working days will result in a penalty that shall be charged against the provider and paid
to the subcontractor in the amount of one-half of one percent (.005) of the amount due per day from the expiration of the period
allowed for payment. Such penalty shall be in addition to actual payments owed and shall not exceed fifteen (15%) percent of the
outstanding balance due.
4. That the State of Florida shall at all times be entitled to assign or transfer its rights, duties, or obligations under this contract to
another governmental agency in the State of Florida, upon giving prior written notice to the provider. In the event the State of Florida
approves transfer of the provider's obligations, the provider remains responsible for all work performed and all expenses incurred in
connection with the contract. This contract shall remain binding upon the successors in interest of either the provider or the
department.
J. Return of Funds
To return to the department any overpayments due to unearned funds or funds disallowed pursuant to the terms and conditions of this
contract that were disbursed to the provider by the department. In the event that the provider or its independent auditor discovers that
an overpayment has been made, the provider shall repay said overpayment immediately without prior notification from the department.
In the event that the department first discovers an overpayment has been made, the contract manager, on behalf of the department,
will notify the provider by letter of such findings. Should repayment not be made forthwith, the provider will be charged at the lawful
rate of interest on the outstanding balance after department notification or provider discovery.
K. Client Risk Prevention and Incident Reporting
1, That if services to clients are to be provided under this contract, the provider and any subcontractors shall, in accordance with
the client risk prevention system, report those reportable situations listed in CFOP 215-6 in the manner prescribed in CFOP 215-6 or
district operating procedures.
2. To immediately report knowledge or reasonable suspicion of abuse, neglect, or exploitation of a child, aged person, or disabled
adult to the Florida Abuse Hotline on the statewide toll-free telephone number (1-800-96A8USE). As required by Chapters 39 and
415, F,S" this provision is binding upon both the provider and its employees.
L. Purchasing
1. To purchase articles which are the subject of or are required to carry out this contract from Prison Rehabilitative Industries and
Diversified Enterprises, Inc., (PRIDE) identified under Chapter 946, F.S" in the same manner and under the procedures set forth in
subsections 946,515(2) and (4), F .S. For purposes of this contract, the provider shall be deemed to be substituted for the department
insofar as dealings with PRIDE. This clause is not applicable to subcontractors unless otherwise required by law. An
abbreviated list of products/services available from PRIDE may be obtained by contacting PRIDE, (850) 487-3774,
2. To procure any recycled products or materials, which are the subject of or are required to carry out this contract, in accordance
with the provisions of sections 403.7065, and 287,045, F.S.
M. Civil Rights Requirements
1, Not to discriminate against any employee in the performance of this contract or against any applicant for employment because
of age, race, religion, color, disability, national origin, marital status or sex. The provider further assures that all contractors,
subcontractors, subgrantees, or others with whom it arranges to provide services or benefits to participants or employees in
conneCtion with any of its programs and activities are not discriminating against those participants or employees because of age, race,
religion, color, disability, national origin, marital status or sex, This is binding upon the provider employing fifteen (15) or more
individuals,
2. To complete the Civil Rights Compliance Questionnaire, CF Forms 946 A and 8, in accordance with CFOP 60-16, This is
binding upon providers that have fifteen (15) or more employees,
N. Independent Capacity of the Contractor
1 To act in the capacity of an independent contractor and not as an officer, employee of the State of Florida, except where the
provider is a state agency. Neither the provider nor its agents, employees, subcontractors or assignees shall represent to others that it
has the authority to bind the department unless specifically authorized in writing to do so,
2 This contract does not create any right to state retirement, leave benefits or any other benefits of state employees as a result of
performing the duties or obligations of this contract,
3 To take such actions as may be necessary to ensure that each subcontractor of the provider will be deemed to be an
independent contractor and will not be considered or permitted to be an agent, servant, joint venturer, or partner of the State of Florida,
4, The department will not furnish services of support (e,g., office space, office supplies, telephone service, secretarial or clerical
support) to the provider, or its subcontractor or assignee, unless specifically agreed to by the department in this contract.
5. All deductions for social security, withholding taxes, income taxes, contributions to unemployment compensation funds and all
necessary insurance for the provider, the provider's officers, employees, agents, subcontractors, or assignees shall be the sole
responsibility of the provider.
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O. Sponsorship
As required by section 286.25, F.S., if the provider is a non-governmental organization which sponsors a program financed wholly or in
part by state funds, including any funds obtained through this contract, it shall, in publicizing, advertising, or describing the sponsorship
of the program, state: "Sponsored by (provider's name) and the State of Florida, Department of Children and Families," If the
sponsorship reference is in written material, the words "State of Florida, Department of Children and Families" shall appear in the
same size letters or type as the name of the organization.
P. Publicity
Without limitation, the provider and its employees, agents, and representatives will not, without prior departmental written consent in
each instance, use in advertising, publicity or any other promotional endeavor any State mark, the name of the State's mark, the name
of the State or any State affiliate or any officer or employee of the State, or represent, directly or indirectly, that any product or service
provided by the provider has been approved or endorsed by the State, or refer to the existence of this contract in press releases,
advertising or materials distributed to the provider's prospective customers.
Q. Finallnvoice
To submit the final invoice for payment to the department no more than 45 days after the contract ends or is terminated, If the provider
fails to do so, all rights to payment are forfeited and the department will not honor any requests submitted after the aforesaid time
period Any payment due under the terms of this contract may be withheld until all reports due from the provider and necessary
adjustments thereto have been approved by the department.
R. Use of Funds for Lobbying Prohibited
To comply with the provisions of sections 11.062 and 216.347, F .S., which prohibit the expenditure of contract funds for the purpose of
lobbying the Legislature, judicial branch, or a state agency.
S. Public Entity Crime
Pursuant to section 287.133, F.S., the following restrictions are placed on the ability of persons convicted of public entity crimes to
transact business with the department: When a person or affiliate has been placed on the convicted vendor list following a conviction
for a public entity crime, he/she may not submit a bid on a contract to provide any goods or services to a public entity, may not submit
a bid on a contract with a public entity for the construction or the repair of a public building or public work, may not submit bids on
leases of real property to a public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant
under a contract with any public entity, and may not transact business with any public entity in excess of the threshold amount
provided in section 287,017, F.S., for CATEGORY TWO for a period of thirty-six (36) months from the date of being placed on the
convicted vendor list.
T. Patents, Copyrights, and Royalties
1. If any discovery or invention arises or is developed in the course of or as a result of work or services performed under this
contract, or in anyway connected herewith, the provider shall refer the discovery or invention to the department to be referred to the
Department of State to determine whether patent protection will be sought in the name of the State of Florida, Any and all patent rights
accruing under or in connection with the performance of this contract are hereby reserved to the State of Florida,
2. In the event that any books, manuals, films, or other copyrightable materials are produced, the provider shall notify the
Department of State, Any and all copyrights accruing under or in connection with performance under this contract are hereby reserved
to the State of Florida.
3. The provider, if not a state agency, shall indemnify and save the department and its employees harmless from any liability
whatsoever, including costs and expenses, arising out of any copyrighted, patented, or unpatented invention, process, or article
manufactured or used by the provider in the performance of this contract.
4. The department will provide prompt written notification of any claim of copyright or patent infringement. Further, if such claim is
made or is pending, the provider may, at its option and expense, procure for the department, the right to continue use of, replace, or
modify the article to render it non-infringing, If the provider uses any design, device, or materials covered by letters, patent, or
copyright, it is mutually agreed and understood without exception that the compensation paid pursuant to this contract includes all
royalties or costs arising from the use of such design, device, or materials in any way involved in the work contemplated by this
contract.
U. Construction or Renovation of Facilities Using State Funds
That any state funds provided for the purchase of or improvements to real property are contingent upon the provider granting to the
state a security interest in the property at least to the amount of the state funds provided for at least five (5) years from the date of
purchase or the completion of the improvements or as further required by law, As a condition of receipt of state funding for this
purpose, the provider agrees that, if it disposes of the property before the department's interest is vacated, the provider will refund the
proportionate share of the state's initial investment, as adjusted by depreciation.
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V. Information Security Obligations
1, To identify an appropriately skilled individual to function as its Data Security Officer who shall act as the liaison to the
department's Security Staft and who will maintain an appropriate level of data security for the information the provider is collecting or
using in the performance of this contract. An appropriate level of security includes approving and tracking all provider employees that
request system or information access and ensuring that user access has been removed from all terminated provider employees,
2. To hold the department harmless from any loss or damage incurred by the department as a result of information technology
used, provided or accessed by the provider.
3. To furnish Security Awareness Training to its staft,
4, To ensure that all provider employees who have access to departmental information are provided a copy of CFOP 50-6 and
that they sign the DCF Security Agreement form (CF 114), a copy of which may be obtained from the contract manager,
W. Accreditation
That the department is committed to ensuring provision of the highest quality services to the persons we serve. Accordingly, the
department has expectations that where accreditation is generally accepted nationwide as a clear indicator of quality service, the
majority of our providers will either be accredited, have a plan to meet national accreditation standards, or will initiate one within a
reasonable period of time,
X. Agency for Workforce Innovation and Workforce Florida
That it understands that the department, the Agency for Workforce Innovation, and Workforce Florida, Inc. have jointly implemented an
initiative to empower recipients in the Temporary Assistance to Needy Families Program to enter and remain in gainful employment.
The department encourages provider participation with the Agency for Workforce Innovation and Workforce Florida,
Y. Health Insurance Portability and Accountability Act
Where applicable, to comply with the Health Insurance Portability and Accountability Act (42 U. S, Section 210 et seq) as well as all
regulations promulgated thereunder (45 CFR Parts 160, 162, and 164),
Z. Emergency Preparedness
If the tasks to be performed pursuant to this contract include the physical care and control of clients, the provider shall, within 30 days
of the execution of this contract, submit to the contract manager an emergency preparedness plan which shall include provisions for
pre-disaster records protection, alternative accommodations for clients in substitute care, supplies, and a recovery plan that will allow
the provider to continue functioning in compliance with the executed contract in the event of an actual emergency. The department
agrees to respond in writing within 30 days of receipt of the plan accepting, rejecting, or requesting modifications. In the event of an
emergency, the department may exercise oversight authority over such provider in order to assure implementation of agreed
emergency relief provisions.
II. THE DEPARTMENT AGREES:
A. Contract Amount
To pay for contracted services according to the terms and conditions of this contract in an amount not to exceed $91,713,00, subject to
the availability of funds, The State of Florida's performance and obligation to pay under this contract is contingent upon an annual
appropriation by the Legislature. Any costs or services paid for under any other contract or from any other source are not eligible for
payment under this contract.
8. Contract Payment
Pursuant to section 215.422, F.S., the department has five (5) working days to inspect and approve goods and services, unless the bid
specifications, purchase order, or this contract specify otherwise. With the exception of payments to health care providers for hospital,
medical, or other health care services, if payment is not available within forty (40) days, measured from the latter of the date a properly
completed invoice is received by the department or the goods or services are received, inspected, and approved, a separate interest
penalty set by the Comptroller pursuant to section 55.03, F.S., will be due and payable in addition to the invoice amount. Payments to
health care providers for hospital, medical, or other health care services, shall be made not more than thirty-five (35) days from the
date eligibility for payment is determined, Financial penalties will be calculated at the daily interest rate of .03333%, Invoices returned
to a provider due to preparation errors will result in a non-interest bearing payment delay, Interest penalties less than one (1) dollar
will not be paid unless the provider requests payment.
C. Vendor Ombudsman
A Vendor Ombudsman has been established within the Department of Financial Services, The duties of this office are found in
subsection 215.422 (7), F .S., which include disseminating information relative to the prompt payment of this state and assisting
vendors in receiving their payments in a timely manner from a state agency. The Vendor Ombudsman may be contacted at (850) 410-
9724 or 1-800-848-3792, the State of Florida Comptroller's Hotline.
D. Notice
Any notice, that is required under this contract shall be in writing, and sent by U.S. Postal Service or any expedited delivery service
that provides verification of delivery or by hand delivery. Said notice shall be sent to the representative of the provider responsible for
administration of the program, to the designated address contained in this contract.
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III. THE PROVIDER AND DEPARTMENT MUTUALLY AGREE:
A. Effective and Ending Dates
This contract shall begin on July 1, 2003, or on the date on which the contract has been signed by the last party required to sign it,
whichever is later, It shall end at midnight, local time in Monroe County, Florida, on June 30, 2004,
B. Financial Penalties for Failures to Comply with Requirement for Corrective Action.
1. In accordance with the provisions of Section 402.73(7), Florida Statutes, and Section 65-29.001, Florida Administrative Code,
corrective action plans may be required for noncompliance, nonperformance, or unacceptable performance under this contract.
Penalties may be imposed for failures to implement or to make acceptable progress on such corrective action plans.
