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Backup Documents 09/23/2014 Item #16D16 (ADI 203.14) July 2014 to June 2015 r603.14 160 AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,INC. CONTRACT ALZHEIMER'S DISEASE INITIATIVE THIS CONTRACT is entered into between the Area Agency on Aging for Southwest Florida, Inc. (Agency) and Collier County Board of County Commissioners(Contractor). WITNESSETH THAT: WHEREAS,the Agency has determined that it is in need of certain services as described herein; and WHEREAS, the Contractor has demonstrated that it has the requisite expertise and ability to faithfully perform such services as an independent Contractor of the Agency. NOW THEREFORE, in consideration of the services to be performed and payments to be made,together with the mutual covenants and conditions hereinafter set forth,the Parties agree as follows: 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, forms, exhibits and references incorporated, which constitute the contract document. 2. Incorporation of Documents within the Contract: The contract will incorporate attachments,proposal(s),state plan(s),grant agreements,relevant Department handbooks, manuals or desk books and Master Contract number HM014,as an integral part of the contract,except to the extent that the contract explicitly provides to the contrary. In the event of conflict in language among any of the documents referenced above, the specific provisions and requirements of the contract document(s) shall prevail over inconsistent provisions in the proposal(s)or other general materials not specific to this contract document and identified attachments. 3. Term of Contract: This contract shall begin at twelve (12:00) A.M., Eastern Standard Time July 1,2014 or on the date the contract has been signed by the last party required to sign it,whichever is later. It shall end at eleven fifty-nine(11:59)P.M.,Eastern Standard Time June 30,2015. 4. Contract Amount: (wording re: contract modification after 6 months) The Agency agrees to pay for contracted services according to the terms and conditions of this contract in an amount not to exceed$104,280.00,or the rate schedule,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. 5. Renewals: By mutual agreement of the Parties, in accordance with s. 287.058(1)(g),F.S.,the Agency may renew the contract for a period not to exceed three years, or the term of the original contract, whichever is longer. The renewal price, or method for determining a renewal price, is set forth in the bid, proposal, or reply. No other costs for the renewal may be charged. Any renewal is subject to the same terms and conditions as the original contract and contingent upon satisfactory performance evaluations by the Agency and the availability of funds. 1 July 2014 to June 2015 1 6 0 1 6DO3.14 6.' Official Payee and Representatives(Names,Addresses,and Telephone Numbers): The Contractor name, as shown on page 1 of this Collier County Housing,Human and Veteran a. contract, and mailing address of the official payee to Services whom the payment shall be made is: 3339 E Tamiami Trail,Building H Naples,FL 34112 b The name of the contact person and street address where Kimberly Grant, Director financial and administrative records are maintained is: Collier County Housing, Human and Veteran Services 3339 E Tamiami Trail,Building H Naples,FL 34112 c. The name, address,and telephone number of the Kimberly Grant,Director representative of the Contractor responsible for Collier County Housing,Human and Veteran Services administration of the program under this contract is: 3339 E Tamiami Trail,Building H Naples, FL 34112 (239)252-2273 d The section and location within the Agency where Nancy Dean,Director of Finance Requests for Payment and Receipt and Expenditure Area Agency on Aging for Southwest Florida, Inc. forms are to be mailed is: 15201 North Cleveland Avenue, Suite 1100 North Fort Myers,FL 33903 Marianne Lorini,Executive Director e. The name, address, and telephone number of the Area Agency on Aging for Southwest Florida,Inc. Contract Manager for this contract is: 15201 North Cleveland Avenue, Suite 1100 North Fort Myers,FL 33903 239-652-6900 Upon change of representatives(names,addresses,telephone numbers)by either party,notice shall be provided in writing to the other party and the notification attached to the originals of this contract. 