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Item C08 BOARD OF COUNTY COMMISSIONERS AGENDA ITEM SUMMARY Meeting Date: 6-17-2009 Division: County Administrator Bulls Item: Yes —X No Department: Social Services/In-Home Services_ Staff Contact Person/Phone#: Sheryl Graham/X4510 AGENDA ITEM WORMING: Approval of the Home Care for the Elderly(HCE) Contract KH-972 between the Alliance for Aging, Inc. (Area Agency on Aging) and the Monroe County Board of County Commissioners(Social Services/In-Home Services)for fiscal year 7/1/09 to 6/30/10. ITEM BACKGROUND: Approval of the HCE Contract will enable Monroe County In-Home Services to continue providing services to Monroe County's elderly population under the Home Care for the Elderly Grant PREVIOUS RELEVANT BOCC ACTION: Prior approval granted to the Home Care for the Elderly (HCE) Grant Contract WH872 on 6-1"8. CONTRACT/AGREEMENT CHANGES: none STAFF RECOMMENDATIONS: Approval TOTAL COST: $12,112.00 INDIRECT COST: ,-0-_BUDGETED: Yes TNo_ COST TO COUNTY: $0 (No Cash Match&ouired) SOURCE OF FUNDS: REVENUE PRODUCING: Yes X No_ AMOUNT PER MONTH 0.00 Year $600,00 APPROVED BY: County Atty 0 0urchasmg�X—Risk Management—X— DOCUMENTATION: Included X Not Required DISPOSITION: AGENDA ITEM# Revised 1/09 MONROE COUNTY BOARD OF COUNTY COMMISSIONERS CONTRACT SUMMARY Contract with: Alliance for Aging, Inc. Contract#RH-972 Effective Date: July 1, 2009 Expiration Date: June 30,2010 Contract Purpose/Description: Approval of the Home Care for the Elderly(14CE) Contract#KH-972 will enable Monroe County In-Home Services to continue providing services to Monroe County's elderly population. Contract Manager: Sheryl Graham 4510 Social Services/Stop 1 (Name) (Ext.) (Department/Stop#) For BOCC meeting on 6/1712009 Agenda Deadline: 6/2/2009 CONTRACT COSTS Total Dollar Value of Contract: $12,112.00 Current Year Portion: $ Budgeted?Yes X No❑ Account Codes: -_- Grant:$12,112.00(Fiscal Year) - County Match: $0(No Cash Match required) -T- - ADDITIONAL COSTS ------ -------- ---- ----- Estimated.Ouain;Casts: $ for: - ------------------------------ ot included in dollar value above - - e .Mainuaance,ufilities,'anitcxial saiafle etc CONTRACT REVIEW Changes Date Out Date In Needed _ vie er . Division Director ( �d Yes[] No p----�- Risk Management ! Yes❑ No Ci" �( O.Jh./Purchasing �� (00� Yes 0 No I( County A49rneY ��oZ�1�© `I Yes ❑ No Z vg Comments: OMB Form Revised 2/27/01 MCI'#2 Contract Number KH 972 Page 1 HOME CARE FOR THE ELDERLY CONTRACT 2009-2010 THIS AGREEMENT is entered into between the Alliance for Aging, Inc., hereinafter referred to as the "Alliance,"and Monroe County Board of Commissioners, hereinafter referred to as the "recipient." This agreement is subject to all provisions contained in the MASTER AGREEMENT executed between the Alliance and the Recipient,Agreement No. PA829, and its successor, incorporated herein by reference. Attachment I, II, III, IV and V are integral to this Agreement. I. Recipient Agrees: A. Services to be Provided: 1. To plan, develop, and accomplish the services delineated, or otherwise cause the planning, development, and accomplishment of such services and activities, under the conditions specified and in the manner prescribed in Attachment I of this agreement and included in the Service Provider Application (SPA) submitted in response to the March 2008 CCE/Lead Agency RFP. The recipient will not be allowed to provide services that are not included in the SPA submitted in response to the March 2008 CCE/Lead Agency RFP and included related Unit Cost Methodology submitted as an integral part of the RFP application. In the event of the conflict between the Service Provider Application and this contract, the contract controls. Additionally, the recipient is subject to the Referral Protocol and ARC Outsourced Functions included in Attachment III and ARC Outsourced Functions Policies and Procedures outlined in Attachment IV 2. Consumers may not be enrolled in a Department of Elder Affairs' state general revenue funded program, including HCE, who are also enrolled in a Medicaid capitated long term care health plan or program. These programs include the Frail Elder Program operated by United Health Care, the Channeling Program operated by Miami Jewish Home and Hospital for the Aged, the Long Term Care Community Diversion Program and the Program of All Inclusive Care for the Elderly (PACE) program scheduled to begin operation in the Miami- Dade County area. B. Manner of Service Provision: The services will 6e provided in a manner consistent with and described in the recipient's service provider application for state fiscal year 2009 and the Department of Elder Affairs Client Home And Community Based Services Handbook dated 01/03 In the event the manual is revised, such revision will automatically be incorporated into the contract and the recipient will be given a copy of the revisions. 11. The Alliance Agrees: A. Contract Amount: To pay for services in an amount not to exceed $12,112.00, subject to the availability of funds. Obligation to Pay: The Alliance's performance and obligation to pay under this contract is contingent upon an annual appropriation by the Legislature. B. Source of Funds: 1 Contract Number KH 972 Page 2 The costs of services paid under any other contract or from any other source are not eligible for reimbursement under this contract. The funds awarded to the recipient pursuant to this contract are in the state grants and aids appropriations. III. Recipient and Alliance Mutually Agree: A. Effective Date: 1. This contract shall begin on July 1, 2009 or on the date the contract has been signed by both parties, whichever is earlier. 2. Delivery of services shall end on June 30, 2010. IN WITNESS WHEREOF, the parties hereto have caused this agreement to be executed by their undersigned officials as duly authorized. PROVIDER: Monroe County Board of ALLIANCE FOR AGING, INC. Commissioners SIGNED BY: SIGNED BY: Max B. Rothman, JD, LL.M. NAME: George Neugent NAME: Mayor President & CEO TITLE: TITLE: DATE: 6-17-09 DATE: E D ! PE DR J. F A � 1 ` te"' Y .� i�i``l-J i ORNEY U 2 Contract Number KH 972 Page 3 ATTACHMENT HOME CARE FOR THE ELDERLY PROGRAM 1. STATEMENT OF PURPOSE The Home Care for the Elderly (HCE) Program encourages the provision of care in family-type living arrangements in private homes on a not for profit basis as an alternative to nursing home or other institutional care. II. SERVICES TO BE PROVIDED A. Services: 1. The recipient's July 2009 application and any revisions thereto approved by the Alliance and located in the contract manager's file, are incorporated by reference in this contract between the Alliance and the recipient, and prescribe the services to be rendered by the recipient. 