2, The increments of penalty imposition that shall apply, unless the department determines that extenuating circumstances exist,
shall be based upon the severity of the noncompliance, nonperformance, or unacceptable performance that generated the need for
corrective action plan, The penalty, if imposed, shall not exceed ten percent (10%) of the total contract payments during the period in
which the corrective action plan has not been implemented or in which acceptable progress toward implementation has not been
made Noncompliance that is determined to have a direct effect on client health and safety shall result in the imposition of a ten
percent (10%) penalty of the total contract payments during the period in which the corrective action plan has not been implemented or
in which acceptable progress toward implementation has not been made.
3. Noncompliance involving the provision of service not having a direct effect on client health and
safety shall result in the imposition of a five percent (5%) penalty. Noncompliance as a result of unacceptable performance of
administrative tasks shall result in the imposition of a two percent (2%) penalty.
4 The deadline for payment shall be as stated in the Order imposing the financial penalties. In the event of nonpayment the
department may deduct the amount of the penalty from invoices submitted by the provider,
C. Termination
1. This contract may be terminated by either party without cause upon no less than thirty (30) calendar days notice in writing to
the other party unless a sooner time is mutually agreed upon in writing. 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 the contract manager or the representative of the
provider responsible for administration of the program.
2. In the event funds for payment pursuant to this contract become unavailable, the department may terminate this contract upon
no less than twenty-four (24) hours notice in writing to the provider. Said notice shall be sent by U.S. Postal Service or any expedited
delivery service that provides verification of delivery. The department shall be the final authority as to the availability and adequacy of
funds, In the event of termination of this contract, the provider will be compensated for any work satisfactorily completed,
3, This contract may be terminated for the provider's non-performance upon no less than twenty-four (24) hours notice in writing to
the provider, If applicable, the department may employ the default provisions in Rule 60A-1,006(3), FAC, Waiver of breach of any
provisions of this contract shall not be deemed to be a waiver of any other breach and shall not be construed to be a modification of
the terms and conditions of this contract. The provisions herein do not limit the department's right to remedies at law or in equity.
4. Failure to have performed any contractual obligations with the department in a manner satisfactory to the department will be a
sufficient cause for termination. To be terminated as a provider under this provision, the provider must have: (1) previously failed to
satisfactorily perform in a contract with the department, been notified by the department of the unsatisfactory performance, and failed
to correct the unsatisfactory performance to the satisfaction of the department; or (2) had a contract terminated by the department for
cause,
D. Renegotiations or Modifications
Modifications of provisions of this contract shall be valid only when they have been reduced to writing and duly 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 department's
operating budget.
E. Official Payee and Representatives (Names, Addresses, and Telephone Numbers):
1. The provider name, as shown on page 1 of this
contract, and mailing address of the official payee to
whom the payment shall be made is:
Monroe County (Monroe County In Home Services)
1100 Si m onton Street
Key West, FL 33040
3. The name, address, and telephone number of the contract manager
for the department for this contract is:
Theresa Phelan
1111 12th Street, #301
Key West, FL 33040
305 I 292-6810
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CONTRACT # !-\.CJ047
04/10/03
2. The name of the contact person and street address
where financial and administrative records are
maintained is:
Deloris Simpson
Monroe County (Monroe County In Home Services)
1100 Simonton Street
Key West, FL 33040
305 I 292-4589
4. The name, address, and telephone number of the representative of
the provider responsible for administration of the program under this
contract is:
Deloris Simpson
Monroe County (Monroe County In Home Services)
1100 Simonton Street
Key West, FL 33040
305 I 292-4589
5. Upon change of representatives (names, addresses, telephone numbers) by either party, notice shall be provided in writing to the
other party and the notification attached to the originals of this contract.
F. All Terms and Conditions Included
This contract and its attachments, I, II and exhibits A, S, C, D, E & F, and any exhibits referenced in said attachments, together with
any documents incorporated by reference, contain all the terms and conditions agreed upon by the parties. There are no provisions,
terms, conditions, or obligations other than those contained herein, and this contract shall supersede all previous communications.
representations, or agreements, either verbal or written between the parties. If any term or provision of this contract is legally
determined unlawful or unenforceable, the remainder of the contract shall remain in full force and effect and such term or provision
shall be stricken,
By signing this contract, the parties agree that they have read and agree to the entire contract, as described in Paragraph
III.F. above.
IN WITNESS THEREOF, the parties hereto have caused this 71 page contract to be executed by their undersigned officials as duly
authorized.
-Jl6!?:. J,oJ.@
TITLE' ~
DATE: <:~ Ii', 2..003
STATE AGE 29 DIGIT FLAIR CODE:
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PROVIDER: Monroe County (Monroe County In Home
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Provider Fiscal Year Ending Date: ~/30.
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7
CONTRACT # KG047
07/01/2003
Community Care for Disabled Adults/Fixed Price
Adult Services Program
ATTACHMENT I
A. Services to be Provided
1. Definition of Terms
a. Contract Terms
(Refer to the Glossary in CFOP 75-2, Contract Management System for Contractual
Services, which is incorporated by reference herein)
b. Program or Service Specific Terms
(1) Activities of Daily Living - Basic activities performed in the course of daily
living, such as dressing, bathing, grooming, eating, using a commode or urinal,
and ambulating around one's own home.
(2) Client - Any person who is eligible and is at least eighteen (18) years through
age fifty-nine (59), has one (1) or more permanent physical or mental limitations
that restrict the client's ability to perform normal activities of daily living, and
impede the client's capacity to live independently or with relatives or friends
without the provision of community-based services.
(3) Medicaid Institutional Care Program (MICP) - A program that serves Medicaid
recipients who are determined eligible for a nursing home level of care, which
provides primary, acute, and long-term care services at capitated federally-
matched rates.
(4) Nursing home - Any facility which provides nursing services as defined in
Chapter 464, F.S., which is licensed in accordance with Chapter 400, F,S,
(5) Outcomes - Quantitative indicators that can be used by the department to
objectively measure a provider's performance toward a stated goal.
(6) Outputs - Process measures of the quantity(ies) of services delivered, clients
served, or similar units completed.
(7) Performance Measures - Quantitative indicators, outcomes and
outputs, that can be used by the department to objectively measure a provider's
performance.
(8) The Community Care for Disabled Adults Instructional Guide
(Exhibit A) - A publication developed by the department to better assist
department staff and acquaint contract provider staff with the types of services
the department purchases for its clients, and the scope of those services as
established by policy. Hereafter referred to as "The Guide".
2. General Description
a. General Statement
(1) The Community Care for Disabled Adults (CCDA) Program is designed to
assist disabled adults, age eighteen (18) through fifty-nine (59), in utilizing
available community and personal resources enabling them to remain in their own
homes, and preventing their premature or inappropriate institutionalization.
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PSMAI No. GA07
Contract No. KG047
07/01/2003
Community Care IVI Disabled Adults/Fixed Price
Adult Services Program
(2) Service providers will ensure that appropriate community-based services are
provided to clients in a manner designed to meet the client's changing needs, to
assist the client in avoiding or reducing unnecessary dependence on the
delivered service(s), and to increase the client's self-reliance.
b. Authority
Sections 410.601-606, F.S., Chapter 65C-2, Florida Administrative Code (FAC,), and the
annual appropriations act, with any proviso language or instructions to the department,
constitute the legal basis for services to be delivered through the CCDA program.
c. Scope of Service
Services will be targeted toward eligible adults, age eighteen (18) through fifty-nine (59),
in Monroe County, Florida,
d. Major Program Goal
Community-based services provided under this contract are designed to prevent
inappropriate institutionalization of disabled adults.
3. Clients to be Served
a. General Description
Adults with disabilities, age eighteen (18) through fifty-nine (59), who are no longer eligible
to receive children's services, and are too young to qualify for community and home-
based services for the elderly, may be served under the provisions of this contract.
b. Client Eligibility
(1) Applicants must have one or more permanent physical or mental limitations,
that restrict the ability to perform normal activities of daily living, as determined
through the initial functional assessment and medical documentation of disability,
Determination of a permanent disability must be established and evidenced in
one of the following manners:
(a) An applicant may present a check, awards letter, or other proof
showing receipt of Social Security Disability Income, or some other
disability payment (e.g., Worker's Compensation); or
(b) An applicant may present a written statement from a licensed
physician, licensed nurse practitioner, or mental health professional,
which meets the district's criteria for evidence of a disability. This written
statement must, at a minimum, include the applicant's diagnosis,
prognosis, a broad explanation of level of functioning, and the
interpretation of need for services based on identified functional barriers
caused by the applicant's disabling condition.
(2) Applicants must have an individual income at or below the prevailing MICP
eligibility standard in order to receive free CCDA services,
(3) Applicants with incomes above the standard will be assessed for a share of
the costs, or may be required to provide volunteer services in lieu of payment.
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PSMAI No. GAD?
Contract No. KG047
07/01/2003
Community Care for Disabled Adults/Fixed Price
Adult Services Program
c. Client Determination
(1) Clients will be assessed for eligibility determination, and prioritized for
services by district or provider case management staff, in accordance with
subsection 410.604 (2), F.S.
(2) The district's program manager will make the final determination in the event
of a dispute regarding client eligibility.
d. Contract Limits
(1) The total annual cost estimated or actual, for an individual receiving CCDA
services, shall not exceed the average, annual general revenue portion of a
Medicaid nursing home bed within the district area.
(2) Clients must not be receiving comparable services from any other entity. In
order to prevent duplication of services, client files must contain documentation
verifying that all comparable community services and funding sources have been
explored and exhausted.
(3) The provider shall deliver services only to those persons who meet program
eligibility criteria, and only to the extent that funds are available.
B. Manner of Service Provision
1. Service Tasks
a. Task List
(1) The following tasks will be performed under this contract
(check all that apply IZI).
OAdult Day Care X Case Management OEmergency Alert
Response
X Personal Care OHome Health Aide OGroup Activity
Therapy
X Homemaker OHome Nursing X Home Delivered
Meals
Olnterpreter OTransportation OMedical Therapeutic
Services
OChore ORespite OPhysical and
Exams
OEscort
(2) Details of services to be provided under this contract and the negotiated
parameters of those services include: (Descriptions and minimum requirements
for each service listed are listed in "The Guide").
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PSMAI No. GA07
Contract No. KG047
07/0112003
Community Care f(J, Disabled Adults/Fixed Price
Adult Services Program
b. Task Limits
The following task limits are only applicable to a specific service(s) that a provider delivers
to the clients:
(1) Each district CCDA program shall include case management services and at
least one other community service.
(2) Respite Care services may be provided for up to two hundred forty (240)
hours per client per calendar year, depending upon individual need. The service
may be extended to three hundred sixty (360) hours, as recommended by the
case manager and approved by an immediate supervisor. Documentation of
approval must be evident in the case narrative section of the case manager's file.
(3) Personal Care services will not substitute for the care usually provided by a
registered nurse, licensed practical nurse, therapist, or home health aide. The
personal care aide will not change sterile dressings, irrigate body cavities,
administer medications, or perform other activities prohibited by Chapter 59A-8,
FAC.
(4) Homemaker service time does not include time spent in transit to and from
the client's place of residence except when providing shopping assistance,
performing errands or other tasks on behalf of a client.
(5) Several restrictions apply to persons providing Homemaker service activities.
Persons providing services must not:
(a) engage in work that is not specified in the Homemaker assignment;
(b) accept gifts from clients;
(c) lend or borrow money or articles from clients;
(d) handle client money, unless authorized in writing by a supervisor or
case manager (as evident in the personnel file) and unless bonded or
insured by the employer;
(e) transport clients, unless authorized in writing by a supervisor or case
manager.
(6) The parameters of service delivery, by type of service, are detailed in "The
Guide".
(7) District task limits, which exceed those in "The Guide", and are distinctive to
this contract, are listed here:
2. Staffing Requirements
a. Staffing levels
(1) The provider will meet the minimum staffing requirements for each service, as
specified in 'The Guide".
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PSMAI No. GAOl
Contract No. KG047
07/01/2003
Community Care llJ, Disabled Adults/Fixed Price
Adult Services Program
(2) The provider will notify the department, in writing, within thirty (30) days
whenever the provider is unable, or expects to be unable to provide the required
quality or quantity of service because of staff turnovers or shortages.
b. Professional Qualifications
The provider will ensure that staff meets the professional qualifications for each service,
as specified in "The Guide".
c. Staffing Changes
The provider agrees to notify the department's contract manager within two (2) working
days if a key administrative position (e.g., executive director) becomes vacant. Planned
staffing changes that may affect service delivery, as stipulated in this contract, must be
presented in writing to the contract manager for approval at least two (2) weeks prior to
the implementation of the change,
d. Subcontractors
Written requests by the provider to subcontract for the provision of services under this
contract will be routed through the contract manager for department approval. All
subcontracting is subject to the provisions of Section 1.1. of the Standard Contract.
3. Service Location and Equipment
a. Service Delivery Location and Times
(1) CCDA services may be delivered in the client's home or on-site at a facility,
as negotiated by the department and the provider.
