Item C37 C37
BOARD OF COUNTY COMMISSIONERS
COUNTY of MONROE �� i Mayor Holly Merrill Raschein,District 5
The Florida Keys Mayor Pro Tern James K.Scholl,District 3
Craig Cates,District 1
Michelle Lincoln,District 2
' David Rice,District 4
Board of County Commissioners Meeting
July 17, 2024
Agenda Item Number: C37
2023-2678
BULK ITEM: Yes DEPARTMENT: Social Services
TIME APPROXIMATE: STAFF CONTACT: Sheryl Graham
N/A
AGENDA ITEM WORDING: Ratification of Alzheimer's Disease Initiative Program (ADI)
Contract KZ-2497 between the Alliance for Aging, Inc., and Monroe County Board of County
Commissioners/Monroe County Social Services/In-Home Services for the contract year 2024-2025
(07/01/2024-06/30/2025) in the amount of$63,924.48.
ITEM BACKGROUND:
Approval of the Alzheimer's Disease Initiative(ADI) contract enables Monroe County Social Services In-Home
Services Program to continue providing personal services (In-Home respite,Facility-based respite, and Case
Management)to Monroe County's elderly population under the Alzheimer's Disease Initiative Program.
PREVIOUS RELEVANT BOCC ACTION:
BOCC Approved ADI 1st Amendment on 10/18/2023.
INSURANCE REQUIRED:
No
CONTRACT/AGREEMENT CHANGES:
N/A
STAFF RECOMMENDATION: Approval
DOCUMENTATION:
BACKUP ADI 1 st Amendment
2024-2025 ADI Contract Monroe KZ 2497.pdf
FINANCIAL IMPACT:
Grant Funding in the amount of$63,924.48 requiring 10% match
1952
°,,I c°URJB'
Kevin Madok, CPA
5ts
cOUNSy 4 Clerk of the Circuit Court& Comptroller Monroe County, Florida
DATE: November 9, 2023
TO: Sheryl Graham, Director
Social Services
ATTN: Lourdes Francis, Administrator
Social Services
Kim Wilkes Wean, Sr. Administrator
Social Services
FROM: Liz Yongue, Deputy Clerk
SUBJECT: October 18, 2023 BOCC Meeting
The following item has been partially executed:
C32 1st Amendment to Alzheimer's Disease Initiative Program (ADI) Contract KZ-
2397 between the Alliance for Aging, Inc., (AAA) and Monroe County Board of County
Commissioners/Monroe County Social Services/In-Home Services to increase funding by
$25,264.40, bringing the contract total from $60,634.56 to $85,898.96 for the contract period of
07/01/2023-06/3 0/2024.
Please send us the fully executed version, once it has been signed by Alliance for Aging,
Inc., so we can add it to the record. Should you have any questions please feel free to contact me
at(305) 292-3550.
cc: County Attorney
Finance
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
1953
AMENDMENT 001 CONTRACT KZ - 2397 Page 1
THIS AMENDMENT is entered into between the Alliance for Aging, Inc. hereinafter referred to as the
"Alliance",and Monroe County Board of County Commissioners,Social Services/In-Home Services,hereinafter
referred to as the"Contractor",and collectively referred to as the"Parties."
The purpose of this amendment is to add 10 months of funding for the 2 additional clients released into the
program by client choice to Monroe County Social Services for ADI Services.The new monthly average caseload
for this contract is now contract is 6.
Current Additional Revised
Funding Funding Funding
$60,634.56 $25,264.40 $85,898.96
Funding is allocated and indicated below:
Maximum Units of Service
Service Unit Prior Increase/
Service to be Provided Rate Units (Decrease) Total Maximum Dollars
Case Management $ 60.73 21 9 30 $ 1,821.90
Case Aide $ 15.00 3 2 5 $ 75.00
Respite Facility $ 10.96 3,865 1,535 5,400 $ 59,184.00
Respite In-Home $ 24.22 626 293 919 $ 22,249.80
Specialized Medical Equipment Cost Reimb $ 2,568.26
CONTRACT TOTAL $ 85,898.96
All provisions in the contract and any attachments thereto in conflict with this amendment shall be and are
hereby changed to conform with this amendment.All provisions not in conflict with this amendment
are still in effect and are to be performed at the level specified in the contract.This amendment and all its
attachments are hereby made a part of the contract.
IN WITNESS WHEREOF,the parties hereto have caused this Amendment to be executed by their undersigned
officials as duly authorized.
Monroe County Board of County
Commiss' ers,Social Services/ ALLIANCE FOR AGING,INC.
In-Ho a ices
SIGNED BY SIGNED BY:
NAME: Craig Cates .fir NAME: Max B. Rothman,JD,LL.M.
TITLE: Ma or Ya �TITLE: President&CEO
DATE: d ATE:
Prepared 9/23/2023 f � � � J -0 °o"y r ST: KEVIN MADOK, CLERK
Vvvv�
Appsosid ns to form and Ieo su&'mcp
Momoe Cowry Attorney s Of5ce By:
cbdstin.Co*,.Assrstnnt C a y Attoney As Deputy Cliffrk
1954
LC)
LC)
ALZHEINIER'S DISEASE INITIATIVE CONTRACT
2024-2025 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/In-lionile Services, hereinafter referred to as the "Provider," and
collectively referred to as the "parties."
Attachments 1, 11, 111, V1,Vil, Vill, 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 N/lonroe Counties; and
WFIERFAS, 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 N/Ionroe Counties-, and
NOW THEREFORE,in considerationoftlic set-vices to be performed and payments lobe invade,together with the mutual covenants,
and conditions set forth in this Contract,the Parties agree as 1`61lows:
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 C0llSti(UtC the contract(document.
2. Incort)oration of Docurnents,within the Contract
The contract will incorporate attachments, proposal(s), state plan(s), grant agreements, relevant Department oftider Affairs
handbooks, niallUals,or desk books, as an integral part ofthe contract, excelit to the extent that the contract explicitly provides
to tile contrary. In the event of conflict ill language among any of the documents referenced above, the specific provisions and
requirements of the contract docurnent(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 N6th the applicable laws,statute Hs,
and other conditions set for in this Contract.
3. 'Term of Contract
3,1 Elffective Date:
This contract shall begin at twelve (12:00) A.M., Eastern Standard Tinie on July 1, 2024 or oil the date the contract has
been signed by both parties, whichever is later. The contract will end oil June 30,2025,or such earlier date as the contract
is terminated pursuant to Section 5 1 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 11:59 P.M., Eastern Standard Time oil June 30,20�25,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 30,2025 or any earlier termination(late. No changes to funding allocations will be made after Julie 30,
2025. Only limited contract close-out activities are to be performed after June 30, 2025, consisting of reporting, invoicing
and payment as stipulated in ATTACHMEN4''Will.
4. Contract Amount
The Alliance agrees,to pay for contracted services according to the terms anti conditions of this contract ill all amount not to
exceed $63,924.48 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. '['his funding requires an average monthly active case load of4,
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 oil a yearly basis for no more than three 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 arenewal price,is set forth in the bid,proposal"or reply.Requests to renegotiate the original contractual
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established rates are provided for in the Alliance's approved Reimbursement Rate Review Policy, which is incorporated by
reference.
Tile pat-ties 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-SUBS dated September 2801, 2015 and the approved Alliance's
Reimbursement Rate Review Policy.
In the event that contracts cannot be executed prior to the July Ist start date, the Alliance may, at its discretion, extend this
Agreement upon written notice for tip to 120 days to ensure continuity of service. Services provided under this extension will
be paid for Out of the succeeding agreement alllOLHlt.
6. Compliance with Federal Law
6.1. The Provider shall not employ all unauthorized alien. The Alliance shall considerthe employment of Unauthorized aliens
a violation of the Immigration and Nationality Act (8 U.S.C. 1 124 a) and the Immigration Reform all(] Control Act of
1986(8 U.S.C. 1 10 1). Such violation shall be cause for unilateral cancellation of this contract by the Alliance.
6�.2. Ifthe Provider is a non-profit provider and is subject to Internal Revenue Service(IRS)tax exempt organization reporting
requirements(rdinga Form 990 or Forin 990-N)and has its tax exempt starters revoked for failing to comply with the filing
requirements of the 2006 Pension Protection Act or for any other reason,the Provider nitist notify the Alliance in writing
within thirty(30)days of receiving the IRS notice of revocation.
6.3. The Provider sliall comply with Title 2 CFR Part 175 regarding Trafficking in Persons.
6A. Unless exempt under 2 CFR Part 170.1 10(b), the Provider shall comply with the reporting requirenlents 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 NUiliber I I m 116,
Provider agrees to utilize the U.S. Department of Homeland Security's Emverify 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 and/or 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 tile contract
term. Providers meeting the terms and conditions of the E-Verify System are dcerned to be ill compliance with this
provision.
7. Conipliance with State Law.,
7.1 This contract is executed and entered into in the State ot'Horida. and SIM11 be C011SIRled. PCH'Ornle(L and enforced in aril respects ill
accorchince with the Florida law,including Florida provisions fior conflict ot'ha%%s.
T2 The Provider shall comply with Section 215.97,F.S and requirements of s.287.058, F.S. as amended.
7,11 The Provider shall perform all tasks contained in Attachment I.
722 Tile 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 most be in
compliance with laws, rules, regulations, including, but not limited to the Florida Reference Guide for State
Expenditures issued by tile Florida Department of Financial Services("DFS").
7,23 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 Ifitemized 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. Tile Provider's refusal to comply with this provision will constitute
all 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 tinder this contract, the Provider shall comply with the provisions of Chapter 427, F.S.,and
Rifle 4 1-2, F. A.C.
7.4 Subcontractors who are on the Discriminatory Vendor List may riot 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
8,11 The Provider shall ensure that the requirements of s. 430.0402 and C hapter 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 Fong) 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.
9.2 Further information concerning the Procedures fear 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 MininlUrn Guideline for Recipient
Grievance Procedures, Appendix D,Department of Elder Affairs Programs and Services Handbook,to address complaints
regarding tile termination,SUSperiSiOD 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 set-vice 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 tile 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 contract the Provider is providing services,in(] is acfing,on behalf of thee Alliance and the Department as provided under.
s. 119.01](2). Florida Statutes. the Provider, subject to the terms ofs. 287.058(l)(c), Flori(ki Statutes,and any other applicable legal
and equitable runic(fics,agrees to all provisions of Chapter 119,Ha Stat.,and any other applicable law.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.
I O�.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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I O.1.4 Upon completion of this contract, the Provider will transfer, at no cost to tile Alliance, all public records in
possession of tile Provider or will keel)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 pubic 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 I 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 PLI BLIC RECORDS AT:
Public Records Coordinator
Florida Department of Elder Affairs
4040 Esplanade Way
Tallahassee,Floricia 32309
8501-414-2342
10.3 [Jpon tennination 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 tile information
technology systerns of the Alliance.
11. Audits,Ins Pections,I rivestigat ions:
11.1 The Provider shall establish and maintain books, records, and doCUIllents(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.
11.2 'Fire Provider shall retain all client records, financial records, Supporting documents, statistical records, and, my other
d0CU1nC11tS(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 MillinlUrn 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 derriarid,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.
IIA 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 tile 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 'File 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 Conti-act 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. Nondis,crimination-Civil Rights Corriviiance
12.1 The Provider shall execute assurances in ATTACHNIENT 11 that it gill 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, tuarital 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 Nvith 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.
112 During the term of this contract, the Provider shall complete and retain on file a tirriely, complete and accurate Civil
Rights Compliance Checklist,hecklist, attached to this contract.
123 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.
12A These assurances are a condition of continued receipt of or benefit froin financial assistance, and are binding upon the
Provider,its successors, transferees,and assignees for the period during which such assislance is provided. The Provider
forther assures that all sub-Contractors, vendors, or others with whom it arranges to provide services or benefits to
participants or eiriployees 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. lit the event of failure
to cornply,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 Ap_in2
13,1 the Provider shall permit persons ditly authorized by the Alliance to inspect and copy any records,papers,docLunerits, facilities,goods
and services of the Provider which are relevant to this contract,,and to interview any clients,employees and subcontractor
employees of the Provider to assure tile 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 tile CAP in a timely manner as determined by the Conti-act Manager.Failure to comply with the
CAP shall subject Provider to enforcement actions as described in this Contract-
132 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 die Department to be used for monitoring progress or performance of the contractual services. Examples of review
criteria are SUrpIUs/deficit 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 Set-vice Cost Reports (SCR)—Tile Provider shall submit a SCR to the Alliance annually, but no later than ninety (90)
calendar days after the Provider Fiscal Year ends. The SCR shall reflect the 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 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 tile manner described in ATTACI-IMENT 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.
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15. Coordinated Monitoring with Other Agencies
If the Provider receives direct or pass through funding from one or more other State of Florida human service agencies, ill
addition to the Department of Elder Affairs funding passed through the Alliance, it is expected that the provider cooperates with
all rnonitors, inspectors, and/or investigators should a state agency joint inquiry or investigation begin.
16. Indemnification
The Provider shall indemnify,save, defend,and hold harnfless the Department,the Alliance and its officers.agents,and employees from any,
and all claims,demands. actions,causes of action of whatever nature or character, arising out of or by reason of the execution this Contract,
oi performanec of the sort ices plovided for herein. It is understood and agreed that the Provider is not required to indenaliimy�the Department
or the Alliance Im claims,demand,.,.actions,or causes ofaclioii arising sold out ofthe Department's or Allianco's negligence.
17. Insurance and Bonding
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."rhe Provider accepts fill] 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 flirnish the Alliance written verification
supporting both the determination and existence of such insurance coverage. The lirnits of coverage under each policy
maintained by the Provider do not Imlit 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 Th rOUg IIOU I the tUrn 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 all amount commensurate with the funds handled, the degree of risk as
determined by the insurance company and consistent with good business practices.