2. Consumers may not be enrolled in a Department of Elder Affairs' state general revenue funded program, including HCE, who are also enrolled in a Medicaid capitated long-term care health plan or program. These programs include the Frail Elder Program operated by United Health Care, the Channeling Program operated by Miami Jewish Home and Hospital for the Aged, the Long Term Care Community Diversion Program and any other areas that may participate in the Long Term Care Community Diversion Program through expansion and the Program of All Inclusive Care for the Elderly (PACE) program. B. Manner of Service Provision: The services will be provided in a manner consistent with and described in the recipient's July 2009 application and the Department of Elder Affairs Home and Community-Based Services Handbook dated 01/03. In the event the handbook is revised, such revision will automatically be incorporated into the contract and the recipient will be given a copy of the revisions. III. METHOD OF PAYMENT A. The method of payment in this contract is based on a fixed rate reimbursement for approved services. The recipient must ensure fixed rates include only those costs that are in accordance with all applicable state and federal statutes and regulations and are based on audited historical costs in instances where an independent audit is required. All requests for payment and expenditure reports submitted to support requests for payment shall be on DOER forms 106H and 105H. Duplication or replication of both forms via data processing equipment is permissible, provided all data elements are in the same format as included on department forms. B. The recipient shall maintain documentation to support payment requests which shall be available to the Comptroller, the Department of Elder Affairs, or the Alliance upon request. C. The recipient may request a monthly advance for service costs based on anticipated cash needs. Detailed documentation justifying cash needs for advances must be submitted with the signed contract, approved by the Alliance, and maintained in the contract manager's file. All payment requests for the third through the nine months shall be based on the submission of monthly actual expenditure reports beginning with the first month of the contract. The schedule for submission of advance requests is ATTACHMENT If to this contract. Reconciliation and recouping of advances made under this contract are to be completed by May& June 2009 reports. All advance payments are subject to the availability of funds. 3 Contract Number KH 972 Page 4 D. Advance funds may be temporarily invested by the recipient in an insured interest bearing account. All interest earned on contract fund advances must be returned to the Alliance at the end of the first quarter of the contract period. E. Contingent upon the recipient's ability to maintain program expenditures within the assigned quarterly allocations and the availability of funds, the Alliance shall make payment to the provider for provision of services at the rate(s) stated below: SERVICE TO BE PROVIDED UNIT MAXIMUM MAXIMUM RATE UNITS DOLLARS Case Management $47.86 253 $12,112 F. Any payment due by the Alliance under the terms of this contract may be withheld pending the receipt and approval by the Alliance of complete and accurate financial and programmatic reports due from the recipient and any adjustments thereto, including any disallowance not resolved as outlined in Section I.T. of the Master Agreement. IV. SPECIAL PROVISIONS A. State Laws and Regulations: 1. The recipient agrees to comply with applicable parts of Rule Chapter 581-1-1, Florida Administrative Code promulgated for administration of Sections 430.601 through 430.608, Florida Statutes, and the Department of Elder Affairs Home and Community Based Services Handbook dated 01/03. 2. The recipient agrees to comply with the provisions of Sections 97.021 and 97.058, Florida Statutes, and all rules related thereto in the Florida Administrative Code. B. Assessment and Prioritization for Service Delivery for New Consumers: The following are the criteria to prioritize new consumers for service delivery. It is not the intent of the Department of Elder Affairs to remove existing clients from any program in order to serve new clients being assessed and prioritized for service delivery. 1. Priority Criteria for Service Delivery: a) individuals in nursing homes under Medicaid who could be transferred to the community; b) individuals in nursing homes whose Medicare coverage is exhausted and may be diverted to the community; c) individuals in nursing homes which are closing and can be discharged to the community; or d) individuals whose mental or physical health condition has deteriorated to the degree self care is not possible, there is no capable caregiver and institutional placement will occur within 72 hours. 2. Priority Criteria for Other Assessed Individuals: The assessment and provision of services should always consider the most cost effective means of service delivery. Functional impairment shall be determined through the department's 4 CONTRACT KH 972 Page 5 consumer assessment form administered to each applicant. The most frail individuals not prioritized in groups one, two or three above, regardless of referral source, will receive services to the extent funding is available. C. Consumer Information, Registration and Tracking System (CIRTS): 1. The recipient will ensure the collection and maintenance of Home Care for the Elderly (HCE) subsidies and case management information on a monthly basis from the Consumer Information, Registration and Tracking System (CIRTS). Maintenance includes valid exports and backups of all data and systems according to department standards. 2. The recipient must ensure all data for HCE subsidies are entered in the CIRTS by the 15th of each month. HCE subsidy data entered into the CIRTS by the 15th of the month will be for payments incurred between the 16th of the previous month and the 15th of the current month. Case management data entered into the CIRTS by the 15th of the month will be for units of service provided during the previous month from the 16th and up to and including the 15th of the current month or case management units of service may be entered according to the recipient schedule, in aggregate on the 31st or daily, weekly or monthly. 