(2) Facilities delivering on-site services to clients shall pass an annual inspection
by the local environmental health and fire authorities.
(3) Service providers will meet the minimum service location and time
requirements as specified in "The Guide".
(4) Services for this contract will be delivered at the following location(s) and
times:
SERVICE LOCA TION TIMES
Case Management Client's Home As needed
Personal Care Client's Home As needed
Homemaking Client's Home As needed
Home Delivered Meals Client's Home As needed
b. Changes in Location
The provider must notify the department of changes in the location of service delivery.
Once the service delivery location is agreed upon, any proposed change must be
presented in writing to the contract manager for approval, ten (10) days prior to
implementation of that proposed change. In the event of an emergency, temporary
changes in location may necessitate waiver of this designated standard by the district's
04/30/03
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PSMAI No. GA07
Contract No. KG047
07/01/2003
Community Care for Disabled Adults/Fixed Price
Adult Services Program
program office. Such a waiver will take into consideration the continuity, safety, and
welfare of the department's clients, and is at the department's sole discretion.
c. Equipment
(1) If equipment is applicable to a specific provider's contract, the provider must
submit an equipment listing (Exhibit N/A) to the department which lists the
equipment. The equipment required to perform the contracted services must be
negotiated by the department and the provider. To ensure uniformity, safety, and
quality of service to clients, any requests for equipment change must be
presented in writing to the contract manager for approval at least ten (10) days
prior to any proposed change,
(2) The provider must inventory all equipment acquired under this contract
annually. The inventory list must be made available within seven (7) days upon
receipt of written request by the contract manager. The provider must list the
items of equipment on the equipment listing (Exhibit N/A), as applicable to the
provider's contract for specific services.
4. Deliverables
a. Service Units
A service unit is an appropriate, distinct amount of given service, which may include, but
is not limited to, an hour or quarter hour of direct service delivery; a meal; an episode of
travel; or a twenty-four (24) hour period of Emergency Alert Response maintenance, as
defined in "The Guide". All service units, as well as their description and costs, are listed
in "The Guide".
b. Records and Documentation
(1) Case Management provider files shall contain the following:
(a) a completed client assessment (not more than one (1) year old);
(b) a care plan (not more than one (1) year old);
(c) a release of information form;
(d) a copy of a completed Client Information System (CIS) form;
(e) documentation of the client's age, disability, and income;
(f) a copy of the referral/intake form; and
(g) a case narrative.
(2) Providers shall maintain information on each client served by this contract,
which includes the following:
(a) documentation of the client by name or unique identifier;
(b) current documentation of eligibility for services;
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PSMAI No. GAD7
Contract No. KG047
07/01/2003
Community Care tv. Disabled Adults/Fixed Price
Adult Services Program
(c) dates of service provision and delivery;
(d) information documenting the client's need to receive services;
(e) the number of service units provided; and
(f) all other forms or records necessary for program operation and
reporting, as set forth by the department.
(3) Providers must ensure that all client records accurately match the invoices
submitted for payment. Records must cross reference to each invoice for
payment.
(4) Providers must maintain documentation necessary to facilitate monitoring and
evaluation by the department.
(5) The case management provider must maintain documentation in the client's
file that all comparable community services and funding sources have been
explored and exhausted before using CCDA funding.
c. Reports
Report Title Reporting Report Date Due Number of DCF Office address
Frequency copies due to receive report
Quarterly Cumulative Quarterly 10/30/03 One Contract Manager
Summary Reports 02/15/04
04/30/04
08/15/04
Performance Data Monthly 10th of the month One Contract Manager
Report following the
report period
Active Client Log Monthly 10th of the month One Contract Manager
following the
report period
Wait List Log Monthly 10th of the month One Contract Manager
following the
report period
Client Cost Plans Updated 10th of the month One Contract Manager
Monthly following the
report period
Cost Report Monthly 10th of the month One Contract Manager
following the
report period
(1) Reporting requirements for this contract include, Exhibit B, Quarterly
Cumulative Summary Reports, if applicable. Districts will negotiate with the
provider on specific submission requirement criteria for these reports,
(2) Providers of case management services agree to submit Quarterly
Cumulative Summary Reports, which include management program data (e,g"
04/30/03
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PSMAI No. GA07
Contract No, KG047
07/01/2003
Community Care fur Disabled Adults/Fixed Price
Adult Services Program
client identifiable data) to the department, according to negotiated instructions
provided by the districts.
(3) In the event of early termination of this contract, the provider will submit the
final Quarterly Cumulative Summary Report within forty-five (A5) days after the
contract is terminated. -
(4) The provider agrees to submit a monthly Cost Report, Exhibit C, which
details the number of units of service provided to each client during the report
period.
(5) The provider agrees to submit all other reports indicated above in formats to
be determined by the provider.
5. Performance Specifications
a. Performance Measures
(1) 99 % of adults with disabilities receiving services will not be placed in a
nursing home.
(2) 25 # of qualified disabled adults (ages 18-59) provided
case management.
(3) 29 # of qualified disabled adults (ages 18-59) in the
CCDA and ADA Medicaid Waiver Programs.
b. Description of Performance Measurement Terms
Placed - Assessment of an individual who is no longer able to remain in his
present place of residence. (To place a client involves preparation for and follow
up of moving a client into a more restrictive alternative living environment),
c. Performance Evaluation Methodology
(1) Measuring Outcomes. The department will measure the outcomes found in
paragraph S.5.a, above as follows:
(a) The outcome measurement contained in paragraph S.5.a.(1) above
will be measured by dividing the total, fiscal year-to-date number of
clients in the Community Care for Disabled Adults, Home Care for
Disabled Adults, Cystic Fibrosis, and Medicaid waiver programs not
transferred to a nursing home, by the total, fiscal year-to-date number of
clients in the Community Care for Disabled Adults, Home Care for
Disabled Adults, Cystic Fibrosis, and Medicaid wavier programs.
(b) The outcome measurement contained in paragraph S,5.a,(2) above
will be measured by the total number clients actively receiving case
management from the Community Care for Disabled Adults, Home Care
for Disabled Adults, Cystic Fibrosis, and Medicaid waiver programs,
(c) The outcome measurement contained in paragraph S.5.a(3) above
will be measured by the total number clients actively receiving daily living
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PSMAI No. GA07
Contract No. KG047
07/01/2003
Community Care tv, Disabled Adults/Fixed Price
Adult Services Program
(1) By execution of this contract, the provider hereby acknowledges and agrees
that its performance under the contract must meet the standards set forth above
and will be bound by the conditions set forth below. If the provider fails to meet
these standards, the department, at its exclusive option, may allow up to six
months for the provider to achieve compliance with the standards, If the
department affords the provider an opportunity to achieve compliance, and the
provider fails to achieve compliance within the specified time frame, the
department will terminate the contract in the absence of any extenuating or
mitigating circumstances. The determination of the extenuating or mitigating
circumstances is the exclusive determination of the department.
(2) The Contract Performance Unit ("CPU") may elect to perform an on-site
administrative and programmatic monitoring during the contract period. At a
minimum, an annual desk monitoring will be performed which will be
accomplished by a combination of the review(s) of reports or other documentation
submitted by the provider, input from service recipients and others, and visits to
the site of service delivery for programmatic review,
(3) For on-site monitorings, a random discovery sample of open and closed files
will be taken for review. This sample may be increased to a random statistical
sample depending on the results of our review. The number of files reviewed will
be contingent upon the population size of services rendered, To facilitate the
sampling process, upon CPU request, the provider shall submit a universal
events listing of all services provided under the contract prior to the monitoring
visit.
(4) A report outlining the department's findings during the on-site monitoring will
be submitted to the provider within 30 days of concluding field work with an exit
conference. The provider agrees to respond and submit a corrective action plan,
if required, within 30 days of receiving the department's monitoring report,
C. Method of Payment
1. Payment Clause
a. This is a Fixed Price (Unit Cost) contract. The department shall pay the provider for
the delivery of service units provided in accordance with the terms of this contract for a
total dollar amount not to exceed $91,713.00, subject to the availability of funds.
b. The department shall make payments to the provider for provision of services up to
the maximum number of units of service at the rates shown below.
Service Units Unit Price Maximum # of Units
Case Management $47.73 220
Personal Care $51.11 278
Homemaking $27,11 1,241
Home Delivered Meals $ 6.97 4,786
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PSMAI No. GA07
Contract No. KG047
07/01/2003
Community Care lv' Disabled Adults/Fixed Price
Adult Services Program
c. The provider's dollar match for this contract is 10,190.00. Case management and
transportation services may be exempt from match requirement at the discretion of each
district.
d. Cash or in kind resources may be used to meet this match requirement.
2. Invoice Requirements
The provider shall request payment through submission of a properly completed Invoice, Exhibit
D, within 15 days following the end of the month for which payment is being requested. The
provider shall submit to the contract manager an original Invoice, Exhibit D, and no copies, along
with supporting documentation. Payment due under this contract will be withheld until the
department has confirmed delivery of negotiated services.
3. Supporting Documentation
a. It is expressly understood by the provider that any payment due the
provider under the terms of this contract may be withheld pending the receipt and
approval by the department of all financial and program reports due from the provider as a
part of this contract and any adjustments thereto. Requests for payment, which cannot be
documented with supporting evidence, will be returned to the provider upon inspection by
the department.
b. The provider must maintain records documenting the total number of recipients and
names (or unique identifiers) of recipients to whom services were provided and the dates
the services were provided so that an audit trail documenting service provision can be
maintained.
D. Special Provisions
1. Fees
a. The provider will collect fees for services provided according to Rule 65C-2.007,
FAC.
b. No fees shall be assessed other than those established by the department. Fees
collected in compliance with the department directives will be reinvested in a manner
prescribed by the department.
2. Florida Statewide Advocacy Council
The provider agrees to allow properly identified members of the Florida Statewide Advocacy
Council access to the facility or agency and the right to communicate with any client being served,
as well as staff or volunteers who serve them in accordance with subsections 402,165(8) (a) &
(b), F.S. Members of the Florida Statewide Advocacy Council shall be free to examine all records
pertaining to any case unless legal prohibition exists to prevent disclosure of those records.
3. Federal or State Audit
Any federal or state audit resulting in a disallowance which was caused by the provider's non-
compliance with federal regulations or an incorrect claim shall be repaid to the department by the
provider upon discovery.
4. Information Technology Resources.
All contract providers must adhere to the Department's procedures and standards when
purchasing Information Technology Resources (ITRs) as part of this contract. These resources
04/30103
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PSMAI No. GA07
Contract No. KG047
07/01/2003
Community Care tur Disabled Adults/Fixed Price
Adult Services Program
will revert to the Department at the conclusion of the contract. ITRs are data processing hardware,
software, service, supplies, maintenance, training, personnel, and facilities. The provider agrees
to secure prior written approval through the contract manager from the District Management
Systems Director for the purchase of any ITR. The provider will not be reimbursed for any
purchase made prior to this written approval.
5. Morals Clause
The provider understands that performance under this contract involves the expenditure of public
funds from both the state and federal governments, and that the acceptance of such funds
obligates the provider to perform its services in accordance with the very highest standards of
ethical and moral conduct. Public funds may not be used for purposes of lobbying, or for political
contributions, or for any expense related to such activities, pursuant to Section I R of the Standard
Contract of this contract. The provider understands that the Department is a public agency which
is mandated to conduct business in the sunshine, pursuant to Florida Law, and that all issues
relating to the business of the Department and the provider are public record and subject to full
disclosure, The provider understands that attempting to exercise undue influence on the
Department and its employees to allow deviation or variance from the terms of this contract other
than negotiated, publicly disclosed amendment, is prohibited by the State of Florida, pursuant to
Section III C of the Standard Contract. The provider's conduct is subject to all state and federal
laws governing the conduct of entities engaged in the business of providing services to
government.
6. Employee Loans
Funds provided by the Department under this contract shall not be used by Not-For-Profit
Corporations to make loans to their employees, officers, directors and/or subcontractors.
Violation of this provision shall be considered a breach of contract, the termination of this contract
shall be in accordance with the Standard Contract, Section III, Paragraph S, Subsection 3, A loan
is defined as any advance of money for which the repayment period extends beyond the next
scheduled pay period.
