04/19/2006 Agreement
DANNY L. KOLHAGE
CLERK OF THE CIRCUIT COURT
DATE:
April 20, 2006
TO:
Dotti Albury, Administrative Assistant
In-Home Services
Pamela G. Haw~
Deputy Clerk 0
FROM:
At the April 19, 2006, Board of County Commissioner's meeting the Board granted
approval and authorized execution of the following:
Renewal of the Home Community Based Services Aged and Disabled Adult (ADA)
Medicaid Waiver Case Management Referral Agreement between the Alliance for Aging, Inc.,
and the Monroe County Board of County Commissioners (Monroe County In-Home Services
Program) retroactive to July 1, 2004.
/ Renewal of the Home and Community Based Services Aged and Disabled Adult (ADA)
Medicaid Waiver Referral Agreement between Alliance for Aging, Inc. and the Monroe County
Board of County Commissioners (Monroe County In-Home Services Program) for Direct
In-Home Services retroactive to July 1,2004.
Amendment No. 0001 to the Community Care for Disabled Adults (CCDA) Contract No.
KG052 between the Department of Children and Families and the Monroe County Board of
County CommissionersIMonroe County In-Home Services to reduce/de-obligate the CCDA
Contract by a total of $9,995.66.
Enclosed are four duplicate originals of each of the above-mentioned, executed on behalf
of Monroe County, for your handling. Please be sure to return the fully executed "Monroe
County Clerk's Office Originals" and the "Monroe County Finance Department's Originals"
as soon as possible. Should you have any questions please do not hesitate to contact this office.
cc: County Attorney
Finan<;e wlo documents
File /
~ c.u, CIerl'. oma Orfafwt
HOME AND COMMUNITY BASED SERVICES
AGED AND DISABLED ADULT (ADA) MEDICAJD WAIVER
REFERRAL AGREEMENT
This Referral Agreement between the Alliance for A~ino. Inc., the Area Agency on Aging (AAA) for
Planning and Service Area (PSA) 11 a~M/)()(D _ ('f>JD:bL Th \-hYY1f' C,etVi Ce;.., . ,
the Service Provider, shall begin on Juiy 1, 2004 or on the date ihll agreement has been signed by both
parties, whichever is later. This referral agreement or is In effect for a period of time that is equal to the
Medicaid waiver provider's enrollment period with the State of Fiorida's Medicaid fiscal agent and is
contingent upon an annuai appropriation by the Legislature. One purpose of this agreement is to
promote the development of a coordinated service delivery system to meet the needs of the aged or
disabled adults who are at risk of premature institutionalization. Another purpose of this agreement is to
enable eligible elderiy participants to receive home and community based services from qualified
providers with oversight of the quality of care by the Medicaid Waiver Specialist employed by the AAA.
These services are authorized in order that the participant may remain in the least restrictive setting and
avoid or delay premature nursing home piacement. Services and care are to be furnished in a way that
fosters the independence of each participant to facilitate aging in place. All parties agree that routines of
care provision and service delivery must be consumer driven to the maximum extent possible. Ail parties
agree to and will treat each participant with dignity and respect.
I. Objectives
A. To maintain a climate of cooperation and consultation with and between agencies, in order to
achieve maximum efficiency and effectiveness.
B. To promote programs and activities designed to prevent the premature institutionalization of
elders and disabled adults.
C. To require the parties of this Agreement to provide technical assistance and consultation to each
other on matters pertaining to actual service delivery and share appropriate assessment
information and care plans so duplication may not occur.
D. To establish an effective working relationship between the case management agency that is
responsible for the development of care plans and authorization of services available under the
waiver, the service provider that is responsible for the direct provision of those services to
consumers served under the waiver program, and the AAA that is responsible for management
and oversight of the waiver program.
II. Under this Agreement, the Service Provider agrees to the following:
A. To accept referrals. for the 1915c Home and Community-Based Services - ADA Medicaid
Waiver from the enroiled case management agency.
B. To provide quality service(s) to the waiver participant as specified in Section ~rovision of
service(s), subject to quality monitoring and/or observation by the case ~agement agency
and/or the AAA and/or the Department of Eider Affairs (the "department").
C. To provide only those services specifically outlined in the Plan of Care and authorized by the
enrolled case management agency.
D. To attach documentation regarding the service provider's qualifications to this agreement; and to
provide, as requested, any information regarding Medicaid Waiver billing, payment, or waiver
participant information, to the case management agency or AAA. Provider rates shall not
exceed the approved negotiated rates that are at or below the service provider's usual and
customary rates. If additional services are to be added to this agreement, a written request to
do so must be received by the AAA. If approved, an amendment must be prepared by the AAA
indicating the service(s) to be added. The necessary documentation regarding provider
qualifications for the additionai services must be attached to the agreement.
E. To maintain the waiver participant's confidentiality according to 42 CFR 431.301.
F. To immediately report any changes in the waiver participant's condition to the case
management agency.