3. The recipient will ensure data entry for HCE subsidies will cease on the 15th of the month and the CIRTS Monthly Service Utilization Report, by consumer and by worker identification is run. 4. The recipient will ensure the Monthly Utilization Report, by consumer and by worker identification is verified, corrected, certified no later than the 20th of the month in which the report is generated. 5. The recipient will ensure caregivers determined eligible for the HCE basic subsidy after the 15th of a month, will be processed to begin eligibility for the HCE basic subsidy on the 1st day of the next month. 6. The Alliance will reconcile and verify the CIRTS data prior to payment for HCE basic and special subsidies and case management. 7. The Alliance will reconcile and verify the CIRTS data prior to payment for HCE basic and special subsidies and case management. 5 CONTRACT KH 972 Page 6 ATTACHMENT II HOME CARE FOR THE ELDERLY PROGRAM CONTRACT REPORT CALENDAR Report Submit To Number Based On The Alliance On This Date 1 July Advance* ............................................................. July 1 2 August Advance ** ........................................................ July 1 3 July Expenditure Report ................................................. August 15 4 August Expenditure Report ............................................. September 15 5 September Expenditure Report ........................................ October 15 6 October Expenditure Report ............................................ November 15 7 November Expenditure Report ......................................... December 15 8 December Expenditure Report ......................................... January 15 9 January Expenditure Report ............................................ February 15 10 February Expenditure Report ........................................... March 15 11 March Expenditure Report ............................................... April 15 12 April Expenditure Report ................................................. May 15 13 May Expenditure Report ................................................. June 15 14 June Expenditure Report ................................................. July 15 15 Final Expenditure and Closeout Report July 15 Legend * Advance based on projected cash need. ** Submission of expenditure reports may or may not generate a payment request. If final expenditure report reflects funds due back to the department, payment is to accompany the report. Note# 1: Report#1 for Advance Basis Contracts cannot be submitted to the Alliance prior to July 1 or until the contract with the Alliance has been executed. Actual submission of the vouchers to the Department of Elder Affairs is dependent on the accuracy of the expenditure report. Note#2: The last two months of the recipient's fiscal reports covering actual expenditures should reflect an adjustment repaying advances for the two months of the contract. 6 CONTRACT KH 972 Page 7 ATTACHMENT III REFERRAL PROTOCOL Issue: Screening, Triage, and Referral for Activation under the Community Care for the Elderly/Home Care for the Elderly Programs and for the Aging & Disabled Adults and the Assisted Living for the Elderly Medicaid Waivers. Policy: Referrals will be based on availability of funds, in accordance with prioritization requirements. Purpose: To ensure funding is spent expeditiously and consumers are referred into programs for appropriate services. Procedure for Monroe County: I. Roles and Responsibilities A. Alliance for Aging /Aging Resource Center ➢ Monitors overall program and Lead Agency specific spending levels on a monthly basis to ensure the Lead Agency is operating within the funding allocation. ➢ Determines the number of cases for activation based on projected funding available. Screens consumers to link with appropriate resources and prioritize for DOEA-funded programs and services. ➢ Recommends potential cases for activation based upon projected funding available by Lead Agency. ➢ Selects consumers from the waiting list based on their prioritization score. ➢ Refers consumers from the waiting list to the Lead Agency in Monroe County for activation, based on availability of funds. ➢ Monitors compliance with service standards and outcome measures. ➢ Reviews care plans and files per the File Review Policies and Procedures. ➢ Reviews data in CIRTS. B. Case Management Agency ➢ Accepts referrals from the Aging Resource Center. ➢ Refers inquiries from consumers interested in services to the ARC for Information and Referral to community resources, Screening, Triage, and Long-Term Care Options Counseling, as appropriate. Through outsourcing, the functions of Screening and Intake may also be completed by the Lead Agency. Completes comprehensive assessments on new consumers and annual reassessment on existing consumers and develops care plans and reviews care plans semi-annually. ➢ Authorizes service delivery and enters data into CIRTS. ➢ Screens consumers for Medicaid Waiver eligibility. Bills in CIRTS and Medicaid as appropriate. ➢ Monitors care plans in an effort to keep costs down while sustaining the individuals in the community. II. Management of the Assessed Prioritized Consumer List (APCL). A. Referrals to the ARC are routed to the Information and Referral Specialists or Intake Unit staff depending on the type of referral. Clients are provided information on community resources and programs available including private pay options. Persons are directed to those resources most capable of meeting the need they have expressed to ARC staff. Cases presenting strong identifiers that indicate the consumer might benefit from publicly funded long term care services are screened, entered into CIRTS, triaged and provided options counseling. Through outsourcing, the functions of Screening and Intake may also be performed by the Lead Agency. DOEA prioritization requirements will be adhered to by both 7 CONTRACT KH 972 Page 8 entities, as follows: 1. APS High Risk Referrals (See section B) 2. Imminent Risk cases will be prioritized for activation after APS High Risk Referrals have been served. If budgetary constraints prevent opening new cases, clients will be placed on the APCL. ARC staff will contact the client on a monthly basis to determine if there has been a change in the client's situation. 