7. Emergency Plan
The provider shall be responsible for the care, maintenance and, if necessary, the relocation of
clients during any natural disaster or period of civil unrest. The provider shall submit its
emergency plan to the Department for approval at the time of submission of the agency's proposal
and must be updated annually,
8. Transportation Disadvantaged
The provider agrees to comply with the proVISions of Chapter 427, Florida Statute, Part I,
Transportation Services, and Chapter 41-2, Florida Administrative Code, Commission for the
Transportation Disadvantaged, if public funds provided under this contract are used to transport
clients. The provider agrees to comply with the provisions of CFOP 40-5 if public funds provided
under this contract will be used to purchase vehicles which will be used to transport clients
9. Incident Reporting
The Provider is required to document all reportable incidents, as defined in the District 11 Uniform
Incident Reporting Protocol for Incident Reporting and Client Risk Prevention For Critical and
Non-Critical Incidents, which is incorporated herein by reference,
For each critical incident occurring during the administration of its program, the Provider must,
within 24 hours of the incident, complete and submit the District's approved Incident Report form
(Exhibit F) to the respective department program incident report liaison. The incident report
liaison for this contract is Fernando Deheza, 401 NW 2nd Avenue, Suite N-1007, Miami, FL 33128,
It is the Provider's responsibility to use the most current District 11 approved incident report for
this purpose. A copy of the incident report must also be placed in a central file marked
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PSMAI No. GA07
Contract No. KG047
07/01/2003
Community Care ,...., Disabled Adults/Fixed Price
Adult Services Program
"Confidential Incident Report" and in each client's file involved in the incident. Dissemination of
the report within the department will be the responsibility of the department's program incident
report liaison.
Incidents that threaten the health, safety or welfare of any person or that plac~ any person in
imminent danger must be reported immediately to the department by telephonic.contact.
The information contained in the incident report is confidential. The dissemination, distribution or
copying of the report is strictly prohibited, unless authorized by the Department.
10. Security Agreement Form
The provider agrees to submit to the Department Contract Manager an original signed Security
Agreement Form (CF-114) (Exhibit E) for all required personnel no later than thirty (30) days
following the execution of this contract or thirty (30) days from date of employment. All personnel
who require access to departmental information must sign the Security Agreement Form prior to
receiving access to the information.
/
/
04/30/03
21
PSMAI No. GAD?
Contract No. KG047
711 /200 I
Corrununity Care for Disabled Adults
Adult Services Program
EXHIBIT A
FLORIDA DEPARTMENT OF
CH I LDREN
& FAMILIES
INSTRUCTIONAL GUIDE
The Instructional Guide defines each of the approved Community Care for Disabled
Adults program services and the requirements associated with the service tasks and
delivery of those services as well as other reporting and billing information necessary
for proper completion of the aforementioned model Attachment I's in a statutorily and
administratively sound fashion.
The CCDA program may be contracted for and financially managed in any of the
three following ways:
FIXED PRICE contracting, using the GAD? PSMA
FIXED PRICE ADVANCE FUNDING contracting, using the GAD8 or
COST REIMBURSEMENT contracting, using a district created PSMAI
Each of the 15 districts may enter into anyone, two or three methods of contract
payment with provider agencies serving the CCDA population for any number of
approved CCDA services. All three methods are forms of a formal contract.
The Adult Services Central Office has developed the GAD? and GAD8 Program
Specific Model Attachments (PSMAl's) for your convenience and to insure that the
minimum program requirements of the CCDA program are fulfilled and that uniformity
of procurement and delivery of CCDA contractual services is maintained on a
statewide basis.
Both the GAD? and the GAD8 PSMAI methods of payment will be addressed in its
own instructional chapter to distinguish its unique reporting and billing requirements
from the other;
Section A - FIXED PRICE or PSMA GAD?
Section B - FIXED PRICE ADVANCE FUNDING or PSMA GAD8 and
Section C - A Taxonomy of Services
Revised 6/13/01
Revision No. 01
PSMAI No. CA07
Contract No. KG047
z?-
711 /200 1
COftuilunity Care for Disabled Adults
Adult Services Program
SECTION A
FIXED PRICE
Fixed-price contracts should be used when the service to be provided can be broken
down into standard units (i.e., trips, hours), and a specific rate is paid per unit for a
specific period of time. This formal contract requires a 10% match, either in-kind or
cash. As in the past, case management and/or transportation services may be
exempt from this match requirement at the district's discretion.
Contract providers using the fixed-price method of payment may negotiate monthly
reporting with the district, but are required to submit three, six, nine and twelve
month Cumulative Summary Reports that will be forwarded by the district office to
the Central Office. A copy of the quarterly Cumulative Summary Form to be used in
this reporting process has been labeled as an Exhibit to this contract.
SECTION B
FIXED PRICE ADVANCE FUNDING
Advance funding may be given only to not-for-profit corporations or government
agencies. Such advances may be made on a monthly basis up to the first two
months of the contract and may not exceed the expected cash needs of the provider.
This formal contract requires a 10% match, either in-kind or cash.
Contract providers using the fixed-price advance funding method of payment may
negotiate monthly reporting with the district, but are required to submit three, six,
nine and twelve month Cumulative Summary Reports that will be forwarded by the
district office to the Central Office. A copy Copies of the quarterly Cumulative
Summary Forms to be used in this reporting process has have been labeled as an
Exhibit to this contract and attached.
Revised 6/13/01
Revision No. 01
PSMAI No. CA07
Contract No. KG047
z'?
7/1/2001
Comlllunity Care for Disabled Adults
Adult Services Program
SECTION C
A TAXONOMY OF SERVICES
Adult Day Care
(1) Adult day care means a social program which provides a protective
environment where preventive, remedial, and restorative services are
provided to adults in need of such care.
(2) A unit of service is one hour of actual client attendance at the day care
center, including travel to or from the center if the adult day care center is
providing the transportation with CCDA funds.
Minimum Service Standards
(1) Licensing. This service must be provided in a licensed adult day care
center in accordance with Chapter 400, Part V, Florida Statutes, and Chapter
58A-6, Florida Administrative Code (Regulations).
(2) All adult day care centers, contracted with CCDA funds, must meet the
following additional service standards:
(a) Therapies. Occupational, physical, and speech or language
therapy must be provided if care plans of the enrolled participants
identify the need for such therapies. Arrangements must be made for
clients who need transportation to another location in order to receive
any therapies prescribed by a medical professional.
(b) Transportation. Transportation services consist of conveying
participants from home to the adult day care center and return home. If
the day care center does not provide transportation directly,
arrangements must be made with available transportation providers.
The client's physicallimitation(s) must be considered when planning for
transportation. Wheelchair clients may require an appropriately
equipped vehicle. Provisions must be made to assist persons in
getting on or off the vehicle, if needed.
Revised 6/13/01
Revision No. .01
PSMAI No. CAO?
Contract No. KG047
2tf.
7/1/2001
Community Care for Disabled Adults
Adult Services Program
Minimum Staffing Standards
(a) Nursing Staff. A registered or licensed practical nurse, licensed by
the State of Florida, must be on duty at the site during primary hours of
program operation and available at other times. When the position is
filled by a licensed practical nurse, this person must work under the
supervision of a Registered Nurse.
1. Nursing service by a licensed registered nurse or
licensed practical nurse, currently licensed in Florida,
includes, but is not limited to: screening procedures for
chronic diseases (e.g., hypertension, or diabetes);
observation, assessment, and monitoring of clients health
needs and daily functioning levels; administration or
supervision of medications or treatments; counseling for
participant, family or caregiver in matters relating to health
and prevention of illness; and referral to other community
resources with follow-up of suspected physical, mental, or
social problems requiring definitive resolution.
2. The registered or licensed practical nurse must be on
duty at the site during the primary hours of program
operation. If the nurse leaves the site, the administrator
must be on the premises during the center's hours of
operation.
(b) First Aid Certified Staff. At least one staff person, who has had an
approved First Aid course and Cardio-Pulmonary Resuscitation (CPR)
training, and is capable of recognizing symptoms of distress in this
client population must be at the center at all times.
'"
Minimum Training Standards
(1) Training Requirements. Each position must have a pre-service and in-
service training plan. Areas to be covered must be appropriate to job
responsibilities. Suggested topics include: medical record keeping; medical
emergency procedures, monitoring for change (such as medical,
psychological and social, physiological changes with age, chronic diseases);
Adult Day Care (Health) policies and procedures; rehabilitation, and
prescription drugs common to this population, as well as the interaction of
those common drugs.
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Community Care for Disabled Adults
Adult Services Program
(a) Pre-Service Training. Pre-service training must be documented in
agency records as to content and duration.
(b) In-Service Training. In-service training for staff will qe regularly
scheduled. Minimum in-service training must be six hours'per year with
content and hours documented in agency and staff records.
Adult Day Health Care
(1) Adult day health care is an organized day program of therapeutic, social
and health activities and services provided to disabled adults for the purpose
of restoring or maintaining optimal capacity for self care.
(2) A unit of service is equal to one hour of actual client attendance at the day
care center, including travel to or from the center if the adult day care center is
providing the transportation with CCDA funds.
Minimum Service Standards
(1) Licensing. Adult day health care center will be licensed by the Agency for
Health Care Administration (AHCA) in accordance with Chapter 400.551, F.S.,
and Chapter 58A-6, F.A.C., the Adult Day Care Rule that can be obtained
from the Department of Elder Affairs.
(2) Licensing Exemptions Adult day care centers exempted from licensure
must adhere to the requirements stated in Chapter 400.553, F.S., and
Chapter 58A-6, F.A.C., the Adult Day Care Rule.
(3) Additional Standards. All day care centers, contracted for adult day health
care services must meet the following service additional standards:
(a) Medical Service. Medical services can be provided by either the
personal physician or advanced registered nurse practitioner of the
client, a staff physician, or both, and must emphasize preventive
treatment, rehabilitation, and continuity of care and also provide for
maintenance of adequate medical records. The health needs of clients
may be supervised by an advanced registered nurse practitioner in
accordance with protocols established in collaboration with the
personal physician of the client or the site staff physician.
Revised 6/13/01
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PSMAI No. CAO?
Contract No. KG047
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Revised 6/13/01
Revision No. 01
Community Care for Disabled Adults
Adult Services Program
(b) Medical Therapeutic/Rehabilitative Services. Medical
therapeutic/rehabilitative services appropriate to the needs of the client
must be provided by a contractor or by on-site staff.
1. Physical therapy. Progress notes must be written in the
client's medical record, at least quarterly, and signed by the
physical therapist.
2. Occupational therapy as an adjunct to treatment of patients
with physical and mental limitations. Progress notes must be
written in the client's medical record, at least quarterly, and
signed by the occupational therapist.
3. Speech pathology/audiology for clients with speech and
language disorders. Progress notes must be written in the
medical record of the client, at least quarterly, and signed by the
speech therapist.
(c) Social Work Services. Social work services to assist with personal,
family and other problems that interfere with the effectiveness of
treatment must be provided to clients and their families. These
services will be provided by the social work staff employed by the Adult
Day Care Center and are not to be confused with the case
management responsibilities of the CCDA case manager. [The CCDA
case manager will complete the functional assessment of the client, will
counsel in the development of a service plan, will arrange for services,
and will provide ongoing monitoring of the client's situation to ensure
that needed services are received].
(d) Nutritional Services. The administrator must designate a staff
person to be responsible for the daily operation of the food service.
The program must meet the following criteria:
1. Provide a minimum of one meal per day to participants
attending or in transit to the center for four or more hours daily.
Meals are to be of suitable quality and quantity and meet at least
one third of the current Recommended Dietary Allowance (RDA)
established by the Food and Nutrition Board, National Academy
of Sciences, and the National Research Council, adjusted for
age, sex, and activity.
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2. provide dietary and nutritional education for the client and his
family and as adjunct to nutritional services; and
3. ensure that all basic services provided by program aides in
this service area are provided under the direct su'pervision of the
staff person responsible for the service.
(e) Recreational and Social Activities. Planned recreational and social
activities must be provided by an individual with specialization in
therapeutic recreation. Such services must be suited to the needs of
the clients and designed to encourage physical exercise, to prevent
deterioration, and to stimulate social interaction. All basic services
provided by program aides must be provided under the direct
supervision of the recreation therapist. The registered recreation
therapist may be retained as a consultant.
(f) Transportation Services. Transportation from home to center and
return must be a function of the program. If the center does not provide
transportation directly, arrangements for day care participants needing
transportation must be established. The client's physicallimitation(s)
must be considered when planning for transportation. Wheelchair
clients may require an appropriately equipped vehicle. There must be
an escort on a bus or van to assist persons in getting on and off the
vehicle when needed.
(g) Operational Requirements. Each center must provide services for
a minimum of five hours per day, five days per week.
Minimum Staffing Standards
(1) Staffing Requirements. At least two staff and all staff drivers must have
received training in emergency procedures, CPR by an approved instructor
and basic first aid. At least one staff person who has passed both First Aid
and Cardio-Pulmonary Resuscitation training must be at the site during the
designated daily hours of operation. Minimal staffing must consist of:
(a) Full-Time Professional Staff. A minimum of two full-time (forty
hours per week) professional staff members will be present during all
operational hours. Professionals include the center director, assistant
center director, social worker, registered nurse, and recreational
therapist.
