Resolution 391-1999
fOR RECORO
f\LEO . 44 Board of County Commissioners
\ qqq SE? 2? ?~ 3.
Of.\m\,( L. W.~:~Gc. RESOLUTION NO. 391 -1999
CU\. COIJirr'l'. fL~.
MONROE C .
"A RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY,
FLORIDA, FOR HCBS/MEDICAID WAIVER REFERRAL
WHEREAS, a Referral agreement is required to be entered between Monroe County and service
providers for referrals to be made to service providers; and
WHEREAS, Monroe County In Home Services is the Case Management Agency and MONROE COUNTY
BA YSHORE MANOR is the Service Provider Agency for certain services; and
WHEREAS, it is desired that the two agencies, both constituting sub-departments of the County, promote
the development of a coordinated service delivery system to meet the needs of the aged or disabled adults who
are at risk of premature institutionalization;
NOW THEREFORE, be it resolved by the Board of County Commissioners that In Home Services and
Bayshore Manor shall work together to meet the following:
I. Objectives
1. To maintain a climate of cooperation and consultation with and between agencies, in order to
achieve maximum efficiency and effectiveness.
2, To participate together by means or shared information in the development of services.
3, To promote programs and activities designed to prevent premature institutionalization of elders
and disabled adults.
4. The agencies (sub-departments) will provide technical assistance and consultation to each other
on matters pertaining to actual service delivery and share appropriate assessment information and care plans so
duplication may not occur.
5. Both agencies may terminate services upon no less than thirty days notice without cause; the
Case Management Agency may terminate upon no less than twenty-four hours notice due to lack of funds; and
unless waived by the Case Management Agency, the Agreement may be terminated for breach upon no less than
twenty-four hour notice. All termination notices must be delivered by certified mail, return receipt requested, or in
person with proof of delivery.
II. Under this resolution, the Service Provider Agency shall perform the following:
1. Accept referrals for the Aged/Disabled Home and Community Based Services (HCBS) Medicaid
Waiver from only the Case Management Agency.
2. Provide quality service(s) specified in Section IV for the waiver participant
3. Provide only those service(s) specifically outlined in the Plan of Care or service authorization
submitted by the Case Management Agency.
4. Bill Medicaid at the usual and customary rate for each service.
5. Attach documents regarding provider qualifications to this agreement; and to provide, as
requested, any information, regarding Medicaid Waiver billing, payment, or waiver participant information, to the
Case management Agency or Area Agency on Aging, Provider rate increases/decreases must be forwarded to
the Case Management Agency listing the service(s), The necessary documentation regarding provider
qualifications for additional services will be signed, attached to the agreement and forwarded to the Area Agency
on Aging and the Case Management Agency.
6, Maintain the waiver participant's confidentiality.
7. Immediately report any changes in the waiver participant's condition to the Case Management
Agency.
8. Maintain enrolled provider status by renewing applicable licensure, certification, contract, and
referral agreements.
9. The Service Provider Agency is a sub-department and office of Monroe County Board of County
commissioners and is covered by the County's self-insurance program.
10. Accept referrals for and provide service to participants in all areas of Monroe County.
III. Under this Resolution, the Case Management Agency shall perform the following:
1. Provide the Service Provider Agency with any pertinent information and history on the referred
waiver participant.
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2. Provide the Service Provider Agency with a copy of the Plan of Care or a service authorization
form specifically outlining the service(s) to be delivered.
3. Be available to the Servic~ Provider Agency for discussing the referred case.
4, Immediately report any changes in the waiver participant's condition to the Service Provider
Agency,
IV. Under this Resolution, the Case Management Agency is not bound to only refer to the Service Provider
Agency,
PASSED AND ADOPTED by the Board of County Commissioners of Monroe County, Florida, at a regular
9th September
meeting of the Board held on the day of . 1999.
Mayor Harvey
Commissioner Neugent
Commissioner Freeman
Commissioner Williams
Commissioner Reich
Yes
Yes
Yes
Yes
Yes
BSb~c. ~
Deputy Clerk
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
~~\\-~
By
(S
ATTEST DANNY L. KOLHAGE, CLERK
Mayor/Chairman
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