3. All other CARES referrals will be screened and prioritized in accordance with DOEA requirements. 4. Aging Out consumers will be referred by DCF for prioritization and/or activation in the corresponding aged program managed by the Alliance, as appropriate (See section IV). 5. Consumers applying for the Community Care for the Elderly (CCE) and/or Home Care for the Elderly (HCE) programs will be contacted and screened using the statewide assessment form developed by the Department of Elder Affairs for this purpose (Form 701A). If a consumer is being served through a DOEA-funded agency which enters their annual assessment into CIRTS, the Priority Score generated by that assessment will determine their ranking on the APCL. 6. Consumers referred for inclusion under the Assisted Living for the Elderly (ALE) Medicaid Waiver APCL will be interviewed and screened using the 701A form. 7. Consumers referred for inclusion under the Aging and Disabled Adult (ADA) Medicaid Waiver APCL will be contacted and screened following the same procedure as the one described under Section 5. Individuals who appear as potentially eligible for other types of public assistance will be referred to the Economic Self-Sufficiency Unit at the Department of Children and Families. 8. All other referrals will be waitlisted and prioritized, during which time other community resources will be researched, including private pay/fee for services providers. Consumers on the waiting lists will be reassessed according to Department requirements (NOI#062906-1-I-OVCS 6/29/2006). B. HIPAA forms will be sent to the consumer as appropriate. III. Opening New Cases A. CCE/ADA/ALE/HCE Clients 1. The Fiscal Department will monitor Lead Agency specific spending levels on a monthly basis to ensure each Lead Agency is operating within its quarterly funding allocation and/or spending authority. In addition, the department will do cost projections, and share the information with the Surplus/Deficit review committee to determine slot availability. The ARC and the Quality Assurance Department will be notified when funding is available and the number of new cases to be activated by Lead Agency. 2. Upon notification from the Vice President for Finance of funding availability, the Aging Resource Center Intake Unit Supervisor will run the Prioritized Risk Report to identify the consumers on the APCL to be opened. 3. Based on available funding, the ARC Intake Unit Supervisor will refer wait listed clients to the Lead Agency for activation, in accordance with prioritization 8 CONTRACT KH 972 Page 9 requirements. The Lead Agency will update the wait list enrollment using the appropriate code to terminate from the APCL. B. APS Referrals 1. APS Low and Intermediate Risk referrals will be screened and prioritized for services as per the DOEA/APS Memorandum of Understanding. Low and Intermediate Risk referrals are also offered information and referral to additional community resources, including private pay as appropriate. 2. APS High Risk Referrals are not waitlisted. They are immediately referred for service from DCF in Monroe County to the Lead Agency. ARTT referrals will be forwarded directly the Lead Agency. APS cases are to be served for a maximum of 31 calendar days. If additional time is justified, the case management agency will staff the case with the Alliance to obtain the extension needed. 3. Upon receipt of the APS referral, the Lead Agency will coordinate services to begin within the 72 hour period mandated by statute. A comprehensive assessment will be done within 14 working days of the referral. Services required under the care plan will remain in place for a maximum of 31 days, unless an extension has been granted. 4. The Lead Agency will enter ACTV enrollment under their provider number in CIRTS. In addition, service codes will be entered by service date for all services provided. If a service(s) is not provided as required under the care plan, an NDP code will need to be entered in CIRTS and the case notes under the client file should document the reason for non-delivery of such service(s). IV. Aging Out Consumers: A. All "Aging Out" consumers will be referred by DCF for activation in the corresponding aged program managed by the Alliance. B. Consumers active in the CCDA and HCDA programs that are turning 60 and are eligible for CCE and/or HCE will be opened in the corresponding aged program managed by the Alliance if funding is available. If funding is available, these consumers will be made active. If funding is not available, they will be waitlisted for these programs but will be given priority for activation once funding is available. C. Consumers active in the ADA Medicaid Waiver, upon turning age 60, will continue to be eligible for and receive ADA Medicaid waiver services. 9 CONTRACT KH 972 Page 10 ATTACHMENT IV Aging Resource Center Outsourced Functions A. Perform ARC outsourced functions in accordance with policies and procedures developed by the Alliance for Aging. (ATTACHMENT V) B. Maintain wait lists in CIRTS in accordance with DOEA requirements. C. Report number of client contacts to the Aging Resource Center D. Adhere to prioritization policy as set forth by the Department of Elder Affairs E. Update the agency Disaster Plan to incorporate ARC outsourced functions. F. Ensure against conflicts of interest and inappropriate self-referrals by referring consumers in need of options counseling or long-term care services beyond the provider's scope of services to the Aging Resource Center. G. Ensure that services provided are in the clients' best interest, are the most cost effective, of high quality, and are responsive and appropriate to the assessed needs. The Assessed Priority Consumer List(APCL) is maintained when services funded by the department are not available. Through outsourcing, the function of Screening may also be completed by the Lead Agency for the Community Care for the Elderly, Home Care for the Elderly, Aging and Disabled Adults, and the Assisted Living for the Elderly Medicaid Waivers. 