Revised 6/1 3/0 1
Revision No. 01
PSMAI No. CA07
Contract No. KG047
2C(;
7/1/2001
Corrllllunity Care for Disabled Adults
Adult Services Program
(b) Staff/Client Ratio. There will be a minimum of one full-time staff
member for every six participants in the center. The owner or operator
may be considered in the count when serving in a dual capacity and
provided the owner or operator provides direct services ~nd is included
in the work schedule for the center. Additional staff will be required as
the client population increases maintaining a one-to-six ratio. Clerical
staff, accountants, cooks and other non-direct care staff (with the
exception of the administrator) will not be considered when calculating
the staff/client ratio.
(c) Center Director. There will be one full-time professional designated
as center director.
(d) Assistant Center Director. There will be one full-time professional
designated as assistant program director to act in the absence of the
center director.
(e) Nursing Staff. A registered nurse (RN) or licensed practical nurse
(LPN) will be on site during the primary hours of program operation and
on call during the hours the center is open. Arrangements will be
formalized for obtaining the services of an LPN or RN in anticipation of
potential absences, planned and unplanned, of the regular nursing
staff.
(f) Additional Staff. Direct care staff members, from a variety of fields,
will be employed in sufficient number to complete a staffing ration of
one full-time staff member for each six clients.
(2) Staff appropriate to the services offered below must be on the premises of
the center during the designated daily hours of operation.
(a) Nursing. Nursing services must include services rendered by
registered nurses (RN) or licensed practical nurses (LPN) that work
under the supervision of a registered nurse. Such nurses must
evaluate quarterly, at a minimum, the particular needs of each client
and provide care and treatment, including medication supervision, as
indicated. Narrative nursing notes must be entered in the client's
medical record at least weekly indicating the individual's progress
toward achieving health goals. More frequent notes are required if
indicated by the client's condition. Narrative nursing notes should
address the client's progress in self care services oriented toward
activities of daily living and personal hygiene, and the extent of
assistance provided by health care professionalss and program aides
in this service area.
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Community Care for Disabled Adults
Adult Services Program
(b) Nutritionist. Nutritional services must include dietary and nutritional
education and must be provided under the supervision of a dietitian
who meets licensure and certification as set forth in 58A-6, F.A.C.
(c) Social Worker. Minimum qualifications for this position must meet
licensure and certification as set forth in 58A-6, F.A.C. Services
provided by program aides in this service area must be provided under
the direct supervision of a social worker.
(d) Occupational Therapist. Minimum qualifications for this position
must meet licensure and certification as set forth in 58A-6, F.A.C.
(e) Speech Therapist. Minimum qualifications for this position must
meet licensure and certification as set forth in 58A-6, F.A.C.
(f) Physical Therapist. Minimum qualifications for this position must
meet licensure and certification as set forth in 58A-6.01 (6)(c)1., F.A.C.
(g) Center Director. Minimum qualifications for this position must meet
licensure and certification as set forth in 58A-6, F.A.C.
(3) Additional Major Functions and Duties of the Center Director. Major
Functions and Duties, additional to those outlined in Chapter 58A-6, Florida
Administrative Code:
(a) Recruits, screens and trains staff of facility.
(b) Plans and provides organized programs of pre-service and in-
service training for staff.
(c) Interprets policies and procedures to staff and clientele.
(d) Ensures integration and coordination between program and
appropriate community resources.
(e) Maintains close supervision of staff in the following areas of
operation: secretarial and bookkeeping; housekeeping; maintenance;
transportation; food services; consulting services; and direct services.
(f) Evaluates the performance of each staff member.
Revised 6/13/01
Revision No. 01
PSMAI No. CA07
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Community Care for Disabled Adults
Adult Services Program
(g) Assures accurate and timely completion of all records and reports,
including those required for the Client Information System (CIS);
maintains program statistical data and records as required.
(h) Special Requirement. This is an eligible service for clients who are
included within the 2176 Medicaid Waiver Projects (coded 17).
Reporting must comply with the 2176 Medicaid procedures.
Case Management
(1) Case management is a client centered series of activities which
includes planning, arrangement for and coordination of appropriate
community-based services for an eligible Community Care for Disabled Adult
client.
(2) Case management is an approved service, even when delivered in the
absence of other services. Case management includes intake and referral,
comprehensive assessment, development of a service plan, arrangement for
service and monitoring of client's progress to assure the effective delivery of
services and reassessment.
(3) A unit of service is one hour of elapsed time involved in the above
described case management activities.
Recommended Staffing and Caseload Standards
The average caseload should not exceed fifty-five cases per full-time CCDA case
manager, unless approved by the district office. A caseload consists of those clients
determined eligible and receiving case management.
Minimum Qualifications
(1) Contract Service Providers. Case managers must possess a
Bachelor's degree in social work, sociology, psychology, nursing, or related
field. Other directly related job education or experience may be substituted for
all or some of these basic requirements upon approval of the district office.
(2) DCF Staff. DCF case managers must be qualified as described by
departmental job specifications.
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Revision No. 01
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Contract No. KG047
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711/200 I
Community Care for Disabled Adults
Adult Services Program
(b) Tasks to be accomplished will be determined by evaluating the
health and well being of the client, and the capability of chore service
staff.
(c) Specific chore tasks, for example shopping or err;:mds, may be
scheduled at regular intervals, if needed.
(d) Procedures must be developed for chore service workers who
will handle the client's money.
(e) Chore services may include tasks such as those listed in the
service definition, as well as the installation or adjustment of simple
door locks and other basic security devices.
(f) Chore services may be provided by homemaker or other staff,
as long as the worker performing the dual function meets the chore job
description and qualifications. When one employee provides multiple
services, individual tracking documentation must be maintained for
each service. For instance, if a staff person makes a two hour visit to a
client's home and performs an hour of chore and an hour of
homemaker tasks, the time must be recorded as one hour of
homemaker and one hour of chore services rather than two hours of
each service, or two hours of only one or the other.
(3) Training Requirements: Contract Service Providers or Volunteers
Revised 6/13/01
Revision No. 01
(a) Pre-Service Training. Staff or volunteers providing this service
must receive at least three hours of training in the following areas:
1. Safety and home accident prevention;
2. Procedures for handling client's money (if chore-worker
handles money);
3. Client confidentiality;
4. Program policies and procedures;
5. CCDA purpose and philosophy;
6. Emergency procedures in the event of a crisis during the
course of work;
PSMAI No. CA07
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Community Care for Disabled Adults
Adult Services Program
(c) Client must have, or be willing to arrange for, any special provisions
needed for installation, such as private line telephone service.
(d) Client must be mentally and physically able to use the equipment
appropriately.
(3) Service Tasks. The service provides a means of responding to an
emergency situation arising in the home setting involving a disabled adult. It
does not provide emergency services, but rather contacts the appropriate
personnel who will provide emergency services.
(a) Program requires operating a 24-hour, community-based personal
emergency response system designed particularly for functionally
impaired persons living in the community.
(b) Providers will purchase, rent or lease equipment that meets the
attached specifications and arrange for installation, training and
maintenance of the equipment. Batteries and telephone jack installation
fees are costs incurred by the client, unless there is an inability to pay
for these expenses. It is allowable for the provider to purchase batteries
and pay for installation if the client cannot pay.
(c) Providers will designate an emergency response center where
emergency signals are responded to according to a specified operating
protocol.
(d) Providers will ensure that client, signal activity, and service records
are maintained either by the provider or the response center.
(e) Providers will arrange monthly phone calls to each client's home to
test system operation, update records and provide direct client contact.
(f) Operational and technical manuals and training will be provided to
appropriate agency personnel.
(g) The provider or contracting agency will receive detailed manuals
from the emergency response equipment vendor relating to operational
aspects of the system including technical specifications, installation,
testing and field coordination.
(h) The emergency response center will receive detailed manuals
relating to operational aspects of the system including physical
arrangement of equipment, installation of all elements, testing
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PSMAI No. CA07
Contract No. KG047
'3)
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Community Care for Disabled Adults
Adult Services Program
(a) Client must need the above described service in order to
achieve a specific goal which will help them to function more
independently.
(b) Client must show measurable improvement in social,
interpersonal, and communication skills through the provision of this
service in order to continue to be eligible to receive the service.
Scope of Service
(a) Group activity therapy may only be provided by a professional
staff person with demonstrated abilities in group dynamics and skill in
conducting the above described group activities.
(b) Group activity therapy should provide an arena in which clients
in need of service can increase their success in social interaction,
communication, and interpersonal functioning.
(c) Group activity therapy is not considered a psychiatric service
where medical treatment in the form of group therapy is provided.
Training Requirements
(a) Pre-Service Training. A total of ten hours per year is required for
contract service providers and DCF staff. The following topics should
be included:
1.
CCDA Program and purpose;
2.
Local service providers and community resources;
3.
Medical and psychological aspects of disability;
4.
Group therapy and group dynamics;
5.
Communication skill building activities;
6.
Recreational activities for the disabled client;
7.
Interpersonal and social skill building activities.
PSMAI No. CA07
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Community Care for Disabled Adults
Adult Services Program
(b) In-Service Training. Staff providing group activity therapy must
be scheduled for in-service training to augment and/or refresh their
knowledge. A minimum of six hours per year will be scheduled for in-
service training. Content, duration, and documentation of .attendance
must be on file in the agency and staff records.
Home Delivered Meals
(1) A home delivered meal is a hot or other appropriate, nutritionally sound
meal that meets one-third of the current daily recommended dietary
allowances (RDA) served in the home to a disabled person.
(2) The unit of service is one meal delivered.
Scope of Service
The CCDA service criteria will be met if the meals are provided by a contractor
who is approved to provide home delivered meals that are funded by Older
Americans Act (Title III-C), or Community Care for the Elderly (CCE). The
CCDA program cannot claim commodities or cash-in-lieu of commodities, if
subcontracting with a Title III-C-2 provider.
Training Requirements
(a) Pre-Service. All contract service providers and DCF staff
(volunteers or paid) involved in home-delivered meals service, whether
in meal preparation or delivery, must receive pre-service training.
Training will be appropriate to respective job duties and responsibilities
and must minimally provide instructions for performing assigned tasks.
If staff or volunteers have received prior equivalent service training, this
training can be substituted for part or all of the required hours for pre-
service training.
(b) In-Service. In-service training for all staff involved in home-
delivered meals service will be regularly scheduled. Minimum in-
service training must be six hours per year with attendance, content
and hours documented in agency and staff records.
Special Conditions
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Community Care for Disabled Adults
Adult Services Program
(1) Food Service Contract Provisions.
Revised 6/13/01
Revision No. 01
(a) Food service contracts are defined as contracts for the purchase
of meals or portions of meals or for food preparation.
(b) All recipients of awards must adhere to the standards set forth in
this manual.
(c) Written specifications for food service contracts must be
approved by the district program office prior to solicitation of bids for
such contracts.
(d) Specifications for bids, and terms and conditions of the
proposed contracts, must establish methods and responsibilities for
each of the following:
1. Delivery.
a. Transportation: trucks, vans.
b. Delivery sites: number and location.
c. Delivery schedule:
(1) Number of days each week;
(2) Hour of delivery for each site.
d. Types of containers for bulk food delivery, if
applicable.
e. Types of containers for individual service.
f. Return of containers:
(1) How and by whom.
(2) Condition (washed, sterilized, etc.).
2. Menus.
a.
Written by whom.
b.
Approved by whom.
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Adult Services Program
c. Compliance with required meal pattern and other
standards required herein.
d. CCDA program person responsible for receipt and
review of menus at least 5 weeks in advance of service.
e. Approval of substitutions on menus.
3. Sanitation.
a. Compliance with federal, state and local
regulations.
b. Food preparation facility inspection within previous
6 months.
c. Delivery standards:
(1) Temperature maintenance;
(2) Sanitary conditions.
4. Inspections. Inspection of food preparation, packaging
and storage areas by the department.
5. Food.
a. Number of meals:
(1) Provision for flexibility;
(2) Time limits for ordering amounts of food.
b. Cost schedule.
c. Food purchased by whom.
d. Food provided: entree, vegetable, fruit, milk,
dessert, juice, salad, beverage, cream (or substitute),
condiments, butter or margarine.
e. If foods do not meet proper specifications, the
department will not be required to pay.
PSMAI No. CA07
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Adult Services Program
f. If the caterer fails to deliver a meal or any portion
of meals, the department will procure food from other
sources at the caterer's expense.
6. Administration.
a. Sales tax exemption.
b. Caterer's financial records open for audit.
c. Supply information for nutrition reporting on labor
and raw food costs.
d. Insurance coverage.
e. Bonding.
f. Food cost changes.
g. Length of contract.
h. Approval by PDAA.
I. Dates/times of contract payments to contractor.
j. Holidays and other days when meals are not to be
served.
(e) All proposed food service contracts with profit-making
organizations must be submitted for prior approval by the district.
(2) Insurance. It is strongly recommended that food service providers have
adequate liability insurance coverage, including product liability.
Home Health Aide
(1) Home health aide service means health or medically-oriented tasks
furnished to an individual in his or her residence by a trained home health
aide. The home health aide must be employed by a licensed home health
agency and supervised by a licensed health care professional who is an
employee or contractor of the home health agency.
