SFY2005 04/19/2006 •
DANNY L. KOLHAGE
CLERK OF THE CIRCUIT COURT
DATE: April 20, 2006
TO: Dotti Albury, Administrative Assistant
In Home Services
FROM: Pamela G. Han it
Deputy,.Clerk
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 Commissioners/Monroe 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
Finance w/o documents
File./
~C~Clerk'6.~.~
HOME AND COMMUNITY BASED SERVICES
AGED AND DISABLED ADULT (ADA) MEDICAID WAIVER
CASE MANAGEMENT REFERRAL AGREEMENT
Inc. the area agency on aging (AM) for
planning and service area (PSA) 11 and -t :::I:.v1 vi
, a case management agency, shall begin on July 1, 2004 or on the te the agreement has been signed
by both parties, whichever is later. This referral agreement is in effect for a period of time that is equal to
the Medicaid waiver provider's enrollment period with the State of Florida's Medicaid fiscal agent and is
contingent upon an annual appropriation by the Legislature. The purpose of this agreement is to enabie
eligible elderly participants to receive case management services from qualified providers with oversight
of the quality of care by the Medicaid Waiver Specialist employed by the AM. These services are
authorized in order that the participant may remain in the least restrictive setting and avoid or delay
premature nursing home placement. Services and care are to be furnished in a way that fosters the
independence of each participant to facilitate aging in place. All parties agree that routines of care
provision and service delivery must be consumer-driven to the maximum extent possible. All parties
agree to and will treat each participant with dignity and respect.
I. Objectives
A. To maintain a climate of cooperation and consultation with and between agencies, in order to
achieve maximum efficiency and effectiveness.
B. To participate together by means of shared information in the development and expansion of
services.
C. To promote programs and activities designed to prevent the premature institutionalization of
elders and disabied adults.
D. The parties of this agreement will 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.
E. 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 AM that is responsible for management
and oversight of the waiver program.
II. Under this Agreement, the Area Agency on Aging agrees to the following:
A. To facilitate the enrollment of providers with the Medicaid Fiscal Agent.
B. To ensure the case management agency is an active Medicaid provider prior to serving any
consumer under the Aged and Disabled Adult (ADA) Medicaid Waiver and Assisted Living for
Frail Elderly (ALE) Medicaid Waiver Programs and any other Medicaid Waiver program that may
be approved by the Centers for Medicaid and Medicare Services (CMS) and implemented in the
State of Florida.
C. To provide technical assistance and training to the case management agencies.
D. To provide on site monitoring of the case management agency at least semi-annually.
E. To monitor and project Provider expenditures to assure spending is maintained within
spending authority.
F. To complete a new referral agreement signed by all parties when unit rate changes are approved.
III. Under this Agreement, the Case Management Agency agrees to the following:
A. Assign qualified case managers as contained in the ADA Medicaid Waiver to provide case
management services under the Medicaid Home and Community Based Waiver for Aged and
Disabled Adults. Provider rates shall not exceed the approved negotiated rates that are at or
below the service provider's contracted rates.
B. Develop and implement the Plan of Care specifically outlining the service(s) to be delivered that
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must be signed by the consumer.
C. Adhere to the federal waiver requirements and policies and procedures outlined in the
following manuals published by the Agency for Health Care Administration: Aged and
Disabled Adult Waiver Guidelines and the Medicaid Provider Reimbursement Handbook
(Non-Institutional 081), including any and all attachments or updates.
D. Provide to the AAA a monthly summary of Aged and Disabled Adult Medicaid Waiver
expenditures billed and accrued.
E. Refer consumers to any qualified Service Provider as selected by the consumer.
F. Issue written service authorizations to the service provider with at least 24 hours notice. The
referral will contain at a minimum:
1. Name
2. Address (with directions if not easily accessible)
3. Pertinent information regarding consumer's health or disabilities and living situation
4. Detailed service description including frequency, duration and specific tasks to be
performed.
G. Evaluate quality of services and service documentation by the service provider.
H. Accept financial responsibility for service claims found to be out of compliance if the non
compliance was the result of a failure by the case management agency to update, renew, or
terminate the service authorization.
I. To forward a monthly expenditure tracking report to the area agency no later than the date agreed
upon by both parties.
J. Monitor service providers for adherence to authorized care plans, authorized
reimbursement rates, and to ensure that the service provider is billing only for services authorized
in the care plan.
K. 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 or when contracting with
another entity which will be paid by 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 case management
agency must ensure that all individuals make a disclosure to the AAA of any relationship which
may be a conflict of interest, within thirty (30) days of an individual's original appointment or
placement on a board, or if the individual
is serving as an incumbent, within thirty (30) days of the commencement of the agreement.
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 to the Agency for Health Care
Administration for appropriate action.
M. The AAA may impose department-approved sanctions for non-compliance with items of this
agreement.
IV. Under this agreement, the following services will be delivered by the Service provider in
accordance with the plan of care or service authorlzatlon:
Service Unit Rate County/Region Served
A. Case Manaqement $45.00/hr
B.
C.
D.
E.
Monroe
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V. Termination
In the event this agreement is terminated, the case management agency agrees to submit, at the
time notice of intent to terminate is delivered, a plan which identifies procedures to ensure
services to consumers will not be interrupted or suspended by the termination.
A. Termination at Will
This agreement may be terminated by any party upon no less than thirty (30) calendar days
notice, without cause, unless a lesser time is mutually agreed upon by both parties, in writing.
Said notice shall be delivered by certified mail, return receipt requested, or in person with
proof of delivery.
B. Termination Because of Lack of Funds
In the event funds to finance this agreement become unavailable, the area agency may
terminate this agreement upon no less than twenty-four (24) hours notice in writing to the
other party. Said notice shall be delivered by certified mail, return receipt requested, or in
person with proof of delivery. The area agency shall be the final authority as to the
availability of funds.
C. Termination for Breach
Unless a breach is waived by the area agency in writing, or the parties fail to cure the breach
within the time specified by the area agency, the area agency may, by written notice to the
parties, terminate the agreement upon no less than twenty-four (24) hours notice. Said
notice shall be delivered by cerlified 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 caused this ~ page agreement to be executed by their
undersigned officials as duly authorized.
Area Agency on Aging
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Signature
signature
Steven Weisberg, M.S.
Print name
Charles
Print name
President/CEO
5 }l.-) { 0 6
Mayor
Title
Title
Date
Date
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MONROE COUNTY ATTORNEY
APPRO ED AS T? FORM:
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