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Item D30 BOARD OF COUNTY COMMISSIONERS AGENDA ITEM SUMMARY MEETING DATE: 4-19-2006 DIVISION: COMMUNITY SERVICES BULK ITEM: YES X NO DEPARTMENT: SOCIAL SERVICES AGENDA ITEM WORDING: Approval of the Renewal of the Home Community Based/Medicaid Waiver (ADA-MW) Case Management Contract between the Alliance for Aging, Inc. and the Monroe County Board of County Commissioners (Monroe County In-Rome Services Program) retroactive to July 1, 2004. ITEM BACKGROUND: The approval of the ADA-MW Referral for Case Management will enable Monroe County In-Home Services to continue providing Case Management services to Monroe County's elderly population under the Home and Community Based Services/Medicaid Waiver (ADA-MW) program. There had been negotiations in regards to unit cost, thus no agreement was settled for 2005. PREVIOUS RELEVANT BOCC ACTION: Prior approval granted to the Horne And Community Based Medicaid Waver Agreement on August 21,2002 CONTRACT/AGREEMENT CHANGES: N/A STAFF RECOMMENDATION: Approval TOTAL COST: Approx. $300.00 COST TO COUNTY: -0- BUDGETED:YES-2L NO SOURCE OF FUNDS: ADA-MW Referral for Fiscal year 712005 thru 612006 For approx. $300.00 REVENUE PRODUCING: YES NO X AMT.PER MONTH YEAR APPROVED BY: COUNTY ATTY.l OMB/Purchasing RISK MANAGEMENT -X DIVISION DIRECTOR APPROVAL: SHEILA BARKER DOCUMENTATION: INCLUDED X TO FOLLOW NOT REQUIRED DISPOSITION: AGENDA ITEM#: Revised 1 J03 MONROE COUNTY BOARD OF COUNTY COMMISSIONERS CONTRACT SUMMARY Contract with: Alliance For Aging, Inc. Contract Effective Date: April 19, 2006 Expiration Date: Contract PurposelDescription: Approval of the Renewal of the Home and Community Based ~Medicaid Waver (ADAIMW) Case Management Contract between the Alliance for Aging, Inc. and the Monroe County Board of County Commissioners (Monroe County In-Home Services Program). Contract Manager: Deloris (Name) 4589 (Ext) Social Services/Stop 1 (Department/Stop #) For BOCC meetino on 4/19/2006 Agenda Deadline: 4/4/2006 CONTRACT COSTS Total Dollar Value of Contract: Approx. $ 300.00 Budgeted? Yes X No Account Codes: Grant: Approx. $300.00 County Match: $ -0- Current Year Portion: $ Estimated Ongoing Costs: $ (Not included in dollar value above) /yr ADDITIONAL COSTS For: (eg, Maintenance, utilities, janitorial, salaries, ell') CONTRACT REVIEW Division Director Date In Changes Neede~~'" . Yes (N~/j .~.~ Date Out Risk Management O.~jPurchasing "" "1 O~ County Attorney :7 :J Comments: OMB Form Revised 2/27/01 MCr #2 HOME AND COMMUNITY BASED SERVICES AGED AND DISABLED ADULT (ADA) MEDICAID WAIVER CASE MANAGEMENT REFERRAL AGREEMENT Inc. the area agency on aging (AM) for planning and service area (PSA) 11 and en Yl-t :I:h I-h.:: YV I C , a case management agency, shall begin on July 1. 2004 or on the te the agreement has been signed by both parties, whichever is later. This referral agreement is in effect for a period of time that is equal to the Medicaid waiver provider's enrollment period with the State of Florida's Medicaid fiscal agent and is contingent upon an annual appropriation by the Legislature. The purpose of this agreement is to enable eligible elderly participants to receive case management services from qualified providers with oversight of the quality of care by the Medicaid Waiver Specialist employed by the AAA. These services are authorized in order that the participant may remain in the least restrictive setting and avoid or delay premature nursing home placement. Services and care are to be furnished in a way that fosters the independence of each participant to facilitate aging in place. All parties agree that routines of care provision and service delivery must be consumer~driven to the maximum extent possible. All parties agree to and will treat each participant with dignity and respect. I. Objectives A, To maintain a climate of cooperation and consultation with and between agencies, in order to achieve maximum efficiency and effectiveness. B. To participate together by means of shared information in U,€ development and expansion of services. C, To promote programs and activities designed to prevent the premature institutionalization of elders and disabled adults. D. The parties of this agreement will provide technical assistance and consultation to each other on matters pertaining to actual service deUvery and share appropriate assessment information and care plans so duplication may not occur. E. To establish an effective working relationship between the case management agency that is responsible for the development of care plans and authorization of services available under the waiver, the service provider that is responsible for the direct provision of those services to consumers served under the waiver program, and the AAA that is responsible for management and oversight of the waiver program, II. Under this Agreement, the Area Agency on Aging agrees to the following: A. To facilitate the enrollment of providers with the Medicaid Fiscal Agent. B. To ensure the case management agency is an active Medicaid provider prior to