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Adult Services Program
(2) The unit of service is one hour (or quarter hour portion) of time spent
performing designated home health aide services. It does not include time
spent in transit, but rather is the time spent providing services to the client.
(3) This is a health maintenance service as defined by Section 410.603(4),
F.S. It lists those routine health service(s) necessary to help maintain the
health of a disabled adult.
Eligibility to Receive Home Health Aide Services
The client's medical supervision is under an established plan of treatment. A
plan of treatment means a written instruction provided by the attending
physician for the provision of health care to a disabled adult in his or her
home.
Service Tasks
(a) The home health aide will perform only those activities contained
in a written assignment by a health care professional. (A health care
professional is any person who has completed a course of study in a
field of health care, such as a nurse. The person is usually licensed by
a governmental agency, such as a board of nursing, and becomes
registered or licensed in that health care field. In some instances, the
person is certified by a state regulatory body, such as with a certified
nurses' aide.) Home health aide activities include assisting the patient
with personal hygiene, ambulation, eating, dressing and shaving.
(b) The home health aide may perform other activities as taught by
a health professional employee for a specific patient. These include
and are limited to: assisting with the change of a colostomy, ileostomy
or urestomy bag; a shampoo; the reinforcement of a dressing; assisting
with the use of devices for aid to daily living (i.e. walker, wheelchair);
assisting with prescribed range of motion exercises which the home
health aide and the patient have been taught by a health professional,
assisting with prescribed ice cap or collar; doing simple urine tests for
sugar, acetone or albumin; measuring and preparing special diets;
measuring fluid intake and output; and supervising the self-
administration of medications. This supervision means reminding
clients to take medications, opening bottle caps for clients, reading the
medication label to clients, observing clients while taking medications,
checking the self-administered dosage against the label of the
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container and reassuring clients that they have obtained and are taking
the correct dosage.
(c) The home health aide will not: change sterile dres~ings;irrigate
body cavities, such as an enema; irrigate a colostomy or wound;
perform a gastric lavage or gavage; catheterize a patient; administer
medications; apply heat by any method; care for a tracheotomy tube;
administer eye drops; or any personal health service which has not
been included by the professional nurse in the patient care plan.
(d) The home health aide must keep records of personal health care
activities and the hours spent performing the tasks.
(e) The home health aide will observe appearance and gross
behavior changes in the patient and report any changes to the
professional nurse.
(f) The home health aide patient services must be evaluated by a
health professional staff person at least every two weeks in the home
for the purposes of observing service delivery and the status of the
client.
(g) The agency must maintain a ratio of at least one health
professional employee for every five nonprofessional persons providing
health services. When full-time equivalents are used in the case of
part-time nonprofessional persons providing health services, the actual
number of such persons supervised must not exceed twelve clients.
(h) This service must be provided in compliance with Chapter 59A-
8, F.A.C., Home Health Aide.
Service Criteria
(a) The plan of treatment will be established and reviewed by the
attending physician in consultation with agency staff involved in giving
service to the patient, at such intervals as the severity of the patient's
illness requires, but in any instance, at least every 60 days and shall
include, but not be limited to the following:
1.
2.
Diagnosis;
Types of services and equipment required;
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3. Specific frequency of visits such as two times a week or
three times a week;
4. Activities permitted;
5. Diet;
6. Medications and treatments;
7. Dated signature of the physician.
(b) Assessment of the need for home health aide services must be
made by the case manager. A service plan must be developed,
specifying frequency and duration of service, and formulated with the
nurse supervisor, physician, licensed physical therapist, or licensed
occupational therapist prior to the delivery of service.
(c) A registered nurse, either paid or volunteer, must be on staff or
under contract as a consultant to make home visits to each client at
least every two weeks. The registered nurse will supervise the home
health aides, assess whether the service plan is being carried out
properly, attend or provide in-service training, review reports and
records, and assist in employee performance evaluations.
(d) The home health aide records services rendered during each
visit, completes time and attendance records, participates in
performance evaluations, prepares incident reports as the need arises,
and attends pre-service and in-service training.
(e) The service provider must develop emergency procedures to be
followed in the event of a crisis during the course of care.
(f) Home health aide care will not substitute for care provided by a
registered or practical nurse, or a licensed therapist.
Training
(a) Pre-Service. The home health aide must have training in
supportive services, which are required to provide and maintain bodily
and emotional comfort, and assist the patient toward independent living
in a safe environment. If the aide receives training through a vocational
school, licensed/certified home health agency, or hospital, the
curriculum will be documented. If training is received through the
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agency, the curriculum will consist of at least forty-two hours, which
include:
1. Role of the home health aide, differences in families, ethics,
and orientation to the agency (two hours);
2. Physical appearance and personal hygiene (one hour). The
following topics should be included: uniform; hair; hands and
fingernails; cleanliness; teeth; makeup; perfume; jewelry and
smoking;
3. Supervision by a registered nurse, registered physical
therapist, occupational therapist, registered speech therapist
(three hours). The following topics should be included: role of
the supervisor; role of the aide; role of the physician; role of the
patient; plan of care; assignment of tasks; record keeping; and
performance evaluation;
4. Personal care services (twenty-four hours), to include the
following topics; bathing; dressing; toileting; feeding (eating);
bed making; ambulation; body mechanics; transfer techniques;
range of motion and exercises;
5. Nutrition and food management (four hours), to include the
following topics: basic food requirements; purchasing of food;
preparation of food; storage of food; serving of food; and special
diets;
6. Household management (two hours), to include the following
topics: care of bedroom, bathroom, kitchen; care of clothing;
and safety in the home;
7. Emotional aspects of disability, including death and dying (six
hours);
8. If staff or volunteers have received prior equivalent service
training, this training can be substituted for part or all of the
required hours of pre-service training. The personnel file of the
staff member or volunteer must include documentation of the
prior training.
(b) In-Service. In-service training for contract service providers,
DCF staff and home health aides must be regularly scheduled to
augment or refresh the home health aide's knowledge in any of the
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above listed areas. A minimum of six hours per year is required; staff
records must be documented to indicate training provided.
Homemaker Service
(1) Homemaker service means the performance of or assistance in
accomplishing specific home management duties including housekeeping,
meal planning and preparation, shopping assistance, and routine household
activities by a trained homemaker. With district approval, it may include the
purchase of home and/or cleaning supplies needed for the delivery of
services. Otherwise, clients are responsible for purchasing their own cleaning
supplies.
(2) The unit of service is one hour (or quarter hour portion) of time spent in
the provision of designated homemaker duties by a trained homemaker. It
does not include time in transit to and from the client's place of residence
except when providing shopping assistance, performing errands or other tasks
on behalf of the client. If the service is to be provided to a couple, the unit of
service must be assigned to either the eligible husband or wife, preferably the
one who usually performs homemaking duties.
Service Tasks
(a) Meal planning and preparation;
(b) Housekeeping;
(c) Laundry;
(d) Clothing repair;
(e) Minor home maintenance. (e.g. changing light bulbs);
(f) Shopping assistance;
(g) Assistance with budgeting and paying bills;
(h) Client transportation, if permitted;
(i) Record keeping as required;
U)
Reporting changes in client condition or behavior, to supervisor;
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(k)
Following established emergency procedures.
*Restrictions on homemaker activities:
1. Must not engage in work that is not specified in the
homemaker assignment;
2. Must not accept gifts from clients;
3. Must not lend or borrow money or articles from clients;
4. Must not perform services requiring a public health nurse,
a home health aid, or personal care worker to perform;
5. Must not handle money unless authorized by supervisor
or case manager and bonded or insured by employer;
6. Must not transport the client unless authorized by
supervisor or case manager.
Service Provision Log. The homemaker is required to fill out a client service
provision log. Any form used must record the following: the date of the visit;
activities performed during the visit, and number of hours spent performing the
activities.
Training Requirements
(a) Pre-Service. A total of twenty hours are required covering the
following: CCDA program and purpose; medical and psychological
aspects of disability; interpersonal relationships; nutrition and meal
preparation; marketing and food storage; use of household equipment
and supplies; planning and organizing household tasks; principles of
cleanliness and safety of the home; record-keeping; agency policies
and procedures; and emergency procedures.
(b) If staff or volunteers have received prior equivalent service
training, this training can be substituted for parts or all of the required
hours of pre-service training. The personnel file of the staff member or
volunteer must include documentation of the prior training.
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Home Nursing Services
(1) Home nursing service is part-time or intermittent nursing care
administered to an individual by a licensed professional or practical nurse or
advanced registered nurse practitioner, as defined in Chapter 46'4, F.S., in the
place of residence used as the individuals home, pursuant to a plan of care
approved by a licensed physician.
(2) The unit of service is one hour of client contact by the advanced
registered nurse practitioner or the licensed practical nurse.
(3) This is a health maintenance service as defined by Section 410.603(4),
F.S. It lists those routine health service(s) necessary to help maintain the
health of a disabled adult.
Eligibility to Receive Home Nursing Services
(a) A physician's prescription/plan of treatment is required to obtain
home nursing services. A request for continuation of services, signed
by a physician, is required at sixty-day intervals.
(b) Funding sources inclusive of, but not limited to, Medicare,
Medicaid and third party payment must be exhausted prior to utilization
of CCDA funding for provision of home nursing services.
Service Tasks
(a) Home nursing provides services that assist the client in his/her
efforts to maintain an optimal level of health of body and mind.
(b) Home nursing assists the client to prevent the occurrence or
progression of illness, thus decreasing the frequency of
hospitalizations.
(c) Home nursing can be rendered through a home health agency,
or provided by an independently practicing registered nurse, a
registered nurse employed by a county health unit, or an independently
practicing licensed practical nurse working under the direction of a
registered nurse.
(d) Nursing service shall not be rendered in hospitals or skilled or
intermediate care facilities.
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(e) Nursing services rendered in the home shall include observation,
assessment, nursing diagnosis, care, health teaching and counseling,
maintenance of health, prevention of illness, administration of
prescribed medications and treatments, and the supervision and
teaching of others in the performance of nursing tasks.
Training Requirements
(a) Pre-Service. A provider of home nursing services must hold a
license, in good standing, to practice professional or practical nursing in
the State of Florida.
(b) In-Service. In-service training requirements can be met through
attendance at professional meetings/conferences and/or completion of
required course work for continuation of registration or licensure status.
A minimum of six hours of meeting attendance, course work or other
training related to the job function must be obtained per year; content
and duration must be documented in staff and agency records.
Interpreter Service
(1) Interpreter service is assisting a client to communicate despite a
hearing or speech impairment or language barrier.
(2) A unit of interpreter service is one hour spent in providing interpreter
service to and/or for a client. It does not include time spent in transit to and
from a client's home or service provider, but rather is the time spent in
interpreting for the client.
Eligibility to Receive Interpreter Services
(a) Client must have communication barrier significant enough to
prevent him or her from effectively and accurately receiving or giving
information.
(b) Client must not be able to secure the service from his or her own
support system.
Scope of Service
(a) Interpreter service is to be used to free clients from significant
barriers to communication. Barriers: language and deafness.
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(b) Interpreter service should be used to assist clients to access
community resources, medical services, or social security, disability, or
other governmental agency resources.
Training Requirements
(a) Interpreters for the deaf must have one of the following
nationally or state recognized certifications: comprehensive skills
certified, interpreting certified, trans-literator certified, or QA screened
level 3.
(b) Language interpreters must be sufficiently proficient in the
languages to be translated.
Medical Equipment/Supplies
(1) The purchase of medical equipment/supplies for use by CCDA clients
is allowable under the CCDA program. Medical equipment/supplies may be
durable, such as walkers, wheelchairs, bedside commodes, etc., or it may be
non-durable, such as Chux bed pads, colostomy supplies, adult diapers, etc.
Durable equipment should be loaned and returned to the program when the
client no longer needs it, so that others may use it. Non-durable
equipment/supplies are not to be reused. Expenditures of more than $100.00
are to be approved by the district before purchase.
(2) There is no measurable "unit" of service for this category. Instead,
providers are requested to maintain documentation regarding the expenditure
of CCDA funds for this service. The following information should be tracked:
(a) Description of the kinds of equipment requested and needed,
and, how many requests were received for each (annually);
(b) Of the requests documented, how many received the needed
equipment (annually);
(c) Itemization of durable equipment purchased: description,
quantity, and price per item (annually);
(d) Number of clients utilizing each type of durable equipment
purchased (annually);
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(e) Itemization of non-durable equipment purchased: description,
quantity, and price per item (annually);
(f) Number of times non-durable equipment and supplies was given
to CCDA clients.
Scope of Service
(a) The purchase of medical equipment/supplies should be used
only as the last resource to provide the client with needed items.
(b) The purchase of medical equipment/supplies can include both
durable and non-durable equipment. Durable equipment should be
loaned to clients so that more than one person may use the equipment.
