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Agenda 10/14/2008 Item #16D25A,--e -.-t a !tear Ho. 16fl25 October 14, 2003 Paoe 1 of 37 EXECUTIVE SUMMARY Recommendation that the Board of County Commissioners approve and authorize the Chairman to sign agreements between the Collier County Board of County Commissioners and the Area Agency on Aging of Southwest Florida, Inc., authorize the continued payment of grant expenditures, and approve budget amendments to reflect funding for the FY08 -09 program year in the amount of 5827,715. OBJECTIVE: The execution of these agreements and budget amendments is necessary to recognize FY08 -09 grant funding in the Collier County Services for Seniors program from State of Florida General Revenue grants. CONSIDERATIO_5'S: Collier County Services for Seniors provides in -home support services to Collier County's frail elderly through grants funded through State of Florida General Revenue funds. These funds are received by the County through the Area Agency on Aging of Southwest Florida. The contract period is from July 1, 2008 through June 30, 2009. Program Component Anticipated Award Difference Award Amount Community Care for the Elderly (CCE) $706,644 $649,729 $56,915 Alzheimer's Disease Initiative (ADI) 5115,586 5100,615 $14,971 Home Care for the Elderly (HCE) Case $7,81 3 $5,943 51,870 Management Home Care for the Elderly (HCE) $107,516 71,428 $36,088 Subsidies* These funds are retained by the funding agency and do not require a budget amendment. Total Funding $937,559 $827,715.00 $109,844 GROWTH MANAGEMENT: fhere is no growth management impact from this recommendation. FISCAL IMPACT: Funding in the amount of $937,559 was anticipated for the FY08 -09 contract year and was budgeted. This arnendrncnt reflects the actual allocation, resulting in a decrease of 5109,844. Matching funds in the arnount of' 597,100 for these programs has been approved and budgeted in FY08. No additional matching funds are required. LEGAL CONSII3ERATIONS: This item has been revieNved and approved by the County Attorney's Office and is lei-ally sufficient for Board action. - CMG RECOMMENDATIONS: Staff recon7mends that the Board of County Commissioners approve and authorize the Chairman to sign the agreements, authorize the continued payment of grant expenditures and approve the necessary budget amendments. �^ Prepared by: Terri Daniels, A ccountin�; Super�Tisor, Housing and human Services ices Departent ,,I- pate I of I --!a Ienn tl,o `5 COLLIER COUNTY --y Lj I,' T 1 0 N E 'R S Item Number: 1'D 2 5 Item Summary: Recor-,-,mendatp:,n that the Board of County Comr-rissioners aLdh0ri-7C-;he Chairman tc sign c3nt-,E,ct amendments bc-T,,een Col!ler 0,-,urty Board Of COUnty (--3rrrrJszioners and the Area Agency on Aginc Of SIOLith%'C-St FIXtda. inc,, and approve budget amendments to reflect findir,j, for the program year in the amount of x;807.715. Meeting Date: 19 1114 ;., - 2, 9 00:0 `,11, Approved By Marcy Krumbine D rector Date Public Services 11:18 Ate Approved By Colleen Greene Courity AttorrLr Date County Attorney cMze �!241'2,308 4:54 RIM Approved By Marla Remsey late Public Services b S i C e S 4 drn; 11:43 4, r,,A Approved By OWI?3 vrji,,4-,ty Approved By Sherry Pryor e County "Manage Approved By ja,n=as V M'u.nc 1,10ard of Cou-11 y file://C:\A,-Yenda'Fest'\I-_xi)ort\ 1 14-October',4020 14.(Yo'-02008'\ I 6.'N,'20(-'0NSFN'F%20AGEND... 101/81/2008 July 2008 — June 2009 STANDARD CONTRACT AREA AGENCY ON AGING Collier County Services for Seniors -'a iie n "l3. 1 ,C�5 Contract CCE 20��.0 _ 3 -�; -7 THIS CONTRACT is entered into between the Area Agency on Aging for Southwest Florida, Inc., hereinafter referred to as the "agency ", and the Collier County Board of Commissioners, hereinafter referred to as the "recipient." This contract is subject to all provisions contained in the MASTER CONTRACT executed between the agency and the recipient, Contract No. 203.M007, and its successor, incorporated herein by reference. The parties agree: I. Recipient Agrees: A. Services to be Provided: To plan, develop, and accomplish the services delineated, or otherwise cause the planning, development, and accomplishment of such services and activities, under the conditions specified and in the manner prescribed in ATTACHMENT I of this contract. B. Final Request for Adjustments and Payment: 1. Final requests for budget revisions or adjustments to contract funds based on expenditures for services provided through June 30, 2009 must be submitted to the Agency by July 05, 2009. 