07/19/2023 Agreement Kevin Madok, cpA
Clerk of the Circuit Court& Comptroller—Monroe County, Florida
DATE: August 16, 2023
TO: Sheryl Graliarii, Director
Social Scrxices
IA)tir(les Francis, Sr. Administrator
'11'ransportation & Fiscal Senices
FROM: Paincla G. Haiicoc il�(.,.
SUBJECT: JuIN, 19' BOCC Nlccting
Attactied is an electronic copy oftlic 1`611owing, fully executed, item lor your limidling:
D 16 Alzlielnicr's Disease Initiative Prograiii (ADI) Contract K7,2397 between the
Alliance I'Or Aging, Inc., arid Monroe County Board ol'County Commissioners/Monroe
County Social Scrxices/Iii-Home Scrxiccs lor die contract year 2023-2024 (07/01/2023-
06/30/2024) in the amount of%A634.56.
Sliould you liave any(111cstjolis please 1'ecl free to contact inc at (305) 292-3550.
cc: County Attonicy
Finarice
File
KEY WEST MARATHON PLANTATION KEY
500 Whitehead Street 3117 Overseas Highway 88770 Overseas Highway
Key West, Florida 33040 Marathon, Florida 33050 Plantation Key, Florida 33070
ALZHEIMER'S DISEASE INITIATIVE CONTRACT
2023-2024 Fiscal Year
THIS CONTRACT is entered into between the Alliance for Aging Inc., hereinafter referred to as the "Alliance" and Monroe
County Board of County Commissioners, Social Services/ln-Home Services, hereinafter referred to as the "Provider," and
collectively referred to as the"parties."
Attachments I, [I, 111,VI,Vll,Vlll, IX,X,A, B,C,D,and E are incorporated herein and made a part of this Contract.
WHEREAS,the Alliance has been designated as the Area Agency on Aging for Planning and Service Area I I encompassing Miami-
Dade and Monroe Counties;and
WHEREAS, the Florida Department of Elder Affairs (the "Department') has entered into a Contract with the Alliance to fund
Alzheimer Disease Initiative Providers in Miami-Dade and Monroe Counties;and
NOW THEREFORE,in consideration of the services to be performed and payments to be made,together with the mutual covenants
and conditions set forth in this Contract,the Parties agree as follows:
1. Purpose of Contract
The purpose of this contract is to provide services in accordance with the terms and conditions specified in this contract including
all attachments and exhibits,which constitute the contract document.
2. Incorporation of Documents within the Contract
The contract will incorporate attachments, proposal(s), state plan(s), grant agreements, relevant Department of Elder Affairs
handbooks, manuals or desk books,as an integral part of the contract, except to the extent that the contract explicitly provides
to the contrary. In the event of conflict in language among any of the documents referenced above,the specific provisions and
requirements of the contract document(s)shall prevail over inconsistent provisions in the proposal(s)or other general materials
not specific to this contract document and identified attachments and shall be governed in accordance with the applicable laws.statutes,
and other conditions set for in this Contract.
3. Term of Contract
3.1 Effective Date:
This contract shall begin at twelve(12:00) A.M., Eastern Standard Time on July 1,2023 or on the date the contract has
been signed by both parties,whichever is later. The contract will end on June 30,2024,or such earlier date as the contract
is terminated pursuant to Section 51 herein, except that the parties shall continue to perform those limited contract close-
out activities set forth in this contract.
3.2. Delivery of services shall end at 11:54 P.M., Eastern Standard Time on June 30,2024,or such earlier time as the contract
is terminated pursuant to paragraph 10 herein. Under no circumstances will the Alliance reimburse the provider for services
provided after June 30,2024 or any earlier termination date. No changes to funding allocations will be made after June 30,
2024. Only limited contract close-out activities are to be performed after June 30,2024 consisting of reporting, invoicing
and payment as stipulated in ATTACHMENT Vlll.
4. Contract Amount
The Alliance agrees to pay for contracted services according to the terms and conditions of this contract in an amount not to
exceed$60,634.56 subject to the availability of funds. Any costs or services paid for under any other contract or from any other
source are not eligible for payment under this contract.
4.1 Obligation to Pay
The Alliance's performance and obligation to pay under this contract is contingent upon an annual appropriation by the
Legislature to the Department and funding received by the Alliance under its contract with the Department.
5. Renewals
The contract may be renewed on a yearly basis for no more than two additional years. Such renewals shall be contingent upon
satisfactory performance evaluations as determined by the Alliance and the availability of funds. Any renewal of a contract
shall be subject to mutual agreement,confirmed in writing,and subject to the same terms and conditions set forth in the initial
contract, with the exception of establishing unit rates which is described further in this section. The renewal price,or method
for determining a renewal price, is set forth in the bid, proposal, or reply. Requests to renegotiate the original contractual
Page 1 of 58
established rates are provided for in the Alliance's approved Reimbursement Rate Review Policy, which is incorporated by
reference.
The parties shall re-evaluate the contract's reimbursement rates on an annual basis pursuant to DOEA's Notice of Policy
Clarification: Service Cost Reports Notice #092815-1-PC-SCSS dated September 28th, 2015 and the approved Alliance's
Reimbursement Rate Review Policy.
In the event that contracts cannot be executed prior to the July 1st start date, the Alliance may, at its discretion, extend this
Agreement upon written notice for up to 120 days to ensure continuity of service. Services provided under this extension will
be paid for out of the succeeding agreement amount.
6. Compliance with Federal Law
6.1. The Provider shall not employ an unauthorized alien. The Alliance shall consider the employment of unauthorized aliens
a violation of the Immigration and Nationality Act (8 U.S.C. 1324 a)and the Immigration Reform and Control Act of
1986(8 U.S.C. 1101). Such violation shall be cause for unilateral cancellation of this contract by the Alliance.
6.2. If the Provider is a non-profit provider and is subject to Internal Revenue Service(IRS)tax exempt organization reporting
requirements(filing a Form 990 or Form 990-N)and has its tax exempt status revoked for failing to comply with the filing
requirements of the 2006 Pension Protection Act or for any other reason,the Provider must notify the Alliance in writing
within thirty(30)days of receiving the IRS notice of revocation.
6.3. The Provider shall comply with Title 2 CFR Part 175 regarding Trafficking in Persons.
6.4. Unless exempt under 2 CFR Part 170.110(b), the Provider shall comply with the reporting requirements of the
Transparency Act as expressed in 2 CFR 170.
6.5. To comply with Presidential Executive Order 12989 and State of Florida Executive Order Number I 1-116,
Provider agrees to utilize the U.S. Department of Homeland Security's E-verify system to verify the employment of all
new employees hired by Provider during the contract term. Provider shall include in related subcontracts a requirement
that subcontractors andor vendors performing work or providing services pursuant to the state contract utilize the E-
verify system to verify employment of all new employees hired by the subcontractor and?or vendor during the contract
term. Providers meeting the terms and conditions of the E-Verify System are deemed to be in compliance with this
provision.
7. Compliance with State Law
7.1 This contract is executed and entered into in the State old Florida. and shall be construed, performed. and enforced in all respects in
accordance with the Florida law.incNuding Florida provisions,for conflict of laws,
7.2 The Provider shall comply with Section 215.97,F.S and requirements of s.287.058,F.S.as amended.
7.2.1 The Provider shall perform all tasks contained in Attachment 1.
7.2.2 The Provider shall provide units of deliverables, including various client services, and in some instances may
include reports, findings,and drafts, as specified in this Contract,which the Contract Manager must receive and
accept in writing prior to payment in accordance with s. 215.971(1)and (2), Fla. Stat.. Expenditures must be in
compliance with laws, rules, regulations, including, but not limited to the Florida Reference Guide for State
Expenditures issued by the Florida Department of Financial Services("DFS").
7.2.3 The Provider shall comply with the criteria and final date by which such criteria must be met for completion of
this contract as specified in Attachment 1,Section 111.Method of Payment,
7.2.4 The Provider shall submit bills for fees or other compensation for services or expenses in sufficient detail for a
proper pre-audit and post-audit.
7.2.5 If itemized payment for travel expenses is permitted in this contract,the Provider shall submit bills for any travel
expenses in accordance with s. 112.061,F.S.,or at such lower rates as may be provided in this contract.
7.2.6 The Provider shall allow public access to all documents, papers, letters, or other public records as defined in s.
119.01](12), F.S., made or received by the Provider in conjunction with this contract except for those records
which are made confidential or exempt by law. The Provider's refusal to comply with this provision will constitute
an immediate breach of contract for which the Alliance may unilaterally terminate the contract.
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7.3 If clients are to be transported under this contract,the Provider shall comply with the provisions of Chapter 427, F.S., and
Rule 41-2,F.A. C.
7.4 Subcontractors who are on the Discriminatory Vendor List may not transact business with any public entity, in accordance
with the provision of s.287.134, F.S.
7.5 The Provider shall comply with the provisions of s. 11.062, F.S., and s. 216.347, F.S., which prohibit the expenditure of
contract funds for the purpose of lobbying the legislature,judicial branch or a state agency.
7.6 The Alliance and/or Department may terminate the Contract if the Provider is found to have submitted a false certification
as provided under 287.135(5),F.S.,has been placed on the Scrutinized Companies with Activities in Iran Petroleum Sector
List,the Scrutinized Companies with activities in Sudan List,or the scrutinized companies that Boycott Israel list,or if the
Provider has been engaged in business operations in Cuba or Syria or is engaged in a boycott of Israel.
8. Background Screening
8.1 The Provider shall ensure that the requirements of s. 430.0402 and Chapter 435, F.S., as amended, are met regarding
background screening for all persons who meet the definition of a direct service provider and who are not exempt from the
Department's Level 2 background screening pursuant to s. 430.0402(2)-(3), F.S. The Provider must also comply with any
applicable rules promulgated by the Department and the Agency for Health Care Administration regarding implementation
of s, 430.0402 and Chapter 435, F.S. To demonstrate compliance with this provision, Provider shall submit to the
Department, the Background Screening Affidavit of Compliance (Screening Form) upon thirty (30)days of execution of
this contract. Should the Alliance have a completed Screening Form on file for the Provider,a new Screening Form will be
required every twelve(12)months.
8.2 Further information concerning the procedures for background screening is found at
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9. Grievance and Complaint Procedures
9.1 Grievance Procedure
The Provider shall comply with and ensure sub-Contractor compliance with the Minimum Guideline for Recipient
Grievance Procedures,Appendix D,Department of Elder Affairs Programs and Services Handbook,to address complaints
regarding the termination,suspension or reduction of services,as required for receipt of funds.
9.2 Complaint Procedures:
The Provider shall develop and implement complaint procedures and ensure that sub-Contractors develop and implement
complaint procedures to process and resolve client dissatisfaction with services. Complaint procedures shall address the
quality and timeliness of services,Provider and direct service worker complaints,or any other advice related to complaints
other than termination,suspension or reduction in services that require the grievance process as described in Appendix D,
Department of Elder Affairs Programs and Services Handbook, The complaint procedures shall include notification to all
clients of the complaint procedure and include tracking the date, nature of the complaint and the determination of the
complaint on a complaint log.
10. Public Records and Retention:
10.1 If,under this contmct the Provider is providing services and is acting on behalf of the Alliance and the Department as provided under
s.. 119.01 1(2), Florida Statutes, the Provider,subject to the terms of s.287.058(I)(c), Florida Statutes.and any other applicable legal
and equitable remedies, agrees to all provisions of Chapter 119.Fla.Stat.,and any other applicable lau,and shall:
10.1.1 Keep and maintain public records that ordinarily and necessarily would be required by the public agency in order
to perform the services,.
10.1.2 Upon request from the Alliance or the Department,the Provider will provide a copy of the request for records or
allow the records to be inspected or copies within a reasonable time at a cost that does not exceed the cost provided
in Chapter 119,Florida Statutes,or as otherwise provided by law.
10.1.3 Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements
are not disclosed except as authorized by law.
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10.1.4 Upon completion of this contract, the Provider will transfer, at no, cost to the Alliance, all public records in
possession of the Provider or will keep and maintain public records required by the Alliance or the Department. If
the Provider transfers all public records to the Alliance upon completion of the contract,Provider shall destroy any
duplicate public records that are exempt,or confidential and exempt,from public records disclosure requirements.
If the Provider keeps and maintains public records upon completion of the contract, the Provider shall meet all
applicable requirements for retaining public records„ All records stored electronically must be provided to the
Alliance in a format that is compatible with the information technology systems of the Alliance.
10.2 The Alliance may unilaterally cancel this contract notwithstanding any other provisions of this Contract, for refusal by
the Provider to comply with Section 9 of this Contract by not allowing public access to all documents,papers, letters,or
other material made or received by the Provider in conjunction with the contract, unless the records are exempt, or
confidential and exempt,from Section 24(a)of Article 1 of the State Constitution and Section 119.07(1),F.S.
IF THE PROVIDER HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA
STATUTES, TO THE PROVIDER'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS
CONTRACT,CONTACT THE CUSTODIAN OF PUBLIC RECORDS AT:
Public Records Coordinator
Florida Department of Elder Affairs
4040 Esplanade Way
Tallahassee,Florida 32309
850-414-2342
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10.3 Upon termination of this contract, whether for convenience or for cause as detailed in this contract, the Provider and
subcontractors shall,at no cost to the Alliance,transfer all public records in their possession to the Alliance and destroy
any duplicate public records that are exempt, or confidential and exempt, from public records disclosure requirements.
All records stored electronically shall be provided to the Alliance in a format that is compatible with the information
technology systems of the A[liance.
!1. Audits, Inspections, Investieations:
]I.1 The Provider shall establish and maintain books,records,and documents(including electronic storage media)sufficient
to reflect all assets, obligations, unobligated balances, income, interest, and expenditures of funds provided by the
Alliance under this contract.Provider(s)shall adequately safeguard all such assets and assure they are used solely for the
purposes authorized under any contract or agreement which incorporates this Contract. Whenever appropriate,financial
information should be related to performance and unit cost data.
I L2 The Provider shall retain all client records, financial records, supporting documents, statistical records, and any other
documents(including electronic storage media)pertinent to this contract for a period of six(6)years after completion of
the contract or longer when required by law. In the event an audit is required by this contract, records shall be retained
for a minimum period of six(6)years after the audit report is issued or until resolution of any audit findings or litigation
based on the terms of this contract,at no additional cost to the Alliance.
11.3 Upon demand,at no additional cost to the Alliance,the Provider shall facilitate the duplication and transfer of any records
or documents during the required retention period.
11.4 The Provider shall assure that the records described in Paragraph 10 will be subject at all reasonable times to inspection,
review,copying,or audit by federal,state,or other personnel duly authorized by the Alliance.
11.5 At all reasonable times for as long as records are maintained,persons duly authorized by the Alliance and the Department,
pursuant to 45 CFR part 75,will be allowed full access to and the right to examine any of the Provider's contracts and
related records and documents pertinent to this specific contract,regardless of the form in which kept.
11.6 The Provider shall provide a financial and compliance audit to the Alliance as specified in this contract and in
ATTACHMENT III and ensure that all related third-party transactions are disclosed to the auditor.
11.7 The Provider agrees to comply with the Department's Inspector General in any investigation,audit, inspection,review,
or hearing performed pursuant to s.20.055,F.S.. By execution of this Contract the Provider understands and will comply
with this subsection.Provider further agrees that it shall include in related subcontracts a requirement that subcontractors
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performing work or providing services pursuant to this contract agree to cooperate with the Inspector General in any
investigation,audit, inspection,review,or hearing pursuant to s.20.055(5),F.S.
12. Nondiscrimination-Civil Rights Compliance
12.1 The Provider shall execute assurances in ATTACHMENT 11 that it will not discriminate against any person in the
provision of services or benefits under this contract or in employment because of age, race, religion, color, disability,
national origin, marital status or sex in compliance with state and federal law and regulations. The Provider further
assures that all Providers,sub-Contractors,sub-grantees,or others with whom it arranges to provide services or benefits
in connection with any of its programs and activities are not discriminating against clients or employees because of age,
race,religion,color,disability,national origin,marital status or sex.
12.2 During the term of this contract, the Provider shall complete and retain on file a timely, complete and accurate Civil
Rights Compliance Checklist,attached to this contract.
12.3 The Provider shall establish procedures pursuant to federal law to handle complaints of discrimination involving services
or benefits through this contract. These procedures will include notifying clients,employees,and participants of the right
to file a complaint with the appropriate federal or state entity.
12.4 These assurances are a condition of continued receipt of or benefit from financial assistance,and arc binding upon the
Provider, its successors,transferees,and assignees for the period during which such assistance is provided. The Provider
further assures that all sub-Contractors, vendors, or others with whom it arranges to provide services or benefits to
participants or employees in connection with any of its programs and activities are not discriminating against those
participants or employees in violation of the above statutes,regulations,guidelines,and standards. In the event of failure
to comply,the Provider understands that the Alliance may,at its discretion,seek a court order requiring compliance with
the terms of this assurance or seek other appropriate judicial or administrative relief, including but not limited to,
termination of and denial of further assistance.
13. Monitoring by the Alliance for Aging
13.1 The Provider shall permit persons duly authorized by the Alliance to inspect and copy any records.papers,documents,facilities,goods
and services ofthe Provider which are relevant to this contract,and to interview any clients,employees and subcontractor
employees of the Provider to assure the Alliance of the satisfactory performance of the terms and conditions of this
contract. Following such review, the Alliance will provide a written report of its findings to the Provider, and where
appropriate, the Provider shall develop a Corrective Action Plan (CAP). The Provider hereby agrees to correct all
deficiencies identified in the CAP in a timely manner as determined by the Contract Manager. Failure to comply with the
CAP shall subject Provider to enforcement actions as described in this Contract.
13.2 The Alliance will perform administrative, fiscal, and programmatic monitoring of the provider to ensure contractual
compliance,fiscal accountability,programmatic performance,and compliance with applicable state and federal laws and
regulations.The Provider will supply progress reports,including data reporting requirements as specified by the Alliance
or the Department to be used for monitoring progress or performance of the contractual services. Examples of review
criteria are surplusideficit reports, independent audits, internal controls, reimbursement requests, subcontractor
monitoring, targeting, program eligibility, outcome measures, service provision to clients, data integrity, client
satisfaction,and client file reviews.
13.3 Retrospective Unit Cost Methodology Reports (RUCM) — The Provider shall submit Retrospective Unit Cost
Methodology(RUCM)to the Alliance annually,but no later than ninety(90)calendar days after the Provider Fiscal Year
ends. The RUCM shall reflect actual costs of providing each service by program for the preceding contract year. Costs
associated with services provided under this contract shall only include allowable direct and indirect costs as defined by
applicable state law. If the Provider desires to renegotiate its reimbursement rates,the Provider shall make a request in
writing to the Alliance,with the inclusion of a Prospective Unit Cost Methodology, in accordance with the Alliance's
approved Reimbursement Rate Review Policy,which is incorporated by reference.
14. Provision of Services
The Provider shall provide services in the manner described in in ATTACHMENT I of this contract and in the Service Provider
Application(SPA). In the event of a conflict between the Service Provider Application and this contract,the contract language
prevails.
