Loading...
Item C12 BOARD OF COUNTY COMMISSIONERS AGENDA ITEM SUMMARY MEETING DATE: 12-17-2008 DIVISION: SOCIAL SERVICES BULK ITEM: YES X NO DEPARTMENT: IN-HOME AND NUTRITION AGENDA ITEM WORDING: Approval of the Renewal of the Home and Community BasedlMedicaid Waiver (ADA-MW) Contract between the Alliance for Aging, Inc. and the Monroe County Board of County Commissioners (Monroe County In-Home and Nutrition Services Program) for Direct In-Home Services ITEM BACKGROUND: The approval of the ADA-MW Contract will enable Monroe County In-Home Services to continue providing services to Monroe County's elderly population under the Home and Community Based Services/Medicaid Waiver (ADA-MW) program. PREVIOUS RELEVANT BOCC ACTION: Medicaid Waver Agreement on April 19, 2006. Prior approval granted to the Home and Community Based CONTRACT/AGREEMENT CHANGES: N/A STM',F RECOMMENDATION: Approval TOT AL COST: Approx, $45,000.00 COST TO COUNTY: -0- BUDGETED: YES--2L NO SOURCE OF FUNDS: ADA-MW Referral for Fiscal year 7/2008 thru 6/2009 For approx. $45,000.00 REVENUE PRODUCING: YES -J),O X AMT.PER MONTH YEAR APPROVED BY: COUNTY A TTY t OMB/Purchasing l RISK MANAGEMENT l DOCUMENTATION: INCLUDED X TO FOLLOW NOT REQUIRED_ DISPOSITION: AGENDA ITEM#: Revised 8/06 MONROE COUNTY BOARD OF COUNTY COMMISSIONERS CONTRACT SUMMARY Contract with: Alliance For Aging, Inc. Contract Effective Date: December 17,2008 Expiration Date: Contract PurposelDescription: Approval of the Renewal of the Home and Community Based -Medicaid Waver (ADAlMW) Contract between the Alliance for Aging, Inc. and the Monroe County Board of County Commissioners (Monroe County In-Home and Nutrition Services Program), for Direct In-Home Services Contract Manager: Sheryl Graham (Name) For BOCC meeting on 12/17/2008 Agenda Deadline: 12/2/2008 4591 (Ext. ) Social Services/Stop 1 (Department/Stop #) Total Dollar Value of Contract: Approx. $ 45,000,00 Budgeted? Yes X No Account Codes: Grant: Approx. $45,000.00 County Match: $ -0- Estimated Ongoing Costs: $ (Not included in dollar value above) Date In Division Director oi Risk Manag~ment ~ l (./ \ 3 '6..t {'~ /\I\,Q O.M.B.lPuMh}\;ing II \e.L1 \ ~ County Attorney ~\\(\()<6 Comments: OMB Form Revised 2/27/01 MCP #2 CONTRACT COSTS, . Current Year Portion: $ /yr ADDITIONAL COSTS For: (eg, Maintenance, utilities, ianitorial, salaries, etc) CONTRACT REVIEW Ye~C-;," Yes Q ( Yes &~ Yes G "1 ~" ct \ i HOME AND COMMUNITY BASED SERVICES AGED AND DISABLED ADULT (ADA) MEDICAID WAIVER REFERRAL AGREEMENT This ~eferral Agre:ment between the Alliance for AQinCl~ Inc., the Area Agency on Agi~g (AM) for Planmng and Service Area (PSA) 11 and AA.DAJi1..tn;: Co _ J.Jt, .:t,u H&-~ ~--v l CC') , the Service Provider, shall begin on July 1, 2004 or on the date the agreement has been signed by both parties, whichever is later. This referral agreement is in effect for a period of time that is equal to the Medicaid waiver provider's enrollment period with the State of Florida's Medicaid fiscal agent and is contingent upon an annual appropriation by the Legislature, One purpose of this agreement is to promote the development of a coordinated service delivery system to meet the needs of the aged or disabled adults who are at risk of premature institutionalization. Another purpose of this agreement is to enable eligible elderly participants to receive home and community based services from qualified providers with oversight of the quality of care by the Medicaid Waiver Specialist employed by the AAA. These services are authorized in order that the participant may remain in the least restrictive setting and avoid or delay premature nursing home placement. Services and care are to be furnished in a way that fosters the independence of each participant to facilitate aging in place. All parties agree that routines of care provision and service delivery must be consumer driven to the maximum extent possible. All parties agree to and will treat each participant with dignity and respect. I. Objectives A. To maintain a climate of cooperation and consultation with and between agencies, in order to achieve maximum efficiency and effectiveness, B. To promote progrurs and activities designed to prevent the premature institutionalization of elders and disabled adults. C. To require the parties of this Agreement to provide technical assistance and consultation to each other on matters pertaining to actual service delivery and share appropriate assessment information and care plans so duplication may not occur. D. To establish an effective working relationship between the case management agency that is responsible for the development of care plans and authorization of services available under the waiver, the service provider that is responsible for the direct provision of those services to consumers served under the waiver program, and the AAA that is responsible for management and oversight