01/15/2003 Agreement Wert of the
Circuit Court Clerk of Danny L.Kolhage
rcuit Court Phone: )292-3550
FAX: (906)6296 9669
e-mail: phancock@monroe-clerk.com
Memorandum
TO: Louis Latorre, Director
Social Services Division
ATTN: Dotti Albury
FROM: Pamela G. Hancgcic
Deputy Clerk
DATE: January 21, 2003
At the January 15, 2003, Board of County Commissioner's meeting the Board granted
approval and authorized execution of the following:
Amendment 001 to Contract KC271, 2002.03 Community Care for the Elderly, between Monroe
County and Alliance for Aging, Inc. (Area Agency on Aging for Miami-Dade and Monroe Counties) and the
Monroe County Board of County Commissioners/Monroe County Social Services (Monroe County In-Home
Services Program), this will change the approved unit rates(s), Monroe County In-Home Services will be
reimbursed under this contract based on the unit costing spreadsheets retroactive July 1, 2002.
Amendment 001 to Contract KH272, Home Care for the Elderly, for Fiscal Year 7/1/02 through
6/30/03 between the Alliance for Aging, Inc. and the Monroe County Board of County
Commissioners/Monroe County Social Services (Monroe County In Home Service Program), this will
change the approved rate(s), Monroe County In-Home Services will be reimbursed under this contract
based on the unit costing spreadsheets retroactive July 1, 2002.
Amendment 001 to Contract KZ297, Alzheimer's Disease Initiative, between Alliance for Aging, Inc.
and the Monroe County Board of County Commissioners/Monroe County Social Services (Monroe County
In-Home Service Program), this will change the approved unit rate(s), Monroe County In-Home Services
will be reimbursed based on the unit costing spreadsheets retroactive July 1, 2002.
✓Model Coordination Agreement between the Department of Children and Families, Economic
Self-Sufficiency Services Program and the Department of Elder Affairs, Comprehensive Assessment and
Review for Long Term Care Services Program (CARES), Area Agency on Aging and Community Care for the
Elderly (CCE) Lead Agencies for Monroe County to establish a partnership between the agencies to
facilitate communication and cooperation in the completion of Medicaid eligibility determination.
Enclosed are four duplicate originals of each of the above-mentioned, executed on behalf
of Monroe County, for your handling. Please be sure that the fully executed "Monroe County
Clerk's Original" and the "Monroe County Finance Department's Original" are returned
to our office as soon as possible. Should you have any questions please do not hesitate to
contact this office.
cc: County Administrator w/o documents
Finance w/o documents
County Attorney
File
MODEL COORDINA nON AGREEMENT BETWEEN THE
DEPARTMENT OF CuaDREN AND FAMILIES,
ECONOMIC SELF-SUFFICIENCY SERVICES PROGRAM
AND
THE DEPARTMENT OF ELDER AFFAIRS,
COMPREHENSIVE ASSESSMENT AND REVIEW FOR LONG TERM CARE
SERVICES PROGRAM (CARES),
AREA AGENCY ON AGING AND
COMMUNITY CARE FOR THE ELDERLY (CCE) LEAD AGENCIES FOR
MONROE COUNTY
This Memorandum of Agreement, made this_5th _day of December. 2002, shall be in effect
indefinitely between the Department of Children of Families, Economic Self-Sufficiency Services
Program, the Department of Elder Affairs, Comprehensive Assessment and Review for Long Term
Care Services Unit, the Alliance For Aging Inc., the Area Agency on Agingfor Planning and Service
Area -.11_ and Monroe County Social Services, Community Care for the Elderly Lead Agency for
Monroe County. The purpose of this agreement is to establish a partnership between the above
referenced programs of the Department of Children and Families and the Department of Elder
Affairs to facilitate communication and cooperation in the completion of Medicaid eligibility
determination.
Timely Medicaid financial eligibility determination is critical to the success of initiatives to divert
elders from institutional care to home and community-based care. Therefore, this partnership is
formed to streamline and expedite the Medicaid eligibility determination process to enable elders to
receive critical home and community-based care in lieu of institutional care.
CCE Lead Agency agrees to:
A. Submit a current assessment, completed within the past six months, Care Plan
(DOEA Form 203), Patient'Transfer and Continuity of Care. (CF-MED 3008), and
Informed Consent (CF-ES 2040) with the Request for Financial Assistance (RFA)
to the Department of Children and Families (DC&F) Economic Self-Sufficiency
Services office. This same package will be simultaneously forwarded to CARES
for expediting the medical eligibility determination while the Request for Financial
Assistance (RF A) is being processed by the DC&F office.
B. Verify the current Medicaid status of the applicant utilizing Consultec's telephone
verification process, Medifax, Web MD or any other reliable product, prior to
submitting an RF A for processing.
C. Review the RFA ensuring that all required information is completed and the form
is signed by the consumer. The CCE lead agency case manager will also
coordinate the application process when able, with a trusted family member or
friend who agrees to act as the personal representative for the consumer.