18. ConfidentialiO, of Information
'File 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 vvith the written consent Ora person legally authorized to give that consent
Or when authorized by law.
19. Health Instirince portability and Accountability Act
Where applicable, the Provider shall comply with the Health Insurance Portability and Accountability Act(42 LJSC 1320&), as
well as all regulations promulgated thereunder(45 CFR 160, 162,and 164).
20. Incident Reportin
20.1 The Provider shall notify the Alliance immediately but no later than forty-eight(48)hOLll-S fl-Oln the Provider's awareness
or discovery, of conditions that may materially affect the Provider or Subcontracto�r'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 all 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 Flotline an the statewide toll-ftee telephone nuillber (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. Bankruptcl Notification
During the term of this contract,the Provider shall immediately notify the Alliance if the 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: (I) the date of filing or the bankruptcy petition; (2) the case number; (3) the court narne 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.2W25. Fla. Stat., if the Provider is a non-governmenU organization NN,hicli sponsors a prograin financed\\holly or
in part by state funds, including ally funds obtained through this contract, it shall, in publicizirig, ad\,crlising. or describing the
sponsorship of the program. state: "Sponsored by 111ROVIDL,R NAN4F], The Alliance for Aging, tile., 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 Ider Affiairs"shall appear in at least the same size letters or type as the nanic of the orgaiiization.
222 The Provider shall not use the words"Alliance for Aging, Inc,"or"The State of Florida, Department of Elder Affairs" to indicate
sl)onsorshil)of a.prograin olherwise financed,unless specific authorization has been obtained by tile Alliance prior to[Ise.
23. Assiarlments
211 'file Provider shall not assign the rights and responsibilities under any contract as Ihout the prior written approval oftlic Alhance.Any
Sublicense,assignment,Or transfer 01hel-WiSe OCCLII-riuLl Without prior wrincri appl-co"al Of the Alliance will constitute to 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. 'file Provider further agrees that tile 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 front 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.
24,31 "File Provider shall programmatically monitor, at least once per year-, each of its subcontractors, Subrecipients, Vendors,
and/or Consultants. The Provider shall perform programmatic monitoring to ensure contractual compliance, and
prograniniatic performance and compliance with applicable state and federal taws 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 goats. The Provider shall also perform fiscal and administrative monitoring for all
Subcontractors to ensure fiscal accountability,
24A 'file Provider shall have a procurement policy that assures ritaxiniffln free and open competition. Such procurement policy
must conform, as applicable, with Federal and State contracting and procurement regulations, and the Alliance's
procurement policy.
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 tile 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. Service Cost Reports(SCR):
The Provider shall Submit a SCR to the Alliance annually, but no later than ninety (90)calendar days after the Provider Fiscal
Year ends. The SCR shall reflect the costs of providing each set-vice by program for tile 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 Unit Cost Methodology, in accordance with the Alliance's approved Reimbursement
Rate Review Policy, which is incorporated by reference.
26. Fundine 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 tile
Provider's promised performance and unit rates and/or reimbursement capitations specified.
26.3 The A I I iance shall not be liable'to Ilia;Pro%ider for any expenditures Nvhich are not allowable costs as defined in 2 (TR Fart 200 and
45 CIR Pall 92.as amended.or),N'luch expenditures have not been made in accordance with all applicabie state and fQdcral rules.
26.4 The Alliance shall not be liable to the Provider for expenditures made in violation of'regulations promulgated Under tile
Older Americans Act, Department rules, Florida Statutes,or this contract.
27. Independent Cnacity of Provider
It is the intent and understanding of the Pat-ties that tile 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 tire Alliance. It is the further intent and understanding of tile 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 lot-the Provider are the sole responsibility
of the Provider.
28. Payment
281 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 fin-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 tile Alliance's fiscal department for budgetary approval and processing per
ATTACHMENT Vill.
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 fora
proper pre audit and Post audit thereof The Provider shall comply with all state and federal laws governing payments to
be made tuiderthis contract including,but not limited to the following: sections 216.181(16)(a)&(b),215.421 Fla,Stat_;air(]
the invoice Requirements of the Reference Guide for State Expenditures front the Department of Financial Services at:
INN %N 111 N i lo 6�h�c 1'o co ni, d i\/i,-;ion "1�1 11 wn ua Is doc ul n e I I Rc k.,n nceG I t id forsmi c,F\ e (i q r sj)
The Provider shall maintain detailed documentation to support each item oil 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 re(iLiest 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
'File Provider shall return to the Alliance any overpayments due to unearned funds or funds disallowed and any interest
attributable to such fluids 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 tile Alliance first discovers all overpayrnent has been made, the Contract Manager will notify tile
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 integrity and Safeguarding 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 retrieved 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 tire primary systems. The Provider shall insure all sub-Contractors
maintain written procedures for computer system backup and recovery. The Provider shall,prior to execution of this agreernent,
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complete the Certification Regarding Data Integrity Compliance for Agreements, Grants, Loans,and Cooperative Agreerrielits
prior to the execution of this contract. as part of ATTACHMENT 11.
31. Social Aledia 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 Nvith legal obligations. By signing this contract, Provider agrees to the
following social media and personal cell phone use requirements.
31.2 Social Media Defined, file term Social Media and for personal Cellular communication includes, but is not limited to,
social networking websites, blogs, podc:asts, discussion forums, RSS feeds, video sharing, SMS (including Direct
Messages (DMs), iMessages, text messages,,ctc.); social networks like Instagrarn, TikTok, Snapchat,Google Hangouts,
WhatsApp, Signal, Facebook, Pinterest, and Twitter; and content sharing networks such as Flic:kr 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 ally DOEA or other
state business conducted on any of the Providers, Subcontractor's,or their employees' social media accounts or through
personal cellular communication.
31.4 Application to DOEA 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 C0111111111liCati011 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(I 11PAA).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 narlies,of clients, volunteers, staff,ur other affiliates of DOEA
may only be posted when authorized by law and when ally required HIPAA authorizations and any other consents or
authorizations required pursuant to federal,or state law are oil 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 fbi,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 all 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) all
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 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 (3(1) calendar days of all individual's original appointment or placement in
that position, or if the individual is serving as an incumbent, within thirty (10) calendar days of the commencement of this
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 i-nonitored.
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33. Public Entity Crime
Pursuant to s.287.133, F.S., a person or affiliate who has been placed oil the convicted vendor list following a conviction for a
public: entity crime may not Submit a bid, proposal, or reply oil a contract to provide any goods or services to a public entity;
may not Submit a bid,proposal, or reply oil a contract with a public entity for the construction or repair of a public building or
public work, may [lot submit bids, proposals, or replies on leases of real property to, a public entity; may not be awarded or
perforin 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 ill Sk 287.017,F.S.,for Category Two for a period of
36 months following the date of being placed out 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 or this agreement.
34. Pun-chasina:
34.1 The Provider shall procure products and/or services required to perform this contract in accordance with section
413.036, F.S.
34.LI 11' IS EXPRESSLY UNDERSTOOD AND AGREED TFIAT ANY ARTICLES THAT ARE THE SUBJECT
OF, OR REQUIRED I'D CARRY OUT, THIS CONTRACT SHALL BE PURCHASED FROM A
NONPROFIT AGENCY FOR THE' BLIND OR FOR THE SEVERELY HANDICAPPED THAT IS
QUALIFIED PURSUANT' TO CHAPTER 413, FLORIDA STATUTES, IN THE SAME MANNER AND
UNDER THE SAME PROCEDURES SET FORTH IN SECTION 413.036(l) AND (2), FI.ORIDA
STATUTES; AND FOR PURPOSES OF ]'HIS CONTRACT THE PERSON, FIRM, OR OTHER BUSINESS
ENTITY CARRYING OUT THE PROVISIONS OF ']'HIS CONTRA("[' SHALL BE DEEMED TO BE
SUBSTITUTED FOR THE STATE AGEN(11 Y INSOFAR AS DEALINGS WITH SUCH QUALIFIED
NONPROFIT A(..jl-"N(.'.Y ARE (..'ONC E'RN E,D,
34.1.2 Pursuant to sections 413.036(1)and(4), F.S.,the Provider sliall not be required to procure a product or service
from RESPECT if. (a)the product or service is not available within a reasonable delivery time, (b)the Provider
is required by law to procure the product or set-vice from any agency of the state,or(c)the provider determines
that the performance specifications,price,or quality of the product or service is not comparable to the Provider's
requirements.
34.1.3 This act shall have precedence over any law requiring state agency procurement of'products or services from
any other nonprofit corporation UnIeSS such precedence is waived by the alliance or the Department in
accordance with its rules.
34.1.4 Additional infortuation about the designated nonprofit agency and the products it offers is available at
fflor jag amng,.
34.2 Tile Provider shall procure any recycled products or materials which are the Subject of,or are required to carry out,this
contract when the Department of Management Services determines, that those products are available, in accordance
with the provisions of section 403.7065, F.S.
343 The Provider shall procure products and/or services required to perform this contract in accordance Nvith section
946.5 15,F.S.
34.1.1 IT IS EXPRESSLY UNDERSTOOD AND AGREED THAT ANY ARTICLES WHICH ARE THE SUBJECT
OF, OR REQUIRED TO CARRY OUT, THIS CONTRA(-.I T SHALL BE PuRC IIASED FROM 4-1 IE
CORPORATION IDENTIFIED UNDER CHAPTER 946, F,S., IN THE SAME MANNER AND UNDER THE
SAME PROCEDURES SET FORTH IN SECTION 946.515(2) AND (4), F,S,; AND FOR PURPOSES OF
THIS CONTRACT THE PERSON, FIRM, OR OTHER BUSHNESS ENTITY CARRYING OUT THE
PROVISIONS OF THIS CONTRACT SHALL BE DEEMED TO BE SUBSTITUTED FOR THIS AGENCY
INSOFAR AS DEALINGS WITH SUCH CORPORATION ARE CONCERNED.
34.32 The corporation identified is Prison Rehabilitative Industries and Diversified Enterprises, file. (PRIDE).
Additional information about PRIDE and the commodities or contractual services it offers is available at
It t o S:''p6 d.(ell t erpri ses.org".
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34.4 The Provider shall provide a Certified khriority Business Subcontractor Expenditure(CMBE)Report summarizing the
participation of certified suppliers for the Current reporting period and project to date.'file CN113E Report shall include
the names,addresses,and dollar amount of each certified participant,and a copy must be forwarded to the Department,
Division of Financial Administration, and must accompany each invoice submitted to the Department, The Office of
Supplier Diversity (850-487-0915)will assist in furnishing names of qualified minorities. The Department's Minority
Coordinator (850-414-2153) will assist with questions and answers. Tile CMBE Report is attached to this contract
(Attachment F)
3�5, Patents,Copyrights,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 reserve(] to tile State of Florida ill accordance with
Chapter 286,F.S. Pursuant to s. 287.0571 (5)(k),as amended,tile 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 all
Unencumbered right to use such property,notwithstanding any agreement made pursuant to this section.
35.3 If this contract is awarded solely federal funding,the terms all(] conditions are governed by 2 CFR Part 200.315.
36. Emergency Prelmi-edness and Continuity of One"tions
'file Provider shall, within thirty (30) calendar days of the eXCCUti0ll of this contract, submit to the Alliance Contract Manager
verification of all emergency preparedness plan. In the event of all emergency, the Provider shall notify the Alliance of
emergency provisions.
In the event a Situation results in a cessation of services by a sub-Coniractor, the Provider shall retain responsibility for
performance under this contract and in List 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:
\4-dlw�.1111N f](�ri da.Coll) conmit do\\�doad )91),1 177 7,P( k I QQQ (icnc�al omrac�
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 1001t1 Form. I lowever, ifthe conflicting terms or conditions in the
PUR 1000 Form are required by any section of the Ilorida Statutes, the terms or conditions contained in the PUR 10,00 Form
shall take precedence.
38. Use of State Funds to Purchase or Improve Real Property
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. Disl2ute 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 cop),on the Provider.
40. No'Waiver of Sovereign Immunity
Nothing contained in this agreement is intended to serve as a waiver of sovereign ilulnUnity by any entity to which sovereign
immunity may be applicable.
41. Venue
If any dispute arises Out of this contract,the vellkle of such legal recourse will be Miami-Dade County, Florida.
42. Entire Contract
'Phis contract contains all the terms and conditions agreed upon by the Parties. No oral agreements ol,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.
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43, Force Majeure
The Pat-ties will not be liable for any delays or failures ill performance due to Circumstances beyond their control, provided tile
party experiencing the force majeure condition provides immediate written notification to the other party and takes all reasonable
efforts to Cure the condition.
44. Severabilitj Clause
The Parties agree that if a Court Of C0111petentjurisdiction deems any tertil 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 Departniciii and a corresponding allocation under contract front the Department to the
Alliance.
46. Addition/Deletion
The Pat-ties agree that the Alliance reserves the right to add or to delete any of the services required tinder this contract where
deemed to be in the State of Florida's best interest and reduced to a written amendment signed by both Parties. The Parties slial I
negotiate compensation for any additional services added,
47. Waiver
'file delay Or failure by the Alliance to exercise or enforce any of its rights tinder-this contract will not constitute or be deemed
a waiver of tile Alliance's right thereafter to enforce those rights,nor will any single or partial exercise of any such right preclude
an), other or Further exercise thereof or the exercise of any other right.
48. Com[Aiance
The Provider shall abide by all applicable current fLderal statutes, laws, rules and regulations as well as applicable current state
statutes, laws, rules and regulations, policies of the Department,and the ternis,of this Contract. The Parries agree that failure of
the Provider to abide by these laws, rules, regulations, policies,and terms of this Contract shall be deemed all event of default
of the Provider and subject the Provider to disciplinary action including corrective action, unannounced special monitoring,
terriporat-y assumption of the operation of one or more contractual services, placeinent of the Provider on probationary status,
imposing a inoratodurn oil Provider action, imposing financial penalties for nonperformance or noncompliance, or other
administrative action to immediate,unilateral cancellation at the discretion of the Alliance.