Medical Therapeutic Services
(1) Medical Therapeutic Services are those corrective or rehabilitative
services which are prescribed by a physician or nurse practitioner licensed in
the State of Florida, provided by a professionally licensed, registered or
certified professional and are designed to assist the disabled person to
maintain or regain sufficient functional skills to live independently in the least
restrictive environment possible.
(2) Such therapies are necessary services for individuals who have
suffered physical damage or debilitation due to disease or trauma and may
include occupational therapy, physical therapy and services for individuals
with speech, hearing and language disorders.
(3) The unit of service is one hour of client contact by the health
professional in the client's place of residence or facility where the service can
be provided (e.g., hospital outpatient rehab center).
(4) This is a health maintenance service as defined by Section 610.403(4),
F.S. It lists those routine health service(s) necessary to help maintain the
health of a disabled adult.
Eligibility to Receive Medical Therapeutic Services
(a) A physician or nurse practitioner, or speech, occupational, or
physical therapist, must prescribe the needed services. A request for
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continuation of services, signed by one of the professionals named
above is required at sixty day intervals.
(b) A client receiving like services under another prowam
component will not be regarded as eligible for duplicative medical
therapeutic services, for example, a recipient of physical and
occupational therapy while in an adult day care program will not be
eligible for duplicative services in his/her place of residence or at a
provider facility, unless the frequency of treatment(s) required does not
correspond with the frequency of attendance at day care.
Scope of Service
(a) Services shall include occupational therapy, physical therapy,
speech pathology and audiology. Definitions for these therapies may
be found in the glossary.
(b) Payment for supplies and equipment deemed by the therapist or
physician as reasonable and necessary to the success of the treatment
rendered to the client, will be eligible under this program in accordance
with district program budgets. All resources will be exhausted prior to
the utilization of CCDA funds for the purchase of supplies or equipment
for medical therapeutic services. THE CCDA PROGRAM SHALL BE
THE PROVIDER OF LAST RESORT.
Education and Training Requirements. Any provider of a medical therapeutic
service must hold current registration, certification or license to practice in the
State of Florida in the designated area of the services to be provided.
(a) Pre-Service. None is required.
(b) In-Service. In-service training requirements can be met through
attendance at professional meetings/ conferences and/or required
course work for continuation of registration, certification or licensure
status. A minimum of six hours of meeting attendance, course work or
other training related to the job function must be obtained per year;
content and duration must be documented in staff and agency records
holding documentation of the employee's professional qualifications.
Personal Care
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(1) Personal care means services to assist the disabled adult with bathing,
dressing, ambulation, housekeeping, supervision, emotional security, eating,
supervision of self-administered medications and assistance with securing
health care from appropriate sources. Personal care services do not include
medical services.
(2) A unit of service is one hour (or quarter hour) of elapsed time spent in
providing designated personal care services by a qualified personal care aide.
It does not include time spent in transit to and from the client's home.
(3) This is a health maintenance service as defined by Section 410.603(4),
F.S. It lists those routine service(s) necessary to help maintain the health of a
disabled adult.
Service Tasks. The personal care aide will perform such tasks as:
(a) Assisting the client with personal hygiene, dressing, feeding, or
transfer or ambulatory needs, including use of wheelchair, crutches,
walker;
(b) Assisting with toileting and/or use of a bedpan;
(c) Assisting the client with self-administered medications when
ordered by the client's physician, and as prescribed in the personal
care plan. The personal care aide may not administer the medication,
but may bring the medication to the client and remind the client to take
the medication at a specific time;
(d) Assisting with food, nutrition and diet activities including
preparation of meals when essential to good health;
(e) Performing household services such as changing bed linens
when the performance is essential to good health;
(f) Accompanying the client to clinics, physician office visits, or
other trips when health care needs require personal care assistance.
Service Task Restrictions:
(a) A registered nurse, either paid or volunteer, must be on the staff
or under contract to make home visits to supervise personal care aides
at least every 60 days. The registered nurse will assess whether
activities in the service plan are being carried out properly; attend or
provide in-service training; review reports and records; and conduct or
Revised 6/13/01 PSMAI No. CA07
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6. Household management (2 hours), to include: care of
bedroom, bathroom, kitchen, care of clothing and safety in the
home.
7. Physical, mental, and social aspects of disability; social
aspects of death and dying (2 hours).
(b) If staff or volunteers have received prior equivalent training, it
may be substituted for part or all of the required hours of pre-service
training. The personnel file of the staff member of volunteer must
include documentation of the prior training.
(c) In-Service Training. Staff providing personal care must be
regularly scheduled for a minimum of 6 hours in-service training per
year; training must be documented in staff records.
Physical and/or Mental Examinations
(1) CCDA funds may be used to purchase the services of a physician,
psychologist, psychiatrist, or mental health professional in order for a CCDA
client to receive needed medical or mental health services. (Use the
departments approved fee schedule.)
(2) A unit of service is measured in episodes, with one episode (one unit)
defined as one examination, either physical or mental, made by one
physician, psychologist, or mental health professional.
(3) This is a health maintenance service as defined by Section 410.603(4),
F.S. It lists those routine health service(s) necessary to help maintain the
health of the disabled adult.
THE DPOAA MUST APPROVE EACH EXAMINATION BEFORE SERVICES
ARE RENDERED.
Scope of Service. Physical and mental examinations should be provided for
the purpose of evaluation, rather than extensive treatment provided over time
through numerous examinations.
Training Requirements.
(a) Pre-Service Training. A provider of physical or mental
examinations must hold a license in good standing to practice
medicine, or to conduct psychological examinations, or in the case of
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professional mental health counseling, must be certified as a mental
health professional.
(b) In-Service Training. There are no in-service training
requirements.
Respite Care
(1) Respite care means relief or rest for a caregiver from the constant
supervision, companionship, therapeutic and personal care on behalf of the
client for a specified period of time. The purpose of the service is to maintain
the quality of care to the client for a sustained period of time through
temporary, intermittent relief of the primary caregiver.
(2) The unit of service is one hour or quarter hour of elapsed time spent in
the provision of respite care services by a qualified worker.
Scope of Service
(a) Respite care may be provided for up to 240 hours per client per
calendar year depending upon individual need. The service may be
extended up to 360 hours as recommended by the client's case
manager and with documented approval by their immediate supervisor.
The service may be provided during a concentrated period or spaced
throughout the year. Additional hours may be approved by the district
on a case by case basis.
(b) The case manager will determine the level and intensity of care
required by a client. The case manager may obtain consultation from
other service providers, the client's family, caregiver, physician, or
nurse to determine the appropriate level of respite care needed.
(c) Respite care will not be substituted for the care usually
provided by a registered nurse, licensed practical nurse, or
therapist.
(d) In-home respite care may be provided by staff qualified as a
homemaker, home health aide, personal care worker, sitter or
companion, a combination of the above, or a trained volunteer,
provided that service standards are met.
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(e) Services provided for respite purposes will be classified as such
and not as homemaker, home health aide, personal care services and
the like, even though a homemaker or health aide may render the
service.
(f) Respite care staff must be appropriately supervised. A health or
social service professional must be available to supervise and provide
in-service training to workers providing the respite services. If, for
medical reasons, a home health aide must provide all or part of the
respite care services, a registered nurse or health professional must
supervise the aide. As an alternative, an agreement may be developed
with a visiting nurses association, the Red Cross, or a home health
agency, to supervise respite staff.
(g) Respite care staff will be adequately trained to respond to a
crisis, which may occur during the caregiver's absence.
(h) Respite care is to be provided in the client's home in familiar
surroundings, however, when a respite caregiver is not available to go
to the client's home, respite care may be provided by foster homes,
adult congregate living facilities, or nursing homes on a temporary
basis. RESPITE CARE SERVICE MAY NOT BE PROVIDED TO
RESIDENTS RESIDING IN NURSING HOMES OR ASSITED LIVING
FACILITIES.
Training Requirements.
(a) Pre-Service Training. Staff or volunteers providing this service
must receive at least twenty hours of instruction in the following areas:
1. Health problems and care of disabled persons;
2. Basic personal care procedures such as grooming;
3. First aid and handling of emergencies. Formal written
emergency procedures will be developed for the respite staff to
follow should an emergency occur;
4. Food, nutrition, meal preparation, and household
management;
5. If staff or volunteers have received prior equivalent
service training, the prior training can be substituted for part or
all of the required hours of pre-service training.
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(b) In-Service. In-service training for respite care workers will be
scheduled regularly. Minimum in-service training must be provided at
least once per year for a total of six hours. Content and,duration must
be documented in staff records.
Training. Training required is dependent upon level of care provided. If
personal care is to be provided, the personal care standards must be met.
Education. Education required is dependent upon level of care provided;
however, the respite worker must have the ability to read, write, and complete
required reports.
Transportation
(1) Transportation service is the transport of a client to and/or from service
providers or community resources. Any transportation essential to the
implementation of the service plan is allowable.
(2) Transportation service is measured in trips: one trip is defined as one,
one-way trip measured from a point of origin to a destination. The following
are two examples of measurement:
Example #1: Client is taken from home to the doctor's office. 1
trip
Client is taken from the doctor's office to the drug store. 1 trip
Client is taken from the drug store back home. 1 trip
Total # trips this episode: 3
Example #2: Client is taken from home to rehab therapy. 1 trip
Client is taken from rehab therapy to the grocery store. 1 trip
Client is taken from the grocery store to the drug store. 1 trip
Client is taken from the drug store back to the grocery store
(forgot eggs). 1 trip
Client is taken from the grocery store back home. 1 trip
Total # trips this episode: 5
Scope of Service
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(a) Services will be provided on a demand/response basis. Except
for emergencies, clients must request services at least twenty-four
hours in advance to facilitate efficient use of vehicles and staff.
(b) Existing transportation systems and equipment must be utilized
before CCDA funds are used for transportation services.
(c) Services may be provided by ambulance, taxicab, common
carrier, or provider vehicle. The agency or the vehicle owner must
provide excess liability coverage. Transportation services will be
provided only by persons having a valid Florida driver's license. If
volunteers are used, they must have a valid driver's license. Drivers
who transport clients on a regular basis in provider vehicles must have
a valid Florida Chauffeurs license.
(d) When transporting one or two clients, a driver may act as an
escort provided that the case manager determines that the client
cannot be left alone while receiving the services, and the client's needs
will not interfere with the driver's ability to safely control the vehicle. In
such instances, only one or the other may be counted in units of
service; transportation trips or escort hours.
(e) If the client requires supervision while in the vehicle, which the
driver cannot provide, a staff person other than the driver must provide
supervIsion.
(3) Minimum Service Standards. The following service standards for
transportation must be adhered to:
(a) Provide services in compliance with federal, state and local rules
and regulations issued by the Department.
(b) Document that staff personnel and volunteers are fully trained to
provide the services offered by the transportation program.
(c) CCDA funds may not be used to purchase vehicles.
(d) Document that all drivers who transport clients on a regular
basis in provider vehicles have:
1. A valid State of Florida Chauffeur License;
2. Minimum of one year driving experience with vehicles
similar to those to be operated for the provider;
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3.
A safe driving record acceptable for insurance coverage;
4. Successfully completed an American Red Cross or similar
program.
(e) Document that volunteers who drive privately owned
automobiles to transport clients meet the minimum requirements set
forth in CFOP 125-1, Community ResourcesNolunteer Management..
(f) Obtain and maintain minimum vehicle insurance coverage on all
provider owned or leased vehicles in accordance with the Division of
Risk Management.
(g) All unusual incidents, accidents or problems must be reported to
proper authorities and investigated by supervisory staff and records
maintained.
Training Requirements.
(a) Pre-Services Training. A total of 10 hours is required for
contract service providers and DCF staff. If staff or volunteers have
received prior equivalent training, it can be substituted for parts or all of
this requirement. The following topics should be included in the
training: interpersonal relationships; operation of vehicle and
equipment; accident and emergency procedures in the event
something may happen to the client while being transported; and
CCDA program and purpose.
(b) In-Service Training. Contract service staff providing medical
transportation must be scheduled regularly for in-service training to
augment or refresh knowledge in any of the above listed areas. A
minimum of six hours must be scheduled per year, content and
duration documented in agency and staff records.
PSMAI No. CA07
Contract No. KG047
~r
EXHIBIT B
Fiscal Year 2003-2004
Community Care for Disabled Adults Cumulative Summary Report
I. Demographics
District:
Name of Contract Manager:
Phone Number: SC
Reporting Period:
3 Month
6 Month
9 Month
12 Month
Local
II. Expenditures
(1) Total CCDA dollars:
(2) Total expenditures this quarter:
(3) Total expenditures spent to date:
(4) Encumbrances *:
(5) Balance:
III. Report Prepared By:
Phone Number:
* such as medical equipment, retrofitting, special needs etc.