2 July 2014 to June 2015 AIX 203.14 All Terms and Conditions Included 16 016 This contract and its Attachments I, III,VII—X, and K any exhibits referenced in said attachments,together 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. By signing this contract,the Parties agree that they have read and agree to the entire contract. IN WITNESS THEREOF, the Parties hereto have caused this contract to be executed by their undersigned officials as duly authorized. Contractor: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR COUNTY COMMISSIONERS SOUTHWEST LO DA,INC. 1. 04f1/1 SIGNED BY: �i) �! " 1 SIGNED : NAME: Stephen Y. Carrell NAME: RONALD LUCCHINO, PhD TITLE: Public Services Administrator TITLE: BOARD PRESIDENT DATE: July 31, 2014 DATE: 4 i col Federal Tax ID:59-6000558 Fiscal Year Ending Date: 09/30 3 July 2014 to June 2015 16 D 16143.14 INDEX OF ATTACHMENTS ATTACHMENT I STATEMENT OF WORK 5 ATTACHMENT III FUNDING SOURCE 14 ATTACHMENT VII INVOICE REPORT SCHEDULE .15 ATTACHMENT VIII ANNUAL BUDGET SUMMARY 16 ATTACHMENT IX REQUEST FOR PAYMENT 17 ATTACHMENT X RECEIPT AND EXPENDITURE REPORT 18 ATTACHMENT K SERVICE RATE REPORT 19 4 July 2014 to June 2015 ADI 203.14 16 D j I STATEMENT OF WORK ALZHEIMER'S DISEASE INITIATIVE PROGRAM SECTION I: SERVICES TO BE PROVIDED 1.1 DEFINITIONS OF CONTRACT TERMS AND ACRONYMS 1.1.1 DEFINITIONS OF ACRONYMS Alzheimer's Disease(AD) Alzheimer's Disease Initiative(ADO Activities of Daily Living(ADL) Assessed Priority Consumer List(APCL) Adult Protective Services(APS) Client Information and Registration Tracking System(CIRTS) Community Care for Disabled Adults(CCDA) Department of Elder Affairs—(DOEA) or Department Home Care For Disabled Adults (HCDA) Instrumental Activities of Daily Living(IADL) Memory Disorder Clinic(MDC) Planning and Service Area(PSA) 1.1.2 PROGRAM SPECIFIC TERMS Aging Out Clients: Individuals reaching 60 years of age who are being transitioned from the Department of Children and Families Services Community Care for Disabled Adults (CCDA) or Home Care for Disabled Adults (HCDA) services to the Department's community-based services. Area Plan:A plan developed by the Agency outlining a comprehensive and coordinated service delivery system in the respective planning and service area, in accordance with the Section 306 of the Older Americans Act (42 U.S.C. 3026)and Department instructions.The Area Plan includes performance measures and unit rates per service offered per county. Area Plan Update: A revision to the Area Plan wherein the Contractor enters ADI specific data into the CIRTS. An update may also include other revisions to the Area Plan as instructed by the Department. Functional Assessment: A comprehensive,systematic,and multidimensional review of a person's ability to remain independent and in the least restrictive living arrangement. DOEA Form 701B is used by case managers to conduct the functional assessment. Memory Disorder Clinic:Research oriented programs created pursuant to Sections 430.502(1) and(2), F.S.,to provide diagnostic and referral services, conduct basic and service-related multidisciplinary research, and develop training materials and educational opportunities for lay and professional caregivers of individuals with AD. Model Day Care: A program of therapeutic, social and health activities specific to clients with memory disorders. Services and activities include,but are not limited to,active and quiet games,reminiscence,validation therapy,pet therapy,water therapy and other failure free activities appropriate to the client's level of functioning. Model day care centers will also provide training for health care and social service personnel in the care of persons having AD or related memory disorders. 5 July 2014 to June 2015 1 6D 18iM3.14.10 1.2 GENERAL DESCRIPTION 1.2.1 General Statement The ADI program provides a continuum of services addressing the special needs of individuals with AD,their families and caregivers. 1.2.1.1 Alzheimer's Disease Initiative Program Mission Statement The ADI program ensures that persons afflicted with AD and other forms of dementia are given essential services to help them age in place in an elder-friendly environment with security, dignity, and purpose. The program also provides support to family members and caregivers of persons afflicted with AD. 1.2.2 Authority The relevant authority governing the Alzheimer's Disease Initiative Program are as follows: (1) Rule Chapter 58D-1,Florida Administrative Code; and (2) Sections 430.501 through 430.504, Florida Statutes. 1.2.3 Scope of Service The Contractor is responsible for the programmatic, fiscal, and operational management of the ADI program. The program services shall be provided in a manner consistent with and described in the Contractor's Request for Proposal, RFP, and the Agency's current area plan and the current Department of Elder Affairs Programs and Services Handbook. 