Item D31
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 BasedlMedicaid Waiver
(ADA-MW) Contract between the Alliance for Aging, Inc. and the Monroe County Board of County
Commissioners (Monroe County In-Home Services Program) for Direct In-Home Services retroactive to July
1, 2004.
ITEM BACKGROUND: The approval of the ADA-MW Contract wi11 enable Monroe County In-Home
Services to continue providing services to Monroe County's elderly population under the Home and Community
Based ServicesIMedicaid Waiver (ADA-MW) program. There had been continued negotiations in regards to
unit cost, thus no agreement was settled for 2005.
PREVIOUS RELEVANT BOCC ACTION: Prior approval granted to the Home And Community Based
Medicaid \Vaver Agreement on August 21,2002
CONTRACT/AGREEMENT CHANGES: N/A
STAF'F'RECOMMENDATION: Approval
TOTAL COST: Approx. $112,000.00
COST TO COUNTY: -0-
BUDGETED: YES~NO
SOURCE OF FUNDS: ADA-MW
Referral for Fiscal year 7/2005 thru 6/2006
For approx. $112,000.00
REVENUE PRODUCING: YES
NO X AMT.PER MONTH
YEAR
APPROVED BY: COUNTY ATTYl OMB/Purchasing l RISK MANAGEMENT ...x
DIVISION DIRECTOR APPROVAL:
SHEILA BARKER
DOCUMENTATION:
fNCLUDED X
TO FOLLOW
NOT REQUIRED_
DISPOSITION:
AGENDA ITEM#:
Revised 1 !O)
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
CONTRACT SUMMARY
Contract with: Alhance For Aging, Inc. Contract
Effective Date: April 19, 2006
Expiration Date:
Contract Purpose/Description: Approval of the Renewal of the Home and Community Based -Medicaid Waver
(ADAJMW) Contract between the Alliance for Aging, Inc. and the Monroe County Board of County
Commissioners (Monroe County In-Home Services Program), for Direct In-Horne Services
Contract Manager:
Deloris SimpsoN
(Name) /.~::~;.c c .
/k;c
/"/
4589
(Ext. )
Social Services/Stop 1
(Department/Stop #)
For BOCC meetin on
4/19/2006
A enda Deadline:
4/412006
CONTRACT COSTS
Total Dollar Value of Contract: Approx. $ 112,000.00
Budgeted? Yes X No Account Codes:
Grant Approx. $112,000.00
County Match: $ -0-
Current Year Portion: $
Estimated Ongoing Costs: $
(Not included in dollar value above)
Iyr
ADDITIONAL COSTS
For:
(eu. Maintenance, utillties,Janitorial, salaries, ete)
CONTRACT REVIEW
Date In
Changes
N eede.s!r"'p~.,
Yes INo //
"\ on
Date Out
Division Director
Risk Management
W
o .M.B .!Purchasing
Yes
~":',
t NOJ
"'~
Yes
,
01
f
County Attorney
OMB Form Revised 2/27/01 Mer #2
HOME AND COMMUNiTY BASED SERViCES
AGED AND DISABLED ADULT (ADA) MEDICAID WAIVER
REFERRAL AGREEMENT
This Referral Agreement between the Alliance for A in , Inc., the Area Agency on Aging (AAA) for
Planning and Service Area (PSA) 11 and (l 1(; ,
the Service Provider, shall begin on July 1, 2004 or on the date th agreement has been signed by both
parties, whichever is later. This referral agreement or 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. One purpose of this agreement is to
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. Another purpose of this agreement is to
enable eligible elderly participants to receive home and community based services from qualified
providers with oversight of the quality of care by the Medicaid Waiver Specialist employed by the MA.
These selVices are authorized in order that the participant may remain in the Jeast restrictive setting and
avoid or deray premature nursing home placement Services and care are to be furnished in a way that
fosters the independence of each participant to facititate 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 effect/veness.
B. To promote programs and activities designed to prevent the premature institutionaiization of
eiders and disabled adults.
C. 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 duplfcatlon may not occur.
0, 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 AM that is responsible for management
and oversight of the waiver program.
II. Under this Agreement. the Service Provider agrees to the following:
A. To accept referrals. for the 1915c Home and Community-Based Services - ADA 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
service(s), subject to quality monitoring and/or observation by the case management agency
and/or the AM and/or the Department of Elder Affairs (the "department").
C. To provide only those services speclfically outlined in the Plan of Care and authorized by the
enrolled case management agency.
O. To attach documentation regarding the service provider's qualifications to this agreement; and to
provide, as requested, any information regarding Medicaid Waiver biifing, payment, or waiver
participant information, to the case management agency or AAA Provider rates shaft not
exceed the approved negotiated rates that are at or below the service provider's usual and
customary rates. If additional services are to be added to this agreement, a written request to
do so must be received by the AM. If approved, an amendment must be prepared by the AAA
indicating the service(s) to be added. The necessary documentation regarding orovider
qualifications for the additional serAces must be attached to the agreement
E. To maintain the waiver participant's confidentiailty according to 42 CFR 431.301.
F. To immediately report any changes in the waiver partIcipant's condftfon to the case
management agency.