of the waiver program. II. Under this Agreement, the Service Provider agrees to the following: A. To accept referrals for the 1915c Home and Community-Based Services - ADA Medicaid Waiver from the enrolled case management agency. B. To provide quality service(s) to the waiver participant as specified in Section IV., Provision of service(s), subject to quality monitoring and/or observation by the case management agency and/or the AAA and/or the Department of Elder Affairs (the "department"). C. To provide only those services specifically outlined in the Plan of Care and authorized by the enrolled case management agency. D. To attach documentation regarding the service provider's qualifications to this agreement; and to provide, as requested, any information regarding Medicaid Waiver billing, payment, or waiver participant information, to the case management agency or AAA. Provider rates shall not exceed the approved negotiated rates that are at or below the service provider's usual and customary rates. If additional services are to be added to this agreement, a written request to do so must be received by the AAA, If approved, an amendment must be prepared by the AAA indicating the service(s) to be added. The necessary documentation regarding provider qualifications for the additional services must be attached to the agreement. E. To maintain the waiver participant's confidentiality according to 42 CFR 431.301. F. To immediately report any changes in the waiver participant's condition to the case management agency. G. To maintain enrolled provider status by renewing applicable licensure, certification, contract and/or referral agreements and by maintaining all provider qualifications as contained in the Aged and Disabled Adult Medicaid Waiver under which services are provided. H. To include its name and other appropriate information on a list of all enrolled providers which will be shown to consumers during development of an individualized plan of care, understanding that the consumer reserves the right at all times to a choice of enrolled providers. I. To immediately notify the case management agency of staffing shortfalls that will negatively impact provision of service to Medicaid Waiver consumers, J. To submit claim data for billing to the Medicaid fiscal agent after delivery of services has been accomplished. All services should be billed within 60 days after services have been provided or document reasons for delayed submission of claims. Such documentation shall be available for review by the area agency on agency or by the department, upon request. K. To submit claims for billing to the Medicaid fiscal agent at the agency's contracted rate. L. To submit void or adjustment claims no later than 45 days after either party has identified the error. The provider's refusal to adjust or void erroneous claims may result in termination of this agreement and/or referral to the department, and will be referred by the department to the Agency for Health Care Administration for appropriate action. M. To develop and implement a policy to ensure that its employees, board members, and management, will avoid any conflict of interest or the appearance of a conflict of interest when disbursing or using the funds described in this agreement. A conflict of interest includes, but is not limited to, receiving, or agreeing to receive, a direct or indirect benefit, or anything of value from a service provider, consumer, vendor, or any person wishing to benefit from the use or disbursement of funds. T(' avoid a conflict of interest, the service provider must ensure that all individuals make a disclosure to the AAA of any relationship which may be a conflict of interest, within thirty (30) days of an individual's original appointment or placement on a board, or if the individual is serving as an incumbent, within thirty (30) days of the commencement of the agreement. N. To adhere to the federal waiver requirements and the policies and procedures outlined in the following manuals published by the Agency for Health Care Administration: the Aged/Disabled Adult Waiver Guidelines and the Medicaid Provider Reimbursement Handbook (Non- Institutional 081), including any and all attachments or updates. O. If the Service Provider is enrolled as a home delivered meals vendor, the Area Agency will retain the services of a registered dietitian to perform the following: 1. Conduct site inspections of all catering facilities. These may be unannounced. 2. Monitor meal delivery times and temperatures. 3. Review all menus submitted by the service provider and suggest changes as needed. 