1.2.4 Major Program Goal The major goal of the ADI program is to provide services to meet the needs of caregivers and individuals with AD and related memory disorders. 1.3 INDIVIDUALS TO BE SERVED 1.3.1 General Eligibility The ADI Program addresses the special needs of individuals with AD and their caregivers. 1.3.2 Individual Eligibility Those individuals eligible to receive services under this contract must meet the following conditions: (1) 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; and (2) Not be enrolled in a Medicaid capitated long-term care program. 1.3.3 Targeted Groups Priority for services under this contract will be given to those eligible persons assessed to be at risk of placement in an institution. SECTION II: MANNER OF SERVICE PROVISION 2.1 SERVICE TASKS To achieve the goals of the ADI program, the Contractor shall perform or ensure the performance of its Subcontractors, the following tasks: (1) Client Eligibility Determination; (2) Assessment and Prioritization of Service Delivery for New Clients; (3) Delivery of Services to Eligible Clients;and (4) Monitoring the Performance of Subcontractors. 6 July 2014 to June 2015 16 D 11614 x.1.1. Client Eligibility Determination The Contractor shall ensure that applicant data is evaluated to determine eligibility. Eligibility to become a client is based on meeting the requirements described in this ATTACHMENT I, Section 1.3. 2.1.2 Assessment and Prioritization of Service Delivery for New Clients The Contractor shall ensure the following criteria are used to prioritize new clients for service delivery. It is not the intent of the Agency to remove existing clients from any services in order to serve new clients being assessed and prioritized for service delivery. 2.1.2.1 Priority Criteria for Service Delivery (1) Individuals in nursing homes under Medicaid who could be transferred to the community; (2) Individuals in nursing homes whose Medicare coverage is exhausted and may be diverted to the community; (3) Individuals in nursing homes that are closing and can be discharged to the community; (4) Individuals whose mental or physical health condition has deteriorated to the degree self care is not possible, there is no capable caregiver, and institutional placement will occur within 72 hours; and (5) For the purpose of transitioning individuals receiving CCDA and HCDA services through the Department of Children and Families' Adult Services to community-based services provided through DOEA when services are not currently available, area agency on aging staff and lead agency case managers will ensure that"Aging Out"individuals are prioritized for services only after APS High Risk and Imminent Risk individuals. 2.1.2.2 Priority Criteria for Service Delivery for Other Assessed Individuals The assessment and provision of services should always consider the most cost effective means of service delivery. Functional impairment will be determined through the Agency's functional assessment form administered to each applicant. The most frail individuals not prioritized as described in this attachment, Paragraph 2.1.2.1 will receive services to the extent funding is available. 2.1.3 Delivery of Services to Eligible Clients The Contractor shall ensure the provision of a continuum of services addressing the diverse needs of individuals with AD and their caregivers. The Contractor shall ensure services are performed in accordance with the current Department of Elder Affairs Programs and Services Handbook. Services categories include: (1) Caregiver Training/Support; (2) Case Aid; (3) Case Management; (4) Counseling(Gerontological); (5) Counseling(Mental Health/Screening); (6) Education/Training; (7) Intake; (8) Model Day Care; (9) Respite(Facility-Based); (10) Respite(In-Home); and (11) Specialized Medical Equipment, Services, and Supplies. Caregivers benefit from receiving training, respite and related support services to assist them in caring for the ADI client. 