15. Coordina_ted_Monitorine with Other Agencies
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If the Provider receives funding from one or more other State of Florida human service agencies,in addition to the Department
of Elder Affairs,then a joint monitoring visit including such other agencies may be scheduled. For the purposes of this contract,
and pursuant to s. 287.0575,F.S.as amended,Florida's human service agencies shall include the Department of Children and
Families, the Department of Health, the Agency for Persons with Disabilities, the Department of Veterans Affairs, and the
Department of Elder Affairs. Upon notification and the subsequent scheduling of such a visit by the designated agency's lead
administrative coordinator,the Provider shall comply and cooperate with all monitors, inspectors,and?or investigators.
16. Indemnification
The Provider shall indemnify,save,defend,and hold harmless the Department,the Alliance and its officers,agents and employees from an)
and all claims,demands,actions,causes of action of whatever nature or character,arising out of or by reason of the execution this Contract,
or performance of the services provided for herein. It is understood and agreed that the Provider is not required to indemnif) the Department
or the Alliance for claims,demands,actions,or causes of action arising solely out of the Department's or Alliance's negligence.
17. Insurance and Bondine
17.1 Provider must provide continuous adequate liability insurance and worker's compensation insurance coverage,during the
existence of this contract,and during any renewal(s)or extension(s)of it.The Alliance shall be included as an additional
insured on the provider's liability insurance policy or policies and a copy of the Certificate of Insurance shall be provided
annually or when any changes occur.The Provider accepts full responsibility for identifying and determining the type(s)
and extent of liability insurance necessary to provide reasonable financial protections for the Provider and the clients to
be served under this contract. Upon execution of this Contract,the Provider shall furnish the Alliance written verification
supporting both the determination and existence of such insurance coverage. The limits of coverage under each policy
maintained by the Provider do not limit the Provider's liability and obligations under this contract. The Provider shall
ensure that the Alliance has the most current written verification of insurance coverage throughout the term of this
contract. Such coverage may be provided by a self-insurance program established and operating under the laws of the
State of Florida. The Department and the Alliance reserve the right to require additional insurance as specified by this
contract.
17.2 Throughout the term of this contract, the Provider must maintain an insurance bond from a responsible commercial
insurance company covering all officers, directors, employees, and agents of the Provider, authorized to handle funds
received or disbursed under this contract, in an amount commensurate with the funds handled, the degree of risk as
determined by the insurance company and consistent with good business practices.
18. Confidentiality of Information
The Provider shall not use or disclose any information concerning a recipient of services under this contract for any purpose
prohibited by state or federal law or regulations except with the written consent of a person legally authorized to give that consent
or when authorized by law.
19. Health Insurance Portability and Accountability Act
Where applicable,the Provider shall comply with the Health Insurance Portability and Accountability Act(42 USC 1320d.),as
well as all regulations promulgated thereunder(45 CPR 160, 162,and 164).
20. Incident Reportine
20.1 The Provider shall notify the Alliance immediately but no later than forty-eight(48)hours from the Provider's awareness
or discovery of conditions that may materially affect the Provider or Subcontractor's ability to perform the services
required to be performed under this contract. Such notice shall be made orally to the Contract Manager(by telephone)
with an email to immediately follow.
20.2 The Provider shall immediately report knowledge or reasonable suspicion of abuse, neglect, or exploitation of a child,
aged person, or disabled adult to the Florida Abuse Hotline on the statewide toll-free telephone number (1-800-
96ABUSE). As required by Chapters 39 and 415, F.S.,this provision is binding upon both the Provider,subcontractors
and its employees.
21. Bankruptcy Notification
During the term of this contract,the Provider shall immediately notify the Alliance ifthe Provider,its assignees,sub-Contractors
or affiliates file a claim for bankruptcy. Within ten (10) days after notification, the Provider must also provide the following
information to the Alliance: (1)the date of filing of the bankruptcy petition; (2) the case number; (3)the court name and the
division in which the petition was filed(e.g.,Northern District of Florida,Tallahassee Division);and,(4)the name,address,and
telephone number of the bankruptcy attorney.
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22. Sponsorship and Publicity
22.1 As required by s.286.25,Fla.Stet., if the Provider is a non-governmental organization which sponsors a program financed wholly or
in part by state funds, including any funds obtained through this contract, it shall, in publicizing, advertising. or describing the
sponsorship of the program, state: "Sponsored by [PROVIDER NAME], The Alliance for Aging. Inc., and the State of Florida,
Department of Elder Affairs."If the sponsorship reference is in written material,the words"Alliance for Aging,Inc."and"State of
Florida,Department of Elder Affairs"'shall appear in at least the same size letters or type as the name of the organization.
22.2 The Provider shall not use the words"Alliance for Aging,Inc."or"The State of Florida, Department of Elder Affairs" to indicate
sponsorship of a program othenvise financed,unless specific authorization has been obtained by the Alliance prior to use.
23. Assignments
23.1 The Provider shall not assign the rights and responsibilities under and contract without the prior written approval orthe Alliance.Any
sublicense.assignment,or transfer otherwise occurring without prior written approval of the Alliance w ill constitute a material breach
of the contract or agreement.
23.2 This contract shall remain binding upon the successors in interest of the Provider and the Alliance.
24. Subcontracts:
24.1 The Provider is responsible for all work performed and for all commodities produced pursuant to this contract,whether
actually furnished by the Provider or its subcontractors. Any subcontracts shall be evidenced by a written document and
subject to any conditions of approval the Alliance deems necessary.The Provider further agrees that the Alliance will not
be liable to the subcontractor in any way or for any reason,The Provider,at its expense,shall defend the Alliance against
any such claims.
24.2 The Provider shall promptly pay any subcontractors upon receipt of payment from the Alliance or other state agency.
Failure to make payments to any subcontractor in accordance with s, 287.0585,Fla.Stat.,unless otherwise stated in this
contract between the Provider and subcontractor,will result in a penalty as provided by statute.
24.3 The Provider shall programmatically monitor, at least once per year,each of its subcontractors, Subrecipients, Vendors,
andior Consultants. The Provider shall perform programmatic monitoring to ensure contractual compliance, and
programmatic performance and compliance with applicable state and federal laws and regulations. The Provider shall
monitor to ensure that time schedules are met;the budget and scope of work are accomplished within the specified time
periods, and other performance goals. The Provider shall also perfonrt fiscal and administrative monitoring for all
subcontractors to ensure fiscal accountability.
24.4 The Provider shall have a procurement policy that assures maximum free and open competition.Such procurement policy
must conform,as applicable,with Federal and State contracting and procurement regulations,as set forth in Title 2 Code
of Federal Regulations(CFR)Part 200,Ch.287.057,Fla.Stat., U.S.Office of Management and Budget(OMB)Circular
110,Florida Department of Management Services(DMS)Rule 60A-1,F.A.C.,and with the Department's Program and
Services Handbook.
24.5 The Provider shall dedicate the staff necessary to meet the obligations of this contract and ensure that subcontractors
dedicate adequate staff, accordingly. The provider shall ensure that staff responsible for performing any duties or
functions within this contract has the qualifications as specified in the Department's Programs and Services Handbook.
25. Unit Cost Methodologv Reports:
The Provider shall submit Retrospective Unit Cost Methodology(RUCM)to the Alliance annually,but no later than ninety(90)
calendar days after the Provider Fiscal Year ends. The RUCM shall reflect actual costs of providing each service by program
for the preceding contract year. Costs associated with services provided under this contract shall only include allowable direct
and indirect costs as defined by applicable state law. If the Provider desires to renegotiate its reimbursement rates,the Provider
shall make a request in writing to the Alliance,with the inclusion of a Prospective Unit Cost Methodology, in accordance with
the Alliance's approved Reimbursement Rate Review Policy,which is incorporated by reference.
26. Funding Obligations:
26.1 The Alliance for Aging,Inc.acknowledges its obligation to pay the Provider for the performance of the Provider's duties
and responsibilities set forth in this Contract.
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26.2 The Alliance shall not be liable to the Provider for costs incurred or performance rendered unless such costs and
performances are strictly in accordance with the terms of this contract, including but not limited to terms governing the
Provider's promised performance and unit rates and/or reimbursement capitations specified.
26.3 The Alliance shall not be liable to the Provider for any expenditures which are not allowable costs as defined in 2 CFR Part 200 and
45 CFR Part 92,as amended,or which expenditures have not been made in accordance with all applicable state and federal rules.
26.4 The Alliance shall not be liable to the Provider for expenditures made in violation of regulations promulgated under the
Older Americans Act,Department rules,Florida Statutes,or this contract.
27. Independent Capacity of Provider
It is the intent and understanding of the Parties that the Provider,or any of its Subcontractors,are independent Provider's and
are not employees of the Alliance and shall not hold themselves out as employees or agents of the Alliance without specific
authorization from the Alliance. It is the further intent and understanding of the Parties that the Alliance does not control the
employment practices of the Provider and will not be liable for any wage and hour,employment discrimination,or other labor
and employment claims against the Provider or its Subcontractors.All deductions for social security,withholding taxes,income
taxes,contributions to unemployment compensation funds and all necessary insurance for the Provider are the sole responsibility
of the Provider.
28. Payment
28.1 Payments shall be made to the Provider as services are rendered and invoiced by the Provider. The Alliance will have
final approval of the invoice for payment and will approve the invoice for payment only if the Provider has met all terms
and conditions of the contract, unless the bid specifications, purchase order, or this contract specify otherwise. The
approved invoice will be submitted to the Alliance's fiscal department for budgetary approval and processing per
ATTACHMENT VIII.
28.2 The Provider shall maintain documentation to support payment requests which shall be available to the Department of
Financial Services, the Department, or the Alliance upon request. Invoices must be submitted in sufficient detail for a
proper pre audit and post audit thereof.The Provider shall comply with all state and federal laws governing payments to
be made under this contract including,but not limited to the following:sections 216.181(16)(a)&(b).215.422.Fla.Stat..;and
the Invoice Requirements of the Reference Guide for State Expenditures from the Department of Financial Services at:
i fl�ro¢�a a'drt,:i sirs u� ;;ptuua� ,1�„s,;,.1
jV,u,tt�il. .":��w,yPo.�_....p1.•A la..o i�..��...:.�'Gro.._..'u�q:..d._i lk..n..�i....:t.i"u.?:n:irv,iu rt.w ..Ba.......upa.iul pw.rt':..»u o .. ..u'I�i a &..,�..ua�.....
The Provider shall maintain detailed documentation to support each item on the itemized invoice or payment request for
cost reimbursed expenses,fixed rate or deliverables, for this contract, including paid sub-contractor invoices,and will be
produced upon request by the Alliance.The Provider shall only request reimbursement for allowable expenses as defined
in the laws and guiding circulars cited in this Contract section 6, in the Reference Guide for State Expenditures, and any
other laws or regulations,as applicable.
28.3 The Provider and subcontractors shall provide units of deliverables,including reports,findings,and drafts as specified in
this contract to be received and accepted by the Alliance prior to payment.
29. Return of Funds
The Provider shall return to the Alliance any overpayments due to unearned funds or funds disallowed and any interest
attributable to such funds pursuant to the terms and conditions of any contract or agreement incorporating this Contract by
reference that were disbursed to the Provider by the Alliance. In the event that the Provider or its independent auditor discovers
that an overpayment has been made,the Provider shall repay said overpayment immediately without prior notification from the
Alliance. In the event that the Alliance first discovers an overpayment has been made, the Contract Manager will notify the
Provider in writing of such findings. Should repayment not be made forthwith, the Provider shall be charged at the lawful rate
of interest on the outstanding balance pursuant to s.55.03,F.S.,after Alliance's notification or Provider discovery.
30. Data Inteerity and Safeeuardine Information.
The Provider shall ensure an appropriate level of data security for the information the Provider is collecting or using in the
performance of this contract. An appropriate level of security includes approving and tracking all Provider employees that
request system or information access and ensuring that user access has been removed from all terminated employees. The
Provider,among other requirements, must anticipate and prepare for the loss of information processing capabilities. All data
and software must be routinely backed up to insure recovery from losses or outages of computer systems. The security over the
back-up data is to be as stringent as the protection required of the primary systems. The Provider shall insure all sub-Contractors
Page 8 of 58
maintain written procedures for computer system backup and recovery. The Provider shall,prior to execution of this agreement,
complete the Certification Regarding Data Integrity Compliance for Agreements,Grants, Loans,and Cooperative Agreements
prior to the execution of this contract.as part of ATTACHMENT I I.
31. Social Media and Personal Cell Phone use:
31.1 Inappropriate use of social media and personal cell phones may pose risks to DOEA's confidential and proprietary
information and may jeopardize compliance with legal obligations. By signing this contract, Provider agrees to the
following social media and personal cell phone use requirements.
31.2 Social Media Defined.The term Social Media and Jor personal cellular communication includes,but is not limited to,
social networking websites, blogs, podcasts, discussion forums, RSS feeds, video sharing, SMS (including Direct
Messages(DMs), iMessages,text messages,etc.); social networks like Instagram,TikTok,Snapchat, Google Hangouts,
WhatsApp, Signal, Facebook, Pinterest, and Twitter; and content sharing networks such as Flickr and YouTube. This
includes the transmission of social media through any cellular or online transmission via any electronic,internet, intranet,
or other wireless communication.
31.3 Application to any direct or incidental DOEA or other state business. This contract applies to any DOEA or other
state business conducted on any of the Provider's,Subcontractor's,or their employees'social media accounts or through
personal cellular communication.
31.4 Application to DOER and Providers Equipment. This contract applies regardless of whether the social media is
accessed using DOEA's IT facilities and equipment or equipment belonging to Provider,Subcontractor,or their respective
employees. Equipment includes, but is not limited to, personal computers, cellular phones, personal digital assistants,
smart watches,or smart tablets.
31.5 Florida Government in the Sunshine, Florida Public Records Law, and HIPAA. Provider acknowledges that any
DOEA or other state business conducted by social media or through personal cellular communication is subject to
Florida's Government in the Sunshine Law,Florida's Public Records Law(Chapter 119,Florida Statutes),and the Health
Insurance Portability and Accountability Act(HIPAA).Compliance with these laws and other applicable laws are further
detailed in the contract.
31.6 Prohibited or Restricted Postings.
Any social media posts which include photos,videos,or names of clients, volunteers,staff,or other affiliates of DOEA
may only be posted when authorized by law and when any required HIPAA authorizations and any other consents or
authorizations required pursuant to federal,or state law arc on file with the Provider's records.
31.7 Assist DOEA with Communications. Contactors may be asked periodically to assist in distributing certain DOEA
communications through their social media outlets.Any such requests should be posted in adherence to the social media
requirements herein and the other provisions of this contract.
32. Conflict of Interest
The Provider shall establish safeguards to prohibit employees,board members,management and subcontractors from using their
positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest or personal
gain.
No employee,officer,or agent of the Provider or subcontractor shall participate in selection,or in the award of an agreement
supported by state or federal funds if a conflict of interest, real or apparent, would be involved. Such a conflict would arise
when: (a) the employee, officer, or agent; (b) any member of his/her immediate family; (c) his or her partner; or (d) an
organization which employs,or is about to employ,any of the above, has a financial or other interest in the firm selected for
award.The Provider or subcontractor's officers,employees or agents will neither solicit nor accept gratuities,favors or anything
of monetary value from Providers,potential Providers,or parties to subcontracts.
Pursuant to Chapter 4, Section 2 of the Department of Elder Affairs Program and Services Handbook,no Provider may employ,
in any capacity,any member of its governing board or any family member of a person on the board.
The Providers' board members and management must disclose to the Alliance any relationship which may be, or may be
perceived to be, a conflict of interest within thirty(30) calendar days of an individual's original appointment or placement in
that position, or if the individual is serving as an incumbent, within thirty (30)calendar days of the commencement of this
Page 9 of 58
contract.The Providers'employees and subcontractors must make the same disclosures described above to the Providers'Board
of Directors.Compliance with this provision will be monitored.
33. Public Entity Crime
Pursuant to s. 287.133, F.S.,a person or affiliate who has been placed on the convicted vendor list following a conviction for a
public entity crime may not submit a bid, proposal, or reply on a contract to provide any goods or services to a public entity;
may not submit a bid,proposal,or reply on a contract with a public entity for the construction or repair of a public building or
public work; may not submit bids, proposals, or replies on leases of real property to a public entity; may not be awarded or
perform work as a Provider,supplier,sub-Contractor,or consultant under a contract with any public entity;and may not transact
business with any public entity in excess of the threshold amount provided in s.287.017, F.S.,for Category Two for a period of
36 months following the date of being placed on the convicted vendor list. If the Provider or any of its officers or directors is
convicted of a public entity crime during the period of this agreement,the Provider shall notify the Alliance immediately.Non-
compliance with this statute shall constitute a breach of this agreement.
34. Purchasine•
34.1 The Provider may purchase articles which are the subject of or are required to carry out any contract or agreement from
Prison Rehabilitative Industries and Diversified Enterprises,Inc.,(PRIDE)identified under Chapter 946,Fla.Stat.,in the
same manner and under the procedures set forth in ss. 946.515(2) and (4), Fla. Stat. For purposes of this contract, the
Provider shall be deemed to be substituted for the Alliance insofar as dealings with PRIDE.This clause is not applicable
to subcontractors unless otherwise required by law. An abbreviated list of products/services available from PRIDE may
be obtained by contacting PRIDE,800-643-8459.
34.2 The Provider may procure any recycled products or materials,which are the subject of or are required to carry this contract
in accordance with the provisions of section 403.7065,Fla..Stat.
34.3 The Provider may purchase articles that are the subject of, or required to carry out, any contract or agreement from a
nonprofit agency for the Blind or for the Severely Handicapped that is qualified pursuant to Chapter 413,Fla.Stat.,in the
same manner and under the same procedures set forth in s.413,036(1)and (2), Fla. Stat... For purposes of this contract,
the Provider shall be deemed to be substituted for the Alliance insofar as dealings with such qualified nonprofit agency
are concerned. Additional information about the designated nonprofit agency and the products it offers is available at
http:i�,www.respectofflorida.org.This clause is not applicable to subcontractors unless otherwise required by law.
35. Patents,Copyriehts,Royalties
35.1 If this contract is awarded state funding and if any discovery, invention or copyrightable material is developed,produced
or for which ownership was purchased in the course of or as a result of work or services performed under this contract
the Provider shall refer the discovery, invention or material to the Alliance to be referred to the Department.Any and all
patent rights or copyrights accruing under this contract are hereby reserved to the State of Florida in accordance with
Chapter 286,F.S.Pursuant to s.287.0571 (5)(k),as amended,the only exceptions to this provision shall be those that are
clearly expressed and reasonably valued in this contract.
35.2 If the primary purpose of this contract is the creation of intellectual property, the State of Florida shall retain an
unencumbered right to use such property,notwithstanding any agreement made pursuant to this section 33.