serving any consumer under the Aged and Disabled Adult (ADA) Medicaid Waiver and Assisted Living for Frail Elderly (ALE) Medicaid Waiver Programs and any other Medicaid Waiver program that may be approved by the Centers for Medicaid and Medicare Services (CMS) and implemented in the State of Florida. C. To provide technical assistance and training to the case management agencies. D. To provide on site monitoring of the case management agency at least semi~annuaHy. E. To monitor and project Provider expenditures to assure spending is maintained within spending authority. . F. To complete a new referral agreement signed by all parties when unit rate changes are approved. lI!. Under this Agreement, the Case Management Agency agrees to the following: A. Assign qualified case managers as contained in the ADA Medicaid Waiver to provide case management services under the Medicaid Home and Community Based Waiver for Aged and Disabled Adults. Provider rates shall not exceed the approved negotiated rates that are at or below the service provider's contracted rates. B. Develop and implement the Plan of Care specifically outlining the service(s) to be delivered that 1 must be signed by the consumer. C. Adhere to the federal waiver requirements and policies and procedures outlined in the following manuals published by the Agency for Health Care Administration: Aged and Disabled Adult Waiver Guidelines and the Medicaid Provider Reimbursement Handbook (Non-Institutional 081), including any and all attachments or updates. D. Provide to the AM a monthly summary of Aged and Disabled Adult Medicaid Waiver expenditures billed and accrued. E. Refer consumers to any qualified Service Provider as selected by the consumer. F. Issue written service authorizations to the service provider with at least 24 hours notice, The referral will contain at a minimum: 1" Name 2. Address (with directions if not easily accessible) 3. Pertinent information regarding consumer's health or disabilities and living situation 4. Detailed service description including frequency, duration and specific tasks to be performed. G. Evaluate quality of services and service documentation by the service provider. H. Accept financial responsibility for service claims found to be out of camp Hance if the non compliance was the result of a faflure by the case management agency to update, renew, or terminate the service authorization. I, To forward a monthly expenditure tracking report to the area agency no later than the date agreed upon by both parties. J. Monitor service providers for adherence to authorized care plans, authorized reimbursement rates, and to ensure that the service provider is billing only for services authorized in the care plan. K. Develop and implement a policy to ensure that its employees, board members, and management, will avoid any conflict of interest or the appearance of a conflict of interest when disbursing or using the funds described in this agreement or when contracting with another entity which will be paid by the funds described in this agreement. A conflict of interest includes, but is not limited to, receiving, or agreeing to receive, a direct or indirect benefit, or anything of value from a service provider, consumer, vendor, or any person wishing to benefit from the use or disbursement of funds. To avoid a conflict of interest, the case management agency must ensure that all individuals make a disclosure to the AAA of any relationship which may be a conflict of interest, within thirty (30) days of an individual's original appointment or placement on a board, or if the individual is serving as an incumbent, within thirty (30) days of the commencement of the agreement. L. To submit void or adjustment claims no later than 45 days after either party has identified the error. The provider's refusal to adjust or void erroneous claims may result in termination of this agreement and/or referral to the department, and will be referred to the Agency for Health Care Administration for appropriate action. M, The AAA may impose department~approved sanctions for non~compliance with items of this agreement IV. Under this agreement, the follOWing services will be delivered by the Service provider in accordance with the plan of care or service authorization: Service Unit Rate County/Region Served A. Case ManaQement $45.00/hr B. C. D. E. Monroe 2 v. Termination In the event this agreement is terminated, the case management agency agrees to submit, at the time notice of intent to terminate is delivered, a plan which identifies procedures to ensure services to consumers will not be interrupted or suspended by the termination. A. Termination at Will This agreement may be terminated by any party upon no less than thirty (30) calendar days notice, without cause, unless a lesser time is mutually agreed upon by both parties, in writing. Said notice shall be delivered by certified mail, return receipt requested, or in person with proof of delivery. B. Termination Because of Lack of Funds In the event funds to finance this agreement become unavailable, the