7 July 2014 to June 2015 1 �3.14 6D1 �D 2.1.3.1 Memory Disorder Clinics MDCs are required to provide four(4) hours of in-service training to all respite, in-facility respite and model day care centers in their designated service areas. In-service training topics may include physiological, behavioral and emotional aspects of AD and related diseases as well as caregiver techniques, coping strategies and information regarding Silver Alert. The Contractor shall collaborate with MDCs to assist in this effort and in the effort to carry out Silver Alert protocol activities. The Contractor shall respond to requests for evaluation information and statistical data concerning its consumers, based on information requirements of the MDCs and Brain Bank. 2.1.4 Use of Subcontractors If this contract involves the use of a Subcontractor or third party, then the Contractor shall not delay the implementation of its agreement with the Subcontractor. If any circumstances occur that may result in a delay for a period of 60 days or more of the initiation of the subcontract or in the performance of the Subcontractor, the Contractor shall notify the Contract Manager and the Agency's Chief Financial Officer in writing of such delay. 2.1.4.1 The Contractor shall not permit a Subcontractor to perform services related to this agreement without having a binding Subcontractor agreement executed. In accordance with Section 23.1 of the Master Contract, the Agency will not be responsible or liable for any obligations or claims resulting from such action. 2.1.4.2 Monitoring the Performance of Subcontractors The Contractor shall monitor at least once per year each of its Subcontractors, Subrecipients, Vendors and/or Consultants paid from funds provided under this contract. The Contractor shall perform fiscal, administrative and programmatic monitoring to ensure contractual compliance, fiscal accountability, performance, and compliance with applicable state and federal laws and regulations. The Contactor 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 goals stated in this contract are achieved. 2.2 SERVICE TIMES Service Times The Contractor shall ensure the services listed in this contract are available at times appropriate to meet client service needs, at a minimum, during normal business hours. Normal business hours are defined as Monday through Friday, 8:00am to 5:OOpm. 2.2.1 Service Unit The Contractor shall ensure the provision of the services described in the contract in accordance with the current Department of Elder Affairs Programs and Services Handbook and the service tasks described in Section 2.1. The chart below lists the type of services that can be performed. The highest reimbursement unit rate and the method of payment are shown in ATTACHMENT K Units of service will be paid pursuant to the rate established in the contract as updated, and approved by the Agency's reporting requirements. 8 July 2014 to June 2015 ADI 203.14 2.3 DELIVERABLES 16 016 Service Unit of Service Case Aide Counseling; Counseling(Gerontological); Individual; Model Day Care; Hour Respite In-Facility Respite In-Home Caregiver Train/Support(Indv) Case Management Education/Training; Episode Specialized Medical Equipment, Services and Supplies 2.4 REPORTS The Contractor shall respond to additional routine and/or special requests for information and reports required by the Agency in a timely manner as determined by the Contract Manager. The Contractor shall establish due dates for any Subcontractors that permits the Contractor to meet the Agency's reporting requirements. 2.4.2 Client Information and Registration Tracking System (CIRTS) The Contractor shall input ADI specific data into CIRTS to ensure CIRTS data accuracy. The Contractor shall use CIRTS generated reports which include the following: (1) Client Reports; (2) Monitoring Reports; (3) Services Reports; (4) Miscellaneous Reports; (5) Fiscal Reports; (6) Aging and Disability Resource Center Reports; and (7) Outcome Measurement Reports. 2.5 RECORDS AND DOCUMENTATION 2.5.1 The Contractor shall ensure the collection and maintenance of client and service information on a monthly basis from the CIRTS or any such system designated by the Agency. Maintenance includes valid exports and backups of all data and systems according to Agency standards. 9 July 2014 to June 2015 16 016 ADI 203.14 2.5.2 Each Contractor and Subcontractor, among other requirements, must anticipate and prepare for the loss of information processing capabilities. The routine backing up of all data and software is required to recover from losses or outages of the computer system. Data and software essential to the continued operation of Contractor functions must be backed up. The security controls over the backup resources shall be as 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, offsite location. The Contractor shall maintain written policies and procedures for computer system backup and recovery and shall have the same requirement in its contracts and/or agreements with Subcontractors. These policies and procedures shall be made available to the Agency upon request. 