35.3 If this contract is awarded solely federal funding,the terms and conditions are governed by 2 CFR Part 200.315.
36. Emereency Preparedness and Continuity of Operations
The Provider shall,within thirty(30)calendar days of the execution of this contract,submit to the Alliance Contract Manager
verification of an emergency preparedness plan. In the event of an emergency, the Provider shall notify the Alliance of
emergency provisions.
In the event a situation results in a cessation of services by a sub-Contractor, the Provider shall retain responsibility for
performance under this contract and must follow procedures to ensure continuity of operations without interruption.
37. PUR 1000 Form:
The PUR 1000 Form is hereby incorporated by reference and available at:
�rt �ia��aiG�!9�u al 9,1' i I 777 llixl° 101i�i n ��r d ii[inn�w c�..�..
Page 10 of 58
In the event of any conflict between the PUR 1000 Form and any terms or conditions of any contract or agreement terms or
conditions the contract shall take precedence over the PUR 1000 Form. However, if the conflicting terms or conditions in the
PUR 1000 Form are required by any section of the Florida Statutes,the terms or conditions contained in the PUR 1000 Form
shall take precedence.
38. Use of State Funds to Purchase or Improve Real Pro ert
Any state funds provided for the purchase of or improvements to real property are contingent upon the Provider or political
subdivision granting to the state a security interest in the property at least to the amount of state funds provided for at least 5
years from the date of purchase or the completion of the improvements or as further required by law.
39. Dispute Resolution
Any dispute concerning performance of the contract shall be decided by the Contract Manager,who shall reduce the decision to
writing and serve a copy on the Provider.
40. No Waiver of Sovereign Immunity
Nothing contained in this agreement is intended to serve as a waiver of sovereign immunity by any entity to which sovereign
immunity may be applicable.
41. Venue
If any dispute arises out of this contract,the venue of such legal recourse will be Miami-Dade County, Florida.
42. Entire Contract
This contract contains all the terms and conditions agreed upon by the Parties. No oral agreements or representations shall be
valid or binding upon the Alliance or the Provider unless expressly contained herein or by a written amendment to this contract
signed by both Parties.
43. Force Maieure
The Parties will not be liable for any delays or failures in performance due to circumstances beyond their control,provided the
party experiencing the force majeure condition provides immediate written notification to the other party and takes all reasonable
efforts to cure the condition.
44. Severability Clause
The Parties agree that if a court of competent jurisdiction deems any term or condition herein void or unenforceable;the other
provisions are severable to that void provision and shall remain in full force and effect.
45, Condition Precedent to Contract: Appropriations
The Parties agree that the Alliance's performance and obligation to pay under this contract is contingent upon an annual
appropriation by the Legislature to the Department and a corresponding allocation under contract from the Department to the
Alliance.
46. Addition/Deletion
The Parties agree that the Alliance reserves the right to add or to delete any of the services required under this contract when
deemed to be in the State of Florida's best interest and reduced to a written amendment signed by both Parties. The Parties shall
negotiate compensation for any additional services added.
47, Waiver
The delay or failure by the Alliance to exercise or enforce any of its rights under this contract will not constitute or be deemed
a waiver of the Alliance's right thereafter to enforce those rights,nor will any single or partial exercise of any such right preclude
any other or further exercise thereof or the exercise of any other right.
48. Compliance
The Provider shall abide by all applicable current federal statutes,laws,rules and regulations as well as applicable current state
statutes,laws,rules and regulations, policies of the Department,and the terms of this Contract. The Parties agree that failure of
the Provider to abide by these laws, rules, regulations,policies,and terms of this Contract shall be deemed an event of default
of the Provider and subject the Provider to disciplinary action including corrective action, unannounced special monitoring,
temporary assumption of the operation of one or more contractual services, placement of the Provider on probationary status,
imposing a moratorium on Provider action, imposing financial penalties for nonperformance or noncompliance, or other
administrative action to immediate,unilateral cancellation at the discretion of the Alliance.
Page 11 of 58
If the Alliance finds that the Provider fails to abide by all applicable current federal and state statutes,laws,rules and regulations,
as well as conditions of this Contract,the Alliance shall provide the Provider a Notice of Violation which shall include a concise
statement of the specific violations of the Provider and the facts relied upon to establish the violation.
Upon receipt of the Notice of Violation,the Provider shall have twenty-one(2 1)days to respond to the Notice of Violation. The
Provider's response must include a statement of any disputed issues of material fact and a concise statement of the specific facts
the Provider contends warrant reversal or deviation from the Alliance's proposed action, including an explanation of how the
alleged facts relate to the specific rules,statutes,or contractual term.
Failure of the Provider to respond to the Notice of Violation within twenty-one(2 1)days shall be deemed a waiver of the rights
outlined above and the Alliance will proceed against the Provider by default.
The Alliance, upon receiving a timely filed response to a Notice of Violation,will forward the response and all accompanying
documentation to the Contract Manager to review and consider. The Contract Manager shall,within 30 days after the receipt of
the Provider's response,file an order which lays out the final determination of disciplinary action by the Alliance.
49. Final Invoice
The Provider shall submit the final invoice for payment to the Alliance as specified in this contract.If the Provider fails to submit final request
for payment as specified in this contract,then all rights to payment may be forfeited and the Alliance may not honor any requests submitted,
Any payment due under the terms of this contract may be 6vithheld until all reports due from the Provider and necessary adjustments thereto
have been approved by the Alliance.
50. Modifications
Modifications of provisions of this contract shall only be valid when they have been reduced to writing and duly
signed by both parties.
51. Suspension of Work:
The Alliance may in its sole discretion suspend any or all activities under this contract when in the Department of Elder Affairs
and/or the Alliance determines that it is in the best interests of State to do so. The Alliance shalt provide the Provider written
notice outlining the particulars of suspension. Examples of the reason for suspension include,but are not limited to,budgetary
constraints, declaration of emergency, or other such circumstances. After receiving a suspension notice, the Provider shall
comply with the notice and shall not accept any purchase orders. Within ninety days, or any longer period agreed to by the
Provider,the Alliance shall either(1) issue a notice authorizing resumption of work,at which time activity shall resume,or(2)
terminate the Contract or purchase order.Suspension of work shall not entitle the Provider to any additional compensation.
52. Termination
52.1 Termination for Convenience.This contract may be terminated by either party without cause upon no less than thirty(30)
calendar days' notice in writing to the other party unless a sooner time is mutually agreed upon in writing. Said notice
shall be delivered by U.S. Postal Service with verification of delivery or any expedited delivery service that provides
verification of delivery or by hand delivery to the Contract Manager or the representative of the Provider responsible for
administration of the contract.The Provider shall not furnish any product after it receives the notice of termination,except
as necessary to complete the continued portion of the contract, if any. The Provider shall not be entitled to recover any
cancellation charges or lost profits. See notes on email regarding this paragraph.
52.2 Termination for Cause.The Alliance may terminate this Contract if the Provider fails to(1)deliver the product within the
time specified in the contract or any extension, (2) maintain adequate progress, thus endangering performance of the
contract,(3)honor any term of the,(4)abide by any statutory requirement,regulatory requirement,licensing requirement,
or Department policy or(5) in the event funds for payment become unavailable for this Contract. The Alliance will be
the final authority as to the availability and adequacy of funds. In the event of termination of this contract,the Provider
will be compensated for any work satisfactorily completed prior to the date of termination. The Provider shall continue
work on any work not terminated. Except for defaults of subcontractors at any tier, the Provider shall not be liable for
any excess costs if the failure to perform the Contract arises from events completely beyond the control,and without the
fault or negligence,of the Provider. If the failure to perform is caused by the default of a subcontractor at any tier,and if
the cause of the default is completely beyond the control of both the Provider and the subcontractor,and without the fault
or negligence of either,the Provider shall not be liable for any excess costs for failure to perform,unless the subcontracted
products or services were obtainable from other sources in sufficient time for the Provider to meet the required delivery
schedule. If,after termination,it is determined that the Provider was not in default,or that the default was excusable,the
rights and obligations of the Parties shall be the same as if the termination had been issued for the convenience of the
Alliance.The rights and remedies of the Alliance in this clause are in addition to any other rights and remedies provided
Page 12 of 58
by law or under the Contract.
52.3 Upon expiration or termination of this Contract, the Provider and subcontractors shall transfer all public records in its
possession to the Alliance and destroy any duplicate public records that are exempt or confidential and exempt from
public records, disclosure requirements at no cost to the Alliance. All electronically stored records shall be provided to
the Alliance in a format that is compatible with the Alliance's information technology system(s).
53. Successors
This contract shall remain binding upon the successors in interest of either the Alliance or the Provider,subject to the assignment
provisions above.
54. Electronic Records and_Sismature
54.1 The Alliance authorizes,but does not require, the Provider to create and retain electronic records and to use electronic
signatures to conduct transactions necessary to carry out the terms of this Contract. A Provider that creates and retains
electronic records and uses electronic signatures to conduct transactions shall comply with the requirements contained in
the Uniform Electronic Transaction Act,s.668.50, Fla. Stat.All electronic records must be fully auditable;are subject to
Florida's Public Records Law, Ch. 119, and Fla. Stat.; must comply with Section 29, Data Integrity and Safeguarding
Information;must maintain all confidentiality,as applicable;and must be retained and maintained by the Provider to the
same extent as non-electronic records are retained and maintained as required by this Contract.
54.2 The Alliance's authorization pursuant to this section does not authorize electronic transactions between the Provider and
the Alliance. The Provider is authorized to conduct electronic transactions with the Alliance only upon further written
consent by the Alliance.
54.3 Upon request by the Alliance,the Provider shall provide the Alliance with non-electronic(paper)copies of records.Non-
electronic (paper) copies provided to the Alliance of any document that was originally in electronic form with an
electronic signature must indicate the person and the person's capacity who electronically signed the document on any
non-electronic copy of the document.
55. Stiecial Provisions
The Provider agrees to the following provisions:
55.1 Investigation of Criminal Allegations:
Any report that implies criminal intent on the part of the Provider or any sub-Contractors and referred to a governmental
or investigatory agency must be sent to the Alliance. if the Provider has reason to believe that the allegations will be
referred to the State Attorney, a law enforcement agency, the United States Attorney's office, or other governmental
agency,the Provider shall notify the contract manager.A copy of all documents, reports,notes,or other written material
concerning the investigation,whether in the possession of the Provider or Sub-Contractors,must be sent to the Alliance's
contract manager with a summary of the investigation and allegations.
55.2 Volunteers:
The Provider shall ensure the use of trained volunteers in providing direct services delivered to older Individuals and
individuals with disabilities needing such services. If possible,the Provider shall work in coordination with organizations
that have experience in providing training,placement,and stipends for volunteers or participants(such as organizations
carrying out federal service programs administered by the Corporation for National and Community Service), in
community service settings.
55.3 Enforcement;
The Alliance may,without taking any intermediate measures available to it against the Provider,rescind the contract. ifthe Alliance
finds that:
55.3.1 An intentional or negligent act of the Provider has materially affected the health,welfare,or safety of clients served pursuant
to this contract,or substantially and negatively affected the operation of services covered under this contract:
55.3.2 The Provider lacks financial stability sufficient to meet contractual obligations or that contractual funds have been
misappropriated;
55.3.3 The Provider has committed multiple or repeated violations of legal and regulatory standards, regardless of whether such
laws or regulations are enforced by the Alliance,or the Provider has committed or repeated violations of the Alliance or the
Page 13 of 58
Department standards:
55.3 4 The Provider has failed to continue the pro%ision or expansion of services after the declaration of a state of emergency;and/or
55.3.5 The Provider has failed to adhere to the terms of this contract.
In the alternative,the Alliance may,at its sole discretion,take immediate measures against the Provider,including corrective action.
unannounced special monitoring,temporary assumption of the operation of one or more contractual services,placement of the Provider
on probationary status. imposing a moratorium on Provider action. imposing financial penalties for nonperformance, or other
administrative action,
55.4 In making any determination under this prow ision the Alliance may rely upon the findings of another state or federal agency, or
other regulatory body. Any claims for damages for breach of this contract are exempt from administrative proceedings and shall be
brought before the appropriate entity in the venue of Miami-Dade County.
55.5 Use of Service Dollar&
The Provider will optimize the use of contract funds by serving the maximum possible number of individuals with the services allowed
by this contract.The Provider%%ill spend all funds prop ided by this contract to provide such services.
55.6 SurpluslDeficit Report:,
The Provider will submit a consolidated surplusdtdeficit report in a format provided by the Alliance to the Alliance's Contract Manager
in conjunction with the required monthly billing submission.This report is for this contract between the Provider and the Alliance.The
report will include the following
55.6.1 The Pro%ider's detailed plan on how the surplus or deficit spending,exceeding the 1%threshold will be resolved:
55.6,2 Number of clients currently on the APCII.;that receive a priority ranking score of four(4)or five(5):
55.6.3 Number ofclients currently on the AP(.'L designated as Imminent Risk
55.6.4 Number of clients served and Aging and Disability Resource Center("ADRC")client contacts,
In accordance with its surplus/deficit management policies,in order to maximize available funding and minimize the time
that potential clients must wait for services,the Alliance in its sole discretion can reduce funding awards if the Provider
is not spending according to monthly plans and is projected to incur a surplus at the end of the year.
55.7 Training:The Provider will attend all required trainings and meetings schedule by the Alliance.
56. Contract Manager
The Alliance may substitute any Alliance employee to serve as the Contract Manager.
57. Official Payee and Representatives:
The name,address,and telephone number of the representative for the Alliance for this contract is:
Max B. Rothman,JD, LL.M. President and CEO
760 NW I07th Ave, Suite 214
Miami,Florida 33172
(305)670-6500, Ext.224
Page 14 of 58
The name, address, and telephone number of the representative of the Provider responsible for administration of the program
under this contract is:
The Provider name,as shown on page I of this contract, Monroe County Board of County Commissioners,
a. and mailing address of the official payee to whom the Social Services/In-Home Services
payment shall be made is: 1 100 Simonton Street,2-256
Key West, FL 33040
Sheryl Graham,Senior Director
b The name of the contact person and street address where Monroe County Board of County Commissioners,
financial and administrative records are maintained is: Social Services/In-Home Services
1100 Simonton Street,2-256
Key West, FL 33040
The name, address, and telephone number of the Sheryl Graham, Senior Director
C. representative of the Provider responsible for Monroe County Board of County Commissioners,
administration of the program under this contract is: Social Services1n-Home Servicesl 100 Simonton Street,2-256
Key West,FL 33040
The section and location within the AAA where Requests Vice President for Finance
d. for Payment and Receipt and Expenditure forms are to be Alliance for Aging, Inc.
760 NW 107th Avenue, Suite 214
mailed is: Miami,Florida 33172-3155
Contract Monitor
Alliance for Aging, Inc.
The name,address,and telephone number of the Contract
e. Manager for the AAA for this contract is: 760 NW 107th Avenue,Suite 214
Miami, Florida 33172-3155
In the event different representatives are designated by either party after execution of this contract, notice of the name and
address of the new representative will be rendered in writing to the other party and said notification attached to originals of this
contract.
58. All Terms and Conditions Included
This contract and its Attachments and any exhibits referenced in said attachments,together with any documents incorporated by
reference, contain all the terms and conditions agreed upon by the Parties. There are no provisions, terms, conditions, or
obligations other than those contained herein,and this contract shall supersede all previous communications, representations or
agreements,either written or verbal between the Parties.
Page 15 of 58
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INDEX TO ATTACHMENTS
Attachment 1 SERVICE PROVISIONS ALZHEIMER'S DISEASE INITIATIVE
Attachment 11 CERTIFICATIONS AND ASSURANCES
Attachment III FINANCIAL AND COMPLIANCE AUDIT
Attachment VI ASSURANCES NON CONSTRUCTION PROGRAMS
Attachment VII BUDGET SUMMARY
Attachment VI11 INVOICE REPORT SCHEDULE
Attachment IX REQUEST FOR PAYMENT FORM
Attachment X RECEIPT AND EXPENDITURE REPORT
Attachment A DOEA HANDBOOK
Attachment B CIVIL RIGHTS COMPLIANCE CHECKLIST
Attachment C BUSINESS ASSOCIATES AGREEMENT
Attachment D BACKGROUND SCREENING AFFADAVIT OF COMPLIANCE
Attachment E REFERRAL PROTOCOL AGING AND DISABILITY RESOURCE CENTER(ADRC)
Page 17 of 58
ATTACHMENT I
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
SECTION 1.SERVICES TO BE PROVIDED
A. DEFINITIONS OF TERMS AND ACRONYMS
1. ACRONYMS
Alzheimer's Disease(AD)
Alzheimer's Disease Initiative(ADI)
Activities of Daily Living(ADL)
Area Agency on Aging(AAA)
Assessed Priority Consumer List(APCL)
Adult Protective Services(APS)
Client Information and Registration Tracking System (eCIRTS)
Community Care for Disabled Adults(CODA)
Corrective Action Plan(CAP)
Dementia Care&Cure Initiative(DCCI)
Department of Elder Affairs—(DOEA)or Department
Department of Elder Affairs Program and Services Handbook(DOEA HANDBOOK)
Home Care For Disabled Adults(HCDA)
Instrumental Activities of Daily Living(IADL)
Memory Disorder Clinic(MDC)
Planning and Service Area(PSA)
2. PROGRAM SPECIFIC TERMS
Department of Elder Affairs Handbook: An official document of DOEA. TH DOEA Handbook includes program
policies, procedures, and standards applicable to agencies which are recipients'providers of DOEA funded programs. An
annual update is provided through a Notice of Instruction(NOi).
Functional Assessment: A comprehensive, systematic, and multidimensional review of a person's ability to remain
independent and in the least restrictive living arrangement. DOEA Form 701B is used by case managers to conduct the
functional assessment.
Memory Disorder Clinic: Research oriented programs created pursuant to Sections 430.502(1) and (2), F.S., to provide
diagnostic and referral services,conduct basic and service-related multidisciplinary research,and develop training materials
and educational opportunities for lay and professional caregivers of individuals with AD.
Proviso: Language used in a general appropriations bill to qualify or restrict the way in which a specific appropriation is to
be expended.
Program Highlights: Success stories, quotes, testimonials,or human-interest vignettes that are used in the Department's
Summary of Programs and Services(SOPS)to include information that helps tell the story of how programs and services
help elders,families,and caregivers.
Specialized Day Care: Licensed Specialized Alzheimer's Services Adult Day Care Centers, licensed in accordance with
Section 429.918, F.S., that are considered models because they provide specialized Alzheimer's services for AD clients.
FloridaHealthFinder.gov provides an up-to-date listing of all Specialized Alzheimer's Services Adult Day Care Centers.
Specialized Alzheimer's Services:Specialized Alzheimer's services,offered in day care centers include,but are not limited
to,those listed below:
a. Providing education and training on the specialized needs of persons with Alzheimer's disease or related memory
disorders and caregivers.
b. Providing specialized activities that promote,maintain,or enhance the ADI client's physical,cognitive,social,spiritual,
or emotional health.
c. Providing therapeutic,behavioral, health,safety,and security interventions;clinical care,and support services for the
ADI client and caregiver.