D. Designate on the RFA the name and contact information for the designated
representative, type of assistance the applicant is seeking; for example, -.-
AgedlDisabled Adult (ADA) waiver, Assisted Living for the Elderly (ALE)
waiver, exparte for ALE waiver. If there is no one to act as a personal
representative and the person is unable to attend an office appointment, CCE lead
agency case manager will write this on the RF A to advise the Public Assistance
Specialist (PAS).
E. Ensure all appropriate and necessary documentation is attached to the RF A,
specifYing the case manager's name and telephone number as well as the service
status of the individual. All appropriate and necessary documentation will be
updated and forwarded to the DCF Economic Self-Sufficiency Services Specialist
within 5 days of any change that takes place, i.e., change in enrollment status,
change in case manager or change in case manager's contact information. For
consumers transitioning from a nursing home to the ADA or ALE waivers, DC&F
will provide appropriate and necessary documentation to DoEA and subsequent
documentation will be sent to DC&F as soon as the individual is in their new living
arrangement (discharged from nursing home) and receiving waiver services.
F. Provide the consumer or personal representative with the list of documents that
will be needed for the initial as well as the annual eligibility determination and
assist the consumer or personal representative in assembling those documents. -
G. Arrange, upon notification ofthe appointment, for transportation, respite care,
escort or any other services necessary to ensure the consumer or personal
representative keeps a scheduled appointment, if possible.
H. Aid in obtaining any documents that are needed.
DCF Economic Self-Sufficiency Services Unit agrees to:
NOTE: CASES that are direct enrollees such as SSI or MEDS-AD should be excluded from
these requirements.
A. Notify the CCE lead agency case manager and CARES of the Economic Self-
Sufficiency Services Specialist acknowledging receipt and assignment ofthe
application or ex parte process within 5 working days and of any changes
thereafter via the Notice of Receipt ofHospiceIHCBS Referral (CF-AA 2516) or
the Client Status Transmittal (CF-MED 3007).
B. Provide duplicate notices to the CCE Lead Agency case manager via mail or fax of
all scheduled appointments and documentatio~ needed in sufficient time to permit
the case manager to arrange any service that may be needed to facilitate the
appointment, if possible.
C. Arrange for a telephone interview in lieu of a home visit ifthe home visit will delay
the eligibility process or ifthe consumer is physically unable to attend an interview
without jeopardizing his or her welfare.
....-.-
D. Ex parte, upon discharge, all requests for transition applicants currently residing in
a nursing facility under the Institutional Care Program (lCP) to Medicaid Waiver
funded programs in the community when waiver funds are available. Waiver
benefits cannot be authorized until the individual is in the appropriate living
arrangement. Waiver services cannot be authorized while the individual is still
living in a nursing home.
E. Provide duplicate Notices of Case Action (CS-ES Form 2266) or any other
appropriate documentation necessary to the CCE Lead Agency case manager and
CARES for Medicaid waiver participants upon enrollment and each change in
income level.
F. Notify the CCE Lead Agency case manager of any problems that may be identified
in the initial or annual eligibility process as well as any missed or cancelled
appointments or failure to return information by the consumer or personal
representative. The case manager should be notified of any problems prior to
issuing a notice of adverse action.
Area Agency on Aging agrees to:
A. Facilitate communication between the DCF Economic Self-Sufficiency Services
Program unit, DOEA CARES unit and CCE Lead Agencies by arranging for
regular conference calls or meetings to identify, prevent or resolve any problems in
the eligibility determination process.
B. Arrange for training of all CCE Lead Agency case managers on the eligibility
determination process including medical and financial components.
DOEA CARES Program agrees to:
NOTE: Refer to Memorandum of Agreement attached herein for additional local
protocols.
A. Date stamp the same calendar day received, all Medicaid waiver packages, and
medical information consisting of completed forms submitted by Economic Self-
Sufficiency Services Specialists or CCE case managers.
B. Contact the assigned case manager or Economic Self-Sufficiency Services
Specialist by phone, e-mail, fax or written transmittal within four work days
concerning Medicaid waiver cases received by local CARES offices that are absent
necessary forms or required information.
C. Following review of a completed Medicaid waiver package, initiate contact with
the case manager within four workdays for cases that do not appear to meet level
of care criteria. The purpose of this contact is to discuss the assessment and obtain
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any required clarification. Should the client's level of care remain questionable, the
assigned CARES staff will conduct an on-site assessment, at the discretion of their
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supervisor, prior to staffing the case with the CARES Physician Consultant.
D. Staff and mail all levels of care (form #603) on Medicaid Waiver cases within
twelve work- days or less of receipt ofthe completed package offorms. All levels
of care will clearly addressed to the assigned case manager and Economic Self-
Sufficiency Specialist as well as indicate the client's name and the determination
established.
E. Provide assistance as requested to case managers and Economic Self-Sufficiency
Specialists in contacting physician's offices by phone or written correspondence in
order to secure completed Form# 3008 in order to make the level of care
determination within twelve works days.
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Dixie M. Spehar
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Mayor
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January 15, 2003
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