4. Work with the service provider to ensure that standardized recipes and computer-assisted nutritional analyses are carried out. P. The AAA may impose department-approved sanctions for non-compliance with the terms of this agreement. Q. Indemnification 1. Service Provider agrees to indemnify, defend, and hold harmless the AAA, and all of the AAA's officers, agents, and employees and the department and all of the department's officers, agents, and employees from any claim, loss, damage, cost, charge, or expense arising out of any acts, actions, neglect or omission, action in bad faith, or violation of federal or state law by the service provider, its agents or employees, during the performance of this agreement. 2. Service Provider obligation to indemnify, defend, and pay for the defense or, at the AAA's and/or department's option, to participate and associate with the AAA and/or department in the defense and trial of any claim and any related settlement negotiations, shall be triggered 2 ,J \ I by the AAA's and/or department's notice of claim for indemnification to service provider. Service provider's inability to evaluate liability or its evaluation of liability shall not excuse service provider's or's duty to defend and indemnify the AAA and/or department, upon notice by the AAA and/or department. Notice shall be given by registered or certified mail, return receipt requested. Only an adjudication or judgment after the highest appeal is exhausted specifically finding the AAA and/or department solely negligent shall excuse performance of this provision by service providers and s. The service provider shall pay all costs and fees related to this obligation and its enforcement by the AAA and/or department. The AAA's or department's failure to notify the service provider of a claim shall not release service provider of the above duty to defend. 3. It is the intent and understanding of the parties that neither the service provider, nor any of its employees are employees of the AAA or the department and shall not hold themselves out as employees or agents of the AAA or department without specific authorization from the AAA or department. It is the further intent and understanding of the parties that the AAA or department does not control the employment practices of the service provider and shall not be liable for any wage and hour, employment discrimination, or other labor and employment claims against the service provider. III. Under this Agreement, the Area Agency on Aging agrees to the following: A. To facilitate the enrollment of providers with the Medicaid Fiscal Agent. B. To provide technical assistance and training to Service Providers. C. To notify the case management agency within 48 hours of any approved service provider rate adjustment. D. To regularly monitor the Service Providers in accordance with requirements specified by the department. E. To complete a new referral agreement signed by all parties when unit rate changes are approved. IV. Under this agreement, the following services will be delivered by the Service provider in accordance with the plan of care or service authorization: Service A.~ tf2I\J~ ~~r.M<:' B. C Frw1t'iJ '\ C. D. E. Unit Rate ~r cD !~1}t County/Region Served ft1,1) U IUl; (00 AJ~ V. Termination In the event this agreement is terminated, the case management agency and the service provider agree to submit, at the time notice of intent to terminate is delivered, a plan which identifies procedures to ensure services to consumers will not be interrupted or suspended by the termination. A. Termination at Will This agreement may be terminated by any party upon no less than thirty (30) calendar days notice, without cause, unless a lesser time is mutually agreed upon by both parties, in writing. Said notice shall be delivered by certified mail, return receipt requested, or in person with proof of delivery, 3 B. Termination Because of Lack of Funds In the event funds to finance this agreement become unavailable, the area agency may terminate this agreement upon no less than twenty-four (24) hours notice in writing to the other party. Said notice shall be delivered by certified mail, return receipt requested, or in person with proof of delivery. The area agency shall be the final authority as to the availability of funds. C. Termination for Breach Unless a breach is waived by the area agency in writing, or the parties fail to cure the breach within the time specified by the area agency, the area agency may, by written notice to the parties, terminate the agreement upon no less than twenty-four (24) hours notice. Said notice shall be delivered by certified mail, return receipt requested, or in person with proof of delivery. In witness whereof, the parties have caused this ~ page agreement to be executed by their undersigned officials as duly authorized. Area Agency on Aging Service provider signature signature Max B. Rothman. JD. LL.M. print name print name President/CEO title \me date date 4 '1t~ '........'..'." r <#t" HOME AND COMMUNITY BASED SERVICES AGED AND DISABLED ADULT (ADA) MEDICAlD WAIVER REFERRAL AGREEMENT !