10 CONTRACT KH 972 Page 11 ATTACHMENT V Policy and Procedure for Outsourced function -Screening Objective: To ensure that a comprehensive list of clients in need of services is maintained in CIRTS by appropriate funding source and that the ARC is thereby able to effectively gauge the level of elder service need in Miami-Dade and Monroe Counties. Policy: To obtain necessary information from clients in order to assist in determining level of need and eligibility for DOEA funded services Procedure: ARC Contracted Providers will collect information from callers and conduct a 701A assessment. Alternatively, if a 701 B assessment already exists or is provided from another source (i.e. CARES) the information from the 701 B can be utilized. Based on the information provided via the 701A(B) assessment,the ARC Contracted Provider will make a determination as to the services that the caller is in need of receiving. The ARC Contracted Provider will determine the appropriate funding source(s) that provides the needed services. If the caller is in need of a service(s) that is not provided by the ARC Contracted Provider, the ARC Contracted Provider will refer caller to the ARC Elder Helpline utilizing the ARC Referral Form and/or to an ARC Contracted Provider that provides the needed service. The caller will be provided with general information regarding the ARC as well as the ARC Elder Helpline contact number. The caller will be informed of the services and funding sources that they are being placed on the wait list for in CIRTS. ARC Contracted Provider will create a client record in CIRTS (if there is no existing record) and enter the services needed for the caller by funding source and service. [If there is an existing record in CIRTS, the appropriate fields will be updated]. If the ARC Contracted Provider determines that the caller may qualify for more than one funding source, ARC Contracted Provider is encouraged to enter the appropriate information under multiple funding sources. [If there is an existing client record in CIRTS, the client record in CIRTS will be updated with appropriate information]. ARC Contracted Provider will inform caller that they will receive a follow-up call (or home visit in case of active client)to check on their status based on DOEA Wait List Reassessment Standards and encourage caller to contact the ARC Elder Helpline with any questions. Note: These ARC policies and procedures are subject to change. Any modifications will be done through a contract amendment. 11 Contract Lumber KH $72 Page 1 HOME CARE FOR THE ELDERLY CONTRACT 2008.2009 THIS AGREEMENT is entered into between the Alliance for Aging,Inc„hereinafter referred to as the"Alliance,"and Monroe County Hoard of Commissioners, hereinafter referred to as the"recipieat." Thin agrvvsnent is subject to all provisions contained in the MASTER AGREEMENT executed between the Alliance and the Recipient, Agreement No. PA728,and its successor,incorporated herein by referou-ce.Attachment f&11 are integral to this Agreement. 1. Recipient Agrees: A. Services to be Provided: 1. The recipient's service provider application for state fiscal year 2008, and any revisions thereto approved by the Alliance and located in the contract manager's file, are incorporated by reference in this contract between the Alliance and the recipient, and prescribe the services to be rendered by the recipient. 2. Consumers may not be enrolled in a Department of Elder Affairs' state general revenue Banded program, including HCE, who are also enrolled in a Medicaid capitated long term care health plan or program, These programs include the Frail Elder Program operated by United Health Care, the Channeling Program operated by Miami Jewish Home and Hospital for the Aged, the Long Term Care Community Diversion Program and the Program of All Inclusive Care for the Elderly (PACE) program scheduled to begin operation in the Miami-Dade County area. B. Manner of Service Provision: The services will be provided in a manner consistent with and described in the recipient's service provider application for state fmcal year 2007 and the Department of Felder Affairs Client Home And Community Based Services Handbook dated 01103 In the event the manual is revised, such revision will automatically be incorporated into the contract and the recipient will be given a copy of the revisions. II. The Alliance Agrees: A. Contract Amount: To pay for services in an amount not to exceed 612.7N.00 subject to the availability of funds. Obligation to Pay: 1 Contract Number KM 872 Page 2 The Alliance's performance and obligation to pay under this contract is contingent upon an annual appropriation by the Legislature. S. Source of Funds: The costs of services paid under any other contract or from any other source are not eligible for reimbursement under this contract. The funds awarded to the recipient pursuant to this contract are in the state grants and aids appropriations. Ill. Recipient and Alliance Mutually Agree: A. Effective Date: 1. This contract shall begin on July 1, 2008 or on the date the contract has been signed by both parties, whichever is earlier. 2. Delivery of services shall end on June 30, 2009. IN WITNESS WHEREOF, the parties hereto have caused this agreement to be executed by their undersigned officials as duly authorized. PROVIDER: Monroe County Board of ALLIANCE FOR AGING, INC. Commissioners SIGNED BY: SIGNED BY: Max B. Rothman, JD, LL.M. NAME: NAME: President&CEO TITLE: TITLE: DATE: DATE: M qQUN;v ED AS PEDso J. (STY ATTORNEY 6 A c ate 2 Contract[dumber KH $72 page 3 ATTACHMENT HOME CARE FOR THE ELDERLY PROGRAM I. STATEMENT OF PURPOSE The Home Cara for the Elderly(HCE) Program encourages the provision of care in family- type living arrangements in private homes on a not for profit basis as an alternative to nursing home or other institutional care. 11. SERVICES TO BE PROVIDED A. Services: I. The recipient's July 2008 application and any revisions thereto approved by the Alliance and located in the contract manager's file, are incorporated by reference in this contract between the Alliance and the recipient, and prescribe the services to be rendered by the recipient. 