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B. GENERAL DESCRIPTION
I. General Statement
The purpose of the ADI is to address the special needs of individuals with AD, their families,and caregivers.
2. Alzheimer's Disease Initiative Mission Statement
The ADI program assists persons afflicted with AD and other forms of dementia to live as 'independently as possible with
support to family members and caregivers.
3. Authority
The relevant authority governing ADI program are:
a. Rule 58D-1,Florida Administrative Code
b. Sections 430.501 through 430.504, F.S.
c. The Catalog of State Financial Assistance(CSFA)Numbers are 65004 and 65002
4. Scope of Service and Eligible Individuals
The Provider is responsible for the programmatic,fiscal,and operational management of the ADI program per this contract.
The program services shall be provided in a manner consistent with the Area Plan, as updated and the current DOEA
Handbook, which are incorporated by reference. The Provider agrees to be bound by all subsequent amendments and
revisions to the DOEA Handbook,and the Provider agrees to accept all such amendments and revisions.
C Clients to be Served
I. General Eligibility
The ADI Program addresses the special needs of individuals with AD or other related disorders and their caregivers.
2. Client Eligibility
Clients eligible to receive services under this contract must:
a. Be 18 years of age or older and have a diagnosis of AD or a related disorder,or be suspected of having AD or a related
disorder;or
b. If enrolled in Specialized Alzheimer's Services Adult Day Care, be a participant who has a documented diagnosis of
Alzheimer's disease or a dementia-related disorder(ADRD)from a licensed physician, licensed physician assistant,or
a licensed advanced registered nurse practitioner:and
c. Not be enrolled in any Medicaid capitated long-term care program.
3. Targeted Groups
Priority for services provided under this contract shall be given to those eligible persons assessed to be at risk of placement
in an institution.
SECTION II. MANNER OF SERVICE PROVISION
A. Service Tasks
To achieve the goals of the ADI program, the Provider shall perform,or ensure that its subcontractors perform, the following
tasks:
1. Client Eligibility Determination
The Provider shall ensure that applicant data is evaluated to determine eligibility.Eligibility to become a client is based on
meeting the requirements described in Section 1.C.2,
1 Assessment and Prioritization of Service Delivery for New Clients
1"he Provider shall ensure the following criteria are used to prioritize new clients in the sequence below for service delivery.
It is not the intent of the Department to remove existing clients from services to serve new clients being assessed and
prioritized for service delivery.
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a. Imminent Risk individuals: Individuals in the community whose mental or physical health condition has deteriorated
to the degree that self-care is not possible,there is no capable caregiver,and nursing home placement is likely within a
month or very likely within three(3)months.
b. Service priority for individuals not included above, regardless of referral source, will be determined through the
Department's functional assessment administered to each applicant, to the extent funding is available. The Provider
shall ensure that priority is given to applicants at the higher levels of frailty and risk of nursing home placement.
3. Task Limits
The Provider shall not perform any tasks related to the project other than those described in this contract without the express
written consent of the Department.
B. Staffing Requirements
i. Staffing Levels
The Provider shall assign its own administrative and support staff as necessary to meet the obligations of this contract and
shall ensure that subcontractors dedicate adequate staff accordingly.
2. Professional Qualifications
The Provider shall ensure that the staff responsible for performing any duties or functions within this contract have the
qualifications as specified in the current DOEA Handbook.
3. Service Times
The Provider shall ensure the availability of the services listed in this contract at times appropriate to meet client service
needs including, at a minimum,during normal business hours,or as otherwise specified in proviso or the Subcontractor's
approved service provider application.Normal business hours are defined as Monday through Friday,8:00 a.m.to 5:00 p.m.
local time.
4. Use of Subcontractors
If this contract involves the use of a subcontractor or third party,then the Provider shall not delay the implementation of its
agreement with the Subcontractor. If any circumstance occurs that may result in a delay for a period of sixty (60)days or
more of the initiation of the subcontract or the performance of the Subcontractor, the Provider shall notify the Alliance's
Contract Manager of such delay.The Provider shall not permit a Subcontractor to perform services related to this contract
without having a binding Subcontractor agreement executed. The Department will not be responsible or liable for any
obligations or claims resulting from such action.
a. Copies of Subcontracts
The Provider shall submit a copy of all subcontracts to the Alliance Contract Manager within thirty (30) days of the
subcontract being executed.
b. Monitoring the Performance of Subcontractors
The Provider shall monitor, at least once per fiscal year, each of its subcontractors, subrecipients, vendors, andJor
consultants paid from funds provided under this contract. The Provider shall perform fiscal, administrative, and
programmatic monitoring to ensure contractual compliance, fiscal accountability, programmatic performance, and
compliance with applicable state and federal laws and regulations.The Provider shall monitor to ensure that the budget
is met,the scope of work is accomplished within the specified time periods,and other performance goals stated in this
contract are achieved.
c. Copies of Subcontractor Monitoring Reports
The Provider shall forward a copy of all subcontractor Monitoring Reports to the Alliance Contract Manager within
thirty(30)days of the report being issued to the Subcontractors,Subrecipients, Vendors,and!or Consultants.
C. Deliverables
The following section provides the specific quantifiable units of deliverables and source documentation required to evidence the
completion of the tasks specified in this contract.
1. Delivery of Services to Eligible Clients
The Provider shall ensure the provision of a continuum of services addressing the diverse needs of individuals with AD and
their caregivers. The Provider shall ensure performance and reporting of the following services in accordance with the
current DOEA Handbook,which is incorporated by reference,and Section II.A.of this contract. Documentation of service
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delivery must include a report consisting of the following: number of clients served, number of service units provided by
service,and rate per service unit with calculations that equal the total invoice amount.The continuum of services provided
under this contract include those identified by the following service categories:
Respite and Other Services
(1)Caregiver Training/Support.
(2)Case Aide.
(3)Case Management.
(4)Counseling(Gerontological).
(5)Counseling(Mental HeaI6h'Screening).
(6)Education/Training.
(7)Home Delivered Meals.
(8)Housing Improvement.
(9)Material Aid.
(10)Respite(Facility-Based).
(11) Respite(In-Home).
(12) Respite(In-Facility,Specialized Alzheimer's services)
(13) Specialized Medical Equipment,Services,and Supplies;and
(14)Transportation.
2. Services and Units of Service
The Provider shall ensure that the provision of services described in this contract is in accordance with the current DOEA
Handbook and the service tasks described in Section II.A. The Budget Summary (Attachment VII) lists the services that
can be performed,the reimbursement unit rate,the method of payment,and the service unit type. Units of service will be
paid pursuant to the Budget Summary(Attachment VII).
3. Administrative Responsibilities
The Provider shall provide management and oversight of ADI program operations in accordance with the current DOEA
Handbook.Management and oversight of ADI program operations include the following:
a. Establish contractual agreements with appropriate and capable subcontractor and vendor agreements,when applicable.
b. Provide technical assistance to subcontractors and vendors to ensure provision of quality services.
c. Monitor and evaluate subcontractors and vendors for appropriate programmatic and fiscal compliance.
d. Appropriately submit payments to subcontractors.
e. Establish procedures for handling recipient complaints and ensure that subcontractors develop and implement
complaint procedures to process and resolve client dissatisfaction with services. Complaint procedures shall address
the quality and timeliness of services, provider and direct service worker complaints, or any other advice related to
complaints other than termination,suspension or reduction in services that require the grievance process as described
in Appendix D,Department of Elder Affairs Programs and Services Handbook.The complaint procedures shall include
notification to all clients of the complaint procedure and include tracking the date, nature of complaint, and the
determination of each complaint.
f, Ensure compliance with Client Information and Registration Tracking System (eCIRTS)regulations.
g. Monitor outcome measures in accordance with targets set by the Department.
h. Conduct client satisfaction surveys to evaluate and improve service delivery.
D. REPORTS
The Provider shall respond to additional routine or special requests for information and reports required by the Alliance in a
timely manner, as determined by the Alliance Contract Manager... The Provider shall establish reporting due dates for
Subcontractors that permit the Provider to meet the contract reporting requirements.
I. Retrospective Unit Cost Methodology(RUCM):
The Provider shall submit a Retrospective Unit Cost Methodology (R1„''CM) to the Alliance annually no later than ninety
(90) calendar days after the Provider Fiscal Year end. The Rq lCM shall reflect actual costs of providing each service by
program for the preceding Provider fiscal year. If the Provider desires to renegotiate its reimbursement rates,the Provider
shall make a request in writing to the Alliance in accordance with the Alliance's approved Reimbursement Rate Review
Policy,which is incorporated by reference.
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2. (eCIRTS)Reports:
The Provider shall ensure timely input of ADI specific data into eCIRTS. To ensure eCIRTS data accuracy,the Provider
shall adhere to the Alliance's eCIRTS Data Integrity Policy and use eCIRTS-generated reports which include the following:
a. Client Reports;
b. Monitoring Reports;
c. Service Reports;
d. Miscellaneous Reports;
e. Fiscal Reports;and
f. Outcome Measures Reports.
3. Surplus/Deficit Report:
The Provider will submit a consolidated surplus,`deficit report in a format provided by the Alliance to the Alliance's Contract
Manager in conjunction with the required monthly billing submission.The report will include the following:
a. Actual contracted funding utilized each month and YTD
b. Number of active clients compared to the average number of clients funded in the contract
c. Monthly and YTD number of unduplicated clients served
d. Detailed plan on how any projected surplus (or deficit) spending exceeding the Surplus allowance threshold in the
Alliance Policies, incorporated here by referernce,Iwill be resolved.
In accordance with Alliance surplusideficit management policies, in order to maximize available funding and minimize the
time that potential clients must wait for services,the Alliance in its sole discretion can reduce funding awards if the Provider
is not within the Alliance policy surplus allowance.
4. Co-Pay Collections Report
The Provider shall submit a consolidated annual co-payment collections report to the Alliance Contract Manager by July
31,2024,using Attachment 5,located in Appendix B of the Programs and Services Handbook.
5. Program Highlights
The Provider shall submit Program Highlights referencing specific events that occurred in the previous fiscal year by
September 15th of the current contract year. The Provider shall provide a new success story,quote,testimonial,or human-
interest vignette. The highlights shall be written for a general audience, with no acronyms or technical terms. For all
agencies or organizations that are referenced in the highlight,the Provider shall provide a brief description of their mission
or role. The active tense shall be consistently used in the highlight narrative, in order to identify the specific individual or
entity that performed the activity described in the highlight. The Provider shall review and edit Program Highlights for
clarity,readability, relevance,specificity,human interest,and grammar, prior to submitting them to the Alliance.
E. RECORDS AND DOCUMENTATION
The Provider will ensure the collection and maintenance of client and service information on a monthly basis from the Client
Information and Registration Tracking System (eCIRTS). Maintenance includes valid exports and backups of all data and
systems according to Alliance and Department standards.
1. Requests for Payment
The Provider shall maintain documentation to support Requests for Payment that shall be available to the Alliance, the
Department,or other authorized agencies and individuals such as the Florida Department of Financial Services(DFS),upon
request.
2, eCIRTS Data and Maintenance:
The Provider shall ensure,on a monthly basis, collection and maintenance of client and service information in eCIRTS or
any such system designated by the Alliance.Maintenance includes accurate and current data,and valid exports and backups
of all data and systems according to the Alliance and Department standards.
3. Data Integrity and Back up Procedures:
The Provider shall anticipate and prepare for the loss of information processing capabilities. The routine backing up of all
data and software is required to recover from losses or outages of the computer system. Data and software essential to the
continued operation of Provider functions must be backed up. The security controls over the backup resources shall be as
stringent as the protection required of the primary resources. It is recommended that a copy of the backed up data be stored
in a secure,offsite location.
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4. Policies and Procedures for Records and Documentation:
The Provider shall maintain written policies and procedures for computer system backup and recovery and shall have the
same requirement of its Subcontractors.These policies and procedures shall be made available to the Alliance upon request.
F. PERFORMANCE SPECIFICATIONS
1. Outcomes
a. Ensure the provision of the services described in this contract are in accordance with the current DOEA
Handbook and Section ILC of this contract;
b. The Provider shall timely submit to the Alliance all reports described in Section. ILD of this contract;
b. The Provider shall maintain all information described in Section ILE.of this contract;
d. The Provider shall ensure the prioritization and service provision of clients in accordance with Section II.A.2 of this
contract;
e. The Provider shall timely and accurately submit to the Alliance Attachments IX, X and supporting documentation in
accordance with Attachment VI I of this contract.
2. Criteria
The performance of the Provider in providing the services described in this contract shall be measured by the current SPA
strategies for the following criteria:
a. Percent of APS referrals who are in need of immediate services to prevent further harm who are served within 72 hours;
b. Percent of elders assessed with high or moderate risk environments who improved their environment score;
c. Percent of new service recipients with high-risk nutrition scores whose nutritional status improved;
d. Percent of new service recipients whose ADL assessment score has been maintained or improved;
e. Percent of new service recipients whose IADL assessment score has been maintained or improved;
f. Percent of family and family-assisted caregivers who self-report they are likely to provide care;
g. Percent of caregivers whose ability to provide care is maintained or improved after one year of service intervention(as
determined by the caregiver and the assessor);
h. Percent of most frail elders who remain at home or in the community instead of going into a nursing home;
i. Percentage of active clients eating two or more meals per day;
j. After service intervention, the percentage of caregivers who self-report being very confident about their ability to
continue to provide care.
3. The Provider's performance of the measures in F.2. above will be reviewed and documented in the Alliance's Annual
Programmatic Monitoring Report.
4. Monitoring and Evaluation
The Alliance will review and evaluate the performance of the Provider under the terms of this contract. Monitoring shall be
conducted through direct contact with the Provider through telephone, in writing, and?'or on-site visit(s). The Alliance's
determination of acceptable performance shall be conclusive. The Provider agrees to cooperate with the Alliance in
monitoring the progress of completion of the service tasks and deliverables. The Alliance may use, but is not limited to,
one or more of the following methods for monitoring:
a. Desk reviews and analytical reviews;
b. Scheduled,unscheduled,and follow-up on-site visits;
c. Client visits;
d. Review of independent auditor's reports;
e. Review of third-party documents and;ror evaluation;
f. Review of progress reports;
g. Review of customer satisfaction surveys;
h. Agreed-upon procedures review by an external auditor or consultant;
i. Limited-scope reviews;and
j. Other procedures as deemed necessary.
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G. Provider Responsibilities:
I. Provider Accountability
All service tasks and deliverables pursuant to this contract are solely and exclusively the responsibility of the Provider and
are tasks and deliverables for which,by execution of this contract,the Provider agrees to be held accountable.
2. Coordination with Other Providers and/or Entities
Notwithstanding those services for which the Provider is held accountable involve coordination with other entities in
performing the requirements of this contract, the failure of other entities does not alleviate the Provider from any
accountability for tasks or services that the Provider is obligated to perform pursuant to this contract.
H. Alliance for Aging Responsibilities
Alliance Obligations:
The Alliance may,within its resources,provide technical support and assistance to the Provider to assist the Provider in meeting
the requirements of this contract. The Alliance support and assistance,or lack thereof, shall not relieve the Provider from full
performance of contract requirements.
SECTION III. METHOD OF PAYMENT
A. Payment Methods Used
The method of payment for this contract is a combination of fixed feet"unit rate, cost reimbursement, and advance payments,
subject to the availability of funds and Provider performance.The Alliance will pay the Provider upon satisfactory completion
of the Task&'Deliverables, as specified in Section 11., Manner of Service Provision, and in accordance with other terms and
conditions of this contract.
I. Fixed Fee/Unit Rate
Payments for Fixed FeerUnit Rate shall not exceed amounts established in Attachment V11, per unit of service.
2. Cost Reimbursement
Payment may be authorized only for allowable expenditures which are in accordance with the services specified in
Attachment V11. All Cost Reimbursement Requests for Payment must include the Receipt and Expenditure Report,
beginning with the first month of this contract.
3. Advance Payments:
Non-profit Providers may request a monthly advance for service costs for each of the first two months of the contract period,
based on anticipated cash needs. For the first month's advance request, the Provider shall provide to the Alliance
documentation justifying the need for an advance and describing how the funds will be distributed. If the Provider is
requesting two(2) months of advances, documentation must be provided reflecting the cash needs of the Provider within
the initial two (2) months and should be supported through a cash-flow analysis or other information appropriate to
demonstrate the Provider's financial need for the second month of advances.The Provider must also describe how the funds
will be distributed for the first and second month.If sufficient budget is available,and the Department's Contract Manager,
in his or her sole discretion,has determined that there is justified need for an advance, the Department will issue approved
advance payments after July 1 st of the contract year.
All advance payments made to the Provider shall be reimbursed to the Alliance as follows:At least one—tenth of the advance
payment received shall be reported as an advance recoupment on each Request for Payment(Attachment IX),starting with
the invoice submission of the third month activities and billing,in accordance with the Invoice Report Schedule(Attachment
V I11).
B. Method of Invoice Payment
Payment shall be made upon the Providers presentation of an invoice subsequent to the acceptance and approval by the Alliance
of the deliverables shown on the invoice and payment has been received from DOEA.The form and substance of each invoice
submitted by the Provider shall be as follows:
i. Request payment on a monthly basis for the units of services established in this contract,provided in conformance with the
requirements as described in the DOEA Programs and Services Handbook,and at the rates established in Attachment Vil
of the contract. Documentation of service delivery must include a report consisting of the following: number of clients
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served,number of service units provided by service,and rate per service unit with calculations that equal the total invoice
amount. Any change to the total contract amount requires a formal amendment.
2. The Provider shall consolidate all subcontractors'Requests for Payment and Expenditure Reports that support Requests for
Payment and shall submit to the Alliance using forms Request for Payment (Attachment IX), Receipt and Expenditure
Reports(Attachment X)for Case Management and Special Subsidy Services.
3. All Requests for Payment shall be based on the submission of monthly Expenditure Reports beginning with the first month
of the contract.The schedule for submission of advance requests and invoices is Invoice Schedule,Attachment VIll;
4. In the event that services were not billed during the regular billing cycle,the Provider may request payment for services no
later than 90 days after the month in which the expense was incurred,except that requests cannot be made after the contract
closeout date. Request for payment of services rendered 90 days after the month in which the expense was incurred will
require approval of the contract manager prior to the billing of such incurred expenses. Late service billing requests will
not be paid unless justification is submitted and approved by the contract manager;
5. The Provider shall maintain documentation to support payment requests which shall be available to the Alliance, the
Department,and the Department of Financial Services,or other authorized state and federal personnel upon request;and
6. All payments under the terms of this contract are contingent upon an annual appropriation by the Legislature,and subject
to the availability of funds.
C. Payment Withholding
Any payment due by the Department under the terms of this contract may be withheld pending the receipt and approval by the
Department of all financial and programmatic reports due from the Contractor and any adjustments thereto, including any
disallowances.