2.6 PERFORMANCE SPECIFICATIONS 2.6.1 Outcomes (1) The Contractor shall ensure services provided under this contract are in accordance with the current Department of Elder Affairs Programs and Services Handbook; (2) The Contractor shall timely submit to the Agency all reports described in ATTACHMENT I, SECTION 2.4,REPORTS.; and (3) The Contractor shall timely submit to the Agency all information described in ATTACHMENT I, SECTION 2.5,RECORDS AND DOCUMENTATION. 2.6.2 The Contractor shall develop and document strategies in the area plan, to support performance achievement of the following: (1) Percent of most frail elders who remain at home or in the community instead of going into a nursing home; (2) Average monthly savings per consumer for home and community-based care versus nursing home care for comparable client groups; (3) Percent of elders assessed with high or moderate risk environments who improved their environment score; (4) Percent of new service recipients with high-risk nutrition scores whose nutritional status improved; (5) Percent of new service recipients whose ADL assessment score has been maintained or improved; (6) Percent of new service recipients whose IADL assessment score has been maintained or improved; (7) Percent of family and family-assisted caregivers who self-report they are very likely to provide care; (8) Percent of caregivers whose ability to provide care is maintained or improved after one year of service intervention(as determined by the caregiver and the assessor); and (9) Percent of customers who are at imminent risk of nursing home placement who are served with community-based services. The Contractor's performance of these measures will be documented in the Agency's annual monitoring reports. 2.7 CONTRACTOR'S FINANCIAL OBLIGATIONS 2.7.1 Cost Sharing and Co-payments The Contractor must establish annual co-payment goals. The Agency has the option to withhold a portion of the Contractor's request for payment if goals are not met according to the Agency and the Department of Elder Affairs' co-payment guidelines. 10 July 2014 to June 2015 16 D 16 203.14 2.7.1.1 Co-payments include only the amounts assessed consumers or the amounts consumers opt to contribute in lieu of an assessed co-payment. The contribution must be equal to or greater than the assessed co-payment. 2.8 AGENCY RESPONSIBILITIES 2.8.1 Program Guidance and Technical Assistance The Agency will provide the Contractor with guidance and technical assistance as needed to ensure the successful fulfillment of the contract by the Contractor. 2.8.2 Contract Monitoring The Agency will review and evaluate the performance of the Contractor under the terms of this contract. Monitoring shall be conducted through direct contact with the Contractor through telephone, in writing, or an on-site visit. The Agency's determination of acceptable performance shall be conclusive. The Contractor agrees to cooperate with the Agency in monitoring the progress of completion of the service tasks and deliverables. The Agency may use, but is not limited to, one or more of the following methods for monitoring: (1) Desk reviews and analytical reviews; (2) Scheduled, unscheduled and follow-up on-site visits; (3) Client visits; (4) Review of independent auditor's reports; (5) Review of third-party documents and/or evaluation; (6) Review of progress reports; (7) Review of customer satisfaction surveys; (8) Agreed-upon procedures review by an external auditor or consultant; (9) Limited-scope reviews; and (10) Other procedures as deemed necessary. SECTION III: METHOD OF PAYMENT 3.1 General Statement of Method of Payment The method of payment for this contract includes advances, cost reimbursement for administration costs, and fixed rate for services. The Contractor shall ensure fixed rates for services include only those costs that are in accordance with all applicable state and federal statutes and regulations and are based on audited historical costs in instances where an independent audit is required. The Contractor shall consolidate all requests for payment from Subcontractors and expenditure reports that support requests for payment and shall submit to the Agency on forms 106Z(ATTACHMENT IX)and 105Z(ATTACHMENT X). 3.1.1 The Contractor agrees to distribute funds as detailed in the area plan update and the Budget Summary, ATTACHMENT VIII to this contract. Any changes in the total amounts of funds identified on the Budget Summary require a contract amendment. . 