2. Consumers may not be enrolled in a Department of Elder Affairs' state general revenue funded program, including HCE, who are also enrolled in a Medicaid capitated long-term care health plan or program. These programs include the Frail Elder Program operated by united Health Care, the Channeling Program operated by Miami Jewish Home and Hospital for the Aged, the long Term Caret Community Diversion Program and any other areas thet may participate in the Lang Term Care Community Diversion Program through expansion and the Program of All Inclusive Care for the Elderly (PACE) program. B. Manner of Service Provision: The services will be provided in a manner consistent with and described in the recipient's July 2008 application and the Department of Elder Affairs Horse and Community-Based Services Handbook dated 01103. In the event the handbook is revised, such revision will sutornatically be incorporated into the contract and the recipient will be given a copy of the revisions. IN. METHOD OF PAYMENT A. The method of payment in this contract is based on a fixed rate reimbursement for approved services. The recipient must ensure fixed rates include only those costs that are in accordance with all applicable state and federal statutes and regulations and are based on audited historical wets in instances where an independent audit is required. All requests for payment and expenditure reports submitted to support requests for payment shall be on DOEA forms 106H and 105H. Duplication or replication of both forms via data processing equipment is permissible, provided all data elements are in the;tame format as included on department forma. 3 Contract Number NCH 872 Page 4 B. The recipient shall maintain documentation to support payment requests which shall be available to the Comptroller, the Department of Eider Affairs, or the Alliance upon request. C, The:recipient may request a monthly advance for service costs based on anticipated cash needs, Detailed documentation justifying cash needs for advances must be submitted with the signed contract, approved by the Alliance, and maintained in the contract manager's fife. All payment requests for the third through the nine months shall be based on the submission of monthly actual expenditure reports beginning with the first month of the contract. The schedule for submission of advance requests is ATTACHMENT 11 to this contract. Reconciliation and recouping of advances made under this contract are to be completed by May& June 2009 reports. All advance payments are subject to the availability of funds. D. Advance funds may be temporarily invested by the recipient in an insured interest bearing account. All interest earned on contract fund advances must be returned to the Alliance at the end of the firms quarter of the contract period. E. Contingent upon the recipient's ability to maintain program expenditures within the assigned quarterly allocations and the availability of funds,the Alliance shall make payment to the provider for provision of services at the rate(s)stated below: SERVICE TO BE UNIT MAXIMUM MAXIMUM PROVIDED RATE UNITS DOLLARS Case Management $47.86 266 $12,750 F. Any payment due by the Alliance under the terms of this contract may be withheld pending the receipt and approval by the Alliance of complete and accurate financial and programmatic reports due from the recipient and any adjustments thereto, including any disallowance not resolved as outlined in Section I.T. of the Master Agreement. iV. SPECIAL PROVISIONS A. State Laws and Regulations: 1, The recipient agrees to comply with applicable parts of Rule Chapter 581-1-1, Florida Administrative Code promulgated for administration of Sections 430.601 through 430.608, Florida Statutes, and the Department of Elder Affairs Home and Community Based Services Handbook dated 01l03. 2. The recipieant agrees to comply with the provisions of Sections 97.021 and 97.058, Florida Statutes, and all rules related thereto in the Florida Administrative Coda. B. Assessment and Prioritization for Service Delivery for New Consumers: The following are the criteria to prioritize new consumers for service delivery. It is not the intent of the Department of Elder Affairs to remove existing clients from any 4 Contract Number KH 572 Page 5 program in order to serve new clients being assessed and prioritized for service delivery. 1. Priority Criteria for Service Delivery: a) individuals in nursing homes under Medicaid who could be transferred to the community; b) individuals in nursing homes whose Medicare coverage is exhausted and may be diverted to the community; c) individual6 in nursing homes which are closing and can be discharged to the community; or d) individuals whose mental or physical health condition has deteriorated to the degree self care is not possible, there is no capable caregiver and institutional placement will occur within 72 hours. 2. Priority Criteria for Other Assessed Individuals: The assessment and provision of services should always consider the most cost effective means of service delivery, Functional impairment shall be determined through the department's consumer assessment form administered to each applicant. The most frail individuals not prized In groups one, two or three above, regardless of referral source, will receive services to the extent funding is available. C, Consumer Information, Registration and Tracking System (CIRTS): 1. The recipient will ensure the collection and maintenance of Home Care for the Elderly (HCE) subsidies and case management information on a monthly basis from the Consumer Information, Registration and Tracking System (CIRTS). Maintenance includes valid exports and backups of all data and systems according to department standards. 2. The recipient must ensure all data for HCE subsidies are entered in the CIRTS by the 15th of each month. HCE subsidy data entered into the CIRTS by the 15th of the month will be for payments incurred between the 16th of the previous month and the 15th of the current month, Case management data entered into the CIRTS by the 15th of the month will be for units of service provided during the previous month from the 16th and up to and including the 1.5th of the current month or case management units of service may be entered according to the recipient schedule, in aggregate on the 31st or daily, weekly or monthly. 3. The recipient will ensure data entry for HCE subsidies will cease on the 15th of the month and the CIRTS Monthly Service Utilization Report, by consumer and by worker identification is run. 5 CONTRACT NCH 872 Page 6 4. The recipient will ensure the Monthly Utilization Report, by consumer and by worker identification is verged, corrected, certified no later than the 20th of the month in which the report is generated. 