Ifthe 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 121)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(21)days shall be deemed a waiver of the rights
Outlined above and the Alliance will proceed against the Provider by default.
'file 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. 'file 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 frial jiwoice Im payment to the Alliance as specified in this contract.If the provider fails to submit final request
lbr payment as specified in this contract,then all rights to payment inay, be forfeited and the Alliance inay not honor any requests SUbruitted.
Any payment due tinder the terns of this contract may be withheld until all reports due t'rom the Provider and necessary adjustillent.",thereto
have been approved by the Alliance.
50. Modifications
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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 shall provide tile 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 circurn stances. After receiving a SUSpellSiOn 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(I) 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.
5,2. Termination
511 Terinniation for Convenience. This contract inay be terminated by either party without cause UP011 110 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 set-vice 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 ernad regarding this paragraph.
512 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 adeciLHIC) offunds. Ill the event of termination of this contract,the Provider
"rill be compensated for any work satisfactorily completed prior to the date of Termination. The Provider shall Continue
work oil an), work not terminated. Except for defaults of subcontractors at any tier, tile Provider shall not be liable for
any excess costs if the failure to perforni 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 tile 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 fl'(All Offiff Sources in sufflicient time for the Provider to ineet,the required delivery
schedule. I f,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 reniedies of tile Alliance in this clause are in addition to any other rights and remedies provided
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 froin
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 A Hiance's information technology systern(s).
53. Successors
This contract shall remain binding upon the SUCCeSSOI-S in interest of either the Alliance or the Provider.subject to the assignnient
provisions above.
54. Electronic Records and Signature
54.1 'Fiore 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,66,8.50,Fla. Stat. all clectronic 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
lnfannafion; must maintain all confidentiality,as applicable; and must be retained and maintained by the Provider to the
sarne extent as non-electronic records are retained and inaintained as required by this Contract.
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54.2 Jhe 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 forill, with all
electronic signature must indicate:the person and the person's capacity who electronically signed the document on ally
non-electronic copy ofthe document.
55. Special Provisions
The Provider agrees to the following,provisions:
55,1 Investigation of Criminal Allegations:
Any report that implies criminal intent on the part ofthe 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 ofthe 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
individnals with disabilities needing,such services.If possible.file Provider shall work in coordination with ore all izat ions
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 ina),wnhout taking any intermediate Measures available to it against the Provider. rescind the contract. if the Alliance
brads that:
55.3.1 Ali intentional or negligent,let of,1110 Provider has materially affected the health,wettlare,or safi ty ol'clients served purstrant
to this cotllracl,or substantially and negatively affected the operation ol'services covered under this contract„
5 5.3.2 File Provider lacks financial stability sufficient it) rilect contractual obligations or that contractual funds have been
misappropriated;
55,33 The Provider has conininted intiltiple or repeated vjoliitions of legal and regulatory standards, regardless of'whether stich
laws or regulations are enforced by tire Alliance,or the Provider has coinninted or repeated violations ofthe Alliance or[lie
Department StallLfilrds:
55.3.4 The Provider has failed to conliture the provision or CNparision ol'services after the declaration ol'a state ofernergency:and/or
55.3�5 1 lie provider has Failed to adhere to the terms of this contract.
In the alternative, the Alliance ina\, at its sole discretion,take inunediale measures against the Provider. illClUding corrective action,
unannounced special nionitoring,terilporary,assurription ofthe Operation ol'one or rilore contractual services,placernerit ofthe Provider
oil probationary States. ituposing a nioratoriurn on Provider action. imposing financial penalties fro nonperforillance, or other
administrative action.
55A In making an), determination under this provision the Alfiance may rely upon the Findings of another state or federal agency, or
other regulatory body. Any clalins for damages for breach of this contract are excilipt front adniiinstrative proceedings and shall be
brought before the appropriate entity in the VelILW OfN1iaoii-Dade County.
55.5 TJse ot'Seri ice Dollars:
'Flie Provider will optirnize the use of contract funds by serving the inaxinium possible number of individuals with the services allm%ed
by this contract.'fire Providcr will spend all funds provided by this contract to provide such services.
55.6 Surplus/Deficit Report:
'the 1rovider 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.This report is for this contract between the Provider and the Alliance.The
report will,include the fifllo\e,fng:
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55.6.1 The Provider's detailed Plan Oil how the suiplusordelicit spending exccedingthe V%tliresholdNaill be resolved:
55,6.2 Number ot'client's CLIH-Ciuly on the APCL that receive a priority ranking score of fi)ur(4)or five(5);
55.6.3 Nunibo-of clients currently on the APCL designated as imminent Risk.
55.6.4 Number of clients served and Aging and Disability Resource Center("ADRU)client contacts,
In accordance with its surplus/deficit management policies,in order to maximize available funding and minimize the tune
that potential clients must wait for services, the Alliance in its sole discretion can recluce 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 Mannel
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. ['resident and CEO
760 NW 107th Ave, Suite 214
Miami, Florida 33 172
(305),670-6500, Ext, 224
The narne, address, and telephone number of the representative ofthe Provider responsible for administration orthe program
under this contract is:
The provider name, as shown on page I of this contract, N/lonroe County Board Of County COIIIIIIiSSiOIIerS,
a, and mailing address of the official payee to whom the Social Services/In-Home Services
payment shall be made is: I 100 Simonton Street,2-25V
Key West,Fl. 33040
Sheryl Graham, Senior Director
b. The murie of the contact person and street address where Monroe County Board of County Commissioners,
financial and administrative records are maintained is; Social Services/In-Florne Services
1100 Sinionton Street,2-25V
...............................Key West,FL 33040
The name, address, and telephone number of the Sheryl Graham, Senior Director
representative of the Provider responsible for Monroe County Board of County Commissioners,
administration of the program under this contract is: Social Services/In-Florne Services
1100 Simonton Street,2-25V
Key West, Fl, 33040
The section and location within the AAA where Requests Vice President for Finance
cl• for payment and Receipt and Expenditure forms are to be Alliance lot-Aging, [tic.
mailed is:: 760 NW 107th Avenue, Suite 214
Miami, Florida 33172-3155
The name,address, and telephone number of the Contract Contract Monitor
Manager for the AAA for this contract is: Alliance for Aging, lnc,
760 NW 107th AVC11LIe, Suite 214
Miami, Florida 33172-3155
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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 original,,of this
eolltracL
58. All'I"crins,and Conditions Included
This contract and its Attachments and any exhibits referenced in said attachments,to�edier 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.
13Y signing this Contract.the Parties agree that they have read and agree to the entire contract.
IN WITNESS T11FRF10F.the Parties hereto have caused contract,to be executed bv their undersig ned officials as(hit) authorized.
Monroe County Board of County
Provider; Commissioners,Social Services/In-Home ALLIANCE FOR A( ING,INC,
Services
SIGNI-J)BY: S I GN F D 13 Y:mo,B,RrIl hn,,ri(J i a 1 i, 024 10:1 DD I)
NA M F %LA X 13,R 0T It M A N,J 1),L L,N1.
NANIL:
fll
0" TITLE: PRI'SIDENT AND CE0
C,
LL: 'Llrect)rt Z)
DATF' - I.12_022-� Jul 1,2024
16i, NPOE:COUNTY ATTORNEY
rHOVE FORM
SIGNED BY.
ASSI
Pw J., ERCA99—C
MUNTY ATTORNEY NAME' —Holly Raschein
TITLE' —Mayor
DATE'
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1970
INDEX TO ATTACHMENTS
Attachment I SERVICE PROVISIONS ALZHEIMER'S DISEASE INITIATIVE
Attachment 11 CERTIFICATIONS AND ASSURANCES
Attachment III FINANCIAL AND CONIPLIANCE AUDIT
Attachment VI ASSURANCES NON CONSTRUCTION PROGRAMS
Attachment VII BUDGET SUMMARY
Attachment Vill INVOICE REPORT SCHEDULE
Attachment IX REQUEST FOR PAYMENT FORM
Attachment X RECE[PTAND EXPENDITURE REPORT
Attachment A DOEA HANDBOOK
Attachment B CIVIL RICH TS COMPLIANCE(A)EC KLIST
Attachment C BUSINESS ASSOCIATES AGREENIENT
Attachment D BACKGROUND SCREENING AFFADAVIT OF COMPLIANCE
Attachment E REFERRAL PROTOCOL AGING AND DISABILITY RESOURCE CENTER(ADRC)—
Attachment F CERTIFIED NIONORITY BUSINESS SU13(,'ONTRA(.,1TOR EXPENDITURE(CMBE)
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ATTACHMENT I
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
SECTION 1.SERVICES TO BE PROVIDED
A. DEFINITIONS OF TERMS AND ACRONVMS
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 (APCI-)
Adult Protective Set-vices(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—(OOEA)or Department
Department of Elder Affairs Program and Services Handbook (DOEA I IANDBOOK)
Home('are For Disabled Adults(HCDA)
Instrumental Activities of Daily Living(1ADL)
k1lernory Disorder Clinic(MDC)
Planning and Service Area(PSA)
2. PROGRAM SPECIFIC TERMS
Department of Elder Affairs Handbook: Ali official document of DOEA. TH DOEA Handbook includes program
policies, procedures, and standards applicable to agencies which are recipients/providers of DOEA funded programs. All
annual update is provided through a Notice Of Instruction (NO]).
Functional AssessmerW A comprehensive, systematic, and multidimensional review of a person's ability to remain
independent and in the least restrictive living arrangement. DOEA I"orm 70 1 B is used by case managers to conduct the
functional assessment.
Memory Disorder Clinic: Research oriented programs created pursuant to Sections 430,502(l) ,and (2),, F.S., to provide
diagnostic and referral services,conduct basic and service-related rnultidisciplinary 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 quality 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
lielp 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.
FloridallealtliFiiider.gov provides all 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;
it. 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
AD[ client and caregiver.
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B. GENERAL DESICRIPTION
1. 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 AD] 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(I ode
b. Sections 430.501 through 430.504, F.S.
c. The Catalog of State Financial Assistance(1CSF`A)Numbers are 65004 and 65002
4. Scope of Services
The Provider is responsible for the programmatic,fiscal and operational management of ADI.The services shall be provided
in a manner consistent with and described in the Providers Service Provider Application(SPA)as submitted with the 2019
RFP, and any revisions thereto approved by the AAA, and the current DOEA Progranis and Services I landbook and all
subsequent atinerldnients,and revisions to the I landbook,which are hereby incorporated by reference.In the event of conflict
between the SPA and the Handbook, the I landbook prevails.
'File Provider is responsible for adherence to the4 Area Plan and any arnen(finents to the Area Irian
C Clients to lie Serve(]
I. General Eligibility
The AD[ 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 Alzlieirner's Services Adult Day Care, be a participant who has a docurnented diagnosis of
Alzheimer's disease or a dementia-related disorder(ADRD) front a licensed physician, licensed physician assistant, or
a licensed advanced registered nurse practitioner: and
c. Not be enrolled in any N/ledicaid capiitated long-tern care program,
3. Targeted Groups
Priority for services provided under this contract shall be given to those eligible pet-sons assessed to be at risk of placement
ill all institution.
SE(I I TIONIL MANNER OF SERVICE PROVISION
A. Service'Vasks
To achieve the goals of the ADI program, the Provider shall perform, or ensure that its subcontractors perforni, the following
tasks:
1. Client Eligibility. Determination
The Provider shall ellSUre that applicant data is evaluated to determine eligibility. Eligibility to becorne a client is based oil
meeting the requirements described in Section I.C.2.
2. Assessment and Prioritization of Service Delivery for New Clients
The 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 fi-orn 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(1)months.
b. Service: priority for individuals not included above, regardless of referral source, will be determined through the
Department's ffinctional 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 I.Jmits
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
'File 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
"rhe 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 I landbook,
3. Service Times
The Providcr 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 Friclay,8:00 a.m.to 5:00 p.nl.
local tine.
4. I..)se of Subcontractors
if this contract involves the use of 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
ontract 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.
1). Monitoring the Performance of Subcontractors
The Provider shall monitor, at least once per fiscal year, each of its subcontractors, SUbrecipients, vendors, and/or
consultants paid from funds provided Under this contract. The Provider shall perform fiscal, admiliistrative, 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 tnet,the scope or work is accomplished within the specified tinie 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 issited to the Subcontractors, Subrecipients.Vendors,and/or Consultants.
C. Deliverables
The following section provides the specific quantifiable units of defiverables,and source dOCUIlleritation required to evidence the
completion of the tasks specified in this contract.
I. 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
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current DOEA I landbook, which is incorporated by reference, and Section II.A.of this contract. Documentation of service
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 calCLdHti011S that equal the total invoice amount.The C011tilILIL1111 Of Services provided
under this contract include those identified by tile following service categories:
Respite and Other Services
(I)Caregiver Training/Support.
(2)Case Aide,
(3)Case Management.
(4)Counseling(Gerontological).
(5)Counseling(Mental Health/Screening).
(6)EdUcation/Training.
(7)Horne Delivered Meals.
(8)Housing Improvement.
(9) Material Aid,
(10) Respite(I"acility-Based).
(I I) Respite(In-Florne).
(12) Respite(In-Facility, Specialized Alzheimer's services)
(13) Speciahzed Medical Equipment,Services,and Supplies; and
(14)Transportation.
2. Services and Units of Service
The Provider shall ensure that the provision of set-vices described in this contract is in accordance With tile current DOE-'A
Handbook and the set-vice tasks described in Section II.A. 'file Budget Summary (Attachment VII) lists the services that
call be performed, the reinibursenient unit rate,the method of payment, and the service unit type. Units of service will be
paid pursuant to tile Budget Suniniary(Attachnient VII).