D. Final Invoice Instructions
The Provider shall submit the final Request for Payment to the Alliance no later than 30 days after the contract period ends and
as referenced in Attachment Vill.If the contract is terminated prior to the end date of the contract,then the Provider must submit
the final request for payment to the Alliance no more than 30 days after the contract is terminated.If the provider fails to do so,
all right to payment is forfeited,and the Alliance will not honor any requests submitted after the aforesaid time period.
E. eCIRTS Data Entries for Subcontractors
The Provider must require Subcontractors to enter all required data for clients and services in the eCIRTS database per the
DOEA Programs and Services Handbook and the eCIRTS User Manual-Aging Provider Network users(located in Documents
on the eCIRTS Enterprise Application Services). Subcontractors must enter this data into the eCIRTS prior to submitting their
requests for payment and expenditure reports to the Provider. The Provider shall establish deadlines for completing eCIRTS
data entry and to assure compliance with due dates for the requests for payment and expenditure reports that Provider must
submit to the Alliance.
F. Providers' Monthly eCIRTS Reports
The Provider must run monthly eCIRTS reports and verify client and service data in the eCIRTS is accurate. This report must
be submitted to the Alliance with the monthly request for payment and expenditure report and must be reviewed by the Alliance
before the Provider's request for payment and expenditure reports can be approved by the Alliance.
IV.SPECIAL PROVISIONS
A. Provider's Financial Obligations
1. Matching,Level of Effort,and Earmarking Requirement:
The Provider must provide a match of at least 10 percent of the cost for all ADI services. The match will be made in the
form of cash andior in-kind resources.At the end of the contract period,all ADI funds expended must be properly matched.
State funds cannot be used to match another state-funded program.
2. Cost Sharing and Co-payments:
The Provider in conjunction with the Alliance shall establish an annual co-payment goal (amount to be collected from
clients). Using the method prescribed in Appendix B of the current Department of Elder Affairs Program and Services
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Handbook,the provider shall project the annual co-payments to be collected from each active client in all income ranges
prior to the start of each fiscal year. The provider is required to meet the established goal. Co-payments collected in the
ADI program can be used as part of the local match.
3. Management and Use of Service Dollars and Continuity of Service:
a. The Provider is expected to spend all funds provided by the Alliance for the purpose specified in this contract. The
Provider must manage the service dollars in such a manner so as to avoid having a surplus of funds at the end of the
contract period. If the Alliance determines that the Provider is not maximizing available funding, the Alliance, in
accordance with its Fiscal)policies,may transfer funds to other Providers and/or adjust subsequent funding allocations
accordingly.
b. The Provider shall ensure that contract services will be provided until the end of the contract period. In order to enable
the Provider to better manage the services under this contract and to maximize the use of available resources, the
Altliance has established a spending authority as identified in Budget Summary, Attachment Vll. The Provider is
responsible for managing the spending authority so that a continuity of service can be maintained for the maximum
number of consumers.The Provider agrees to assume responsibility for any contractual deficit that may be incurred-
4. Budget Summary:
The Alliance has established a spending authority based on services and rate detailed in the SPA and the Budget Summary,
Attachment VI I and any revisions thereto approved by the Alliance. Any changes in the total amounts of the funds identified
on the Budget Summary require a contract amendment.
B. Remedies for Nonconforming Services
I. The Provider shall ensure that all goods and"or services provided under this contract are delivered timely, completely and
commensurate with required standards of quality. Such goods and/or services will only be delivered to eligible program
participants.
2. If the Provider fails to meet the prescribed quality standards for services, such services will not be reimbursed under this
contract. In addition, any nonconforming goods (including home delivered meals) and,'or services not meeting such
standards will not be reimbursed under this contract. The Provider's signature on the request for payment form certifies
maintenance of supporting documentation and acknowledgement that the Provider shall solely bear the costs associated
with preparing or providing nonconforming goods and/or services.The Alliance requires immediate notice of any significant
and/or systemic infractions that compromise the quality,security or continuity of services to clients.
3. The Alliance will pass through to the provider any financial consequences imposed by the Department on the Alliance
should the provider beat fault and/or cause for the imposed financial consequence. Any passthrough financial consequences
will be withheld by reduction of payment and will levy against the provider for the following:
a. Delivery of services to eligible clients as referenced in Attachment 1, Section II of this contract Failure to comply
with established assessment and prioritization criteria as evidenced by eCRITS reports.
b. Services and units of services as referenced in Attachment I,Section II of this contract—Failure to provider services in
accordance with the current DEOA Handbook
c. Administrative duties as referenced in Attachment I,Section 11 of this contract—Failure to perform management and
oversight of the program operations.
C. Investigation of Criminal Allegations
Any report that implies criminal intent on the part of the Provider or any Subcontractors and referred to a governmental or
investigatory agency must be sent to the Alliance which will in turn forward the information to the Department. If the Alliance
has reason to believe that the allegations will be referred to the State Attorney, a law enforcement agency, the I-Inited States
Attorney's office,or other governmental agency,the Alliance shall notify the Inspector General at the Department immediately.
A copy of all documents, reports,notes or other written material concerning the investigation,whether in the possession of the
Provider or Subcontractors, must be sent to the Alliance which will in turn send the material to the Department's Inspector
General with a summary of the investigation and allegations.
D. Volunteers
The Provider shall ensure the use of trained volunteers in providing direct services delivered to older individuals and individuals
with disabilities needing such services. If possible, the Provider shall work in coordination with organizations that have
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experience in providing training, placement, and stipends for volunteers or participants (such as organizations carrying out
federal service programs administered by the Corporation for National and Community Service),in community service settings.
E. Use of Service Dollars and Management of Assessed Priority Consumer List
The Provider is expected to spend all federal, state,and other funds provided by the Alliance for the purpose specified in the
contract.The Provider must manage the service dollars in such a manner so as to avoid having a surplus of funds at the end of
the contract period, for each program managed by the Provider. The Provider understands and agrees to the reallocation of
funding as described in Attachment I,Section IV.A.3.a.of this contract.
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ATTACHMENT 11
CERTIFICATIONS AND ASSURANCES
The Alliance will not award this contract unless Provider completes the CERTIFICATIONS AND ASSURANCES contained in this
Attachment. In performance of this contract,Provider provides the following certifications and assurances:
A. Debarment and Suspension Certification(29 CFR Part 95 and 2 CFR Part 200)
B. Certification Reeardine Lobbvine(29 CFR Part 93 and 45 CFR Part 93)
C. Nondiscrimination& Equal Opportunity Assurance(29 CFR Part 37 and 45 CFR Part 80)
D. Certification Regarding Public Entity Crimes,section 287.133,F.S.
E. Association of Community Organizations for Reform Now(ACORN)Funding Restrictions Assurance(Pub. L.
111-117)
F. Certification Regarding Scrutinized Companies Lists,section 287.135,F.S.
G. Certification Reeardine Data Integrity Compliance for Agreements. Grants,Loans And Cooperative
Agreements
H. Verification of Employment Status Certification
1. Records and Documentation
J. Certification Reeardine Inspection of Public Records
A. CERTIFICATION REGARDING DEBARMENT,SUSPENSION,AND OTHER RESPONSIBILITY MATTERS-
PRIMARV COVERED TRANSACTION.
The undersigned Provider certifies to the best of its knowledge and belief,that it and its principals:
1. Are not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily excluded from covered
transactions by a Federal department or agency;
2. Have not within a three-year period preceding this Contract been convicted or had a civil judgment rendered against them
for commission of fraud or a criminal offense in connection with obtaining,attempting to obtain,or performing a public
(Federal, State,or local)transaction or contract under a public transaction;violation of Federal or State antitrust statutes or
commission of embezzlement,theft,forgery,bribery,falsification or destruction of records,making false statements,or
receiving stolen property;
3. Are not presently indicted or otherwise criminally or civilly charged by a government entity(Federal,State or local)with
commission of any of the offenses enumerated in paragraph A.2.of this certification;and/'or
4. Have not within a three-year period preceding this application°`proposal had one or more public transactions(Federal, State,
or local)terminated for cause of default.
B. CERTIFICATION REGARDING LOBBYING-Certification for Contracts,Grants,Loans,and Cooperative
Agreements.
The undersigned Provider certifies,to the best of its knowledge and belief,that:
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No Federal appropriated funds have been paid or will be paid,by or on behalf of the undersigned,to any person for influencing
or attempting to influence an officer or employee of Congress,or an employee of a Member of Congress in connection with the
awarding of any Federal contract,the making of any Federal grant,the making of any Federal loan,the entering into of any
cooperative agreement,and the extension,continuation,renewal,amendment or modification of any Federal contract,grant,
loan or cooperative agreement.
If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to
influence an officer or employee of any agency,a Member of Congress,an officer or employees of Congress,or employee of a
Member of Congress in connection with a Federal contract,grant, loan,or cooperative agreement,the undersigned shall also
complete and submit Standard Form- LLL, "Disclosure Form to Report Lobbying,"in accordance with its instructions.
The undersigned shall require that language of this certification be included in the documents for all subcontracts at all tiers
(including subcontracts,sub-grants and contracts under grants, loans and cooperative agreements)and that all sub-recipients
and Providers shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this Contract was made or entered
into. Submission of this certification is a prerequisite for making or entering into this Contract imposed by 31 U.S.C. 1352. Any
person who fails to file the required certification shall be subject to a civil penalty of not less than$10,000 and not more than
$100,000 for each such failure.
C. NON-DISCRIMINATION& EQUAL OPPORTUNITY ASSURANCE(29 CFR PART 37 AND 45 CFR PART 80). As
a condition of the Contract, Provider assures that it will comply fully with the nondiscrimination and equal opportunity
provisions of the following laws:
I. Section 188 of the Workforce Investment Act of 1998(WIA),(Pub. L. 105-220),which prohibits discrimination against all
individuals in the United States on the basis of race,color,religion,sex national origin,age,disability,political affiliation,
or belief,and against beneficiaries on the basis of either citizenship/status as a lawfully admitted immigrant authorized to
work in the United States or participation in any WIA Title 1-financially assisted program or activity;
2. Title VI of the Civil Rights Act of 1964(Pub.L. 88-352),as amended,and all requirements imposed by or pursuant to the
Regulation of the Department of Health and Human Services(45 CFR Part 80),to the end that,in accordance with Title VI
of that Act and the Regulation,no person in the United States shall,on the ground of race,color,or national origin,be
excluded from participation in,be denied the benefits of,or be otherwise subjected to discrimination under any program or
activity for which the Applicant receives Federal financial assistance from the Alliance.
3. Section 504 of the Rehabilitation Act of 1973 (Pub.L.93-112)as amended,and all requirements imposed by or pursuant to
the Regulation of the Department of Health and Human Services(45 CFR Part 84),to the end that, in accordance with
Section 504 of that Act,and the Regulation,no otherwise qualified handicapped individual in the United States shall,
solely by reason of his handicap,be excluded from participation in,be denied the benefits of,or be subjected to
discrimination under any program or activity for which the Applicant receives Federal financial assistance from the
Alliance.
4. The Age Discrimination Act of 1975 (Pub. L. 94-135),as amended,and all requirements imposed by or pursuant to the
Regulation of the Department of Health and Human Services(45 CFR Part 91),to the end that, in accordance with the Act
and the Regulation,no person in the United States shall,on the basis of age,be denied the benefits of,be excluded from
participation in,or be subjected to discrimination under any program or activity for which the Applicant receives Federal
financial assistance from the Alliance.
5. Title IX of the Educational Amendments of 1972(Pub.L. 92-318),as amended,and all requirements imposed by or
pursuant to the Regulation of the Department of Health and Human Services(45 CFR Part 86),to the end that,in
accordance with Title IX and the Regulation,no person in the United States shall,on the basis of sex,be excluded from
participation in,be denied the benefits of,or be otherwise subjected to discrimination under any education program or
activity for which the Applicant receives Federal financial assistance from the Alliance.
6. The American with Disabilities Act of 1990(Pub.L. 101-336),prohibits discrimination in all employment practices,
including,job application procedures,hiring,firing,advancement,compensation,training,and other terms,conditions,and
privileges of employment.It applies to recruitment,advertising,tenure,layoff,leave,fringe benefits,and all other
employment-related activities,and;
Page 29 of 58
Provider also assures that it will comply with 29 CFR Part 37 and all other regulations implementing the laws listed above. This
assurance applies to Provider's operation of the W IA Title I-financially assisted program or activity,and to all agreements
Provider makes to carry out the WIA Title I-financially assisted program or activity. Provider understands that the Alliance,
Department,and the United States have the right to seek judicial enforcement of the assurance.
D. CERTIFICATION REGARDING PUBLIC ENTITY CRIMES,SECTION 287.133,F.S.
Provider hereby certifies that neither it,nor any person or affiliate of Provider,has been convicted of a Public Entity Crime as
defined in section 287.133,F.S.,nor placed on the convicted vendor list.
Provider understands and agrees that it is required to inform DOEA immediately upon any change of circumstances regarding
this status.
E. ASSOCIATION OF COMMUNITY ORGANIZATIONS FOR REFORM NOW (ACORN) FUNDING
RESTRICTIONS ASSURANCE(Pub.L. 111-117).
As a condition of the Contract, Provider assures that it will comply fully with the federal funding restrictions pertaining to
ACORN and its subsidiaries per the Consolidated Appropriations Act,20 10,Division E, Section 511 (Pub.L, 1 l 1-117).The
Continuing Appropriations Act,2011,Sections IOI and 103 (Pub.L. 1 11-242),provides that appropriations made under Pub.
L. I I 1-1 17 are available under the conditions provided by Pub. L. 1 I 1-1 17.
The undersigned shall require that language of this assurance be included in the documents for all subcontracts at all tiers
(including subcontracts,sub-grants and contracts under grants, loans and cooperative agreements)and that all sub recipients
and Providers shall provide this assurance accordingly.
F. SCRUTINIZED COMPANIES LISTS CERTIFICATION,SECTION 287.135,F.S.
In accordance with section 287.135, F.S., Provider hereby certifies that it is not participating in a boycott of Israel.
If this Contract is in the amount of S I million or more,in accordance with the requirements of section 287.135,F.S., Provider
hereby certifies that it is not listed on either the Scrutinized Companies with Activities in Sudan List or the Scrutinized
Companies with Activities in the Iran Petroleum Energy Sector List and that it does not have business operations in Cuba or
Syria.
Provider understands that pursuant to section 287.135, F.S.,the submission of a false certification may result in the Alliance
ands"or Department terminating this contract and the submission of a false certification may subject the Provider to civil
penalties,attorney's fees,and/or costs, including costs for investigations that led to the funding of false certification.
If Provider is unable to certify to any of the statements in this certification, Provider shall attach an explanation to this Contract.
G. CERTIFICATION REGARDING DATA INTEGRITY COMPLIANCE FOR AGREEMENTS,GRANTS, LOANS
AND COOPERATIVE AGREEMENTS
1. The Provider and any Subcontractors of services under this contract have financial management systems capable of
providing certain information,including:(1)accurate,current,and complete disclosure of the financial results of each
grant-funded project or program in accordance with the prescribed reporting requirements;(2)the source and application of
funds for all agreement supported activities;and(3)the comparison of outlays with budgeted amounts for each award.The
inability to process information in accordance with these requirements could result in a return of grant funds that have not
been accounted for properly.
2. Management Information Systems used by the Provider,Subcontractors,or any outside entity on which the Provider is
dependent for data that is to be reported,transmitted or calculated, have been assessed and verified to be capable of
processing data accurately,including year-date dependent data. For those systems identified to be non-compliant, Providers
will take immediate action to assure data integrity.
3. if this contract includes the provision of hardware,software,firmware,microcode or imbedded chip technology,the
undersigned warrants that these products are capable of processing year-date dependent data accurately.All versions of
these products offered by the Provider(represented by the undersigned)and purchased by the state will be verified for
accuracy and integrity of data prior to transfer.
Page 30 of 58
4. In the event of any decrease in functionality related to time and date related codes and internal subroutines that impede the
hardware or software programs from operating properly,the Provider agrees to immediately make required corrections to
restore hardware and software programs to the same level of functionality as warranted herein,at no charge to the state,
and without interruption to the ongoing business of the state,time being of the essence.
5. The Provider and any Subcontractors of services under this contract warrant their policies and procedures include a disaster
plan to provide for service delivery to continue in case of an emergency including emergencies arising from data integrity
compliance issues.
H. VERIFICATION OF EMPLOYMENT STATUS CERTIFICATION
As a condition of contracting with the Alliance,Provider certifies the use of the U.S. Department of Homeland Security's E-
verify system to verify the employment eligibility of all new employees hired by Provider during the contract term to perform
employment duties pursuant to this contract and that any subcontracts include an express requirement that Subcontractors
performing work or providing services pursuant to this Agreement utilize the E-verify system to verify the employment
eligibility of all new employees hired by the Subcontractor during the entire contract term.
1. RECORDS AND DOCUMENTATION
The Provider shall make available to the Alliance and the Department staff and/or any party designated by the Alliance and the
Department any and all contract related records and documentation.The Provider shall ensure the collection and maintenance
of all program related information and documentation on any such system designated by the Alliance and the Department.
Maintenance includes accurate and current data,and valid exports and backups of all data and systems according to
Department standards.
J. CERTIFICATION REGARDING INSPECTION OF PUBLIC RECORDS
I. In addition to the requirements of section 9 of this contract,and 119.0701(3)and(4)F.S.,and any other applicable law,if a
civil action is commenced as contemplated by Section 119.0701(4),F.S.,and the Alliance and/or Department if Elder
Affairs is named in the civil action, Provider agrees to indemnify and hold harmless the Alliance an&or Department for any
costs incurred by the Alliance and/or Department,and any attorneys' fees assessed or awarded against the Alliance and/or
Department from a Public Records Request made pursuant to Chapter 119,F.S.,concerning this contract or services
performed thereunder.
2. Section 119.01(3),F.S.,states if public funds are expended by an agency in payment of dues or membership contributions
for any person,corporation,foundation,trust,association,group,or other organization,all the financial, business,and
membership records of such an entity which pertain to the public agency(Florida Department of Elder Affairs)are
public records. Section 119.07,F.S,states that every person who has custody of such a public record shall permit the record
to be inspected and copied by any person desiring to do so,under reasonable circumstances.
The Provider shall require that the language of this certification be included in all sub agreements,subgrants,and other
agreements and that all Subcontractors shall certify compliance accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered
into.Submission of this certification is a prerequisite for making or entering into this transaction imposed by OMB Circulars A-
102 and 2 CFR Part 200(formerly OMB Circular A-110).
By signaii
Provider certifies the representations outlined in parts A through I above are true and correct.
Si nat of Authorized ere
( gsentative)
Provider Date
(Street Address)
� ""��: ,. ",t
(City,S t Zip code)
Page 31 of 58
ATTACHMENT III
FINANCIAL AND COMPLIANCE AUDIT
The administration of resources awarded by the Alliance for Aging, Inc. to the Provider may be subject to audits and/or monitoring
by the Alliance or the Florida Department of Elder Affairs,as described in this section.