5. The recipient will ensure caregivers determined eligible for the HGE basic subsidy after the 15th of a month, wiH be processed to begin eligibility for the HGE basic subsidy on the 1 st day of the next month. f. The Alliance will reconcile and verify the CIRTS data prior to payment for HGE basic and special subsidies and case management. 7. The Alliance will reconcile and verify the GIRTS data prior to payment for HCE basic and special subsidies and case management. 6 CONTRACT FAH 872 Rage 7 ATTACHMENT II HOME CARE FOR THE ELDERLY PROGRAM CONTRACT REPORT CALENDAR Report Submit To Number- Based On The Alliance On This Date 1 July Advance` .,..,.<.<<........................<.......................... July 1 2 August Advance '* ........................................................ July 1 3 July Expenditure Report ................................................. August 15 4 August Expenditure Report .......................................... September 15 5 September Expenditure Report ........................................ October 15 6 October Expenditure Report ............................................ November 15 7 November Expenditure Report ......................................... December 15 $ December Expenditure Report ......................................... January 15 8 January Expenditure Report ............................................ February 15 10 February Expenditure Report ........................................... March 15 11 March Expenditure Report ............................................... April 15 1 April Expenditure Report ........................................ ....... May 15 13 May Expenditure Report/July Advanced Reconciliation *' ..... June 15 14 June Expenditure Report(August Advanced Reconciliation*' July 15 15 Final Expenditure and Closeout Report July 15 Lind * Advance fused on projected cash need. Submission of expenditure reports may or may not generate a payment request. If final expenditure report reflects funds due back to the department, payment is to accompany the report. Note# 1; Report#1 for Advance Basis Contracts cannot be submitted to the Alliance prior to July 1 or until the contract with the Affiance has been executed. Actual submission of the vouchers to the Department of Eider Affairs is dependent on the accuracy of the expenditure report. Note#; The last two months of the recipient's fiscal reports covering actual expenditures should reflect an adjustment repaying advances for the two months of the contract. 7 CONTRACT KN 872 Page g EXHIBIT A Issue; Screening, Triage, and Referral for Activation under the Community Care for the Elderly/Home Care for the Elderly Programs and for the Aging & Disabled Adults and the Assisted Living for the Elderly Medicaid Waivers. Pollcy: Referrals will be based on availability of funds, in accordance with prioritization requirements. Purpose; To ensure funding is spent expeditiously and consumers are referred into programs for appropriate services. Procedure for Monroe County: I. Roles and Responsibilities A. Alliance for Aging 1 Aging Resource Center 30 Monitors overall program and Lead Agency specific spending levels on a monthly basis to ensure the Lead Agency is operating within the funding allocation. Determines the number of uses for activation based on projected funding available. v Screens consumers to link with appropriate resources and prioritize for DQEA-funded programs and services. Recommends potential cases for activation based upon projected funding available by Lead Agency. Selects consumers from the waiting list based on their prioritization score. Refers consumers from the waiting list to the Lend Agency in Monroe County for activation, based on availability of funds. Monitors compliance with service standards and outcome measures. Reviews dare;plans and files per the File Review Policies and Procedures. Reviews data in CIRTS. B. Case Management Agency Accepts referrals from the Aging Resource Center. All Refers inquiries from consumers interested in services to the ARC for Information and Referral to community resources, Screening, Triage, and Long-Term_ Care Options Counseling, as appropriate. r Through outsourcing, the functions of Screening and Intake may also be completed by the Lead Agency. :01 Completes comprehensive assessments on new consumers and annual reassessment on existing consumers and develops care plans and reviews care plans semi-annua4. Authorizes service delivery and enters data into CIRTS. Screens consumers for Medicaid Waiver eligibility. Bills in CIRTS and Medicaid as appropriate. r Monitors care plans in an effort to keep costs down while sustaining the individuals in the community. II, Management of the Assessed Prioritized Consumer List(APCL). 8 CONTRACT KH 872 Page 8 A, Referrals to the ARC are routed to the Information and Referral Specialists or Intake Unit staff depending on the type of referral. Clients are provided information on community resources and programs available including private pay options. Persons are directed to thin resources most capable of meeting the need they have expressed to ARC staff. Cases presenting strong identifiers that indicate the consumer might benefit from publicly funded long term care services are screened, entered into CIRTS, triaged and provided options counseling. Through outsourcing, the functions of Screening and Intake may also be performed by the Lead Agency. DOEA prioritization requirements will be adhered to by both entities, as fellows: 1. APS High Risk Referrals (See section H) 21 Imminent Risk cases will be prioritized for activation after APS High Risk Referrals have been served. If budgetary constraints prevent opening new cases, clients will be placed on the APCL. ARC staff will contact the client on a monthly basis to determine if there has been a change in the client's situation. 3, All other CARES referrals will be screened and prioritized in accordance with DOEA requirements. 4. Aging Out consumers will be reefermd by DCF for prioritization and/or activation In the corresponding aged program managed by the►Alliance, as appropriate(See section iV). 