3. Administrative Responsibilities
The Provider shall provide nianagerrient and oversight of AD] prcigrarn Operations in accordance with the Current DOER
Handbook, Management and oversight of AD] 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 progranunatic and fiscal compliance.
d. Appropriately submit jXlynlCntS 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 ill Services that require the grievance process as described
in Appendix D,Department ofEider Affairs Programs and Services Handbook."file complaint procedures shall include
notification to all clients of the cornpiaint procedure and include tracking the date, nature of complaint, and the
determination of each complaint.
f Ensure compliance with Client information and Rei jstration 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 within five (5) bLISiness days to tile Alliance's request for routine and/or special requests for
information and ad lioc reports. The Provider Must establish due dates for any subcontractors that permit the Provided-to Meet
the Alliance's reporting requirements.
1. Service Cost Report(SCR):
The Provider shall submit a SCR to the Alliance annually no later than ninety (90) calendar days after the Provider Fiscal
Year end. The SCR shall reflect actual costs of providing each service by prograrn 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 cCIRTS data accuracy,, the Provider
shall adhere to the Alliance's eCIRTS Data Integrity Policy and Use eCIRTS-generated reports whichinclude the following:
a. Client Reports;
b. Monitoring Reports,
c. Service Reports;
d. Miscellaneous Reports;
e. Fiscal Reports; and
1'. 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 Conti-act
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 tile 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 ill the
Alliance Policies, incorporated here by referernee,I will be resolved.
In accordance with Alliance surplus/deficit management policies, in order to maximize available funding and minimize the
tinie that potential clients must wait for set-vices,the Alliance in its sole discretion can reduce funding awards if the Provider
is not within the Alliance policy surplus allowance.
4. Co-Pay C'ollections Report
The Provider shall submit a consolidated annual co-payment collections report to the Alliance Contract Manager by July
3 1,2025.using Attachment 5, located in Appendix B of the Programs and Set-vices Handbook.
5, Program Highlights
The Provider shall submit Program Highlights referencing specific events that, occurred in the previous fiscal year by
September 15(h of the current contract year, The Provider shall provide a new success story,quote,tcsfirrionial,Or human-
interest vignette. The highlights shall be written Im a general audience, with no acronyms cr technical terms, For all
agencies or organizations that are referenced in the highlight,the Provider shall provide a briet'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. REC.ORDS AND DOC'UNIENTATION
The Provider will ensure tile collection and maintenance of client and service information oil a monthly basis from the Client
Information and Registration Tracking System (eC I IRTS). 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, tile
Department,or other authorized agencies and individuals such as the Florida Department of Financial Services(DFS), Up011
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.
I Data Integrity and Back up Procedures:
The Provider shall anticipate and prepare for the loss of information processing capabilities.The routine backing up of afl
data and software is required to recover front losses or Outages of the computer system. Data and software essential to the
continued operation of Provider functions niust be backed up. The security controls over the backup resources shall be as
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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,off'site location.
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 niade available to tile Alliance upon request,
F. PERFORMANCE SPECIFICATIONS
I. Outcomes
a. Ensure the provision of the services described in this contract are in accordance With the Current DOEA
Handbook and Section I LC of this contract;
b. The Provider shall timely submit to the Alliance all reports described in Section. ILL of this contract;
b. The Provider shall maintain all information described in Section H.E.of this contract;
d. Tile Provider shall ensure the prioritization and service provision of clients in accordance with Section ll.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 V1 It of this contract.
2. C"i-itet-hi
The performance of the Provider in providing the set-vices described in this contract shall be measured by the current SPA
strategies for the following criteria:
a. Pei-cent of APS refierrals who are in need of immediate services to prevent f1ullier 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 i lite rvent loll (as
determined by tile caregiver and the assessor);
h. Percent of most frail elders NA(lio,remain at home or in the community instead of going into a nursing borne;.
j. Percentage of active clients eating two or more meals Pei-day;
1. After set-vice 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 Section H.F.2. above will be reviewed and documented in tile 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 tile service tasks and deliverables. Tile Alliance May use, but is not limited to,
one or more of the following methods for monitoring:
a. D,esk reviews and analytical reviews;
b. Scheduled,Unscheduled, and follow-up on-site visits;
c. Client visits;
cl. Review of independent auditor's reports;
e. Review of third-party documents and/or evaluation;
f. Review of progress reports;
g. Review Of Customer satisfaction surveys-,
h. Agreed-upon procedures review by all external auditor or consultant;
i. Limited-scope reviews;and
J. Other procedures as deemed necessary.
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G. Provider Responsibilities:
1. Provider Accotmitability
All service tasks and deliverables purstiant to this contract are solely and exclusively the responsibility of the Provider and
are tasks and deliverables for which, by eXeCLIti011 of this contract,the Provider agrees to be held accountable.
2. Coordination with Other Providers and/or rntities
Notwithstanding those services for which the Provider is held accountable involve coordination kvith other entities in
performing the requirements of this contract, the failure of other entities does not alleviate the Provider frorn any
accountability for tasks or set-vices that the Provider is obligated to perform pursuant to this contract.
3. The Provider Understands that its contracted funding for Access and Coordination of Service is based oil a predetermined
niontlily average caseload of 4 and a Pet,Member Pei,Month (PMPM)rate of$1,331.76 for the Access and Coordination of
Services and for all services contracted to be provided under this contract.
In order to ensure all funding is maximized to serve as many cIients,as possible, Provider agrees,to maintain the average
monthly active caseload as per Section 4 of this contract and an average PMPN/I rate for all services including the Access
and oordination Services(Case Management)as stated in the above paragraph Further,the Provider Understand and
agrees that the A Iliance will review a monthly Surplus Deficit Report for each CC E provider and a consolidated PSA-wide
Surplus Deficit Report. Should funding be in a surplus Situation due to caseload variances, insufficient PMPNII, or other
reasons, the Alliance may de-obligate funding from Provider as per the Alliance policy incorporated here by reference,
H. Alliance for Aging Responsibilities
1, Alliance Obligations;
The Alliance may provide technical SUPPOrt and assistance to the Provider within the resources of the Alliance to assist
the provider in ineeting the required tasks in the above Section 11.
1 Alliance Deterniinations:
The Alliance reserves the exclusive right to inake certain cleterillinations in the tasks and approaches. The absence of the
Alliance setting forth a specific reservation of rights does not mean that all other areas ofthe contract are subject to InUtual
agreement.
SECTION III. NI ET 1-10 D OF P A YNI E NT
A Payment Methods Used
The method of payment for this contract is a combination of fixed fee/unit rate, cost reimbursement, and advance payments,
subject to the availability of funds mid Provider performance. The Alliance will pay the Provider upon satisfactory completion
of the Tasks/Deliverables, as specified in Section [L, Manner of Set-vice Provision, and in accordance with other terms and
conditions of this contract.
1. Fixed Fee/Unit Rate
Payments for I`ixed 1,ee/[Jtiit Rate shall not exceed amounts established in Attachment VII,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 VIL All Cost Reimbursement Requests for Payment niust include the Receipt and Expenditure Report,
beginning with(lie first nionth of this contract.
:a. Advance Payments:
Non-profit Providers may request a monthly advance for service costs for each of the first two nionths,of the contract period,
based on anticipated cash needs. For the first month's advance request, the Provider shall provide to the Alliance
docurnentation justifying the need for an advance and describing lie", the funds will be distributed. If' the Provider is
requesting two(2) months of advances, docurnentation must be provided reflecting the cash needs of the Provider within
the initial two (2) nionths 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 fluids
will be distributed for the first and second month. If sufficient budget is available,and the Department's Contract Manager,
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in his Or her sole discretion, has d etc rnii tied that there is justified need for all advance,the Department will is s Lie approved
advance payments after July I st of the contract year.
All advance payments made to tile Provider shall be reimbursed to the Alliance as fol tows: At least one—tenth of tile advance
payment received shall be reported as all advance MCOUpluent On each Request for Payment(Attachment IX),starting with
the invoice submission ofthe third mouth activities and billing,in accordance with the Invoice Report Schedule(Attachment
vlll).
B. Method of Invoice Payment
Payment shall be made upon the Provider's presentation of all illVOiCC 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:
1, Request payment on a monthly basis tor the units of services established in this contract, provided in conformance with the
requirements as described in the DOER Programs and Services Handbook, and at the rates established in Attachment it
of the contract. Documentation of service defivery Must include a report consisting of the following: number of clients
served, number Of Service units provided by service, and rate per service Linit 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 tbri-ris Request for Payment (Attachment IX), Receipt arid Expenditure
Reports(Attachment X)for Case Management and Special Subsidy Services.
3. All Requests for Payment shall be based on the submission ofniontlily Expenditure Reports beginning with the first month
of1he contract.Tile schedule for submission of advance requests and invoices is Invoice Schedule, Attachment VIII;
4, In (lie 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 clays after the month in which the expense was incurred will
require approval of tile contract manager prior to the billing Of Such incurred expenses. Late service billing requests will
not be paid unlessJustification is submitted and approved by the contract manager;
5 *file 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 all annual appropriation by the Legislature, and subject
to tile 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
Departnient 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 tile final ReCIUCSt for Payment to the Alliance no later than 30 days after the contract period ends and
as referenced in Attachment VIII.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 tile 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
DOJEA 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. 'file Provider shall establish deadlines for completing eCIRTS
data entry and to assure coniphance with due dates for the requests for payment and expenditure reports that Provider must
submit to the Alliance.
F. Providers' Monthly eCIRTS Reports
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Tile Provider Must rLfll Monthly eCIRTs reports and verify client and service data in the eCIRTS is accurate. This report must
be Submitted to the Alliance with tile 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 tile Alliance.
G. Consequences of No"-Compliance:
Should it be determined that the Provider is found to not be incompliance with any deliverables,aspects or requirements of
this contract, the Alliance may employ any or all of the following consequences:
I Require a Corrective Action Plan (CAP)
a. If at any time the Provider is notified by the Alliance's Contract Manager that it has failed to correctly, completely,
and/or adequately perform contract deliverables identified in Section 1I.0 and HID, or any other contractual
requirements ofthis contract,the Provider will have ten(10)business days to submit a CAP to the Alliance's Contract
Manager that addresses the deficiencies and states how the deficiencies will be remedied Nvithin the time approved by
the: Alliance's Contract Manager. The Alliance may assess a Financial Consequence for Non-Compliance oil tile
Contractor as referenced in Section III.G.2. of this contract for each deficiency identified in the CAP which is not
corrected pursuant to the CAP. The Alliance may also assess to financial consequence for failure to timely submit a
CAP.
b. If tile Provider fails to correct an identified deficiency within the approved time specified in the CAP, tile Alliance
may deduct a financial consequence established in Section I I I.G.2. of this contract from the payment for the invoice
of the following month,
c, Ifthe Provider fitilS to timely submit a CAP,the Alliance shall deduct the amount established in Section HI.G.2 of this
contract. The deduction will be trade from the payment for the invoice ofthe following month(s),
d, Failure to submit a CAP may result in contract termination.
2, Financial Consequences
a. Failure to submit a CAP timely may result in a financial penalty up to the lower of$25,000 or 51!1a of the Provider
Contract amount and may, be calculated on the totality of all Alliance funded contracts,depending on the area of non-
compliance.
b. Failure to Correct all identified deficiency may result in a financial penalty UP to the lower of$25,0100 or 5%of the
Provider Contract amount and may be calculated oil the totality of all Alliance funded contracts related to the
deficiency,depending on the area of non-compliance.
c. Failure to comply with established assessment and prioritization criteria as per Section II.A and as evidenced by
cC.IRTS reports may result in a financial penalty of the lower of$25,000 or 5%0 and may be calculated oil the totality
of all related Alliance funded contracts, depending oil tile area of compliance. A second offense may result in a
financial C01lSetjUe1lCe of tile lower of$50,000 or lamer and may be calculated oil the totality of related alliance ftnided
contracts.
d. failure to provide set-vices in accordance With tile CLU'rCrit DO :AHandbook, the service tasks described in Section
ILA., and the Budget summary (Attachment XII), and/or failure to SUbillit required documentation may result in a
result in a financial penalty of the lower ofS25,000 or 5%and may be calculated on the totality of all related Alliance
funded contracts,depending oil the area of conip]iance.A second offense may result in a financial consequence of tile
lower of$50,000 or 10%and may be calculated oil the totality of related Alliance funded contracts.
e. Failure to perform management and oversight of the CC E Program operations may result in a financial consequence
of the lower of$501,000 or 10%and may be calculated oil the totality of related Alliance funded contracts.
Ili'. 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 tile cost for all ADI services. The match will be made in the
form of cash and/or 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-finided program.
2. Cost Sharing and Co-payrnents:
The Provider in conJunction with the Alliance shall establish an annual co-payment goal (amount to be Collected frorn
chents). 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-payrnents collected in the
ADI program call be used as part of the local match.
3. Management and Use of Service Dollars and Continuity ol'Service:
a. The Provider is expected to spend all fluids provided by the Alliance for the purpose specified in this contract. The
Provider inust manage the service dollars in such a manner so as to avoid having a surplus of funds at the end of tile
contract period. If the Alliance determines that tile 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. Tile Provider shall ensure that contract services will be provided until tire 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
Alliance has established a spending authority as identified in Budget Summary, Attachment VII. Tile Provider is
responsible for managing the spending authority so that a continuity of service can be maintained for the maxitnUrn
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 oil services and rate detailed in the SPA and the Budget Summary,
Attachment VII and any revisions thereto approved by the Alliance. Any changes in the total amounts of the funds identified
oil the Budget Suniniary require a contract amendment.