MONITORING
In addition to reviews of audits conducted in accordance with OMB Circular A-133, as revised, and Section 215.97, F.S., (see
"AUDITS"below),monitoring procedures may include, but not be limited to,on-site visits by the Department of Elder Affairs and
Alliance staff, limited scope audits as defined by OMB Circular A-133, as revised, andior other procedures. By entering into this
agreement, the Provider agrees to comply and cooperate with any monitoring procedures/processes deemed appropriate by the
Alliance or the Department of Elder Affairs. In the event the Alliance for Aging, Inc. determines that a limited scope audit of the
Provider is appropriate,the Provider agrees to comply with any additional instructions provided by the Alliance for Aging,Inc.to the
Provider regarding such audit. The Provider further agrees to comply and cooperate with any inspections,reviews, investigations,or
audits deemed necessary by the Chief Financial Officer(CFO)or Auditor General.
AUDITS
PART 1: FEDERALLY FUNDED
This part is applicable if the Provider is a State or local government or a non-profit organization as defined in OMB Circular A-133,
as revised.
In the event that the Provider expends$750,000 or more in federal awards during its fiscal year,the Provider must have a single or
program-specific audit conducted in accordance with the provisions ofOMB Circular A-133,as revised. EXHIBIT I to this agreement
indicates federal resources awarded through the Department of Elder Affairs and the Alliance by this agreement. In determining the
federal awards expended in its fiscal year, the Provider shall consider all sources of federal awards, including federal resources
received from the Alliance or the Department of Elder Affairs. The determination of amounts of federal awards expended should be
in accordance with the guidelines established by OMB Circular A-]33,as revised. An audit of the Provider conducted by the Auditor
General in accordance with the provisions of OMB Circular A-133,as revised,will meet the requirements of this part.
In connection with the audit requirements addressed in Part 1,paragraph 1,the Provider shall fulfill the requirements relative to auditee
responsibilities as provided in Subpart C of OMB Circular A-]33,as revised.
If the Provider expends less than$750,000 in federal awards in its fiscal year,an audit conducted in accordance with the provisions
of OMB Circular A-133,as revised, is not required. In the event that the Provider expends less than$750,000 in federal awards in its
fiscal year and elects to have an audit conducted in accordance with the provisions of OMB Circular A-133,as revised,the cost of the
audit must be paid from non-federal resources(i.e.,the cost of such audit must be paid from Provider resources obtained from other
than federal entities.)
An audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal year. Compliance
findings related to agreements with the Alliance for Aging,Inc.shall be based on the agreement's requirements,including any rules,
regulations,or statutes referenced in the agreement.The financial statements shall disclose whether or not the matching requirement
was met for each applicable agreement. All questioned costs and liabilities due to the Alliance for Aging, Inc.shall be fully disclosed
in the audit report with reference to the Alliance for Aging,Inc.agreement involved. If not otherwise disclosed as required by Section
310(b)(2)of OMB Circular A-133,as revised,the schedule of expenditures of federal awards shall identify expenditures by agreement
number for each agreement with the Alliance for Aging, Inc.in effect during the audit period. Financial reporting packages required
under this part must be submitted within the earlier of 30 days after receipt of the audit report or 9 months after the end of the Provider's
fiscal year end.
Page 32 of 58
PART Ill: STATE FUNDED
This part is applicable if the Provider is a non-state entity as defined by Section 215.97(2), Florida Statutes.
In the event that the Provider expends a total amount of state financial assistance equal to or in excess of$750,000 in any fiscal year
of such Provider(for fiscal years ending September 30,2004 or thereafter),the Provider must have a State single or project-specific
audit for such fiscal year in accordance with Section 215.97,Florida Statutes;applicable rules ofthe Department of Financial Services;
and Chapters 10.550 (local governmental entities)or 10.650(nonprofit and for-profit organizations), Rules of the Auditor General.
EXHIBIT I to this agreement indicates state financial assistance awarded through the Alliance for Aging,Inc. by this agreement. In
determining the state financial assistance expended in its fiscal year,the Provider shall consider all sources of state financial assistance,
including state financial assistance received from the Alliance for Aging,Inc.,other state agencies,and other non-state entities. State
financial assistance does not include federal direct or pass-through awards and resources received by a non-state entity for federal
program matching requirements.
In connection with the audit requirements addressed in Part II,paragraph I;the Provider shall ensure that the audit complies with the
requirements of Section 215.97(8), Florida Statutes. This includes submission of a financial reporting package as defined by Section
215.97(2),Florida Statutes,and Chapter 10.550(local governmental entities)or 10.650(nonprofit and for-profit organizations),Rules
of the Auditor General.
If the Provider expends less than $750,000 in state financial assistance in its fiscal year(for fiscal years ending September 30,2004
or thereafter),an audit conducted in accordance with the provisions of Section 215.97, Florida Statutes, is not required. In the event
that the Provider expends less than $750,000 in state financial assistance in its fiscal year and elects to have an audit conducted in
accordance with the provisions of Section 215.97, Florida Statutes, the cost of the audit must be paid from the non-state entity's
resources(i.e.,the cost of such an audit must be paid from the Provider resources obtained from other than State entities),
An audit conducted in accordance with this part shall cover the entire organization for the organization's fiscal year. Compliance
findings related to agreements with the Alliance for Aging, Inc. shall be based on the agreement's requirements, including any
applicable rules,regulations,or statutes. The financial statements shall disclose whether or not the matching requirement was met for
each applicable agreement. All questioned costs and liabilities due to the Alliance for Aging, Inc.shall be fully disclosed in the audit
report with reference to the Alliance for Aging, Inc. agreement involved. If not otherwise disclosed as required by Rule 691-5.003,
Fla.Admin.Code,the schedule of expenditures of state financial assistance shall identify expenditures by agreement number for each
agreement with the Alliance for Aging, Inc. in effect during the audit period. Financial reporting packages required under this part
must be submitted within 45 days after delivery of the audit report,but no later than 12 months after the Provider's fiscal year end for
local governmental entities. Non-profit or for-profit organizations are required to be submitted within 45 days after delivery of the
audit report, but no later than 9 months after the Provider's fiscal year end. Notwithstanding the applicability of this portion, the
Alliance and the Department of Elder Affairs retain all right and obligation to monitor and oversee the performance of this agreement
as outlined throughout this document and pursuant to law.
PART III: REPORT SUBMISSION
Copies of reporting packages for audits conducted in accordance with OMB Circular A-133, as revised,and required by PART I of
this agreement shall be submitted,when required by Section.320(d),OMB Circular A-133,as revised,by oron behalf of the Provider
directly to each of the following:
The Alliance for Aging, Inc.at each of the following addresses:
Alliance for Aging,Inc.
Attn: Fiscal Monitor
760 NW 1071h Ave.Suite 214
Miami,FL.33172-3155
The Federal Audit Clearinghouse designated in OMB Circular A-133,as revised(the number of copies required by Sections .320(d)
(I)and(2),OMB Circular A-133,as revised,should be submitted to the Federal Audit Clearinghouse),at the following address:
Federal Audit Clearinghouse
Bureau of the Census
1201 East 10"Street
Jeffersonville,IN 47132
Other federal agencies and pass-through entities in accordance with Sections.320(e)and(f),OMB Circular A-133,as revised.
Page 33 of 58
Pursuant to Sections.320(f),OMB Circular A-]33,as revised,the Provider shall submit a copy of the reporting package described in
Section .320(c),OMB Circular A-133, as revised,and any management letter issued by the auditor,to the Alliance for Aging, Inc.at
each of the following addresses:
Alliance for Aging,Inc.
Attn: Fiscal Monitor
760 NW 107"Ave.Suite 214
Miami,FL.33172-31550
Additionally, copies of financial reporting packages required by Part II of this agreement shall be submitted by or on behalf of the
Provider directly to each of the following:
The Alliance for Aging, Inc.at each of the following addresses:
Alliance for Aging,Inc.
Attn: Fiscal Monitor
760 NW 107"Ave.Suite 214
Miami,FL.33172-3155
The Auditor General's Office at the following address:
State of Florida Auditor General
Claude Pepper Building,Room 574
111 West Madison Street
Tallahassee,Florida 32399-1450
Any reports, management letter, or other information required to be submitted to the Alliance for Aging, Inc. pursuant to this
agreement shall be submitted timely in accordance with OMB Circular A-133, Florida Statutes, and Chapters 10.550 (local
governmental entities)or 10.650(nonprofit and for-profit organizations), Rules of the Auditor General,as applicable.
Providers, when submitting financial reporting packages to the Alliance for Aging, Inc. for audits done in accordance with OMB
Circular A-133 or Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and for-profit organizations), Rules of the
Auditor General,should indicate the date that the reporting package was delivered to the Provider in correspondence accompanying
the reporting package.
PART IV: RECORD RETENTION
The Provider shall retain sufficient records demonstrating its compliance with the terms of this agreement for a period of six years
from the date the audit report is issued,and shall allow the Alliance for Aging,Inc.or its designee,the CFO or Auditor General Access
to such records upon request. The Provider shall ensure that audit working papers are made available to the Alliance for Aging, Inc.,
or its designee,the Department or its designee,CFO,or Auditor General upon request for a period of six years from the date the audit
report is issued,unless extended in writing by the Alliance for Aging,Inc.
Page 34 of 58
ATTACHMENT III
EXHIBIT—1
1. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS AGREEMENT CONSIST OF THE
FOLLOWING:
MATCHING RESOURCES FOR FEDERAL PROGRAMS
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL STATE AWARD $0
STATE FINANCIAL ASSISTANCE SUBJECT TO Sec.215.97,F.S.
PROGRAM TITLE FUNDING SOURCE CSFA AMOUNT
Alzheimer's Disease Initiative Program General Revenue 65.002 $60,634.56
TOTAL AWARD $60,634.56
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS
AGREEMENT ARE AS FOLLOWS:
State Financial Assistance
Section 215.97 F.S.
Chapter 691-5 Fla.Administrative Code
Page 35 of 58
ATTACHMENT III
EXHIBIT-2
PART 1: AUDIT RELATIONSHIP DETERMINATION
Providers who receive state or federal resources may or may not be subject to the audit requirements of OMB Circular A-133, as
revised, and/or s. 215.97, Fla. Stat. Providers who are determined to be recipients or sub-recipients of federal awards an&or state
financial assistance may be subject to the audit requirements if the audit threshold requirements set forth in Part I and/or Part 11 of
Exhibit I is met. Providers who have been determined to be vendors are not subject to the audit requirements of OMB Circular A-
133,as revised,and/or s. 215.97,Fla.Stat. Regardless of whether the audit requirements are met,Providers who have been determined
to be recipients or sub-recipients of federal awards ands"or state financial assistance must comply with applicable programmatic and
fiscal compliance requirements.
In accordance with Sec.210 of OMB Circular A-133 and/or Rule 691-5.006, FAC, Provider has been determined to be:
Vendor or exempt entity and not subject to OMB Circular A-133 and°or s. 215.97,F.S.
X Recipientsub-recipient subject to OMB Circular A-]33 an&or s. 215.97, F.S.
Exempt organization not subject to 2 CFR Part§200 and/or s. 215.97, F.S. For Federal awards,for-profit organizations are
exempt;for state financial assistance projects,public universities,community colleges,district school boards,branches of
state(Florida)government,and charter schools are exempt. Exempt organizations must comply with all compliance
requirements set forth within the contract or award document.
NOTE: If a Provider is determined to be a recipient R"sub-recipient of federal and or state financial assistance and has been approved
by the Department to subcontract,they must comply with s. 215.97(7), F.S.,and Rule 691-.006(2), FAC [state financial assistance]
and Section .400 OMB Circular A-133 [federal awards].
PART 11: FISCAL COMPLIANCE REQUIREMENTS
FEDERAL AWARDS OR STATE MATCHING FUNDS ON FEDERAL AWARDS. Providers who receive federal awards or
state matching funds on federal awards and who are determined to be a sub-recipient must comply with the following fiscal laws,
rules and regulations:
STATES,LOCAL GOVERNMENTS AND INDIAN TRIBES MUST FOLLOW:
2 CFR Part 225 Cost Principles for State,Local and Indian Tribal Governments(Formerly OMB Circular A-87)*
OMB Circular A-102 Administrative Requirements
OMB Circular A-133—Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws,rules and regulations
NON-PROFIT ORGANIZATIONS MUST FOLLOW:
2 CFR Part 230 Cost Principles for Non-Profit Organizations(Formerly OMB Circular A-122—Cost Principles)"
2 CFR Part 215 Administrative Requirements(Formerly OMB Circular A-I 10—Administrative Requirements)
Requirements)
OMB Circular A-133 �-Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws,rules and regulations
EDUCATIONAL INSTITUTIONS(EVEN IF A PART OF A STATE OR LOCAL GOVERNMENT)MUST FOLLOW:
2 CFR Part 220 Cost Principles for Educational Institutions OMB(Formerly Circular A-21 —Cost Principles)*
2 CFR Part 215 Administrative Requirements(Formerly OMB Circular A-1 10—Administrative Requirements)
OMB Circular A-133�-Audit Requirements
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws,rules and regulations
*Some federal programs may be exempted from compliance with the Cost Principles Circulars as noted in the OMB Circular
Page 36 of 58
A-133 Compliance Supplement, Appendix 1.
STATE FINANCIAL,ASSISTANCE. Providers who receive state financial assistance and who are determined to be a recipient/sub-
recipient must comply with the following fiscal laws,rules and regulations:
Section 215.97, Fla.Stat.
Chapter 691-5,Fla. Admin.Code
State Projects Compliance Supplement
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws,rules and regulations
THE REST Of THIS PAGE WAS LEFT BLANK INTENTIONALLY
Page 37 of 58
ATTACHMENT VI
ASSURANCES—NON-CONSTRUCTION PROGRAMS
Public reporting burden for this collection of information is estimated to average 45 minutes per response,including time for reviewing
instructions,searching existing data sources,gathering and maintaining the data needed and completing and reviewing the collection
of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden, to the Office of Management and Budget. Paperwork Reduction Project (0348-0043),
Washington,DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET,
SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
Note:Certain of these assurances may not be applicable to your project or program. If you have questions,please contact
the awarding agency. Further,certain federal awarding agencies may require applicants to certify to additional
assurances. If such is the case,you will be notified.
I. Has the legal authority to apply for federal assistance,and the institutional,managerial,and financial capability(including
funds sufficient to pay the non-federal share of project cost)to ensure proper planning,management,and completion of the
project described in this application.
2. Will give the awarding agency,the Comptroller General of the United States,and if appropriate,the State,through any authorized
representative,access to and the right to examine all records,books,papers,or documents related to the award;and will establish
a proper accounting system in accordance with generally accepted accounting standards or agency directives.
3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes orpresents the appearance
of personal or organizational conflict of interest,or personal gain.
4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency.
5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. 4728-4763)relating to prescribed standards for
merit systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPM's Standards for a
Merit System of Personnel Administration(5 C.F.R.900, Subpart F).
6. Will comply with all federal statutes relating to nondiscrimination.These include but are not limited to: (a)Title VI of the Civil
Rights Act of 1964(P.L. 88-352)which prohibits discrimination on the basis of race,color or national origin;(b)Title IX of the
Education Amendments of 1972,as amended(20 U.S.C. 1681-1683,and 1685-1686),which prohibits discrimination on the
basis of sex;(c)Section 504 of the Rehabilitation Act of 1973,as amended(29 U.S.C. 794),which prohibits discrimination on
the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. 6101-6107), which prohibits
discrimination on the basis of age;(e)the Drug Abuse Office and Treatment Act of 1972 (P.L.92-255),as amended,relating to
nondiscrimination on the basis of drug abuse;(f)the Comprehensive Alcohol Abuse and Alcoholism Prevention,Treatment and
Rehabilitation Act of 1970(P.L.91-616),as amended,relating to nondiscrimination on the basis of alcohol abuse or alcoholism;
(g) 523 and 527 of the Public Health Service Act of 1912(42 U.S.C. 290 dd-3 and 290 ee 3), as amended, relating to
confidentiality of alcohol and drug abuse patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. 3601 et
seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination
provisions in the specific statute(s)under which application for federal assistance is being made;and 0)the requirements of any
other nondiscrimination statute(s)which may apply to the application.
7. Will comply, or has already complied,with the requirements of Titles II and Ill of the uniform Relocation Assistance and Real
Property Acquisition Policies Act of 1970 (P.L.91-646)which provide for fair and equitable treatment of persons displaced or
whose property is acquired as a result of federal or federally assisted programs. These requirements apply to all interests in real
property acquired for project purposes regardless of federal participation in purchases.
S. Will comply, as applicable, with the provisions of the Hatch Act (5 U.S.C. 1501-1508 and 7324-7328), which limit the
political activities of employees whose principal employment activities are funded in whole or in part with federal funds.
9. Will comply, as applicable,with the provisions of the Davis-Bacon Act(40 U.S.C. 276a to 276a-7),the Copeland Act (40
U.S.C.276c and 18 U.S.C. 874)and the Contract Work Hours and Safety Standards Act(40 U.S.C. 327-333),regarding
labor standards for federally assisted construction sub-agreements.
Page 38 of 58
10. Will comply, if applicable,with flood insurance purchase requirements of Section 102(a)of the Flood Disaster Protection Act of
1973 (P.L. 93-234)which requires recipients in a special flood hazard area to participate in the program and to purchase flood
insurance if the total cost of insurable construction and acquisition is$10,000 or more.
11, Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of environmental
quality control measures under the National Environmental Policy Act of 1969(P.L.91-190)and Executive Order(EO) 11514;
(b)notification of violating facilities pursuant to EO 11738; (c)protection of wetlands pursuant to EO 11990;(d)evaluation of
flood hazards in floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved State
management program developed under the Coastal Zone Management Act of 1972 (16 U.S.C. 1451 et seq.); (f)conformity
of federal actions to State(Clear Air)Implementation Plans under Section 176(c)of the Clear Air Act of 1955,as amended(42
U.S.C. 7401 et seq.);(g)protection of underground sources of drinking water under the Safe Drinking Water Act of 1974,
as amended,(P.L. 93-523); and (h) protection of endangered species under the Endangered Species Act of 1973,as amended,
(P.L.93-205).
12. Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. 1721 et seq.) related to protecting components or
potential components of the national wild and scenic rivers system.
13. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as
amended(16 U.S.C. 470),EO 11593 (identification and protection of historic properties),and the Archaeological and Historic
Preservation Act of 1974(16 U.S.C. 469a-1 et seq.).
14. Will comply with P.L.93-348 regarding the protection of human subjects involved in research,development,and related activities
supported by this award of assistance.
15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544,as amended, 7 U.S.C. 2131 et seq.) pertaining
to the care, handling, and treatment of warm-blooded animals held for research, teaching, or other activities supported by this
award of assistance.
16, Will comply with the Lead-Based Paint Poisoning Prevention Act(42 U.S.C. 4801 et seq.),which prohibits the use of lead-
based paint in construction or rehabilitation of residence structures.
17. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act Amendments
of 1996 and OMB Circular No. A-133,Audits of States,Local Governments,and Non-Profit Organizations.
18, Will comply with all applicable requirements of all other federal laws, executive orders, regulations and policies governing this
program.