51 Consumers applying for the Community Care for the Elderly (CCE) and/or Home Care for the Elderly (HCE) programs will be contacted and screened using the statewide assessment form developed by the Department of Elder Affairs for this purpose (Form 701A). if a consumer is being served through a DOER-funded agency which enters their annual assessment into CIRTS, the Priority Score generated by that assessment will determine their ranking on the APCL. 6, Consumem referred for inclusion under the Assisted Living for the Elderly (ALE) Medicaid Waiver APCL will be interviewed and screened using the 701A form. 7. Consumers referred for inclusion under the Aging and Disabled Adult (ADA) Medicaid Waiver APCL will be contacted and screened following the same procedures as the one described tinder Section x. Individuals who appear as potentially eligible for other types of public assistance will be referred to the Economise Self-Sufficiency Unit at the Department of Children and Families. 8. All other referrals will be waitlisted and prioritized, during which time other community resources will be researched, including private pay/fee for services providers. Consumers on the waiting Vista will be reassessed according to Department requirements (NOI #062906-1-1-OVCS 6129/2006). B. HIPAA forms will be sent to the consumer as appropriate. Ill. Opening New Cases 9 CONTRACT KH 872 Page 10 A. CCE/ACA/ALE/HCE Clients 1, The Fiscal Department will monitor Lead Agency specific spending levels on a monthly basis to ensure each Lead Agency is operating within its quarterly funding allocation and/or spending authority. In addition, the department will do cost projections, and share the information with the Surplus/Deficit review committee to determine slot availability. The ARC and the Quality Assurance Department will be notified when funding is available and the number of new cases to be activated by Lead Agency. Z Upon notification from the Vice President for Finance of funding availability, the Aging Resource Center Intake Unit Supervisor will run the Prioritized Risk Report to identify the consumers on the APCL to be opened. 3. Based on available funding, the ARC Intake Unit Supervisor will refer wait listed clients to the Lewd Agency for activation, in accordance with prioritization requirements. The Lead Agency will update the wait list enrollment using the appropriate code to terminate from the APCL. IV. Aging Out Consumers: A. All "Aging Cut" consumers will be referred by QCF for activation In the corresponding aged program managed by the Alliance. E. Consumers active In the CODA and HCQA programs that are turning 60 and are eligible for CCE and/or HCE will be opened in the corresponding aged program managed by the Alliance if funding is available. If funding is available, these consumers will be made active. If funding is not available, they will be waitilsted for these programs but will be given priority for activation once funding is available. C, Consumers active In the ADA Medicaid Waiver, upon turning age 60, will continue to be eligible for and receive AQA Medicaid waiver services. V. Aging Resource Center Qutsourced Functions, A. Perform ARC outsourced functions in accordance with policies and procedures developed by the Alliance for Aging. B. Maintain wait lists in CIRTS in accordance with DOEA requirements. C. Report number of client contacts to the Aging Resource Center D, Adhere to prioritization policy as sect forth by the Department of Elder Affairs E. Update the agency Disaster Plan to incorporate ARC outsourced functions. 10 CONTRACT KH 872 Page 11 F. Ensure against conflicts of interest and inappropriate self-referrals by referring consumers in need of options counseling or long-term care services beyond the provider's scope of services to the Aging Resource Center. G. Ensure that services provided are in the clients' hest interest, are the most cost effective, of high quality, and are responsive and appropriate to the assessed needs. The Aesessed Priority Consumer Llst(APDL) is maintained when services funded by the department are not available. Through}outsourcing, the function of Screening may also be completed by the Lead Agency for the Community Care for the Elderly, Home Care for the Elderly, Aging and Disabled Adults, and the Assisted Living for the Elderly Medicaid Waivers. Policy and Procedure for Qutsourced function - Screening Objective; To ensure that a comprehensive list of clients in need of services is maintained in CtRTS by appropriate funding source and that the ARC is thereby able to effectively gauge the level of elder service need in Miami-Dade and Monroe Counties. Policy: To obtain necessary information from clients in order to assist in determining level of need and eligibility for DOEA funded services Procedure: ARC Contracted Providers will collect informWon from callers and conduct a 701A assessment. Alternatively, If a 7010 assessment already exists or Is provided from another source (i.e. CARES) the information from the 701E can be utilized. Based on the information provided via the 701A(E)assessment, the ARC Contracted Provider will make a determinaWn as to the services that the sailer is in need of receiving. The ARC Contracted Provider will determine the appropriate funding source(s) that provides the needed services. If the caller is in need of a services)that is not provided by the ARC Contracted Provider, the ARC Conti Provider will refer caller to the ARC Elder Helpiine utilizing the ARC Referral Form and/or to an ARC Contracted Provider that provides the needed service. The caller will be provided with general information regarding the ARC as well as the ARC Elder Helpline contact number. The caller will be informed of the services and funding sources that they are being placed on the wait list for In CIRTS. 11 CONTRACT KH 872 Page 12 ARC Contracted Provider will create a client record In CIRTS(if there is no existing record) and enter the services needed for the caller by funding savrce and services [hF there is an existing record in CIRTS,'the appropriate fields will be updated]. If the ARC Contracted Provider determines that the caller may qualify for more than one funding source, ARC Contracted Provider Is encouraged to enter the appropriate information under multiple funding sources. [I€there is an existing client record in CIRTS, the client record in CIRTS will be updated with appropriate information]. ARC contracted Provider will inform caller that they will receive a follow-up call (or home visit in case of active client) to check on their status based on DOEA Wait List Reassessment Standards and encourage caller to contact the ARC Elder Helpline with any questions. Note: These ARC policies and procedures are subject to change. Any modifications will be done through a contract amendment. 12