B. Remedies for Nonconforming Services
1. The Provider shall ensure that all goods and/or services provided under this contract are delivered timely, completely and
C011111lerISM-ate with required standards of quality. Such goods and/or services will only be delivered to eligible program
participants.
2. If tile 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 horne 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 noncowforming goods and/or services.The Alliance requires immediate notice ofany 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 tile Department oil the Alliance
Should the provider be at 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 11 of this contract — Failure to Comply
with established assessment and prioritization criteria as evidenced by eCRITS reports.
b. Sen ices and units of services as referenced in Attachment 1,Section It of this contract—Failure to provider services in
accordance with the current DEOA Handbook
c. Administrative duties as referenced in Attachment 1, 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 our the part of the Provider or any Subcontractors and referred to a governmental or
investigatory agency nILISt be sent to the Alliance which will in turn forward the information to the Department. I f the Alliance
has reason to believe that tile allegations will be referred to the State Attorney, a law enforcement agency, the United 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 arid 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 parr VOILuItCers or participants (SLICh 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 1, Section I V.A.3.a of this contract.
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ATTACHMENT11
CERTIFICATIONS AND ASSURANCES
The Alliance twill not award this contract unless Provider completes the CM11FICATIONS AND ASSURANCES contained in this
Attachment, lnI)et-foi-matice cif this cotitract, Providei pi,ovides the folioNviiig certifications acid asstti-ai,ices:
A. Debarment and Suspension Certification(29 CFR Part 95 and 2 CFR Part 200)
B. C'ertification Rej!ardin2 Lo1b1bjina_(29_CFR_Part 93 and 45,CF,RPart 93)
C. Nondiscrimination& Equal OpUortunity Assurance(29 CFR Part 37 and 45 CFR Part 8(I)
D. Certification Regarding Public Entity Crimes,section 287.133, F.S.
E. Association of Community Organizations for Reform Now(ACORN) Ftiridina_Restrictions Assurance(Pub._L.
111-117)
F. Certification Regarding Scrutinized Companies Lists,section,287.135, F.S.
G. Certification Regardinj! Data Inte2rity Compliance for AgreE ments. Grants, Loans And Cooperative
A&MMOLS
F1. Verification of EmLfloyrnertt Status Certification
1. Records and Documentation
1 Certification Regarding Inspection of Public Records
A. CL11TIFICATION REGARDING DERARNIEN't',SUSPENSION,AND OTHER RESPONSIBILITY MATTERS -
PRIMARY COVERED,TRANSAc'rION.
The undersigned Provider certifies to the best of its knowledge and belief,that it and its principals:
L Are not presently debarred, suspended,proposed for debarment,declared ineligible,or voluntarily excluded from covered
transactions by Federal department or agency;
2, Have not within a three-year period preceding this Contract been convicted or had a civil judgment rendered against therm
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 public transaction; violation of Federal or State antiti-LiSt statutes Or
commission of embezzlement,theft, forgery bribery, falsification or de traction ofrecords,making false statements,or
receiving stolen property;
3. Are not presently indicted or otherwise criininally or civilly charged by a government entity (Federal,State or local)with
commission ofany of the offenses enUrnerated 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 CaUSC of default.
K CERTIFICATION REGARDING LOBBYING -Certification for Contracts,Grants, Loans,and Cooperative
Agreements.
The undersigned Provider certifies,to the best of its knowledge and belief,that:
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 ran 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 tire extension,continuation, renewal,amendment or modification of any Federal contract,grant,
loan or cooperative agreement.
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(D
If any funds other than Federal appropriated funds have been paid or will be paid to any pet-soil for illfILICIlCing Or attenlpting to
influence an officer or employee of any agency,a Member of Congress,an officer or employees of Congress,or employee of a
Mernber of Congress in connection with a Federal contract,grant, loan,or cooperative agreement,tile undersigned slialf 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,submgrants 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 Nvas placed when this Contract Nvas made or entered
into. Submission of this certification is a prerequisite for making or entering into this Contract imposed by 31 U.S.C. 1351 Any
person who fails to file file required certification shall be Subject to a civil penalty of not less than$10,000 and not more than
$1 00,O00 for each SUCII 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 oaf either citizenship/status as a lawfully admitted immigrant authorized to
work in the United States or participation in any WfA Title 1-financially assisted program or activity;
2. Title VI of the Civil Rights Act of 1964 (Pub. L. 88-352),as arnerided,and all requirements imposed by or PUBLiant to the
Regulation of the Department of Health and Human Services(45 Cf`R 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 fi-oill participation in, be denied tile benefits of,or be otherwise subjected to discrimination under any program or
activity for which the Applicant receives Federal financial assistance frorn the Alliance.
3. Section 504 of file Rehabilitation Act of'1973 ([)Lib.L. 93-112)as amended, and all requirements imposed by Or PLIA-SLiant to
the Regulation of the Department ofl lealth and HUrnan 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 liandicap, be excluded frorn 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 file
Regulation of the Department of Health and Human Set-vices(45 CFR Part 91),to the eild 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 Y'.1ducational Amendments of 1972 (Pub. L.92-3 18),as amended,and all reqUirenients 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 Nvitli Title IX and the Regulation,no person in the tJnited States shall,on the basis of sex, be excluded from
participation in, be denied file benefits of;or be otherwise subjected to discrimination Linder 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. I_ 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;
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 WIA 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.
1). CERTIFICATION REGARDING PUBLIC ENTITY CRIMES,SECTION 287.133,F.S.
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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 oil the convicted vendor list.
Provider understands and agrees that it is required to inform DOE . immediately upon any change Of circumstances regarding
this status,
E. ASSOCIATION OF COMMUNITY ORGANIZATIONS FOR REFORM NOW(ACC RN)FIJNI)jNG
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 1 Q1, Division E,Section 511 (Pub. L. I I 1-117). The
Continuing Appropriations Act, 2011, Sections 1011 and 103 (Pub. 1— 111-242), provides that appropriations made tinder Pub.
L. I I 1-117 are available Under the conditions provided by Pub. L. I I 1-117.
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 tinder grants, loans and cooperative agreements)and that all sub recipients
and Providers shall provide this assurance accordingly.
F. SCRUTINIZED COMPANIES) J[11ISTS CERTIFICAITON,SE(r..J,[ON 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.
Ifthis Contract is in the anlount of$1 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 ofa false certification inay result in the Alliance
and/or Department terminating this contract and the submission ofa 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 (r17OMPLIANCE FOR AGREEMENTS,GRANTS, LOANS,
AND COOPERATIVE AGREEMENTS
L The Provider and any Subcontractors of services tinder this contract have financial management systems capable of
providing certain information, including: (1)accurate, current,and complete disclosure of the financial results of cacti
grant-ftinded 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 cacti 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 property.
2. Management Information Systems used by the Provider, Subcontractors, or any outside entity oil 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 tuidersigned)and I)Urchased by the state will be verified for
accuracy and integrity of data prior to transfer.
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 property,the Provider agrees to immediately make required corrections to
restore hardware and software progranis to the same level of fitrictionality as warranted herein, at no charge to tile state,
and without interruption to the ongoing business Of the State,time being of the essence.
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5. File Provider and any Subcontractors of'services under this contract warrant their policies icies and pi-ccedures include a disaster
plan to provide for service delivery to COntirILIC in case of an emergency including emergencies arising hrorn data integrity
compliance issues,
IL VERIFICATION OF EMPLOYMENT STATUS CERTIFIC'ATION
As a condition of contracting%vitli the Alliance, Provider certifies the rise of the U.S. Department off loincland,Security's E-
verify system to verify the employment eligibility ofall new employees hired by Provider during the Contract term to perform
eniployrnent duties pursuant to this Contract and that any subcontracis include an express requirement that Subcontractors
performing work or providing services pursuant to this Agreement utilize the F-vcrify systein to verily the employment
eligibility of all new employees hired by the SUbcontiraclor during the entire contract term,
I. RECORDS AND DOCUMENTATION
Fite Provider shalt make available to the Alliance and the Department staff and/or any party designated by the Alhance and the
Department any and all contract related records and documentation.The Provider shall ensure the collection and maintenance
of all program related int6nnalion and documentation on any such system designated by the Alliance and the Department,
Mainlenance includes accurate and current data,and valid exports and backups ofall data and systems according to
Department standards.
J. CERTIFICATION RLGARDING INSPECTION OF' PUBLIC RECORDS
1. In addition to the requirements of section 9 of this contract,and 119.0701(.3)and(4)F&,and any other applicable la%v, ifa
civil action is Commenced as contempkitc(I by Section 119.070 1(4),F.S.,and the Alliance and/or Department it'Elder
Affairs is nanied in the civil action. Provider agrees to indemnify and hold harmless tire Alliance and/or Department for kury
costs incurred [)y the Alliance and/or Department,and any attorneys" fees assessed or awarded against tire Alliance and/or
Department fironi,a Public Records Request ninde pursuant to Chapter 119,F.S., concerning this contract or Services
performed thereunder.
1 Section 1 19.01(31), l,,S,,states it'public Funds are expended by an agency in payinent of dues or membership contributions
for any person,corporation, foundation, trust, association,group,or other organization,all the financial, business,and
membership records of sirch an entity which pertain to the public agency,(Horida Department of Elder Affairs)are
pablic records. Section 119.07, F.S,states that every person %Vho has custody of such a pLiblic 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 cerlification be included in all sub agreements.subgrants,and other
agreements and that all Subcontractors shah m 6(v coniphance accordin- y,
This certification is a material representation of(tact upon which reliance seas placed when this trans"IcHon %%as illade or entered.
into. Submission of this certification is a prerequisite R)r making or entering irrtcr this transaction iniposed by 01VIB Circulars A-
102 and 2 CFR Part 2001(formerly ON113 Circular A-I 10).
fly signing belo%v, Provider certifies time representations outlined in parts,A 1hidongh i above are true and correct.
(I Represent,
NROAOV P COU, ArrOnNEY
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-ovider I-Xite sew
PEDI, UUTYCA9G---
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Street Address)
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e,tip code
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ATTACHMENT ILL
FINANCIAL AND COMPLIANCE ALtDIT
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 of-the I"lorida 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, and/or other procedures. By entering into this
agreement, the Provider agrees to comply and cooperate with any monitoring procedures/processes deemed appropriate by the
Alliance of- 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 Nvith 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))of-Auditor General.
AI1DITS
PART 1: FEDERALLY FtJNDED
This part is applicable if the Provider is a State or.local government of,a non-profit organization as defined in OVIB 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 III List have a single or
program-specificaUdit conducted in accordance with the provisions of0MB Cit-CLIJar A-133,as revised. I"XIHBIT I to this agreement
indicates federal resources awarded through the Department of Eider 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 of,the Department of Elder Affairs. The determination of aniounts of federal awards expended should be
in accordance with the guidelines established by OMB Circular A-1 13,as revised. An audit of the Provider conducted by the Auditor.
General in accordance with the provisions of OM13 Circular A-]33,as revised, will meet the requirements of this part.
In connection with the audit reqUirernerns 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-133,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
of0VIB 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-1 13,as revised,the cost of the
audit must be paid fi,oni non-federal resources(i.e., the cost of such audit must be paid from Provider MSOUrCeS 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. Comp Hance
findings related to agreements with the Alliance for Aging,Inc.shall be based on the agreement's requirements,including any rules,
regulations,01'statutes referenced in the agreement. The financial statements shall disclose whether of,not the matching re(ILfirement
was met for each applicable agreement. A]I questioned costs and liabilities due to the Alliance for Aging, Inc. shall be fully disclosed
iiitiieatiditrepoi-t%vitlij,efei,eilcetotlieAlliaiicefc)rAgiiig,liic.agreeiiieiitiiivolved, Iftiototherwise disclosed as required by Section
31 O(b)(2)of OMB Circular A-13 3,as revised,the schedule of expendi ILI res 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 ofthe Provider's
fiscal year end.
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PART ]I: STATE FUNDED
This part is applicable ifthe Provider is 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 5750,000 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 ill accordance with Section 215.97,Florida Statutes;applicable rules of the Department of inancial Services;
and Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and for-profit organizations), Rules of the Alldiw 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 inatching reqUireinClItS.
In connection with the audit requirements addressed in Part 11, paragraph 1;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'10,2004
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).
Ali 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 niet for
each applicable agreement. All qLJCStioncd 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. Nora-profit or Par-profit organizations are required to be submitted within 45 days after delivery ofthe
audit report, but 110 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 ofthis agreement
as outlined throughout this document and Pursuant to law.
PARTIM. REPORTSURMISSION
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),ON/M OrUllalA-133,as revised,by or on behalfofthc Provider
&g!ctl to each of the following:
The Alliance for Aging,Inc:. at each of the hallowing addresses:
Alliance for Aging, Inc.
Attn: Fiscal Monitor.
760 NW 107"Ave.Suite 214
Miami, FL 33172-3155
The Federal Audit Ocaringliouse designated in OMB Circular A-133,as revised(tile number of copies required by Sections .320 (d)
I)and(2),ONIB 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 101"Street
Jeffersonville,IN 47132
Other federal agencies and pass-through entities in accordance with Sections .320(e)and(f),OMB Circular A-13,3,as revised.
Page 34 of 60
0)
00
Pursuant to Sections 120(f),OMB Oren I ar A-133),as revised,the Provider shall submit acopy of the reporting package described in
Section 320(c), OMB Circular A-] 13, 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
76,0 NW 10711,Ave.Suite 214
Miami,FL.33172-31550
Additionally, copies of financial reporting packages required by Part 11 of this agreement shall be submitted by or on behalf of the
Provider directly to each of the fallowing:
'I'lie Alliance for Aging, Inc. at each of the following addresses:
Alliance for Aging, Inc.