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL TITLE
APPLICANT ORGANIZATION DATE SUBMITTED
Monroe County Board of County Commissioners, Social
Services/]n-Home Services
Page 39 of 58
ATTACHMENT VII
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
BUDGET SUMMARY
The Alliance shall make payment to the Provider for provision of services up to a maximum number of units of service and at the
rate(s)stated below:
Maximum
Service Unit Units of Maximum
Service to be Provided Rate Service Dollars
Case Management $ 60.73 21 $ 1,264.58
Case Aide $ 15.00 3 $ 40.12
Respite Facility $ 10.96 3,865 $ 42,359.88
Respite In-Home $ 24.22 626 $ 15,157.08
Specialized Medical Equipment Cost Reimb $ 1,812.89
Tota 1 $ 60 634.56
Page 40 of 58
ATTACHMENT VIII
ALZHEIMER'S DISEASE INITIATIVE
INVOICE REPORT SCHEDULE
Report Number Based On Submit to Alliance on
this Date
l July Advance* July 1
2 August Advance* July 1
3 July Expenditure Report August 10
4 August Expenditure Report September 10
5 September Expenditure Report 1 1110 advance reconciliation October 10
6 October Expenditure Report + 1110 advance reconciliation November 10
7 November Expenditure Report di 1/10 advance reconciliation December 10
8 December Expenditure Report + 1110 advance reconciliation January 10
9 January Expenditure Report-ii.. 1/10 advance reconciliation February 10
10 February Expenditure Report V.. 1110 advance reconciliation March 10
I I March Expenditure Report+ 1110 advance reconciliation April 10
12 April Expenditure Report 1110 advance reconciliation May 10
13 May Expenditure Report 1/10 advance reconciliation June 10
14 June Expenditure Report"- 1110 advance reconciliation July 10
15 Final Expenditure and closeout July 31
Legend: * Advance based on projected cash need.
Note 1: All advance payments made to the Provider shall be returned to the Alliance as follows:
One-tenth of the advance payment received shall be reported as an advance recoupment on each Request
for Payment, starting with report 45, The adjustment shall be recorded in Part C, Line 1 of the report
(Attachment IX).
Note 2:Submission of expenditure reports may or may not generate a payment request. If final expenditure
report reflects funds due back to the Alliance,payment is to accompany the report.
Page 41 of 58
ATTACHMENT IX
REQUEST FOR PAYMENT
Form 106
ADI
Provider Name,Address,PhemeN Type Of Report
Contract N
Provider Advance
Address Canlractpanp(;
Telephone Reim burs ernenii Report 13@00
r PORTO
CERTIFICATION:I hereby certify that this request or refund conforms with the terms of the above contract.
Prepared By: Date Approved By: Date! ................................
BUD SLIM
SETMARY ADI T TOT
Approved Contract Amount 0.00, 000
Previous Month YTD Bided L
000
Prior Ending Contract
Balanw 00& 0.00
A 2
Current Wnth Amount®filled ri oo 0.00
Less Current lyonth Adv Payback 000 0.00
Contacted Funds Rannested f ntlt 000 0.00
CO-PAYMENTS CURRENT MONTH CONTRACT YM Prior Mo.YTD
I Num ber of persons assessed Co-payments
2 Number of persons trernmated for non-payment
3 Number of persons waived from lermin for non-paymank
4 Number of persons waived from assessment
5 Number of persons exam pt from co-pay
6 Total amount of co-pay as sessed
7 Total ArnoualolCo-paycoftctad
8 Total amouhni of co-pay expended
FGA 011 Ad Forms Revosed December 2020
Page 42 of 58
Attachment X
RECEIPTS&UNIT COST REPORT
Form 105
AIN
EJUMUNII-SOURC
0 ADO Contracts 0 L
0
0 Contract Pend D
0
Report Period 0
REPORT 9
CERTIFICATION: I wrVir In the best of my knovAedge and belief that this report is complete and caffecl and all outlays heroin am for purposes set milh in
Me contract Further I cedfirkhatthe aftachad manthlyand YTO service unkslundmallealed dkints'repod is coffeeL
Prepared by Date.- A ovsd by f .1 ll'i-
INCOMEIREMP A Appirmed Budget B Actual Total Billing C To LEffilling . %of A
fdbY pproved
r this re to Date Budget Prior o.RomelptnYTO
State Funds $ S NDIVA?
Prograwn Income
Cash Match v
SUBTOTAL Cash Receipts S
Local"Kind match $000 e- 4DV/01
TOTAL RECEIPTS S $ 11DIV/D
(A) IB) (C) ID) (F} (G) (A) 03)
Services Contract Billable Unit Reate,7Azounft)m d Y!T-D Y-TZ CLvent Month Y-T-D
Me
Arribuird. Urals This' PI ill
atem Billable Undue CA Undup Qents
Units cost Served Sethed PflarYTDurdb Pri®a
S S
Is
S S
PSA 90 1 ADO Pam Reused GcWbu 2019
Page 43 of 58
ATTACHMENT A
Title: Department of Elder Affairs Programs& Services Handbook
Page 44 of 58
ATTACHMENT B
STATE OF FLORIDA DEPARTMENT OF ELDER AFFAIRS
PART 1: READ THE ATTACHED INSTRUCTIONS FOR ILLUSTRATIVE INFORMATION WHICH WILL HELP YOU COMPLETE THIS
FORM.
1. Briefly des ribe the geogrVhic area served by the program;facility and t e type of service provided:--CllP_r PA+V
lVia 's
rQ `
c.. a a�iyt • • �i
2. POPULATION OF AREA SERVED. Source of data:
Total# White %Black o 142spamc °^oOther %Female
't3 1 Z. .3 19
3. SKAFF CURRENTLY EMPLOYED. Effective date:
To I °"o W hite G Black %His anic 4�o Other °ro emote %D led
4. CLIENTS CURRENTLY ENROLLED OR REGISTERED. Effective date:
Total % While %B ck !!o H ispanic %Other %Female °o Disabled 4vr Over 4
O'd v!p
S. ADVISORY OR GOVERNING BOARD, IF APPLICABLE.
Total# %While %Black %Hispanic I ter aye a e °Io Disub led
0 00
o
PART 11: USE A SEPARATE SHEET OF PAPER FOR ANY EXPLANATIONS REQUIRING MORE SPACE.
6. Is an Assurance of Compliance on file with DOEA? If NIA or NO,explain. NSA YES NO
❑ ❑
7. Compare the staff composition to the population. Is staff representative of the population?
If WA or NO,explain. N,/A YES NO
❑ ❑
8. Compare the client composition to the population. Are race and sex characteristics representative
s°'A or NO,explain„ ..._._______. N� YES NO
of the population?!N
4. Are eligibility requirements for services applied to clients and applicants without regard to race,
color,
national origin,sex,age,religion or disability If NFA or NO,explain. N/A YES NO
m � ❑ 1K ❑
10. Are all benefits,services and facilities available to applicants and participants in an equally effective
manner regardless of race, sex, color, age, national origin, religion or disability? If N,'A or NO,
explain. N/A YES NO
11. For in-patient services,are room assignments made without regard to race,color,national origin
or disability? If N/A or NO,explain. NIA ES NO
„�.,, .�mm . ❑ ❑
Page 45 of 58
12. Is the program^"facility accessible to non-English speaking clients? If N!°A or NO,explain. MA YES N
13. Are employees, applic is and part pants i. rmed of their protection against discrimination? If
YES,how? Verbal0Written Pofster If NIA or NO,explain, N,'A YES NO
❑ ❑
14, Give the number and current status of any discrimination complaints regarding services or
employment filed against the program/facility. NIA NUM ER
15, Is the program/facility physically accessible to mobility,hearing,and sight-impaired individuals? If
NdA or NO,explain,. N?A YES/NO
PART[H:THE FOLLOWING QUESTIONS APPLI TO PROGRAMS AND FACILITIES WITH 15 OR MORE EN1PLOI EES,
16. Has a self-evaluation been conducted to identify any barriers to serving disabled individuals,and to
make any necessary modifications? If NO, explain. YES/ NO
17. Is there an established grievance procedure that incorporates due process in the resolution of
complaints? If NO,explain. YI( NO
�� ❑
18 Has a person been designated to coordinate Section 504 compliance activities? If NO,explain. YEEY NO
19. Do recruitment and notification materials advise applicants, employees and participants of
nondiscrimination on the basis of disability? If NO,explain. YV NO
20. Are auxiliary aids available to assure accessibility of services to hearing and sight-impaired
individuals? If NO,explain. YE,S' NO
PART IV:FOR PROGRAMS OR FACILITIES WITH 50 OR MORE ENIPLOVEES AND FEDERAL CONTRACTS OFS50,000.00 OR NIORE.
21. Do you have a written affirmative action plan? If NO,explain. YESy NO
Reviewed By In Compliance: YES ❑ NO* ❑
Program Office *Notice of Corrective Action Sent _°°'.............
...
Date Telephone Response Due I t
On-Site ❑ Desk Review ❑ Response Received I if
Page 46 of 58
Revised August 2010,Page 2 of 2
INSTRUCTIONS FOR THE CIVIL RIGHTS COMPLIANCE CHECKLIST
I. Describe the geographic service area such as a district,county,city or other locality. If the program facility serves
a specific target population such as adolescents, describe the target population. Also, define the type of service
provided.
2. Enter the percent of the population served by race and sex. The population served includes persons in the
geographical area for which services are provided such as a city,county or other regional area. Population statistics
can be obtained from local chambers of commerce, libraries,or any publication from the 1980 Census containing
Florida population statistics. Include the source of your population statistics. ("Other"races include Asian/Pacific
Islanders and American Indian.°"Alaskan Natives.)
3. Enter the total number of full-time staff and their percent by race, sex and disability. Include the effective date of
your summary.
4. Enter the total number of clients who are enrolled, registered or currently served by the program or facility,and list
their percent by race,sex and disability. Include the date that enrollment was counted.
5. Enter the total number of advisory board members and their percent by race, sex, and disability. If there is no
advisory or governing board, leave this section blank.
6. Each recipient of federal financial assistance must have on file an assurance that the program will be conducted in
compliance with all nondiscriminatory provisions as required in 45 CFR 80. This is usually a standard part of the
contract language for DOEA recipients and their sub-grantees,45 CFR 80.4(a).
7. Is the race, sex, and national origin of the staff reflective of the general population? For example, if 1016 of the
population is Hispanic,is there a comparable percentage of Hispanic staff?
8. Where there is a significant variation between the race,sex or ethnic composition of the clients and their availability
in the population, the program/facility has the responsibility to determine the reasons for such variation and take
whatever action may be necessary to correct any discrimination. Some legitimate disparities may exist when
programs are sanctioned to serve target populations such as elderly or disabled persons,45 CFR 80.3 (b)(6).
9. Do eligibility requirements unlawfully exclude persons in protected groups from the provision of services or
employment? Evidence of such may be indicated in staff and client representation (Questions 3 and 4) and also
through on-site record analysis of persons who applied but were denied services or employment,45 CFR 80.3 (a)
and 45 CFR 80.1 (b)(2).
10. Participants or clients must be provided services such as medical, nursing and dental care, laboratory services,
physical and recreational therapies,counseling and social services without regard to race,sex,color,national origin,
religion,age or disability. Courtesy titles,appointment scheduling and accuracy of record keeping must be applied
uniformly and without regard to race, sex, color, national origin, religion, age or disability. Entrances, waiting
rooms,reception areas,restrooms and other facilities must also be equally available to all clients,45 CFR 80.3 (b).
11. For in-patient services, residents must be assigned to rooms, wards, etc., without regard to race, color, national
origin or disability. Also, residents must not be asked whether they are willing to share accommodations with
persons of a different race,color,national origin,or disability,45 CFR 80.3(a).
12. The program1facility and all services must be accessible to participants and applicants,including those persons who
may not speak English. In geographic areas where a significant population of non-English speaking people live,
program accessibility may include the employment of bilingual staff. In other areas,it is sufficient to have a policy
or plan for service,such as a current list of names and telephone numbers of bilingual individuals who will assist in
the provision of services,45 CFR 80.3(a).
Page 47 of 58
1 . Programs,tfacilities must make information regarding the nondiscriminatory provisions of Title VI available to their
participants, beneficiaries or any other interested parties. This should include information on their right to file a
complaint of discrimination with either the Florida Department of Elder Affairs or the U.S. Department of HHS.
The information may be supplied verbally or in writing to every individual or may be supplied through the use of
an equal opportunity policy poster displayed in a public area of the facility,45 CFR 80.6(d).
14. Report number of discrimination complaints filed against the program/facility. Indicate the basis,e.g., race, color,
creed,sex,age,national origin,disability,retaliation;the issues involved,e.g.,services or employment,placement,
termination, etc. Indicate the civil rights law or policy alleged to have been violated along with the name and
address of the local, state or federal agency with whom the complaint has been filed. Indicate the current status,
e.g.,settled,no reasonable cause found,failure to conciliate, failure to cooperate,under review,etc.
15. The program facility must be physically accessible to disabled individuals. Physical accessibility includes
designated parking areas,curb cuts or level approaches,ramps and adequate widths to entrances. The lobby,public
telephone, restroom facilities, water fountains, information and admissions offices should be accessible. Door
widths and traffic areas of administrative offices,cafeterias,restrooms,recreation areas,counters and serving lines
should be observed for accessibility. Elevators should be observed for door width,and Braille or raised numbers.
Switches and controls for light, heat, ventilation, fire alarms, and other essentials should be installed at an
appropriate height for mobility impaired individuals.
16. Section 504 of the Rehabilitation Act of 1973 requires that a recipient of federal financial assistance conduct a self-
evaluation to identify any accessibility barriers. Self-evaluation is a four step process:
a. With the assistance of disabled individualorganization, evaluate current practices and policies which do not
comply with Section 504,
b. Modify policies and practices that do not meet Section 504 requirements.
c. Take remedial steps to eliminate any discrimination that has been identified.
d. Maintain self-evaluation on file. (This checklist may be used to satisfy this requirement if these four steps have
been followed.),45 CFR 84.6.
1 T Programs or facilities that employ 15 or more persons must adopt grievance procedures that incorporate appropriate
due process standards and provide for the prompt and equitable resolution of complaints alleging any action
prohibited by Section 504.45 CFR 84.7(b).
18, Programs or facilities that employ 15 or more persons must designate at least one person to coordinate efforts to
comply with Section 504.45 CFR 84.7(a).
19 Continuing steps must be taken to notify employees and the public of the programdfacility's policy of
nondiscrimination on the basis of disability. This includes recruitment material, notices for hearings, newspaper
ads,and other appropriate written communication,45 CFR 84.8(a).
20, Program s1faci liti es that employ 15 or more persons must provide appropriate auxiliary aids to persons with impaired
sensory,manual or speaking skills where necessary. Auxiliary aids may include,but are not limited to, interpreters
for hearing impaired individuals,taped or Braille materials,or any alternative resources that can be used to provide
equally effective services,45 CFR 84.52(d).
21, Program sifaci I ities with 50 or more employees and $50,000,00 in federal contracts must develop, implement and
maintain a written affirmative action compliance program in accordance with Executive Order 11246,41 CFR 60
and Title VI of the Civil Rights Act of 1964,as amended.
DOEA Form 101-B,Revised August 2010
Page 48 of 58
ATTACHMENT C
Alliance for Aging,Inc.
Business Associate Agreement
This Business Associate Agreement is dated ,by the Alliance for Aging, Inc.("Covered Entity")
and Monroe County Board of County Commission rs,S eial Services/In-Home Services,(`Business Associate"),a not-
for-profit Florida corporation.
1.0 Background.
1.1 Covered Entity has entered into one or more contracts or agreements with Business Associate that involves the use of
Protected Health Information(PHI).
1.2 Covered Entity recognizes the requirements of the Health Insurance Portability and Accountability Act of 1996
(HIPAA)and has indicated its intent to comply in the County's Policies and Procedures.
1.3 HIPAA regulations establish specific conditions on when and how covered entities may share information with
Providers who perform functions for the Covered Entity.
1.4 HIPAA requires the Covered Entity and the Business Associate to enter into a contract or agreement containing
specific requirements to protect the confidentiality and security of patients' PHI,as set forth in,but not limited to the
Code of Federal Regulations(C.F.R.),specifically 45 C.F.R. §§ 164.502(e), 164.504(e), 164.308(b),and 164.314(a-
b)(2010)(as may apply)and contained in this agreement.
1.5 The Health Information Technology for Economic and Clinical Health Act (2009), the American Recovery and
Reinvestment Act(2009)and Part I—Improved Privacy Provisions and Security provisions located at 42 United States
Code(U.S.C.) §§ 17931 and 17934(2010)require business associates of covered entities to comply with the HIPAA
Security Rule,as set forth in,but not limited to 45 C.F.R,§§ 164.308, 164.310, 164.312,and 164.316(2009)and such
sections shall apply to a business associate of a covered entity in the same manner that such sections apply to the
covered entity.
The parties therefore agree as follows:
2.0 Definitions. For purposes of this agreement,the following definitions apply:
2.1 Access. The ability or the means necessary to read,write,modify,or communicate data/information or otherwise use
any system resource.
2.2 Administrative Safeguards. The administrative actions, and policies and procedures, to manage the selection,
development, implementation, and maintenance of security measures to protect electronic Protected Health
Information(ePHI)and to manage the conduct of the covered entity's workforce in relation to the protection of that
information.
2.3 ARRA. The American Recovery and Reinvestment Act(2009)
2A Authentication. The corroboration that a person is the one claimed.
2.5 Availability. The property that data or information is accessible and useable upon demand by an authorized person.
2.6 Breach. The unauthorized acquisition, access, use,or disclosure of PHI which compromises the security or privacy
of such information.
2.7 Compromises the Security. Posing a significant risk of financial,reputational,or other harm to individuals.
Page 49 of 58
2.8 Confidentiality. The property that data or information is not made available or disclosed to unauthorized persons or
processes.
2.9 Electronic Protected Health Information(ePHI). Health information as specified in 45 CFR§160.103(1)(i)or
(1)(ii),limited to the information created or received by Business Associate from or on behalf of Covered Entity.
2.10 HITECH.The Health Information Technology for Economic and Clinical Health Act(2009)
2.11 Information System. An interconnected set of information resources under the same direct management control
that shares common functionality. A system normally includes hardware,software,information,data,applications,
communications,and people.
2.12 Integrity. The property that data or information have not been altered or destroyed in an unauthorized manner.
2.13 Malicious software. Software,for example,a virus,designed to damage or disrupts a system.
2.14 Part I. Part I—improved Privacy Provisions and Security provisions located at 42 United States Code(U.S.C.)§§
17931 and 17934(2010).
2.15 Password. Confidential authentication information composed of a string of characters.
2.16 Physical Safeguards. The physical measures, policies, and procedures to protect a covered entity's electronic
information systems and related buildings and equipment, from natural and environmental hazards, and
unauthorized intrusion.
2.17 Privacy Rule. The Standards for Privacy of Individually Identifiable Health Information at 45 CFR Part 160 and
Part 164,subparts A and E.