3.2 Advance Payments 3.2.1 The Contractor may request up to two months of advances at the start of the contract period to cover program administrative and service costs. The payment of an advance will be contingent upon the sufficiency and amount of funds released to the Agency by the State of Florida Department of Elder Affairs ("budget release"). The Contractor shall provide the Contract Manager documentation justifying the need for an advance and describing how the funds will be distributed. 11 July 2014 to June 2015 In nn- 11 � .API 203.14 3.2.2 The Contractor's requests for advance require the approval of the Contract r.�tt nt budget is available,the Agency will issue approved advance payments after July 1, 2014. 3.2.3 All advance payments made to the Contractor shall be returned to the Agency as follows: one — tenth of the advance payment received shall be reported as an advance recoupment on each request for payment, starting with report number five,in accordance with the Invoice Report Schedule,ATTACHMENT VII to this contract. 3.2.4 The Contractor may temporarily place advanced funds in a FDIC insured interest bearing account. All interest earned on contract fund advances must be returned to the Agency within thirty (30) days of the end of each quarter of the contract period. 3.3 Invoice Submittal and Requests for Payment All requests for payment documentation and expenditure reports submitted to support requests for payment shall be on DOEA forms 106Z (ATTACHMENT IX) and 105Z (ATTACHMENT X).. The Contractor shall include with its request for payment documentation of services provided,the units of services provided,and the rates for the services provided in conformance with the requirements as described in the deliverables and service tasks. 3.3.1 Remedies-Nonconforming Services The Contractor shall ensure that all goods and/or services provided under this contract are delivered timely, completely and commensurate with required standards of quality. Such goods and/or services will only be delivered to eligible program participants. 3.3.1.1 If the Contractor fails to meet the prescribed quality standards for services, such services will not be reimbursed under this contract. In addition, any nonconforming goods (including home delivered meals) and/or services not meeting such standards will not be reimbursed under this contract. The Contractor's signature on the request for payment form certifies maintenance of supporting documentation and acknowledgement that the Contractor shall solely bear the costs associated with preparing or providing nonconforming goods and/or services. The Agency requires immediate notice of any significant and/or systemic infractions that compromise the quality, security or continuity of services to clients. 3.3.2 Financial Consequences Contractor shall ensure the provision of services to the projected number of clients in accordance with the Area Plan as updated and within the contract amount. The Contractor shall ensure expenditure of 100%of the contract amount budgeted for services to clients at the unit rates established in the Area Plan. In the event the Contractor has a surplus of 1% or more at the end of the contract term,the Agency will reallocate 1% of the budget for the next year contract term to other area agencies found to be serving clients to the fullest extent of their allocated budgets. If, or to the extent, there is any conflict between this paragraph and paragraphs 39.1 and 39.2 of the Master Contract,this paragraph shall have precedence. 3.3.2.1 All payment requests shall be based on the submission of actual monthly expenditure reports beginning with the first month of the contract. The schedule for submission of advance requests (when available) and invoices is ATTACHMENT VII to this contract. 3.3.2.2 Payment may be authorized only for allowable expenditures,which are in accordance with the limits specified in ATTACHMENT VIII,Budget Summary. 3.3.2.3 Any payment due by the Agency under the terms of this contract may be withheld pending the receipt and - approval by the Agency of all financial and programmatic reports due from the Contractor and any adjustments thereto, including any disallowance not resolved as outlined in Section 26 of the Master Contract. 3.3. Date For Final Request For Budget Revisions Final requests for budget revisions or adjustments to contract funds based on expenditures for services provided through June 25,2015,must be submitted to the Contract Manager no later than June 25, 2015. 12 July 2014 to June 2015 ATM 203.14 16016 3.4 Date for Final Request for Payment The final request for payment is due to the Agency no later than July 25,2015. 