1
G. To maintain enrolled provider status by renewing applicable licensure, certification, contract
2nd/or referral agreements and by maintaining af! 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 enroHed providers which
wW be shown to consumers during development of an individualized plan of care,
understanding that the consumer reserves the right at all times to a choice of enrolled
providers.
r. To immediately notify the case management agency of staffing shortfalls that will negativelv
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 bifted 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, upon request.
K. To submit claims for billing to the Medicaid fiscal agent at the agency's contracted rate.
L. To submit void or adjustment cfaims no rater 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 wiIf be referred by the department to the
Agency for Health Care Administration for appropriate action.
M. To devefop and implement a poricy 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 MA of any relationship which may be a conflict of interest
within thirty (30) days of an individual's original apP9intment or placement on a board, or if th~
indIvidual is serving as an incumbent, within thirty (30) days of the commencement of the
agreement.
N. To adhere to the federal waiver requirements and the policies and procedures outlined in the
following manuals published by the Agency for Health Care Administration: the Aged/Disabfed
Adult Waiver Guidelines and the Medicaid Provider Reimbursement Handbook (Non-
Institutional 081). including any and alf attachments or updates.
0, rf the Service Provider is enroUed as a home delivered meals vendor, the Area Agency wilf
retain the services of a registered dietitian to perform the forrowing:
1. Conduct site inspections of aU catering facilities. These may be unannounced.
2. Monitor meat deUvery times and temperatures.
3. Review all menus submitted by the service provider and suggest changes as needed.
4, Work with the service provider to ensure that standardized recipes and computer-assisted
nutritional analyses are carried out.
P, The AAA may impose department-approved. sanctions for non~compliance with the
terms of this agreement.
Ill. Under this Agreement, the Area Agency on Aging agrees to the fol/owing:
A. To facilitate the enroilment of providers with the Medicaid Fiscaf Agent.
S, To provide technical assistance and training to Service Providers.
C. To noW:'1 the case management agency within 48 hours of any approved service provider
rate adjustment.
D, To regularly monitor the Serka ProvIders in accordance with requirements specified by the
department.
E. complete a new referral agreement signed by arl parties when unit rate Changes are approved.
2
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.
B.
C.
D.
E.
V. Termination
In 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
term ination.
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 cause this ;1 page agreement to be executed by their
undersigned officials as duly authorized.
Area Agency on Aging
Service Provider
signature
Charles "sonny" MCCoy
Signature
steven weisberg, M.S.
Print name
President/CEO
name
Mayor
Title
Title
Date
EY
3
~ t "Oi4
'< ...--;
HOl'vIE AND COlVIlVIUNITY BASED "V AIVER
REFERRAL AGREEMENT
This Referral Agreement, made this 1st day of July, 2002 between Amance..f~~p.ging, the Area
Agency on Aging for Planning and Service Area 11; and Monroe County.(f'ii:if-:tilln) Service
Provider. This Referral Agreement is in effect for a period of time that is equal to the Medicaid
\'1uiver provider's enrollment period with the State of Florida's Medicaid fiscal agent. One purpose
of this agt.rment is to promote the development of a coordinated service delivery system to 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.
B. 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 occuc
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. Under this Agreement, the Service provider agrees to the following:
A. To accept referrals for the 1915c Home and Community Based Service (HCBS)
:'vledicaid Waiver from the enrolled case management agency.
B. To provide quality service(s) to the waiver participant as specified in Section rv.
Provision of service(s) is subject to quality monitoring and/or observation by the
case management agency and/or the ATea Agency on Aging and/or the Depanment
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 agreement, 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 431.301.
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.
I. 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. It 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.
M. To develop and implement a policy to ensure that its employees, board members,
and management, wilI 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
Unit Rate
CountylRegion
Served
MONROE
.mGr') eve,
mon R-OE
men 0:::f_
rYJe:nr2C:F .
A.NUTRITION PROG. MEALS
B.f'elLSt:rQL (rlt2!2
c. 6Hc:X.Le
D .H(ynf'lyk':)JL,eJ2..
E. ~Il.e-
$ 5.00
$46 . OD
~l}l, 00
-'a?cD
.Jt 2%.00
V. Termination'
In 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 \viIl not be interrupted or suspended by the termination.
A, Termination at Will
This agreement may be tenninated 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
tlnal 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 L page agreement to be executed by their
undersigned officials as duly authorized.
A /1 A'~S. 'd
rea rt~ncy on gmg . erVlce provl er
\Vf \-L~ LU~
signature. \ signature
ChcLv!e5 '5'"",,,,( 1-1<:'(<>1
:5 1'\ V~ f\ tvt I ;.sf /')
print name ,.
frt.(tAe.....J. ( c..C~
f
prim name
H<{...;.J'-
I
title
title
). I~) h'l-
f?/ZI /2-'" L
date