Attn: Fiscal Monitor
760 NIA' 107"' Ave,Suite 214
Miarni, FL.33172-3155
The Auditor General's Office at the following address:
State of Florida Auditor General
(.1aude Pepper Building,Room 574
111 West Madison Strect
J'allahassee, Florida 32399-1450
Any reports, management letter, or other information required to be submitted to the Alliance for Aging, 111C. PUrSUMIt to this
Z�
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: RE('ORD REJ'ENTJON
The Provider shall retain sufficient records demonstrating its compliance with the terms of this agreement for a period of six years
fi-orn the date the audit report is issued,and shall allow the Alliance for Aging,Inc.Or its designee,the CFO or Auditor Gencral 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 UpOu request for a period of six years from the(late the audit
report is issued, unless extended in writing by the Alliance for Aging, Inc.
Page 35 ol'60
C)
A'ITACUIMENTIII
EXHIBIT— 1
1 STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS AGRELMENT CONSIST OF THE
FOLLOWING:
MATCHING RESOURCES FOR FEDERAL PROGRAMS
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
-
TOTAL STATE AWARD —T so I
STATE FINANCIAL ASSISTANCE SUBJECT TO Sec.215.97, F.S.
PROGRAM TITLE FUNDING SOURCE CSFA ANIOUNT
Atzheirner's Disease Initiative Program General RevellLIC 65.002 S63,924,48
TOTAL AWARD $63,924.48
COMPLIANCE REQUIREMENTS APPLICABLE To STATE RESOURCES AWARDED PURSUANT TO TIIIS
AGREEMENT ARE AS FOLLOWS:
State Financial Assistance
Section 215.97 F.S.
C'hapter 691-5 Fla. Administrative Code
Page 36 of 60
ATTACHMENT III
EXHIBIT-2
PART 1: AUDIT RELATIONSHIP DETERMINATION
Providers who receive state or federal resources may or inay not be subject to the audit requirements of ON/113 Circular A-1313, as
revised, an&or s. 215.97, Fla. Stat. Providers who are determined to be recipients or sub-recipients of federal awards and/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 [lot subject to the audit requirements of OMB Circular A-
t 113,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 and/or state Financial assistance must comply with applicable programmatic and
fiscal compliance requirements.
In accordance with See.210 of ON113 Circular A-133 and/or Rule 691-5,006, FAC,Provider has been determined to be:
Vendor or exempt entity and not subject to ON1113 Circular Am 133 and/or s. 215.97,F.S.
Recipient/SUb-i-ecipient subject to OMB Circular A-133 and/or s. 2 15.97, 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/sub-recipient of federal and or state financial assistance and has been approved
by tile Department to subcontract,they MUSt comply with s. 215.97(7)1, F.S., and Rule 691-.006(2), FAC[state financial assistance]
and Section A00 O1v113 Circular A-133 ]federal awards].
PANT II: FISCAL COMPLIANCE REQUIREMENTS
FEDERAL AWARDS OR STATE MATCHING FUNDS ON FEDERAL AWARDS. Providers whc) receive federal awards or
state matching funds oil 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 M UST 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 ExpenclitUMS
Other fiscal requirements set'forth in program laws, rules and regulations
NON-PROFIT ORGANIZATIONS MUST FOLLOW:
2 CFR Part 2110 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-1 3)J—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 Pail 220 Cost Principles for Educational Institutions OMB(Formerly Circular A-21 —Cost Principles)*
2 CFR Part 215 Administrative Requirements(Formerly OMB Circular A-]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 37 ot'60
C14
A-1.1.1 Compliance Supplement, Appendix 1,
STATE FINANCIAL Assis,rANCE. 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, I-']a. Stat.
Chapter 691-5, Fla. Admin.Code
State Projects Compliance SUPpIeMeDt
Reference Guide for State Expenditures
Other fiscal reqUirements set forth in program laws, I'LlIes and regulations
THE REST OF THIS PAGE WAS LEFT BLANK INTENTIONALLY
Page 38 of 60
ATTACIIMENTVI
ASSLIIZANCES'--NON-CONS'I'RIJC'I'ION PROGRAMS
Public reporting burden for this collection of information is estimated to average45 minutes per response,inClUdingfirne 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 Nye 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. 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 ofthe
pro.ject described in this application.
2. Will give the awarding agency,the Comptroller General ofthe 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,
1 Will establish safeguards to prohibit employees from Using their positions for a Purpose that constitutes or presents the appearance
ofpci-sonal or organizational conflict of interest,or personal gain.
4. Will initiate and complete the work within the applicable time frarne after receipt of approval ofthe awarding agency.
5. Will comply with the Intergovernmental Personnel Act of 1 970 (42 U. S.C. 4728-4763) relating to prescribed standards for
merit Systerns for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPM's Standards for a
Met-it 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 ofthe 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 ofsex; (c)Section 504 ofthe Rehabilitation Act of 1973,as amended(29 U.S.C. 794),which prohibits discrimination oil
the basis of handicaps; (d) the Age Discrimination Act of 1975, as amencled (42 U.S.C 6101-6107), which prohibits
discrimination on the basis ofage,- (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(PJ_ 91-616),as amended,relating to nondiscrimination on the basis of alcohol abuse or alcoholism;
(g) 523 and 5,27 of the Public Health Service Act of 1912 (42 U&C. 290 dd-3 and 290 ee 3), as amended, relating to
confidentiality of alcohol and drug abuse patient records; (h) Title VI H of the Civil Rights Act of 1968 (42 tJ,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 (j)the requirernentsofany
other nondiscrimination statutes)which may apply to the application.
7. Will comply, or has already complied, with the requirements of Titles 11 and III ofthe uniforni 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 ait interests in real
property acquired for project purposes regardless of federal participation in purchases.
8. Will comply, as applicable, with the provisions of the Hatch Act (5 US.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 ofthe Davis-Bacon Act (40 U.S.C. 276a to 276a-7), the Copeland Act (40
LJ.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 39 of 60
10. Will comply, if applicable,N,vith flood insurance PUrChaSe NCILlil-ClIlellIS Of Section 102(a)of the Flood Disastes 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 it'the total cost of,insurable construction and acquisition is$10,000 or'111101'e,
11. Will comply with environsuental standards which may be prescribed pursuant to the following: (a) illStitl,lt ion Of ell Vironnientaf
quality control measures under the National Envirornalental Policy Act of 1969(111. 91-190)and Executive Order(FO) 11514;
(b) notification of violating facilities pursuant to EO 11738;(c) protection of wetlands pursuarst to EO 11990;(d)evaluation of
flood hazards in floodplains in accordance with E0 11988; (e) assurance of proJecl Consistency with the approved State
management prograrn developed under the Coastal Zone Management Act of 1 972 (16 tJ,S.(', 1451 et seq.); (f)conformity
of federal actions to State(Clear Air)Implementation [,falls under Section 176(c)ofthe Clear An,Act of 1955,as amended (42
U.S.C. 7401 ct sc(l);(g)protection of' underground sources of drinking Nvater under the Safe Drinking Water Act Of'1974,
as amended,(II.L.93-523)�; and (10 protection ofendangered 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 l968 (116 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 I fistoric Preservation Act of 1966, as
amended(16 [J.Sk' 470), F'0 1 1593(identification and pr(,-aection of historic properties),and the Archaeological and I listoric
Preservation Act of 1974(16 U S.(-I', 469a-i et seq.).
14 Will comply with P,L.93-:148 regarding the protection of human subjects involved in research,development,and related activities
supported by this award of assistance.
15. Will comply with the haboralory Animal Welfare Act of 1966 (PI, 89-544, as amended, 7 U.S,C, 2 131 et seq.) pertaining
to the care, handling, and treatment of warm-blooded animals hold for rescarch, teaching, or other activities SUPINA-ted by this
award ofassistance.
16, Will cornlfly wins the Lead.-Based Paint Poisoning Prevention Act(42 U.S.C. 480l ct seq.), which prohibits the use ol']Qacl-
hased 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 Anicridnients
of 1996 and 0IMB Circufar No, A-1.33, Audits of'States, Local Governments,and Non-Profit Organi/ations.
18. Will compl), with all applicable requirements ot'all other federal laws, executive orders, regulations and policies governing this
program,
SIONATURFOF AI 'I tlaltwlll I7(TRI II YING 01IFFICIAL Tl I IT
CN
::IA. P'o-e-akbr 'zbocl�,4 Z)eruLC-t%
APPI ICANII 0ROA41/AH4YN DATT"SUR%fl F1 FD
Motwoe Comity Board of Coullity Conimissiolaell-s, Social I+
Services/In-Ito me Services
NROE COUNTY ATTOnNEY
7 ArPIOV EAtY7,FOPJ
A8916TOP. MdANTRY"AMMME;
Data-7/1/24
["age 40 of'60
LC)
ATTACHMENT V11
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
BUDGET SUMMARY
The Alliance shall make payment to the Provider for provision of services tip to a maximuni number of units of service and at the
rate(s)stated below:
Maximum
Service Unit Units of Maximum
Service to be Provided Date Service Dollars
Case Management $ 60.73 29 $ 1,760.45
Case Aide $ 15.00 1 $ 115.00
Respite Facility $ 10.96 4,,8,87 $ 53,561.40
Respite In-Hqme $ 24,22 352 $ 8,514.66
Specialized Medical Equipment Cost Reimb $ 72.97
ITotal $63,924.48
Page 41 of 60
cfl
L !
ATTACH MEN'FVI I I
ALZHEIMER'S DISEASE INITIATIVE
INVOICE REPORT SCHEDULE
Report Number Based On Submit to Alliance on
this Date
KZ24,97-ADV I Rdy Advance* July I
KZ2497'-ADV2 August Advance* July I
KZ2497-JUL July Expenditure Report August 8
KZ2497-AUfCT August Expenditure Report September 8
KZ2497-SINE' September Expenditure Report+ 1/10 advance reconciliation October 8
KZ2497-0('T October Expenditure Report+ I/10 advance reconciliation November 8
KZ2497-NOV November Expenditure Report 1 1/10 advance reconciliation December 8
KZ2497-DEC December 1.'xpendiftircRcport-r 1/10 advance i•eroiiciliaitioii January 8
KZ2497-JAN January Expenditure Report-+ 1/10 advance reconciliation February 8
KZ2497-FEB February Expenditure Report i I/10 advance reconciliation March 8
KZ2497-MAR March Expenditure Report + 1/10 advance reconciliation April 8
K7.2497-,APR April Expenditure Report + I/10 advance reconciliation May 8
KZ2497-MAY May Expenditure Report +- I/10 advance reconciliatiou June 8
KZ2497-JLJN June FNpenditure Report+ 1/10 advance reconciliation July 8
KZ2497-FIN Final Expenditure an(]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 #5. The adjustment shall be recorded in Pail C, Line I of'the report
(Attachment IX),
Note 2: Submission of expenditure reports may or may not generate a payment mqUCSt. If final expenditure
report reflects funds due back to the Alliance,payment is to accompany the report.
Page 42 of 60
ti
ATTACHMENT IX
REQUEST FOR PAYMENT
Form 106
AD)
Provider Name,Address,Phone# Type Of Report Corlractk
Prwder. Advance
Address Contract Period'.
Tellepho R-1111 b7l s-1---r-11 Report Penod
REPORTO
CERTIFICATION I hereby certify that this request or refund conforms w0i the terryis of the above contract.
Prepared Date_ Approved By, gate:______ ._
BUDGET SUMMARY ADI TOTAL
Appfowed Contract Am cunt o ola 000
Prevous Month Yll D Bifl.d 000 0,00
T kB) I I I
Prior Month Ending Contract Ballance 0 on,
................
Current Month Am aunt Billed 0 0 OD
Less Current hlonth AdvPaybark a no 0.00
Contracted Funds Requested for lvonM 0 00 0,00
CO-PAYMENITS CURRENT MONTH CONTRACTYTO Prior Mo.YTD
1 NLrmberofpersons assessed!Co-payments
2 Numbejr of persons tremmated for non-payment
3.Nurriber ofpersons w,w ed from terrain.for non-payrnent
4 Nurnbaralpersons wwwed from assessment
5.Number of persons exempt ftorn co-pay
6 TotM amounl of co-pay assessed
7 'rOtallAITuOLirolOfCO.-paycalldected
8,To ta J a rn a uh n t of ca-p a y e xp�e n d e d
PSA 911 At)]Forrrs Revised December 20�20
Page 43 of 60
00
Attaichiment X
RECEIPTS&UNIT COST REPORT
Form 1106
ADI
.. --............
RRQYIDER NA—ME—ADQ-ftkS5.._pHQNE# EUNQLNQ-SQUR-C9 THIS REPORT PERIOD:
0 AIDI Ccsiftact#: 10
0
Contract Peviud 0
0
Z.—P-Pel-It ............
REPORT# 10
9JkahUqADC2N- I cerli1y to the beat or my kn.Medge and befiel qhat This repoo:is MmPlWe and correct and a0M cu0ays herein are for purposes set fohr,in
the contract Further I cervy that the attached monthly and Y-TD sertce uniWunduplicated dier1s'reporl is corirecA
Prepared by Cate Approved by Date
INCOMEJRECEIPTS A Approwd Budget B. AcWai Totall BHHng C. Total BiNing D %rap Apprmed
fior Iha report Year to Cate Budget Pfior Mo.Receipts YTO
State Funds S - S ODIVIV
Poogmnn lnuorne
Cash March
SUBTOTAL Cash Receipts S
LocaV In-Kind rnatch S0.00
'fr OTAL RECEtPI'S KOO S S
-ff 81 ahJA�Qtl�i C(h!.Rq.P.Qr! Unduv�lcaked C�ILents erved
k- A...
QA) iB) (E (F)i (A (Bb
serwces Cordrac.¢ Biltable Unt Rate, Ar-noun a ed Y-r-D Y-T-D Current Month Y-T-D
Annount Units Tns rle Billable Billable Undup ClieMs Undup CInanls
UnRs Cash Seined Served
Prior YTD units Prior YTD S
............................... .......... 5 S .............