3.5 Consequences for Non-Compliance The Contractor shall ensure 100%of the deliverables identified in Section 1.2.3 Scope of Services are performed pursuant to contract requirements, and as described in Section 2.3 are identified as major deliverables in this contract. If at any time the Contractor is notified by the Agency's Contract Manager that it has failed to correctly, completely, or adequately perform these major deliverables, the Contractor will have 10 days to submit a Corrective Action Plan("CAP")to the Contract Manager that addresses the deficiency and states how the deficiency will be remedied within a time period approved by the Contract Manager. The Agency shall assess a Financial Consequence for Non-Compliance on the Contractor for each deficiency identified in the CAP which is not corrected pursuant to the CAP. The Agency will also assess a Financial Consequence for failure to timely submit a CAP. In the event Contractor fails to correct an identified deficiency within the approved time period specified in the CAP, the Agency shall deduct, from the payment of the invoice for the following month, 1% of the monthly value of the contract funds for each day the deficiency is not corrected. The Agency may also deduct, from the payment of the invoice for the following month, 1% of the monthly value of the contract funds for each day the Contractor fails to timely submit a CAP, beginning the 11th day after notification by the Contract Manager of the deficiency. The deduction will be made from the payment for the invoice of the following month. If, or to the extent, there is any conflict between this paragraph and paragraphs 39.1 and 39.2 of the Master Contract,this paragraph shall have precedence. 3.6 Documentation for Payment The Contractor shall maintain documentation to support payment requests that shall be available to the Agency or authorized individuals,such as the Department of Financial Services, upon request. 3.6.1 The Contractor must enter all required data per the Department's CIRTS Policy Guidelines for clients and services in the CIRTS database. The data must be entered into the CIRTS before they submit their request for payment and expenditure reports to the Agency. The Agency shall establish time frames to assure compliance with due dates for the requests for payment and expenditure reports to the Agency. 3.6.2 The Contractor must run monthly CIRTS reports and verify client and service data in the CIRTS is accurate. This report must be submitted to the Agency with the monthly request for payment and expenditure report and must be reviewed by the Agency before the Contractor's request for payment and expenditure reports can be approved by the Agency. 13 July 2014 to June 2015 ADI 203.14 16D 1,, 6 4 TACHMENT III 1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS CONTRACT CONSIST OF THE FOLLOWING: PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT TOTAL FEDERAL AWARD COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT TO THIS CONTRACT ARE AS FOLLOWS: N/A 2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS CONTRACT CONSIST OF THE FOLLOWING: MATCHING RESOURCES FOR FEDERAL PROGRAMS PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT TOTAL STATE AWARD $0 STATE FINANCIAL ASSISTANCE SUBJECT TO Sec.215.97, F.S. PROGRAM TITLE FUNDING SOURCE CSFA AMOUNT Alzheimer's Disease Initiative General Revenue/TSTF-Collier 65004 $ 104,280.00 TOTAL AWARD $ 104,280.00 COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS CONTRACT ARE AS FOLLOWS: STATE FINANCIAL ASSISTANCE Section 215.97, Fla. Stat. Chapter 69I-5,Fla. Admin. Code 14 July 2014 to June 2015 16 D 16 4DI 203.14 ATTACHMENT VII INVOICE REPORT SCHEDULE ALZHEIMER'S DISEASE INITIATIVE(ADI) INVOICE SCHEDULE Report Number Based On Submit to Agency on This Date 1 July Advance* July 1 2 August Advance* July 1 3 July Expenditure Report August 9 4 August Expenditure Report September 9 5 September Expenditure Report October 9 6 October Expenditure Report November 9 7 November Expenditure Report December 9 8 December Expenditure Report January 9 9 January Expenditure Report February 9 10 February Expenditure Report March 9 11 March Expenditure Report April 9 12 April Expenditure Report May 9 13 May Expenditure Report June 9 14 June Expenditure Report July 9 15 Final Request for Payment July 25 16 Closeout Report August 1 Legend: * Advance based on projected cash need. Note# 1: Report #1 for Advance Basis Contracts cannot be submitted to the Area Agency on Aging for Southwest Florida, Inc. prior to July 1 or until the contract with the Agency has been executed and a copy sent to the Agency on Aging for Southwest Florida, Inc. Actual submission of the vouchers to the Agency is dependent on the of the expenditure report. Note#2: All advance payments made to the Contractor shall be returned to the Agency as follows: one—tenth of the advance payment received shall be reported as an advance recoupment on each request for payment, starting with report number five. The adjustment shall be recorded in Part C, Line 1 of the report(ATTACHMENT X). Note# 3: Submission of expenditure reports may or may not generate a payment request. If final expenditure report reflects funds due back to the Agency,payment is to accompany the report. 