~ <:ftll. This Referral Agreement between the Alliance for A in . Inc., the Area Agency on Aging (AM) for Planning and Service Area (PSA) 11 and j (; I the Service Provider, shall begin on July 1, 2004 or on the date th agreement has been signed by both parties, whichever is later. This referral agreement or is in effect for a period of time that is equal to the Medicaid waiver provider's enroHment period with the State of Florida's Medicaid fiscal agent and is contingent upon an annual appropriation by the Legislature. One purpose of this agreement is to promote the development of a coordinated service delivery system to meet the needs of the aged or disabled adults who are at risk of premature institutionalization. Another purpose of this agreement is to enable eligible elderly participants to receive home and community based services from qualified providers with oversight of the quality of care by the Medicaid Waiver Specialist employed by the AAA. These services are authorized in order that the participant may remain in the least restrictive setting and avoid or delay premature nursing home placement. Services and care are to be furnished in a way that fosters the independence of each participant to facilitate aging in place. All parties agree that routines of care provision and service delivery must be consumer driven to the maximum extent possible. All parties agree to and will treat each participant with dignity and respect. I. Objectives A. To maintain a climate of cooperation and consultation with and between agencies, in order to achieve maximum efficiency and effectiveness. B. To promote programs and activities designed to prevent the premature institutionalization of elders and disabled adults. C. To require the parties of this Agreement to provide technical assistance and consultation to each other on matters pertaining to actual service delivery and share appropriate assessment information and care plans so duplication may not occur. D. To establish an effective working relationship between the case management agency that is responsible for the development of care plans and authorization of services available under the waiver, the service provider that is responsible for the direct provision of those services to consumers served under the waiver program, and the AAA that is responsible for management and oversight of the waiver program. If. Under this Agreement, the Service Provider agrees to the following: A. To accept referrals, for the 1915c Home and Community-Based Services - ADA Medicaid Waiver from the enrolled case management agency. B. To provide quality service(s) to the waiver participant as specified in Section IV., Provision of service(s), subject to quality monitoring and/or observation by the case management agency and/or the AAA and/or the Department of Elder Affairs (the "department"). C. To provide only those services specifically outlined in the Plan of Care and authorized by the enrolled case management agency, D. To attach documentation regarding the service provider's qualifications to this agreement; and to provide, as requested, any information regarding Medicaid Waiver billing, payment, or waiver participant information, to the case management agency or AAA. Provider rates shall not exceed the approved negotiated rates that are at or below the service provider's usual and customary rates, If additional services are to be added to this agreement, a written request to do so must be received by the AAA. If approved, an amendment must be prepared by the AAA indicating the service(s) to be added. The necessary documentation regarding provider qualifications for the additional services must be attached to the agreement. E. To maintain the waiver participant's confidentiality according to 42 CFR 431.301. F, To immediately report any changes in the waiver participant's condition to the case management agency. ~. G. To maintain enrolled provider status by renewing applicable licensure, certification, contract and/or referral agreements and by maintaining all provider qualifications as contained in the Aged and Disabled Adult Medicaid Waiver under which services are provided. H. To include its name and other appropriate information on a list of all enrolled providers which will be shown to consumers during development of an individualized plan of care, understanding that the consumer reseNes the right at all times to a choice of enrolled providers. To immediately notify the case management agency of staffing shortfalls that will negatively impact provision of service to Medicaid Waiver consumers. J. To submit claim data for billing to the Medicaid fiscal agent after delivery of services has been accomplished, All services should be billed within 60 days after services have been provided or document reasons for delayed submission of claims. Such documentation shall be available for review by the area agency on agency or by the department, upon request. K. To submit claims for