S
S
.................... .........
S
$
...........
PSA#11 ADF-,,s,Re,-,d C>rt.b,,2'019
Page 44 of 60
ATTACHMENTA
Title: Department of Elder Affairs Programs& Services Handbook
d
Cw., hadbool,hit 11 �j � r Wn
Page 45 of 60
C)
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ATTACHMENT B
STATE OF FLORIDA DEPARTMENT OF ELDER AFFAIRS
PAR'I'L READ"I'llE AI'TACIJ ED INS'I'RI'(-FIONS FOR ILIA V FIN FORNIA"I'T(IN NVIIICI I NVILL TIE 1,11 VOU C0 NII1I-E'I'E"[1I IS
FORM.
aZjmc=area �r I. Briefly desep'be the ge I ved by the program/ ifity and tile type of'service 1) Ovided: i
rc-0,0-(O& kEq'S 11N\tnmso� yr&i a
�2. POPULATION OF AREA SERVED, Source of data; Cemus 10 C'j
, 'I'oW 4 9q 1 q 1 1/' %k11 %Wg 1h Panic Other '/o Female
.11 a .2%6�'- 3
3. S'VAFF CURRENTLY EMPI..,OYED. Effective date: (& i A4
I FmWhite I L lhsp�nic N 01her al /' Disabled
4. CIJENTS CURRENTUY ENROLLED OR REG)ISTERED. Effective date: (017-,+) 2-4
FoW# %White /'6 111 spame 11�/o other Female 1) �ver 40
'0
...................I................. 112- ..
5. ADVISORY OR GOVERNING BOARD, WAPPLICABLE.
it %Whit( ,Ell �k 'X�I I I span ic 1/1;1 01hel
IIAR'1'11: USE A SEPARA'111'SHELA OIA'APER FOR ANY EXPLANA'UIONS 11F."QUIRING,MORE SPACE.
6. Is an Assurance of C ornphance oil file with DOEA? If N/A or NO, explain, N/A YES NO
F-1
7. Cornpare the staff composition to the population. Isslafl'i'epi,esenttliveoi'tliel�)OI)Lllatioti?
If N/A or NO,explain. N/A YES NO
El Zi 1:1
8. Compare the client composition to the population. Are race and sex characteristics representative
of the population? If N/A or NO,explain, N/A YES NO
El 0
9. Are eligibility requirements for services applied to clients and applicants Without regard to race,
color,
national origin, sex,age,religion ordisability? If N/A or NO,explain. N/A YES NO
E I E I
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 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. N/A S NO
r-1 r-1
Page 46 of 60
T"
C)
C)
CN
12. Is the program/facility accessible to non-English speaking clients? If N/A or NO,explain. N/A Y ES NO
R ❑
13. Are employees, apl' ants and participants informed of their protection against discrimination? If
YES,hom 114 Written X Poster K If N/A or NO,explain. N/A YES NO
1:1 K R
14, Give the number and current staws of any discrimination complaints regarding services or
employment filed against the program/facility. N/A NU_4.r R
............
15. Is the program/facility physically accessible to mobility,hearing,and sight-impaired individuals? If
N/A or NO,explain. N/A Y!,"," ' NO
El ❑
PART II I.T]IE FOLLONVINGQUES]IONS APPLY TO PROGMANISAND F.AWILITIES WITH I i ORNIORE,EM111 ON ETS.
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? IMO,explain. S
NO
18. 1 ias a person been designated to coordinate Section 504 compliance activities? If NO, explain, YES Y1',S NO
19. Do recruitment and notification materials advise applicants, employees and participants of
nondiscrimination oil the basis of disability? If NO,explain. YES NO
......................- ............. .................................................
20. Are auxiliary aids available to assure accessibility of services to hearing and sight-impaired
individuals? If NO,explain. YE NO
6� 0
PART IV: FOR PROGRAMS Oil FACILITIES WITH 50 Oil MORE EMPLOYEES AND FEDERAL CONTRACTS OFS50,000,00 OR NIORE,
21. Do you have a written affirmative action plan? If NO,explain. Y ��3 N 0
R
Reviewed By In Compliance: YES 0 NO* E]
Prograrn Office *Nofice of Corrective Action Sent
Date Telephone Response Due . /
On-Site ❑ Desk Review Response Received
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Rey iced August 201 O Page 2(42
INSTRUCTIONS FOR THE CIVIL RIGHTS COMPLIANCE CHECKLIST
I Describe the geographic set-vice area such as a district, count),,city or other locality. If the program/facility serves
a specific target population such as adolescents, describe the target population. Also, define the type or 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 I)r(,.)vided such as a city,COLUlty or other regional area. Population statistics
can be obtained from local chambers of commerce, libraries, or any publication fi-oni 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 arid their percent by race, sex and disability. Include the effective date of
your stumnary.
4. Enter the total number ofelients who are enrolled, registered Or Currently served by the program or facility, and list
their percent by race,sex arid disability. Include the date that enrollment was C01.111tcd.
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, Fach recipient of federal financial as; 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 orthe
contract language for DOEA recipients and their sub-grantees, 45 (Il,"R 80A(a),
7, Is the race, sex, and national origin of the staff reflective of the general population`? For example, if 10% of the
population is I lispanic, is there a comparable percentage of I lispartic staff?
8. Where there is a significant variation between the race,sex or ethnic composition of the clients arid 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)
arid 45 CFR 80.1 (b)(2).
10. Participants or clients must be provided services such as medical, nursing and dental care, laboratory services,
physical arid 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,restroorns and other facilities must also be equally available to all clients,45 CFR 80.3 (b).
I, 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 ofa different race, color, national origin,or disability,45 CFR 80.3(a).
l 1 The program/facility and all services must be accessible to participants and applicants, including those persons Nvllo,
may not speak English. In geographic areas where a significant population of non-English speaking people live,
prograrn 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 narnes and telephone numbers of bilingual individuals who will assist in
the provision of services,45 CFR 80.3 (a).
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13. Program s/faci I i ties must make information regarding the nondiscriminatory provisions offitle V] available to their
participants, beneficiaries or any other interested parties, This should include inronnation oil 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 programIacility. 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 fOLIntains, 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.
SNvitches 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 ofthe 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 lour step process:
a. With the assistance of disabled individual/organization, evaluate Current practices air(] 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.),415 (T'R 84.6.
17. 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 504A5 CF-R 84,7(b).
18, Prograiris 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 program/facility'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).
M Prograirls/facilities 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. Programs/facilities 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.
DOLA Forni M-B.Revised ALHZList 2010
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A'r1fACt1N1FN'r c
Alliance for Aging,(tic.
Business As ociate Agreement
This Business Associate Agreement is dated 111 )2-4 ,by the Alliance for Aging, Inc. ("'Covered Entity")
and Monroe County Roard of County Cornmissionds,Slicial � ervices/ln-tlome Services,("Business Associiate")�, anot-
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 recinirenients 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 pert6rin 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 (CER.), speci really 45 C.F.R. §§ 164.502(c), I 64.504(e), 164.308(b), and 164.3 14(a-
b)(20t 10)(as may apply) and contained in this agreement.
1.5 The Health hil'ormation 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 Q LI.S.C.) §§ 17931 and 17934(20110)require business associates of covered entities to comply with the FIIPAA
Security Rule,as set forth in,but not limited to 45 C.F.R. §§ 164.308, 1643 10, 164.3 12,and 164.3 16(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 Pat-ties 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 coullnUnicate data/inforination or otherwise use
any system resource.
12 Administrative Safeguards. 'file administrative actions, and policies and procedures, to manage the selection,
development, implementation, and Maintenance of security measures to protect electronic Protected Health
Infarnitation (ePI 11)and to manage the conduct of the covered entity's workforce in relation to the protection of that
information.
23 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.
23 Compromises the Security. Posing a significant risk of financial,reputational,or other harm to individuals.
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2.8 Cotifidentiality. The property that data or information is not made available or disclosed to unauthorized persons or
processes.
19 Eledl-OuiC Protected Ilealth Information (Mll). Health information as specified in 45 CF"R §1601.103(1)(i)or
(1)(ii), limited to the information created or received by Business Associate from or on behalf of Covered Entity.
2.10 111TECIL The Health Inf6rination Technology For Economic and Clinical Health Act(2009)
2.11 Information System. Ali interconnected set of information resources under the same direct management control
that shares coninion functionality. A system normally includes hardware,software, infbi-niation,data,applications,
communications,and people.
2.12 Integrity. The property that data or information have not been altered or destroyed in all unauthorized manner.
2.13 N1:IdiCi0US software. Software, for example, a virlis,designed to damage or disrupts a system.
2.14 Part 1. Part I—Improved Privacy Provisions and Security provisions located at 42 Onited States Code(U.S.C.)§§
17931 and 17934 (2010).
2.15 Password. Confidential authentication information composed of,a string of characters.
2.1�6 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.
217 Privacy Rule. The Standards fior Privacy Of IndiVidLially WC11fifiable Health Infibrination at 45 CFR Part 160 and
Part 164, subparts A and E.
118 Protected Health Information (Pill). Health information as defined in 45 CFR §160.103, limited to the
information created or received by Business Associate froin or on behalf of Covered Entity.
2.19 Required By Lms.Has the same meaning as the term "required by law"in 45 CFR§ 164.103,
2.20 Secretary, The Secretary of the Department of I lealth and I Inman Services or his or her designee,
2.21 Security incident. The attempted Or SUCCCSSfUl unauthorized access, use, &CiOSUre, modification, or destruction
of information Or interference with system operations in an inforinafion system.
2.22 Security or Security measures. All of the administrative, physical, and technical safeguards in all 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 Pill. Protected health information that is not secured through the Use of technology or methodology
specified by the Secretary in guidance jSSIlCd Under 42 U.S.C. section I 7932(h)(2),
2.26 All other terms used, but not otherwise defined, in this Agreement shall have the same meaning as those terns in
the Privacy Rode.
3.0. Obligations and Activities of Business Associate.
3.1 Business Associate agrees to 110t Use Or disclose Pill other than as permitted or required by this agreement or as
Required by Law.
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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 PI 11 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 ePIll 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, 164.3 10, 164.3,12,and 164.3 16.
3.3 Business Associate agrees to mitigate, to the extent practicable, any harmful effect that is known to Business
Associate of a 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 Agreeinern of which it becomes aware.]'his includes any requests for inspection,copying or amendment of
such inforination and including any security incident involving PEI].
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 PI-11 has been, or is reasonably believed by the Business
Associate to have been, accessed, acquired,or disclosed during SUCII security breach; and
(b) All information required fior the ,Volice lei thee �ecrelai-y (4111N ql'Breach ql'Unsecidre,cl M-oleclezi Ileallh
h!ftwinalion
3,6 Business Associate agrees to ensure that any agent, including a subcontractor, to whom it provides PI-11 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 bUSitle!SS hours,to
PHI ill a Designated Record Set, to Covered Entity or,as directed by Covered Entity,to ail individual in order
to rneet the requirements under 45 CFR §164.524; and
(b) Business Associate agrees to make any arneridnient(s) to P]11 in a Designated Record Set that the Covered
Entity directs or agrees to pursuant to 45 C'FR § 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 snake 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 UpOu request of either party, for purposes of
determining Covered Entity's compliance with the Privacy Rule.
3.9 Business Associate agrees to docurnent Such disclosures of PHI and information related to such(IiSCIOSLIres as NVOUld
be required for Covered Entity to respond to a request by an individual for an accounting of disclosures of PI-11 in
accordance with 45 CFR§ 164.528,
Business Associate agrees to provide to Covered Entity or ail individual, upon request, information collected to
permit Covered Entity to respond to a reqUest by ail Individual for an accounting of disclosures of PI 11 in accordance
with 45 CFR§ 164.528 and ARRA § 13404.
3.I I Business Associate specifically agrees to use security measures that reasonably and appropriately protect the
confidentiality, integrity,and availability of PIJI in electronic or any other form,that it creates, receives,maintains,
or transmits on behalf of the Covered Entity.
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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 soffivare 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 uleaSUres to safeguard ePHI that it accesses,maintains,or transmits
as part of this agreement (torn malicious software and other man-made and natural Vulnerabilities to assure the
availability, integrity, and confidentiality of such information.
114 Business Associate agrees to comply with:
(a) ARRA § 13404 (Application of Knowledge Element-,Associated with Contracts);
(b) ARRA § 13405 (Restrictions oil Certain Disclosures and Sales of Health Information); and
(c) ARIBA § 13406(Conditions on Certain Contacts as Part of Health(.'are Operations).
4.O 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 rise Or disclosure Would not
violate the Privacy Rule if done by Covered Entity or the millinlUrn necessary policies and Procedures of the Covered
Entity.
5.01 Specific Use and Disclosure Provisions.
5,1 Except as otherwise limited in this agreement or any related agreement, Business Associate may rise Pill for the
proper nianagenient and administration of the Business, Associate or to carry Out the legal responsibilities of the
Business Associate.
5.2 Except as otherwise Iiinited in this agreement or all)/ 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 whorn 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 131-11 to provide data aggregation services to Covered Entity as permitted by 45 (J R
§I 64.504(e)(2)(i)(B),only when specifically authorized by Covered Entity.
5A Business Associate may use PHI to report violations of law to appropriate Federal and State authorities,consistent
with 45 CFR §164,502(j)fl
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 CER§ 164.520,to the extent that such limitation may affect Business Associate's use
or disclosure of PI-11, 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
alhwlce.16 ��' i
-...............___L�i_M--
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 rise or disclose Pill 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.