G. To maintain en roiled provider status by renewing applicable licensure, cerIlTlca!ion, contract
and/or referral agreements and by maintaining all provider qualifrcations 2S contained in the
Aged and Dis2bled Adult Medicaid Waiver under which services are provided.
H. To include its name and other appropriate information on a list of all enrolled providers which
will be shown to consumers during development of an individualized plan of care,
understanding that the consumer reserves the right at all times to a choice of enrolled
providers.
I. To immediateiy notify the case management agency of staffing shortfalls that will negatively
impact provision of service to Medicaid Waiver consumers.
J. To submit claim data for billing to the Medicaid fiscal agent after delivery of services has been
accomplished. All services should be billed within 60 days after services have been provided or
document reasons for delayed submission of claims. Such documentation shali be available for
review by the area agency on agency or by the department. upon request.
K. To submit claims for billing to the Medicaid fiscal agent at the agency's contracted rate.
L. To submit void or adjustment claims no later than 45 days after either party has identified the
error. The provider's refusal to adjust or void erroneous claims may result in termination of this
agreement and/or referral to the department, and will be referred by the department to the
Agency for Health Care Administration for appropriate action.
M. To develop and implement a policy to ensure that its employees, board members, and
management, will avoid any conflict of interest or the appearance of a conflict of interest when
disbursing or using the funds described in this agreement. A conflict of interest inclUdes, but Is
not limited to, receiving, or agreeing to receive, a direct or indirect benefit, or anything of value
from a service provider, consumer, vendor, or any person wishing to benefit from the use or
disbursement of funds. To avoid a conflict of interest, the service provider must ensure that all
individuals make a disclosure to the AAA of any relationship which may be a conflict of interest
within thirty (30) days of an individual's original apppintment or placement on a board, or if th~
individual is serving as an incumbent, within thirty (30) days of the commencement of the
agreement.
N. To adhere to the federal waiver requirements and the policies and procedures outlined in the
following manuals published by the Agency for Health Care Administration: the Aged/Disabled
Adult Waiver Guidelines and the Medicaid Provider Reimbursement Handbook (Non-
Institutional 081), including any and all attachments or updates.
O. If the Service Provider is enrolled as a home delivered meals vendor, the Area Agency will
retain the services of a registered dietitian to perform the following:
1. Conduct site inspections of all catering facilities. These may be unannounced.
2. Monitor meal delivery times and temperatures.
3. Review all menus submitted by the service provider and suggest changes as needed.
4. Work with the service provider to ensure that standardized recipes and computer-assisted
nutritional analyses are carried out.
P. The AAA may impose department-approved. sanctions for non-compliance with the
terms of this agreement.
III. Under this Agreement, the Area Agency on Aging agrees to the following:
A. To facilitate the enrollment of providers with the Medicaid Fiscai Agent.
B. To provide technical assistance and training to Service Providers.
C. To notify the case management agency within 48 hours of any approved service provider
rate adjustment.
D. To regularly monitor the Service Providers in accordance with requirements specified by the
department.
E. To compiete a new referrai agreement signed by all parties when unit rate changes are approved.
2
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IV. Under this agreement. the following services will be delivered by the Service provider in
accordance with the plan of care or service authorization:
Service Unit Rate County/Region Served
A.
B.
C.
D.
E.
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V. Termination
In the event this agreement is terminated, the case management agency and the service provider
agree to submit, at the time notice of intent to terminate is delivered, a plan which identifies
procedures to ensure services to consumers will not be interrupted or suspended by the
termination.
A Termination at Will
This agreement may be terminated by any party upon no less than thirty (30) calendar days
notice, without cause, unless a lesser time is mutually agreed upon by both parties, in writing.
Said notice shall be deiivered by certified maii, return receipt requested, or in person with
proof of delivery.
B. Termination Because of Lack of Funds
In the event funds to finance this agreement become unavaiiable, the area agency may
terminate this agreement upon no less than twenty-four (24) hours notice in writing to the
other party. Said notice shall be delivered by certified maii, return receipt requested, or in
person with proof of delivery, The area agency shall be the final authority as to the
availability of funds.
C. Termination for Breach
Unless a breach is waived by the area agency in writing, or the parties faii to cure the breach
within the time specified by the area agency, the area agency may, by written notice to the
parties, terminate the agreement upon no iess than twenty-four (24) hours notice. Said
notice shall be delivered by certified mail, return receipt requested, or in person with proof of
delivery.
VI. Agreement
Not withstanding the effective date as determined in the First Paragraph of this agreement, this
contract is retroactive to July 1, 2004.
In witness whereof, the parties have cause this ~ page agreement to be executed by their
undersigned officials as duly authorized.
Area Agency on Aging
. <( A._~
VSignature "')
steven Weisberg, M.S.
signature
Charles
Print name
President/CEO
Title
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Date
N M. GRIMSL
COUNTY ATTORNEY
3