billing to the Medicaid fiscal agent at the agency's contracted rate. L. To submit void or adjustment claims no later than 45 days after either party has identified the error, The provider's refusal to adjust or void erroneous claims may result in termination of this agreement and/or referral to the department, and will be referred by the department to the Agency for Health Care Administration for appropriate action. M. To develop and implement a policy to ensure that its employees, board members, and management, will avoid any conflict of Interest or the appearance of a conflict of Interest when disbursing or using the funds described In this agreement. A conflict of interest Includes, but is not limited to, receiving, or agreeing to receive, a direct or indirect benefit, or anything of value from a service provider, consumer, vendor, or any person wishing to benefit from the use or disbursement of funds. To avoid a conflict of interest, the service provider must ensure that all individuals make a disclosure to the MA of any relationship which may be a conflict of interest within thirty (30) days of an individual's original apP9intment or placement on a board, or if th~ individual is serving as an Incumbent, within thirty (30) days of the commencement of the agreement. N. To adhere to the federal waiver requirements and the policies and procedures outlined in the fof/owing manuals published by the Agency for Health Care Administration: the Aged/Disabled Adult Waiver Guidelines and the Medicaid Provider Reimbursement Handbook (Non- Institutional 081), including any and all attachments or updates. O. If the Service Provider is enrolled as a home delivered meals vendor, the Area Agency will retain the services of a registered dietitian to perform the following: 1. Conduct site inspections of all catering facilities. These may be unannounced. 2. Monitor meal delivery times and temperatures. 3. Review all menus submitted by the service provider and suggest changes as needed. 4. Work with the service provider to ensure that standardized recipes and computer-assisted nutritional analyses are carried out. P. The AAA may Impose department.approved, sanctions for non-compliance with the terms of this agreement. .~, /.'.','~.."'. i'''9!' I. 11/, Under this Agreement, the Area Agency on Aging agrees to the following: A. To facilitate the enrollment of providers with the Medicaid Fiscal Agent. B. To provide technical assistance and training to Service Providers, C. To notify the case management agency within 48 hours of any approved service provider rate adjustment. D. To regularly monitor the Service Providers in accordance with requirements specified by the department. E, To complete a new referral agreement signed by all parties when unit rate changes are approved. 2 :"cl'> ~-_;J!~>_ ~{> <CI"~ C0~ ~- , IV, Under this agreement, the following services will be delivered by the Service provider in accordance with the plan of care or service authorization: Service Unit Rate A.' B. C, 0, E. V. Termination In the event this agreement is terminated, the case management agency and the service provider agree to submit, at the time notice of intent to terminate is delivered, a plan which identifies procedures to ensure services to consumers will not be interrupted or suspended by the termination. A. Termination at Will This agreement may be terminated by any party upon no less than thirty (30) calendar days notice, without cause, unless a lesser time is mutually agreed upon by both parties, in writing. Said notice shall be delivered by certified mail, return receipt requested, or in person with proof of delivery. B. Termination Because of Lack of Funds In the event funds to finance this agreement become unavailable, the area agency may terminate this agreement upon no less than twenty-four (24) hours notice in writing to the other party. Said notice shall be delivered by certified mail, return receipt requested, or in person with proof of delivery. The area agency shall be the final authority as to the availability of funds. C. Termination for Breach Unless a breach is waived by the area agency in writing, or the parties fail to cure the breach within the time specified by the area agency, the area agency may, by written notice to the parties, terminate the agreement upon no less than twenty-four (24) hours notice, Said notice shall be delivered by certified mail, return receipt requested, or in person with proof of delivery. VI. Agreement Not withstanding the effective date as determined in the First Paragraph of this agreement, this contract is retroactive to July 1, 2004. In witness whereof, the parties have cause this ~ page agreement to be executed their undersigned officials as duly authorized. Area Agency on Aging r~ t~ C;;-si~n-atur~ ) steven Weisberg, M.S. Print name President/CEO signature Charles Print name Mayor Title j' j '"L> ]v G Date i 1