area agency may terminate this agreement upon no less than twenty.four (24) hours notice in writing to the other party. Said notice shall be delivered by certified mail, return receipt requested, or in person with proof of delivery, The area agency shall be the final authority as to the availability of funds. C. Termination for Breach Unless a breach is waived by the area agency in writing, or the parties fail to cure the breach within the time specified by the area agency, the area agency may, by written notice to the parties, terminate the agreement upon no less than twenty.four (24) hours notice. Said notice shall be delivered by certified mail, return receipt requested, or in person with proof of delivery. VI. Agreement Not withstanding the effective date as determined in the First Paragraph of this agreement, this contract is retroactive to July 1, 2004. In witness whereof, the parties have caused this ~ page agreement to be executed by their undersigned officials as duly authorized. Area Agency on Aging Service Provider Signature signature Steven Weisberg, M.S. Print name Charles "Sonny" McCoy Print name Mayor President/CEO Title Tille Date Date 3 ", J ~. '"" f6c'! HOl\IE AND COl\Il\IIUNITY BASED WAIVER REFERRAL AGREEMENT This Referral Agreement, made this 1st day of July, 2002 between Alliance. ff~o~p. ging, the Area Agency on Aging for Planning and Service Area lL and Monroe County.(~tigJ:l) Service Provider. This Referral Agreement is in effect for a period of time that is equal to the Medicaid waiv~r prtY'der's.enrollment period with the Stme ofFlori~a's Medic~id fis~al agent. One purpose of this agre eot IS to promote the development of a coordmated serVIce delIvery system [0 meet the needs the aged or disabled adults who are at risk of premature institutionalization. Another purposeo! this agreement is to enable eligible elderly participants to receive Home and Community Based Waiver Services from qualified providers with oversight of the quality of care by the Medicaid Waiver Specialist employed by the Area Agency on Aging. These services are authorized in order that the participant may remain in the least restrictive setting and avoid or delay premature nursing home placement. Services and care are to be furnished in a way that fosters the independence of each participant to facilitate aging in place. All parties agree that routines of care provision and service delivery must be consumer driven to the maximum extent possible. All parties agree to and will treat each participant with dignity and respect. I. Objectives A. To maintain a climate of cooperation and consultation with and between agencies, in order to achieve maximum efficiency and effectiveness. R To participate together by means of shared information in the development and expansion of services. C. To promote programs and activities designed to prevent the premature institutionalization of elders and disabled adults. D. To require the parties of this Agreement to 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. E. To establish an effective working relationship between the case management agency that is responsible for the development of care plans and authorization of services available under the waiver, the service provider that is responsible for the direct provision of those services to consumers served under the waiver program, and the Area Agency on Aging that is responsible for management and oversight of the waiver program. II. Vnder this Agreement, the Service provider agrees to the following: A. To accept referrals for the 1915c Home and Community Based Service CHCBS) Medicaid Waiver from the enrolled case management agency. B. To provide quality service(s) to the waiver participant as specified in Section IV, Provision of serVlcets) is subject to quality monitoring and/or observation by the case management agency andlor the Area Agency on Aging and/or the Department of Elder Affairs. C To provide only those services specifically outlined in the Plan of Care and authorized by the enrolled case management agency, D. To attach documentation regarding the service provider's 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 Area Agency on Aging along with justification for any increase. If additional services are to be added to this agreemem, a written request to do so must . be received by the Area Agency on Aging and an amendment must be prepared by the Area Agency on Aging listing the added service(s). The necessary documentation regarding provider qualifications for the additional services must be attached to the agreement. E. To maintain the waiver participant's confidentiality according to 42 CFR 431.30l. F To immediately report any changes in the waiver participant's condition to the case management agency. G. To maintain enrolled provider status by renewing applicable licensure, certification, contract, and/or referral agreements and by maintaining all provider qualifications as contained in the Aged and Disabled Adult Medicaid Waiver under which services are provided, H. To include its name and other appropriate information on a list of all enrolled providers which will be shown to consumer during development of an individualized plan of care, understanding that the consumer reserves the right at all times to a choice of enrolled providers. 