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DEPARTMENT OF CHILDREN AND FAMILIES EXHIBIT 0
OFFICE OF FAMILY SAFTEY
MONTHLY REQUEST FOR PAYMENT AND EXPENDITURE REPORT
PROVIDER FED. ID #
NAME AND MAILING ADDRESS OF PAYEE:
CONTRACT AMNT.:_
REIMBURSEMENT YTD.:
CONTRACT BALANCE:
DATE:
CONTRACT#:
PERIOD OF SERVICE PROVISION:
NAME OF SERVICE UNITS! AMOUNT PER UNIT! TOTAL AMOUNT
OR DESCRIPTION OF MATERIALS QUANTITY EPISODE DUE
TOTAL
TOTAL MATCH REQUIRED PAYMENT
FOR CONTRACT: REQUESTED
THIS MNTH. YTD.
LOCAL CASH MATCH n FLORIDA DEPARTMENT OF
LOCAL IN-KIND ~ CHILDREN
TOTAL DEDUCTIONS
~I , FAMILIES
REMAINING MATCH BALANCE
SIGNITURE OF PREPARER
APPROVED BY
DATE COMPLETED
TITLE
'IF THIS INVOICE IS FOR A FIXEO PRICE CONTRACT, THE REQUEST FOR PAYMENT WILL BE DETERMINED
BY DIVIDING THE LENGTH OF THE CONTRACT INTO THE CONTRACTED AMOUNT (EX.-S12,OOOIALlOCATlONj DIVIDED BY
12 MONTHS [THE LENGTH OF THE CONTRACT]=S1.000 PAYMENT REQUEST) ON A COST REIMBURSEMENT CONTRACT
THE PAYMENT REQUEST WILL BE THE MONTHLY REQUEST EXPENSE.
CHILDREN AND FAMILIES USE ONLY
DATE INV. RCD.
APPROVED BY:
DATE
IORG
AMNT.
EO
OBJ
DESC.
IOCA
Gf
~LCIH riApREN
lS2J & FAMI LI ES
EXHIBIT E
SECURITY AGREEMENT FORM
The Department of Children and Families has authorized you:
Employee's Name/Organization
to have access to sensitive data through the use of computer-related media (e.g., printed reports,
microfiche, system inquiry, on-line update, or any magnetic media).
Computer crimes are a violation of the department's disciplinary standards and, in addition to
departmental discipline, the commission of computer crimes may result in Federal and/or State
felony criminal charges.
. By my signature, I acknowledge that I have received, read and understand the Computer
Related Crimes Act, Chapter 815, F.S.
. By my signature, I acknowledge that I have received, read and understand Sections 7213,
7213A, and 7431 of the Internal Revenue Code, which provide civil and criminal penalties
for unauthorized inspection or disclosure of Federal tax data.
. By my signature, I acknowledge that it is the policy of the Department of Children and
Families that under no circumstances shall any contract employee be allowed access
to IRS tax information.
I understand that a security violation may result in criminal prosecution according to the provisions
of Federal and State statutes and may also result in disciplinary action against me according to the
provisions in the Employee Handbook. I agree to be bound by the provisions of CFOP 50-6. The
minimum department security requirements are:
. Personal passwords are not to be disclosed.
. Information is not to be obtained for my own or another person's personal use.
Print Employee's Name
Signature of Employee
Date
Print Supervisor's Name
Signature of Supervisor
Date
(pc)
Distribution of Copies: Original - Personnel File/Contract File
Copy - Security File
Copy - Employee
CF 114, JF 08/2001
Florida Department of
CHILDREN
& FAMI LI ES
District 'cking Number (for CRITICAL incidents)
11,66 (COL), 59
(SFETC)
YEAR Sequence Code
Check if CLOSED
Program Code (AS, DA, DD, ESS, FS), MH, SA
DISTRICT 11 INCIDENT REPORT
EXHIBIT F
(Critical incidents must be reported to District Administrator within 24 hours of notification.) CHECK IF CRITICAL 0
[CONFIDENTIAL
WARNING: The information contained in this report is confidential. You are hereby notified that dissemination, distribution, or
copying of this document is strictly prohibited, unless authorized by the Department of Children & Families.
I. IDENTIFYING INFORMATION
Reporting Party Phone #:
Reporting Party Name
District Program Area: Specific Program:
Please respond to one of the following as appropriate.
a. Contract Provider Name Contract Facility Name (if appropriate)
b. Foster Home Name c. DS Home Name
d. DCF Facility Name e. Other Name
Is this a licensed facility? 0 Yes 0 No 0 Don't know.
Specific location/address where incident occurred:
Date of Incident
/
/
Time of Incident
DCF Unit #
Check one box only.
1. 0 Abuse/Neglect/Exploitation
2.0 Altercation
3. 0 Bomb Threat
4.0 Client Injury 0 Illness
5. 0 Client Death
6.0 Contraband DDrugs
7.0 Elopement
8.0 Escape
9.0 Media Coverage
10. 0 Misconduct DCriminal Activity
11. 0 Sexual Battery
12. 0 Suicide Attempt
13. 0 Theft DVandalism DDamage DSabotage
14. 0 Other Incidents
15. 0 Non-Critical Other
FIRST Name LAST Name Add SS# if Birth Date Race Gender Client Employee Participant Witness
employee or client
is a participant
_I ---.!_ D D D 0
_1_1- 0 0 0 0
_1_1- 0 D 0 0
_1_1- 0 0 0 0
. ...
Give Detailed Account - (Who, What, When, Where, Why, How) - Add Pages If Necessary
,lP Co
CONFIDENTIAL
V. CORRECTIVE ACTION AND FOLLOW UP
Immediate corrective action taken
Is follow-up action needed? NOD
YEsD
If yes, specify:
&7
CONFIDENTIAL
VI. INDIVIDUALS NOTIFIED
EXTERNAL NOTIFICATION
Agency Notified Person Contacted Status Date/Time Called Copy
Abuse Registry Name Report Accepted
1-800-962-2873 D D
ID# Yes D NoD
Agency for Health Care
Administration Name: N/A D D
Law Enforcement-Department Officer's Name
I Badge # Case # (if avail) N/A D D
ParenUGuardian/
Family Member Name Name: N/A D D
Other (Please Specify)
Name: N/A D D
DCF (for providers only) Name: N/A D D
VII. REVIEW AND SIGNATURES
NAME SIGNATURE TITLE PHONE # DATE
REPORTING / /
EMPLOYEE ---
SUPERVISOR / /
---
l
DCF INTERNAL NOTIFICATION
Individual/Agency DatelTime Called Copy Individual/Agency Notified DatelTime Called Copy
Notified
Client Relations D D Employee Safety Program D D
District Administrator D D Florida Local Advocacy Committee D D
Division Director/ H.R. Workers' Compensation
Facility Director D D Coordinator (employee related incidents only) D D
District Legal Counsel D D Program Office/Risk Manager D D
DS Support Coordinator/Case D D Others - (Please specify) D D
Manager
EEOC D D Contract Manager
VIII. DCF REVIEW AND SIGNATURES
IR Liaison Review: NAME SIGNATURE TITLE PHONE # DATE
Initial if complete.
ADMINISTRATOR /
ON CALL MANAGER / /
---
DIVISION DIRECTOR/
FACILITY DIRECTOR / /
---
(Q g
ATTACHMENT I I
The administration of resources awarded by the Department of Children & Families to the pi'ovider may be
subject to audits as described in this attachment.
MONITORING
In addition to reviews of audits conducted in accordance with OMS Circular A-133 and Section 215.97,
F.S., as revised, the Department may monitor or conduct oversight reviews to evaluate compliance with
contract, management and programmatic requirements. Such monitoring or other oversight procedures
may include, but not be limited to, on-site visits by Department staff, limited scope audits as defined by
OMS Circular A-133, as revised, or other procedures. Sy entering into this agreement, the recipient agrees
to comply and cooperate with any monitoring procedures deemed appropriate by the Department. In the
event the Department determines that a limited scope audit of the recipient is appropriate, the recipient
agrees to comply with any additional instructions provided by the Department regarding such audit. The
recipient further agrees to comply and cooperate with any inspections, reviews, investigations, or audits
deemed necessary by the Department of Financial Services or the Auditor General.
AUDITS
PART I: FEDERAL REQUIREMENTS
This part is applicable if the recipient is a State or local government or a non-profit organization as defined
in OMS Circular A-133, as revised.
In the event the recipient expends $300,000 or more in Federal awards in its fiscal year, the recipient mllst
have a single or program-specific audit conducted in accordance with the provisions of OMS Circular A-
] 33, as revised. In determining the Federal awards expended in its fiscal year, the recipient shall consider
all sources of Federal awards, including Federal resources received from the Department of Children &
Families. The determination of amounts of Federal awards expended should be in accordance with
guidelines established by OMS Circular A-133, as revised. An audit of the recipient conducted by the
Auditor General in accordance with the provisions of OMS Circular A-133, as revised, will meet the
requirements of this part. In connection with the above audit requirements, the recipient shall fulfill the
requirements relative to auditee responsibilities as provided in Subpart C of OMS Circular A-133, as
revised.
The schedule of expenditures should disclose the expenditures by contract number for each contract with
the Depat1ment in effect during the audit period. The financial statements should disclose whether or not
the matching requirement was met for each applicable contract. All questioned costs and liabilities due the
Department shall be fully disclosed in the audit report package with reference to the specific contract
number.
03/01/2003
eoq
PART II: STATE REQUIREMENTS
This part is applicable if the recipient is a nonstate entity as defined by Section 215.97(2)(1), Florida
Statutes.
In the event the recipient expends a total amount of state financial assistance equal to or in excess of
$300,000 in any fiscal year of such recipient, the recipient 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 Executive
Office of the Governor, the Department of Financial Services and Chapters 10.550 (local governmental
entities) or 10.650 (nonprofit and for-profit organizations), Rules of the Auditor General. In determining
the state financial assistance expended in its fiscal year, the recipient shall consider all sources of state
financial assistance, including state financial assistance received from the Department of Children &
Families, 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 the preceding paragraph, the recipient shall ensure
that the audit complies with the requirements of Section 215.97(7), Florida Statutes. This includes
subm ission of a financial reporting package as defined by Section 215.97(2)( d), Florida Statutes, and
Chapters 10.550 or 10.650, Rules of the Auditor General.
The schedule of expenditures should disclose the expenditures by contract number for each contract with
the Department in effect during the audit period. The financial statements should disclose whether or not
the matching requirement was met for each applicable contract. All questioned costs and liabilities due the
Department shall be fully disclosed in the audit report package with reference to the specific contract
number.
P ART III: REPORT SUBMISSION
Any reports, management letters, or other information required to be submitted to the Department pursuant
to this agreement shall be submitted within 180 days after the end of the provider's fiscal year or within 30
days of the recipient's receipt of the audit report, whichever occurs first, directly to each of the following
unless otherwise required by Florida Statutes:
A. Contract manager for this contract (2 copies)
B. Department of Children & Families
ASFMI
Building 2, Room 301
1317 Winewood Boulevard
Tallahassee, FL 32399-0700
03/01/2003
10
C. Copies of the reporting packages for audits conducted in accordance with OMB Circular A-] 33, as
revised, and required by Part 1 of this agreement shall be submitted, when required by Section .320(d),
OMB Circular A-133, as revised, by or on behalf of the recipient directly to the Federal Audit
Clearinghouse designated in OMB Circular A-133, as revised (the number of copies required by
Sections .320(d)(l) and (2), OMB Circular A-133, as revised, should be submitted tQ the Federal
Auditing Clearinghouse), at the following address: .
Federal Audit Clearinghouse
Bureau of the Census
120 I East 10'h Street
Jeffersonville, IN 47132
and other Federal agencies and pass-through entities in accordance with Sections .320(e) and (t),
OMB Circular A-133, as revised.
D. Copies of reporting packages required by Part II of this agreement shall be submitted by or on behalf
of the recipient directly to the following address:
Auditor General's Office
Room 401, Pepper Building
111 West Madison Street
Tallahassee, Florida 32399-1450
Providers, when submitting audit report packages to the Department for audits done in accordance with
OMB Circular A-133 or Chapters 10.550 (local governmental entities) or 10.650 (nonprofit or for-profit
organizations), Rules of the Auditor General, should include, when available, correspondence from the
auditor indicating the date the audit report package was delivered to them. When such correspondence is
not available, the date that the audit report package was delivered by the auditor to the provider must be
indicated in correspondence submitted to the Department in accordance with Chapter 10.558(3) or Chapter
10.657(2) Rules of the Auditor General.
PART IV: RECORD RETENTION
The recipient shall retain sufficient records demonstrating its compliance with the terms of this agreement
for a period of six years from the date the audit report is issued and shall allow the Department or its
designee, the Department of Financial Services, or the Auditor General access to such records upon
request. The recipient shall ensure that audit working papers are made available to the Department or its
designee, the Department of Financial Services, or the Auditor General upon request for a period of three
years from the date the audit report is issued, unless extended in writing by the Department.
03/0 I /2003
1(