SJ 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 all(] that the provisions of tutus 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, HITEC11 and Part I 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 tile Use of PHI;
(b) The electronic Security Provisions hereof shall be effective the later of April 21, 2005 or tile effective date of
the earliest contract entered into between Business Associate and Covered Entity that involves the LISe ofPHI;
and
(c) Provisions hereof mandated by ARRA, HITECI I and/or Part I shall be effective the later of February 17,20 10
or the effective date of the earliest contract entered into between covered entity and business associate that
involves the use of PHI or ePHI.
82 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 core is not possible„or
(c) If neither termination nor cure is feasible, Covered Entity,shall report the violation to the Secretary.
83 E ATect ofTermination. Except as provided ill Subparagraph(b)of this section,upon termination ofthis agreement,
for any reason,Business Associate shall return all PI 11 and ePHI received from Covered Entity or created or receive(]
by Business Associate on behalf of Covered Entity.
(a) This provision shall apply to Pl It and ePI-11 that is in the possession of'subcontractors or agents of Business
Associate. Business Associate shall retain no copies of the 1`141 and eP1 IL
(b) In the event that Business Associate or Covered Entity determines that returning the PHI or ePl-Il 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 ePI-11 and firnit
furtherUSCS and disclosures of'such retained PHI and ePHI, for a inininiurn of six years and so long as Business
Associate maintains such PHI all(] ePI-11, but 110 less than six(6r)years after the termination of this agreement.
9.0 Regulatory References. A reference in this agreernent 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 froin time to time as is
necessary for Covered Entity to comply with the requirements of the Privacy Role, the Security Rule and the I lealth
Insurance portability and Accountability Act of 1996,Pub. L. No. 104-191.
11.O 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 requiretnent(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 oil the respective effective date(s).
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14.0 Notices, \It notices and communications required, necessary or desired to be given purstrant to this agreenrent,
including -it change of address for purposes of such notices and Coln In Linicati ons, shall be in writing -aid delivered
personally to the other party or self by express gal-hour guaranteed courier or delivery service,or by certified mail of
the United States Postal Service. postage prepaid and return receipt requested,addressed to the other party as lolloivs
for to such other place its any party ma) by notice to the others spccify):
To Covered Entity: Alliance for Aging,file,
Attention: Max Rothman
760 N\kr 107 Avenue
Miami,Florida 33 172
To Business Associate: klonroc Counti Board of County(+ommissioners,�Ocial serkices/111-1-lonle Services
1100 Simonton S(reet,2-256
Key \Vest,FI, 33040
Aril such notice shall be deemed delivered upon actual receipt, If arly notice cannot be delivered or dehvca) thereof is
refused,delivery will he deemed to have occurred on the date such delivery was attempted.
15.0 Governing Lavv, -file laws of the State of Florida. without;*ruing effect to principles of conflict of laws,govern all
matters ariSilig Under this agreement.
16.0 SM,O)rnj)jjjjy.. lfarjyr provision in this agreement is townforecable to any extent, the remainder of this agreement, or
application of that provision to any persons m circumsiances other than those as to Mdch it is held unenforceable,will
not be affected by that unien fiorceabi lit% and will be enforceable to the fullest extent permitted by law.
17,O Successors, Ali.) successor to Business Associate(%%hedna by(fliect of indirect km by ptlrOmse,merger,consolidation.
or otherwise)is required to assume Business Associate's obligation,;under this agreement and agree to perfonn them in
the same manner and to the same exitnit that llusirjess %s,,ociate would havc,been rC(jUiI-Cd 10 ifthat SUCCCSSi011 had not
taken place. This assumption by the successor ofthe Business Associate's obligations shall be by written agreement
satisfactory to Covered Fntity,
18.0 Entire Agreement. This agreernent consfitutes the entire agreement ofthe parties relatirqg to the subJect matter of this
agreement and supersedes all other oral or wrilren agrn reeents or policies relating thereto, except that a this greenrent
does not limit the amendment of this agrecorellt in accordance stifll SeC6011 10,0 orthis ingreenlerrL
('overcd Entity: Alliance for Aging,Inc.
—A"-R-OMMt 1.-......
Jul 1,2024
(signature)
Business Associate:Monroe County Roard of Count} Commissioners,Social Services
13y Date:
(u)z4
(signature)
NROE COU nNV SIGNED BY:
A, AOVE
NAME' Holly Raschein
PED J�MERCADO-1-
ASSISIA CWWY AFMRNEY
Date TITLE' Mayor
DATE'
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0
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T.I'Afi:'f-[MENT fly
DEPARTMENT Of EMER AFFAIRS
BACKGROU"ND SCREENING
AUTHORITY.AL I,VAIP1.0YERS are required to annually submit this form attesting to
compliance mith the provisions of chapter 45 and,section 4 t.il401 of the Florida Statues,
Lire tetarr acenpiny'er neaaw; aary peaso n or eantatyr recyaa:ired by lawrr to conduct b-mlapn rand acreerdrapw,imclu'hnE
but trot limited to,Area A.pe-ncien on Ap nig/Agi rg aatd Disabuhtyr Re saran ire Center ,Lead Agencie.,and Sen e
raaw,aden that co ntnact dinec tly can indirectly with the C partnmmit ofEldet i'ffatrt t E l annul any alma person.
stir enrtrt*,r varlaach huea wannpkrty^ a aav 6na^n w^rrlaxrmteer H nau maw ice uwhaa rrteet the defaanrtxanra ra a drxert°,enw�nce prraw�adem
See 455.p1 430.0402w,Fla Stat,
A rhrect serwace prmider is"a petJson IS ye at'rr of ape cot older who,pinsuant taa a pogirmi to prrwwrrde ser% ce,n to
the eldexly,has d'urect,fxeio-face contact wwith a client aarlrnle parcaw-rdmg wmcea to the chernt and has access to
the clnennt'ra hvurgmext,fLu a p*j5onat pjopemty or pea:anal identification iad'raanzwrticran as def ed in s.817 568
The tem also inrinadii No r°r twnt lu united to,the adrnin TrhrxBr+r or a smulaxly titled per,nn who is re.paamnble for
the day-to day attierattcataa of the prolkiden,the fmarncial officer car sirmlatly^titled perszim who is mpaatmabte for the
fitaarwial <apetaticrienw of the prrawrt¢ten, crnar-dinnatarra„ marrapem, arnd sap .nwa°aaaa^, of mnalet'aAaal facilities, azari
wolwaznteeaw„and my ether pen warn s,mekmg employment with a pitomdea ww1wwa i%expected to or wwirose renpaansibditae=;
stay reapadre hiaan or her to,prraaide pnenwaaana$care cir ja rire�, directly to c9'mis or 1mve accennrn to client funds,
financial aanattea n,legal ranters?p nwrsrna6 pmaapetty,or h%riaapp area,« 410 0407111i'b'l,Fla Stwat.(2023)
As the duly authort.zed rqresmitabve Of, A-04rin Cella)
(Narne,ctf Pt al }t r
I,rac aced at—,1 Cc 6.w �...Do __
ttvetaddress City StAte ZipCode
_.
Under Penalty of lreajalry,1, + �_.... �.
a of Regtre�serrtatrae
hereby swear or a rarta that the above-im reed employer is in compliance with the larovisiom of chapter
43 and sec 431)0402 of the Florida Statutes,re ardrrrt level 2 backgTotrard wereenmg
rgrtattrre of Representative Date
DOEA Ewrancra 215,Attestation of Compliance-Employer,Effective October 2023,f t
Eann available at'hvt rkdis.„ , , n Awn . .....,,.. a;.,a�n.iaai,.Ra4,ai
/M! NROE CCU ATTOnNEY
I)PROVEI FORM
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ATTACHMENT E
REFERRAI,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 Nods, in accordance with prioritization requirements.
Purpose: TO ensure funding is spent expeditiously and corimuners,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 prograiii and ADI Agency specific spending levels on a inonthl,y basis to ensure the ADI
Agency is operating within the funding allocations.
• Screens Consumers to link with appropriate resources and prioritize for DOEA-funded prograills 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 froin C011SUrnerS interested in services to the ADRC for Information and Referral to community
resources, Screening,Triage,and Long-Terns Care Options Counseling,as appropriate.
• Completes comprehensive assessments oil new consumers and ainim-d reassessment oil existing consumers and
develops care plans and reviews care plans semi-annually.
• Authorizes service dclivei) and enters data into eCIRTS.
• Bills in eCIRTS as appropriate.
• Monitors care plans in an effort to keel)costs down voile SUSAulmiug the individuals in the community.
H. Management of the Assessed Prioritized Consumer List(APCL).
A. As clients are referred to the ADRC,clients are provided information on community resources and prograrris 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 cORTS,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
(Forrn 701 S). The 701 S will determine their ranking on the appropriate waiting list(s)APCL status. .
2. The ADRC will reassess consumers oil 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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111. Opening New Cases
A ADI Clients
1. The Alliance Fiscal Department will monitor ADI Agency specific spending levels oil a monthly basis to ensure
each AD[Agency is operating within its-spending authority. In addition,the Alliance will analyze SUrplus/cleficit
projections, and share the information with the ADI Agency to assist in their determination of s,lot availability.
The ADI Agency will request referrals directly from tile 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 ADI Agency, the ADRC Intake Unit Supervisor will run tile
Prioritized Risk Report to identify the consumers on the APCL to be opened.
In response to the request for referrals, the ADRC Intake Unit Supervisor will refer waitfisted clients to tile 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 AD[ Agency ('I"'AEL),
4. Upon receipt of the list of clients released from the waiting list,the ADI Agency will enter the API'L 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 enSLH-c referrals have tirnely outcomes in eCIRTS.
6, Ifunallocated funds become available at the Alliance to allow for new client enrollments into ADI, the ADRC
will follow the following process(for Nfiarni-Dade County only);
a, The ADRC Intake Unit Supervisor will run the Prioritized Risk Report to identify the consumers on the
AP0,to be opened.
b. 'file ADRC' Intake Unit Supervisor will refer waiAlisted clients, to the ADI Case Management Agency for
activation, in accordance with prioritization requirements.
c. The referrals will be provided on as rotation basis as per direction from the fiscal department which will be
determined by The AD[Casse Management Agency surplus'nformation and per the fscal department policy.
(L 'file Intake Unit will update tire wait list enrollment using the appropriate code to terminate from the APCL.,
for release to the ADI Agency (Terminated APCL,Determining Eligibility.
e. Upon receipt of the list of clients released from the waiting list, the ADI Agency will enter the AIIPL
enrollment,contact clients to offer program enrollment,and proceed with tile process for activation.The ADI
Agency will enter subsequent enrollments into cCIRTS to reflect client status.
B. Statewide Medicaid Managed Care Long'Ferm Care Program Clients
1. The Department of Elder Affairs will run the statewide APCL(Assessed Priority Consumer List)report to review
clients wait listed for the SMMCI-T'CP program. DOEA will provide the ADRC with a list of individuals
authorized for release from the APO-
2. For clients identified as active in ADI and authorized for release from the SN1MCL'I'CP waiting list,the ADRC
will be responsible for the SMM(.I.TCP 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
I. Consumers may change AN Agencies oil 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 1611,of that same month.
3. If the request is made after the first of the month,the change will take effect by the 16"'of the following month.
B. Process for Changes
1. Requests to change case management agency nILISt COrne from the client or their personal representative to the
ADRC/Elder Helpline. Requests made by a case management agency will not be honored.
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2. When reqUesting a change, the consumer will be asked by the ADRC staff person to share his/her 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
requesting a change.
4. If the consumer does not want to speak with the ADD 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 ADRC/Intake Unit will send a Transfer Form to the selected AD] Agency and to the CUrrent ADI Agency.
Both AD] 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 cCIRTS to the new ADI Agency.
7. The Current ADI Agency will terminate enrollment in eCIRTS as of tile 15",of the month wilen tile,transfer is to
take place. file new ADI Agency will activate enrollment in eCIRJS as of the 16"of the month when the transfer
is to take place.
8, [,.ach 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 Nv°ill be done through a contract
amen(InteW.
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ATTACHMENT F
CERTIFIED MINORITY BUSINESS SUBCONTRACTOR EXPENDITURES(CNIBE FORM)
C1,11131"' 70 ALLI-11 ACI,'
PROVIDER:
CONTRACT NUMBER:
*REPORTING PERIOD-FROM: TO;
'(DATE RANGE OF RENDERED SERVICES, MUST MATCH INVOICE SUBMITTED)
BLUIBIALL LNUNDI'LLULS NAUL IQ LIBLEILD MINQ11131 BLSINL5��11ULONIHALJDBS
.('0A'7'1,K'TQ01,.'j CHBECOORDINAMR],*(.)'R',,I,\')'OL,"L5'7JO,,\,S, zll'850-414-2153.
SUBCONTRACTOR NAME SUBCONTRACTOR'S CMBE EXPENDITURES
FEID
DOEA USE OINLY--REPORTING ENTITY(DIVISION,,OFFICE,ETC)
SEND CONIPIKI 1,1"I)l,'ORMS VIA INTE"ROI-TWE MAI[,'1'0:R�S'f INTAYLOR
If Unsure il'SUbcontractor-is a certified mingrity supplier,click on the hyperli!ik Wow. Enter the name of the supplier, click
"search".Qnly Certified Minoti1y Business Entities will be displayed.
osdjmsjrl
(A) Etitet,tlief)rc)vi(lertiameasitappeai'soiiyotii-Alliiiicecoiiti,act.
(11) Enter the Alliance contract manber.
(Q Enter the service period matching the current invoice's service period.
(D) Enter all certified minority hUsiness expenditures for the time period covered by the invoice:
1. 1-Inter certified minority businessname.
2. Enter the certified rninority business I'Elf)number.
3. Enter the certified minority business CMBE number.
4. Enter 11IC'MoOLInt expended with the certified minority business for the time period covered by the invoice.
(E) C1ti4BI,--,be lornI must accompany invoice submitted to the Alliance for processing.
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