15 July 2014 to June 2015 16 0 16 ADI 203.14 ATTACHMENT VIII ALZHEIMER'S DISEASE INITIATIVE PROGRAM ANNUAL BUDGET SUMMARY For Collier County Board of County Commissioners Collier ALLOCATION TOTAL $ 104,280 16 July 2014 to June 2015 1 6 0 1 6,1)1203.14 ATTACHMENT IX REQUEST FOR PAYMENT ALZHEIMERS DISEASE INITIATIVE PROGRAM REC RENT NAME,ADDRESS.PHO*IE and FED:: TYPE OF REPORT: This Request Period PSA# A PAYMENT REQUEST: Report s Regular Supplemental Contract€ B.PJETHOD OF PAYMENT: Contract Period Advance Reimtwrsemert C ERTF CATION:I hereby certify to the best of mylorowledge that Os request i s complete and correct and coriormswith the terms and the purposes of the above contract. Prepared by. —Date: Approved by Date: (1) - (2) PARTA BUDGET WhiMARY Respite Model DavCare TOTAL 1 Approved CortractAmaut 50.00 50.00 50.00 2.Previous Funds Received for Conrad Period 50.00 50.00 50 00 3.Contract Balance fine 1 minus line 2) 5000 50.00 50.00 4.Previous Fuids Requested and Not Received for Contract Period 5000 5000 50.00 5.Contract Balance(i ne 3 sinus lined) 50.00 50.00 5000 PARTS: CONTRACT FUNDS REQUEST 1.Anticipated Cash Needs(1st-2nd mo nth.AttachJustificalion) 50.00 5000 5000 2.Net Erpenditues For Month 50.00 5000 50.00 (DOEA Form 102 Part B.Line 3) 3.TOTAL 50 00 50 00 50.00 PART C: NET FUNDS REQUESTED 1.Less Advance Applied $0 00 S0 00 50.00 2.Contract Funds are Hereby Requested for(Part B.Line 3 50.00 50.00 50.00 sinus Part C.Line 1) List of Services/Units/Rates provided-See attached report. DOEA FORM 106Z Rt.iitS 54,2 17 July 2.014 to June 2015 1 6 0 1 6AD1 203.14 ATTACHMENT X RECEIPT AND EXPENDITURE REPORT ALZHEIMERS DISEASE INITIATIVE PROGRAM PROVIDER NAME,ADDRESS,PHONE*and FEIN;Program Funding: THIS REPORT PERIOD. From To _ Respite CONTRACT PERIOD: Model Day Care _ CONTRACT# REPORT# PSA# CERTIFICATION: I certif y to the best of my knowledge and belief that the report is complete and correct and all outlays herein are for purposes set forth in the contract_ Prepared by:_ Date: Approved by: ____Date: PART A:BUDGETED INCOME/RECEIPTS 1.Approved 2.Actual Receipts 3.Total Receipts 4.Percent of Budget For This Report Year to Date Approved Budget 1.State Funds 50.00 $0.00 S0.00 : 4DIV/0! 2.Program Income $0.00 $0.00 $0.00 #DIV/0l 3.Local Cash Match $0.00 S0.00 $0.00 #DIV/0! 4.SUBTOTAL:CASH RECEIPTS 5.Local In-Kind Match 6.TOTAL RECEIPTS $0.00 $0.00 $0.00 4DIV/0! PART B:EXPENDITURES 1.Approved 2.Expenditures 3.Expenditures 4.Percent of Budget For This Report Year to Date Approved Budget 1.Administrative Services S0.00 $0.00 $0.00 44DIV/0! 2.Service Subcontractor(s) S0.00 $0.00 $0.00 #DIV/0! 3.TOTAL EXPENDITURES $0.00 $0.00 $0.00 #DIV10! PART C:OTHER REVENUE AND EXPENDITURES II.Interest: III.Advance Recouped I.Program Income(PI) 1. Earned on GR Advance S _ S 1.ADI:PI Collected YTD S 2.Return of GR Advance S (Includes co-payments collected) 3.Other Earned S_ PART D:CO-PAYMENTS CURRENT MONTH YEAR-TO-DATE 1.Total of Co-payments assessed S S 2.Total of Co-payments collected S S (For Tracking Purposes only) GOEA FOAM 1052 Revised 5,292010 18 July 2014 to June 2015 ADI 203.14 16016 ATTACHMENT K SERVICE RATE REPORT HIGHEST METHOD OF DELIVERABLES REIMBURSEMENT PAYMENTS UNIT RATE Case Aide: Collier $33.88 Fixed Fee/Unit Rate Case Management: Collier $60.00 Fixed Fee/Unit Rate Respite In-Facility: Collier $12.22 Fixed Fee/Unit Rate Respite In-Home: Collier $24.44 Fixed Fee/Unit Rate Specialized Medical Equipment, Services and Supplies Cost Reimbursement 19 16016 Attestation Statement Agreement/Contract Number ADI 203.14 Amendment Number n/a 1, Stephen Y. Carnell ,attest that no changes or revisions have been made to the (Recipient/Contractor representative) content of the above referenced agreement/contract or amendment between the Area Agency on Aging for Southwest Florida and Public Services Administrator (Signature of Recipient/Contractor name) The only exception to this statement would be for changes in page formatting,due to the differences in electronic data processing media,which has no affect on the agreement/contract content. /��•!��`i ( July 31, 2014 Signature of Recipi nt/Contractor representative Date