Item C25
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
MEETING DATE: 6-18-2008
DIVISION: COMMUNITY SERVICES
BULK ITEM:
YES X
NO
DEPARTMENT: SOCIAL SERVICES
STAFF CONTACT PERSON: JERRY ESKEW EXT. 4425
AGENDA ITEM WORDING: Approval of the Home Care for the Elderly (HCE) Case Management Contract
Number KH 872 between the Alliance for Aging, Inc. and the Monroe County Board of County Commissioners
(Monroe County Social Services/In-Home Services Program) for Fiscal Year July 1, 2008 through June 30,
2009.
ITEM BACKGROUND: The approval ofthis 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)
Case Management Grant Contract Number KH 772 on June 20, 2007.
CONTRACT/AGREEMENT CHANGES: None
STAF.F RECOMMENDATION: Approval
TOTAL COST: $12,750
COST TO COUNTY: $0
No Match Commitment Required
REVENUE PRODUCING: YES
BUDGETED:YES~ NO
SOURCE OF FUNDS:
NO -X- AMT.PER MONTH
YEAR
APPROVED BY: COUNTY ATTY.l OMBlPurchasing l RISK MANAGEMENT -X
DOCUMENTATION:
INCLUDED X
TO FOLLOW
NOT REQUIRED_
DISPOSITION:
AGENDA ITEM#:
Revised 8/06
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
CONTRACT SUMMARY
Contract with: Alliance For Aging, Inc. Contract KH 872
Effective Date: July 1, 2008
Expiration Date: June 30, 2009
Contract Purpose/Description: Approval of the Home Care for the Elderly (HCE) Case Management Contract
Number KH 872 between the Alliance for Aging, Inc. and the Monroe County Board of County Commissioners
(In-Home Services Program) for Fiscal Year July 1,2007 through June 30, 2008.
Contract Manager:
Jerry Eskew
(Name)
For BOCC meeting on
6/18/2008
4425
(Ext. )
Social Services/Stop 1
(Department/Stop #)
Agenda Deadline:
6/3/2008
CONTRACT COSTS
Total Dollar Value of Contract: $12,750
Budgeted? Yes X No Account Codes:
Grant: $12,750.00
County Match: $0 No Cash Commitment Required.
Additional Match: $0
Total Match: $0
Estimated Ongoing Costs: $
(Not included in dollar value above)
Division Director
w71 'to y
(0- 3/0 i
G' 13/09
& / yo!
Risk Management
o .M.B./Purchasing
County Attorney
Comments:
OMB Form Revised 2/27/01 MCP #2
Current Year Portion: $3,187
125 - 6153908
/yr
ADDITIONAL COSTS
For:
(eg. Maintenance, utilities, janitorial, salaries, etc)
CONTRACT REVIEW
Changes
Need~
Yes ~
Yes @
Yes No
vesG
.~........
~;:~
\p :-5.-Q(
Contract Number KH 872
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 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.
PA729, and its successor, incorporated herein by reference. Attachment I & II are integral
to this Agreement.
I. 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 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 be provided in a manner consistent with and described in the
recipient's service provider application for state fiscal year 2007 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.
II. The Alliance Agrees:
A. Contract Amount:
To pay for services in an amount not to exceed J12.750.00, subject to the
availability of funds.
Obligation to Pay:
1
Contract Number KH 872
Page 2
The Alliance's performance and obligation to pay under this contract is
contingent upon an annual appropriation by the Legislature.
B. 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.
III. 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
Commissioners
ALLIANCE FOR AGING, INC.
SIGNED BY:
SIGNED BY:
Max B. Rothman, JD, LL.M.
NAME:
NAME:
President & CEO
TITLE:
TITLE:
DATE:
DATE:
2
Contract Number KH 872
Page 3
ATTACHMENT I
HOME CARE FOR THE ELDERLY PROGRAM
I. 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 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 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 2008 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 DOEA forms 106H and 10SH. 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.
3
Contract Number KH 872
Page 4
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 II 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 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
RATE
MAXIMUM
UNITS
MAXIMUM
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 1.1. of the Master Agreement.
IV. SPECIAL PROVISIONS
A. State Laws and Regulations:
1. The recipient agrees to comply with applicable parts of Rule Chapter 58H-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
4
Contract Number KH 872
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) 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 Indiviouals:
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 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 CI RTS 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 31 st 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 KH 872 Page 6
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 1 st 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.
6
Report
Number
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
CONTRACT KH 872 Page 7
ATTACHMENT II
HOME CARE FOR THE ELDERLY PROGRAM
CONTRACT REPORT CALENDAR
Based On
July Advance * ... ... ... ............... ......... ......... ... ... ... ..........
August Advance ** ......................,.................................
July Expenditure Report... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .
August Expenditure Report... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
September Expenditure Report...... ... ......... ... ...... .............
October Expenditure Report ...... ... ... ......... ... ... ... ... ... ... .....
November Expenditure Report...... ... ... ......... ... ...... ...... .....
December Expenditure Report ... ......... ...... ... ... ...... ...... .....
January Expenditure Report... ... ... ... ... ... ... ... ... ... ... ... ... ... ..
February Expenditure Report... ... ... ... ... ... ... ... ... ... ... ... ... ....
March Expenditure Report ........................ ... ... ... ...... ........
April Expenditure Report ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
May Expenditure Report / July Advanced Reconciliation ** .....
June Expenditure Report / August Advanced Reconciliation **
Final Expenditure and Closeout Report
Leqend * Advance based on projected cash need.
Note # 1:
Note # 2:
Submit To
The Alliance
On This Date
July 1
July 1
August 15
September 15
October 15
November 15
December 15
January 15
February 15
March 15
April 15
May 15
June 15
July 15
July 15
Submission of expenditure reports mayor may not generate a payment request.
If final expenditure report reflects funds due back to the department, payment is
to accompany the report.
**
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.
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 KH 872
Page 8
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.
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 I 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.
y 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.
y 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).
8
CONTRACT KH 872
Page 9
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 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
9
CONTRACT KH 872
Page 10
A. CCE/ADAlALE/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 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 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.
V. Aging Resource Center Outsourced 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 set 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' 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.
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 701B assessment already exists or is provided from another source (Le. CARES) the
information from the 701B 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.
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 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.
12