1. To immediately notify the case management agency of staffing shortfalls which will negatively impact provision of service to Medicaid Waiver consumers. J. To submit claim data for billing to the Medicaid fiscal agent after delivery of services has been accomplished. All services should be billed within 60 days after services have been provided or document reasons for delayed submission of claims. Such documentation shall be available for review by the area agency on agency or by the Department of Elder Affairs, upon request. K. To submit claims for billing to the Medicaid fiscal agent at the agency's usual and customary rate. Ir is a violation of federal regulation to bill Medicaid more than the agency's usual and customary rate. L. To submit void or adjustment claims no later than 45 days after the error has been identified by either party. Any error not adjusted or voided within 45 days may be adjusted or voided by the Area Agency on Aging. The provider's refusal to adjust or void erroneous claims will result in termination of this agreement. Nt To develop and implement a policy to ensure that its employees, board members. and management, will avoid any conflict of interest or the appearance of a conflict of interest when disbursing or using the funds described in this agreement. A conflict of interest includes, but is not limited to, receiving, or agreeing to receive, a direct or indirect benefit, or anything of value from a service provider, consumer, vendor, or any person wishing to benefit from the use or disbursement of funds. To avoid a conflict of interest, the service provider must ensure that all individuals make a disclosure to the Area Agency on Aging of any relationship which may be a conflict of interest, within thirty (30) days of an individual's original appointment or placement on a board, or if the individual is serving as an incumbent, within thirty (30) days of the commencement of the contract. N. To adhere to the policies and procedures as outlined in the following manuals published by the Agency for Health Care Administration: the AgedJDisabled Adult Waiver Guidelines and the Medicaid Provider Reimbursement Handbook (Non- Institutional 081), induding any and all attachments or updates. III. Under this Agreement, the Area Agency on Aging agrees to the following: A. To facilitate the enrollment of providers with the Medicaid Fiscal Agent. B. To provide technical assistance and training to Service Providers. C. To notify the case management agency within 48 hours of any approved service provider rate adjustment. D. To regularly monitor the Service Providers in accordance with requirements specified by the Department of Elder Affairs. IV. Under this agreement, the following services will be delivered by the Service provider in accordance with the plan of care or service authorization: Service U nit Rate CountylRegion Served A.NUTRITlorr PROG. MEALS B.''PeIlSLWL COf2Q c. 6HcQ.e_ D. tt(:ynerrYlKe12- E. ~ i1.e- $ 5.00 jl;>46 . DD ...$41.00 -J05,cD ..tt 2Z, 00 MONROE mcnQDt?.. monR...DE. men (2.C;f_ n1cnt2C'f . V. Termination- fn the event this agreement is terminated, the case management agency and the service provider agree to submit, at the time notice of intent to terminate is delivered, a plan which identifies procedures to ensure services to consumers will not be interrupted or suspended by the termination. A. Termination at Will This agreement may be terminated by any par1y upon no less than thirty (30) calendar days notice, without cause, unless a lesser time is mutually agreed upon by both parties, in writing. Said notice shall be delivered by certitled mail, return receipt requested, or in person with proof of delivery. B. Termination Because of Lack of Funds In the event funds to finance this agreement become unavailable. the area agency may terminate this agreement upon no less than twenty-four (24) hours notice in writing to the other party. Said notice shall be delivered by certified mail, return receipt requested, or in person with proof of delivery, The area agency shall be the final authority as to the availability of funds. C. Termination for Breach Unless a breach is waived by the area agency in writing. or the parties fail to cure the breach within the time specified by the area agency. the area agency may. by written notice to the parties, terminate the agreement upon no less than twenty-four (24) hours notice. Said notice shall be delivered by certified mail, return receipt requested, or in person with proof of delivery. In witness whereof, the parties have caused this 3- page agreement to be executed by their undersigned officials as duly authorized. A.r, A'~S' 'd rea tt~ncy on gmg . erVlce provl er \.lJ( (J:.~ LJ~ signature signature [''/tu/le.,> '$'"".-.( f-1<-CJf j t\ Vi f'\ print rlame M'-t if oJ'" I title title siL.l / 2-~" L date /." !