2.18 Protected Health Information (PHI). Health information as defined in 45 CFR §160.103, limited to the
information created or received by Business Associate from or on behalf of Covered Entity.
2.19 Required By Law.Has the same meaning as the term"required by law"in 45 CFR§ 164.103.
2.20 Secretary.The Secretary of the Department of Health and Human Services or his or her designee.
2.21 Security incident.The attempted or successful unauthorized access, use, disclosure, modification, or destruction
of information or interference with system operations in an information system.
2.22 Security or Security measures. All of the administrative, physical, and technical safeguards in an information
system.
2.23 Security Rule.The Security Standards for the protection of Electronic Protected Health Information at 45 CFR part
164,subpart C,and amendments thereto.
2.24 Technical Safeguards.The technology and the policy and procedures for its use that protect electronic protected
health information and control access to it.
2.25 Unsecured PHI. Protected health information that is not secured through the use of technology or methodology
specified by the Secretary in guidance issued under 42 U.S.C. section 17932(h)(2).
2.26 All other terms used, but not otherwise defined, in this Agreement shall have the same meaning as those terms in
the Privacy Rule.
3.0. Obligations and Activities of Business Associate.
3.1 Business Associate agrees to not use or disclose PHI other than as permitted or required by this agreement or as
Required by Law.
Page 50 of 58
3.2 Business Associate agrees to:
(a) Implement policies and procedures to prevent, detect, contain and correct Security violations in accordance
with 45 CFR§ 164.306;
(b) Prevent use or disclosure of the PHI other than as provided for by this Agreement or as required by law;
(c) Reasonably and appropriately protect the confidentiality, integrity, and availability of the ePHI that the
Business Associate creates,receives,maintains,or transmits on behalf of the Covered Entity;and
(d) Comply with the Security Rule requirements including the Administrative Safeguards, Physical Safeguards,
Technical Safeguards, and policies and procedures and documentation requirements set forth in 45 CFR §§
164.308, 164.310, 164.312,and 164.316.
3.3 Business Associate agrees to mitigate, to the extent practicable, any harmful effect that is known to Business
Associate of use or disclosure of PHI by Business Associate in violation of the requirements of this Agreement.
3.4 Business Associate agrees to promptly report to Covered Entity any use or disclosure of the PHI not provided for
by this Agreement of which it becomes aware.This includes any requests for inspection,copying or amendment of
such information and including any security incident involving PHI.
3.5 Business Associate agrees to notify Covered Entity without unreasonable delay of any security breach pertaining
to:
(a) Identification of any individual whose unsecured PHI has been, or is reasonably believed by the Business
Associate to have been,accessed,acquired,or disclosed during such security breach;and
(b) All information required for the Notice to the Secrelmy of HHS of Breach of Unsecured Prolecled Ilealth
Information
3.6 Business Associate agrees to ensure that any agent, including a subcontractor, to whom it provides PHI received
from,or created or received by Business Associate on behalf of Covered Entity,agrees to the same restrictions and
conditions that apply through this Agreement to Business Associate with respect to such information.
3.7 If Business Associate has PHI in a Designated Record Set:
(a) Business Associate agrees to provide access,at the request of Covered Entity during regular business hours,to
PHI in a Designated Record Set,to Covered Entity or,as directed by Covered Entity,to an individual in order
to meet the requirements under 45 CFR§164.524;and
(b) Business Associate agrees to make any amendment(s) to PHI in a Designated Record Set that the Covered
Entity directs or agrees to pursuant to 45 CFR § 164.526 at the request of Covered Entity or an Individual
within 10 business days of receiving the request.
3.8 Business Associate agrees to make internal practices, books, and records, including policies and procedures and
PHI,relating to the use and disclosure of PHI received from,or created or received by Business Associate on behalf
of Covered Entity,available to the Covered Entity or to the Secretary upon request of either party for purposes of
determining Covered Entity's compliance with the Privacy Rule.
3.9 Business Associate agrees to document such disclosures of PHI and information related to such disclosures as would
be required for Covered Entity to respond to a request by an individual for an accounting of disclosures of PHI in
accordance with 45 CFR § 164.528.
3.10 Business Associate agrees to provide to Covered Entity or an individual, upon request, information collected to
permit Covered Entity to respond to a request by an Individual for an accounting of disclosures of PHI in accordance
with 45 CFR§ 164.528 and ARRA § 13404.
3.11 Business Associate specifically agrees to use security measures that reasonably and appropriately protect the
confidentiality,integrity,and availability of PHI in electronic or any other form,that it creates,receives,maintains,
or transmits on behalf of the Covered Entity.
Page 51 of 58
3.12 Business Associate agrees to implement security measures to secure passwords used to access ePHI that it accesses,
maintains, or transmits as part of this Agreement from malicious software and other man-made and natural
vulnerabilities to assure the availability, integrity,and confidentiality of such information.
3.13 Business Associate agrees to implement security measures to safeguard ePHI that it accesses,maintains,or transmits
as part of this agreement from malicious software and other man-made and natural vulnerabilities to assure the
availability, integrity,and confidentiality of such information.
3.14 Business Associate agrees to comply with:
(a) ARRA § 13404(Application of Knowledge Elements Associated with Contracts);
(b) ARRA § 13405(Restrictions on Certain Disclosures and Sales of Health Information);and
(c) ARRA § 13406(Conditions on Certain Contacts as Part of Health Care Operations).
4.0 Permitted Uses and Disclosures by Business Associate. Except as otherwise limited in this Agreement or any related
agreement, Business Associate may use or disclose PHI to perform functions, activities,or services for,or on behalf of,
Covered Entity as specified in any and all contracts with Covered Entity provided that such use or disclosure would not
violate the Privacy Rule if done by Covered Entity or the minimum necessary policies and procedures of the Covered
Entity.
5.0 Specific Use and Disclosure Provisions.
5.1 Except as otherwise limited in this agreement or any related agreement, Business Associate may use PHI for the
proper management and administration of the Business Associate or to carry out the legal responsibilities of the
Business Associate.
5.2 Except as otherwise limited in this agreement or any related agreement, Business Associate may disclose PHI for
the proper management and administration of the Business Associate, provided that disclosures are Required By
Law, or Business Associate obtains reasonable assurances from the person to whom the information is disclosed
that it will remain confidential and used or further disclosed only as Required By Law or for the purpose for which
it was disclosed to the person,and the person notifies the Business Associate of any instances of which it is aware
in which the confidentiality of the information has been breached.
5.3 Business Associate may use PHI to provide data aggregation services to Covered Entity as permitted by 45 CFR
§164.504(e)(2)(i)(B),only when specifically authorized by Covered Entity.
5.4 Business Associate may use PHI to report violations of law to appropriate Federal and State authorities, consistent
with 45 CFR§164.5020)(1).
6.0 Obligations of Covered Entity.
6.1 Covered Entity shall notify Business Associate of any limitation(s) in its notice of privacy practices of Covered
Entity in accordance with 45 CFR§ 164.520,to the extent that such limitation may affect Business Associate's use
or disclosure of PHI, by providing a copy of the most current Notice of Privacy Practices (NPP) to Business
Associate. Future Notices and/or modifications to the NPP shall be posted on Covered Entity's website at
..... a....�....,..� acin.�a M uniri.�,�.n.111..7.pm.
6.2 Covered Entity shall notify Business Associate of any restriction to the use or disclosure of PHI that Covered Entity
has agreed to in accordance with 45 CFR § 164.522, to the extent that such restriction may affect Business
Associate's use or disclosure of PHI.
7.0 Permissible Requests by Covered Entity. Except for data aggregation or management and administrative activities of
Business Associate,Covered Entity shall not request Business Associate to use or disclose PHI in any manner that would
not be permissible under the Privacy Rule if done by Covered Entity.
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8.0 Effective Date and Termination.
8.1 The Parties hereby agree that this agreement amends,restates and replaces any other Business Associate Agreement
currently in effect between Covered Entity and Business Associate and that the provisions of this agreement shall
be effective as follows:
(a) These Business Associate Agreement provisions, with the exception of the electronic security provisions and
the provisions mandated by ARRA,HITECH and Part 1 shall be effective upon the later of April 14,2003,or
the effective date of the earliest contract entered into between Business Associate and Covered Entity that
involves the use of PHI;
(b) The electronic security provisions hereof shall be effective the later of April 21, 2005 or the effective date of
the earliest contract entered into between Business Associate and Covered Entity that involves the use of PHI;
and
(c) Provisions hereof mandated by ARRA, HITECH and/or Part I shall be effective the later of February 17,2010
or the effective date of the earliest contract entered into between covered entity and business associate that
involves the use of PHI or ePHI.
8.2 Termination for Cause. Upon Covered Entity's knowledge of a material breach by Business Associate,Covered
Entity shall either:
(a) Provide an opportunity for Business Associate to cure the breach or end the violation and terminate this
agreement if Business Associate does not cure the breach or end the violation within the time specified by
Covered Entity;
(b) Immediately terminate this agreement if Business Associate has breached a material term of this Agreement
and cure is not possible;or
(c) If neither termination nor cure is feasible,Covered Entity shall report the violation to the Secretary.
8.3 Effect of Termination. Except as provided in subparagraph(b)of this section,upon termination of this agreement,
for any reason,Business Associate shall return all PHI and ePHI received from Covered Entity or created or received
by Business Associate on behalf of Covered Entity.
(a) This provision shall apply to PHI and ePHI that is in the possession of subcontractors or agents of Business
Associate. Business Associate shall retain no copies of the PHI and ePHI.
(b) In the event that Business Associate or Covered Entity determines that returning the PHI or ePHI is infeasible,
notification of the conditions that make return of PHI or ePHI infeasible shall be provided to the other party.
Business Associate shall extend the protections of this Agreement to such retained PHI and ePHI and limit
further uses and disclosures of such retained PHI and ePHI,for a minimum of six years and so long as Business
Associate maintains such PHI and ePHI,but no less than six(6)years after the termination of this agreement.
9.0 Regulatory References. A reference in this agreement to a section in the Privacy Rule or Security Rule means the
section then in effect or as may be amended in the future.
10.0 Amendment. The Parties agree to take such action as is necessary to amend this agreement from time to time as is
necessary for Covered Entity to comply with the requirements of the Privacy Rule, the Security Rule and the Health
Insurance Portability and Accountability Act of 1996,Pub. L.No. 104-191.
11.0 Survival. Any term,condition,covenant or obligation which requires performance by either party hereto subsequent to
the termination of this agreement shall remain enforceable against such party subsequent to such termination.
12.0 Interpretation. Any ambiguity in this agreement shall be resolved to permit Covered Entity to comply with the Privacy
Rule and Security Rule.
13.0 Incorporation by reference. Any future new requirement(s),changes or deletion(s)enacted in federal law which create
new or different obligations with respect to HIPAA privacy and/or security, shall be automatically incorporated by
reference to this Business Associate Agreement on the respective effective date(s).
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ATTACHMENT D
ELDERAFFA %1,�,he IN,H 4 1 I ;11 ni
Sill li Mille-1V
R,
BACKGROUND SCREENING
Attestation of Compliance-Employer
AUTHORITY:This form is required annually of all employers to comply with the attestation
requirements set forth in section 435.05(3),Florida Statutes.
> The term "employer" means any person or entity required by law to conduct background
screenings,including but not limited to,Area Agencies on Aging/Aging and Disability Resource
Centers, Lead Agencies, and Service Providers that contract directly or indirectly with the
Department of Elder Affairs(DOEA),and any other person or entity which hires employees or
has volunteers in service who meet the definition of a direct service provider.See§§435.02,
430.0402,Fla.Stat.
> A direct service provider Is"a person 18 years of age or older who, pursuant to a program
to provide services to the elderly,has direct,face-to-face contact with a client while providing
services to the client and has access to the client's living area,funds, personal property, or
personal identification information as defined in s. 817.568.The term includes coordinators,
managers,and supervisors of residential facilities and volunteers," §430-0402(1)(b),Fla.Stat.
ATTESTATION:
As the duly authorized representative of
(Aonrcc. Ciioilllliill.n+y
IF
Employer Name
located at 1100 aid
Street Address City t(4Lf CALWState ZIP code
1, 6_ h1104P-!J I Q-9-a-PI CL/Vt do hereby affirm under penalty of
I Name of Representative
perjury that the above-named employer is in compliance with the provisions of
Chapter 435 and section 430,0402, Florida Statutes, regarding level 2 background
screening.
SignaiAepresentative Dati
DOEA Form 235,Attestation of Compliance-Employer,Effective January 19,2021
F.S.Formavailableorht_tp:/A1deraffairs.stomfl.us/english ck roundscreenin lh
Page 55 of 58
ATTACHMENT E
REFERRAL PROTOCOL
Issue: Screening,Triage,and Referral for Activation under the Alzheimer's Disease Initiative(ADI)Program.
Policy: Referrals will be made based on availability of funds,in accordance with prioritization requirements.
Purpose: To ensure funding is spent expeditiously and consumers are given a choice of case management agencies,to
the extent possible.
Procedure:
1. Roles and Responsibilities
A, Alliance for Aging �Aging and Disability Resource Center
• Reconciles overall program and ADI Agency specific spending levels on a monthly basis to ensure the ADI
Agency is operating within the funding allocations.
• Screens consumers to link with appropriate resources and prioritize for DOEA-funded programs and services.
• Releases cases for activation based upon Adi Agency Requests.
• Releases cases from the waiting list based on their prioritization score.
• Monitors compliance with service standards and outcome measures.
• Reviews files per the File Review Policies and Procedures.
• Reviews data in eCIRTS.
B. ADI Agency
• Requests and accepts referrals from the Aging and Disability Resource Center,to serve an optimal caseload and
to avoid surpluses or deficits in accordance with the Alliance Surplus/Deficit Analysis policy.
• Refers inquiries from consumers interested in services to the ADRC for Information and Referral to community
resources,Screening,Triage,and Long-Term Care Options Counseling,as appropriate.
• 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 eCIRTS,
• Bills in eCIRTS 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. As clients are referred to the ADRC,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 ADRC staff. Cases presenting strong identifiers that indicate the consumer might benefit from publicly
funded long-term care services are screened,entered into eCIRTS,triaged and provided options counseling.
I. Consumers applying for the Alzheimer's Disease Initiative(ADI)program will be contacted by Intake Unit staff
and screened using the statewide assessment form developed by the Department of Elder Affairs for this purpose
(Form 701 S). The 701S will determine their ranking on the appropriate waiting list(s)APCL status. .
2. The ADRC will reassess consumers on the waiting lists according to the 2018 Department of Elder Affairs
Programs and Services Handbook,or any revisions made thereafter.
B. HIPAA forms will be sent to the consumer as appropriate.
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IIl. Opening New Cases
A. ADI Clients
I. The Alliance Fiscal Department will monitor ADI Agency specific spending levels on a monthly basis to ensure
each ADI Agency is operating within its-spending authority. In addition,the Alliance will analyze surplus/deficit
projections, and share the information with the ADI Agency to assist in their determination of slot availability.
The ADI Agency will request referrals directly from the ADRC. The Fiscal Department will be notified of the
number of new cases being referred to the ADI Agency for activation.
2. Upon receipt of the request for referrals from the AD[ Agency, the ADRC Intake Unit Supervisor will run the
Prioritized Risk Report to identify the consumers on the APCL to be opened.
3. In response to the request for referrals,the ADRC Intake Unit Supervisor will refer wait listed clients to the ADI
Agency for activation, in accordance with prioritization requirements. The Intake Unit will update the wait list
enrollment using the appropriate code to terminate from the APCL,for release to the ADI Agency(TAEL).
4. Upon receipt of the list of clients released from the waiting list,the ADI Agency will enter the APPL enrollment,
contact clients to offer program enrollment, and proceed with the process for activation. The ADI Agency will
enter subsequent enrollments into eCIRTS to reflect client status.
5. The Alliance will oversee the enrollment process to ensure referrals have timely outcomes in eCIRTS.
6. Choice(for Miami-Dade County only): In the event that unallocated funds become available at the Alliance to
allow for new client enrollments into AD[,the ADRC will contact consumers from the waiting list to offer choice
of ADI Agency. If the client is no longer interested in receiving services, the appropriate wait list enrollment(s)
will be closed and the next client on the list will be contacted.
a. Intake Unit Specialists will contact the client to obtain choice of Provider.The client referral will then be sent
to the ADI Agency selected by the client.
b. If after two attempts by phone the Intake Unit staff is unable to reach the consumer,the client will be assigned
for release to an agency on a rotation basis.
c. Upon receipt of referral, the ADI Agency will enter the APPL enrollment, and subsequent enrollments to
reflect client status. Contract amendments will follow in accordance with the number of clients referred for
activation.
B. Statewide Medicaid Managed Care Long Term Care Program Clients
I. The Department of Elder Affairs will run the statewide APCL(Assessed Priority Consumer List)report to review
clients wait listed for the SMMCLTCP program. DOEA will provide the ADRC with a list of individuals
authorized for release from the APCL.
2. For clients identified as active in ADI and authorized for release from the SMMCLTCP waiting list,the ADRC
will be responsible for the SMMCLTCP application process. For ADI active clients, the ADRC will notify the
ADI Agency in order to waive the ADI co-pay.
IV. Clients Changing ADI Agencies
A. Frequency of Changes
1. Consumers may change ADI Agencies on a monthly basis if they so choose.
2. Consumers will need to request a change of ADI Agency by the first(I'")of the month in order for the change to
be in effect by the 16"of that same month.
3. If the request is made after the first of the month,the change will take effect by the 1611 of the following month.
B. Process for Changes
1. Requests to change case management agency must come from the client or their personal representative to the
ADRC/Elder Helpline. Requests made by a case management agency will not be honored.
2. When requesting a change, the consumer will be asked by the ADRC staff person to share his1her reasons for
doing so; if they spoke with their case management agency about their concerns;and if they would like to speak
with someone else at that agency.
3. If the consumer chooses to call the agency, nothing will be done until the consumer calls the ADRC back
Page 57 of 58
requesting a change.
A. If the consumer does not want to speak with the ADI Agency and wants to change, the ADRC will initiate the
transfer process. A verbal choice will be accepted and documented in the REFER database.
5. The ADRCil Intake Unit will send a Transfer Form to the selected ADI Agency and to the current ADI Agency.
Both ADI Agencies will work closely with the ADRC to ensure the transfer process is completed by the 15"of
the month,as long as the transfer request was received at the ADRC by the first of that same month.
6. The ADRC Intake Unit will change the owner provider record in eCIRTS to the new ADI Agency.
7. The current ADI Agency will terminate enrollment in eCIRTS as of the 15"of the month when the transfer is to
take place. The new ADI Agency will activate enrollment in eCIRTS as of the 16"of the month when the transfer
is to take place.
8. Each ADI Agency will notify its respective vendors of the termination and!or activation of services for the
transferred client as appropriate.
9. Services will start on the 16"of the month when the change becomes effective.
Note:These ADRC policies and procedures are subject to change. Any modifications will be done through a contract
amendment.
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