2. The final request for payment invoice must be submitted by July 25, 2009. H. The Agency Agrees: A. Contract Amount: To pay for services according to the conditions of ATTACHMENT I in an amount not to exceed the $649,729.00, subject to the availability of funds. B. Obligation to Pay: The State of Florida's performance and obligation to pay under this contract is contingent upon an annual appropriation by the Legislature. C. Source of Funds: The costs of services paid under any other contract or from any other source are not eligible for reimbursement under this contract. The funds awarded to the recipient pursuant to this contract are in the state grants and aids appropriations and consist of the following: Services i Year Total Rate/Reimbursement Rate Case Management $50.51/S45.45 Case Aide 2008 -2009 $26.34/$23.70 Transportation 90% Cost Reimbursement July 2008 — June 2009 Contract CCE'20& 4 f;:,s V 3' —Program Title Funding Source CFDA/CSFA Fund Amount Community Care for the Elderly 2007 -2008 General Revenue/ 65010 $97,459.00 — Lead Agency Operations Tobacco Settlement Trust Fund Community Care for the Elderly 2007 -2008 General Revenue/ 65010 $113,000.00 — CM, CA, Intake Allocation Tobacco Settlement Trust Fund Community Care for the Elderly 2007 -2008 General Revenue/ �65 $ - Spending Authority Tobacco Settlement Trust Fund TOTAL FUNDS CONTAINED IN THIS CONTRACT: $649,729.00 NOTE: Case Management, Case Aide, and Intake were allocated based on historical data from 2003 -2004 through 2007 -2008. Transportation and Home Delivered Meals will not be allocated separately; they are included in the spending authority. III. Recipient and Agency Mutually Agree: A. Effective Date: 1. This contract shall begin on July 1. 2008. 2. This contract shall end on June 30, 2009. B. Termination and/or Enforcement: The causes and remedies for suspension or termination of this contract shall follow the same procedures as outlined in Section XXIV and Section XXV of the Master Contract. C. Recipient Responsibility: Notwithstanding the pass - through language contained in the Assignments and Subcontracts clause of the Master Contract, the recipient maintains responsibility for the performance of all subrecipients and vendors in accordance with all applicable federal and state laws. D. Notice, Contact, and Payee Information: 1. The name, address, and telephone number of the contract manager for the agency for this contract is: Leigh E. Schield, Executive Director Area Agency on Aging for Southwest Florida, Inc. 2285 First Street Fort Myers, Florida 33901 -2959 (239) 332 -4233 2. The name, address, and telephone number of the representative of the recipient responsible for administration of the program under this contract is: Marcy Knm.bine, Director Collier County Housing and Human Services 3301 East Tamiami Trail, BIdg H. Naples, Florida 34112 (239) 252 -2273 2 July 2008 - June 2009 �Jb r 14 2L,60 Pa-le °= 1 of 37 Contract CCE 203.08 3. 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 originals of this contract. 4. The name (recipient name as shown on page 1 of this contract) and mailing address of the official payee to whom the payment shall be made: Collier County Housing and Human Services 3301 East Tamiami Trail, Bldg H. Naples, Florida 34112 (239) 252 -2273 IN WITNESS THEREOF, the parties hereto have caused this 12 page contract to be executed by their undersigned officials as duly authorized. ATTEST: DWIGHT E. BROCK, Clerk By: Deputy Clerk Approved as to form and leEV al sufficiency gaz�- Assistant Coun Attorney FEDERAL ID NUMBER: 59- 6000558 FISCAL YEAR -END DATE: 9/30 COLLIER COUNTY HOUSING AND HUMAN SERVICES BY: BOARD OF COUNTY COMMISSIONERS COLLIER COUNTY, FLORIDA 0 TOM HENNING, CHAIRMAN Date: October 14. 2008 AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA By: ROBERT D. JOHNSON BOARD PRESIDENT Date: June 30. 2008 3 July 2008 — June 2009';�� Contract CCE 20.3�4 ,f - ATTACHMENT COMMUNITY CARE FOR THE ELDERLY PROGRAM I. STATEMENT OF PURPOSE The Community Care for the Elderly (CCE) Program was created to assist functionally impaired elderly persons live dignified and reasonably independent lives in their own homes or in the homes of relatives or caregivers. The program provides a continuum of care through the development, expansion, reorganization and coordination of multiple community -based services to assist elders to reside in the least restrictive environment suitable to their needs. 11. SERVICES TO BE PROVIDED A. Services: I. The recipient's service provider application for state fiscal year 2006 -2009, and any revisions approved by the agency and located in the grant manager's file, are incorporated by reference in this contract between the agency and the recipient, and prescribe the services to be rendered by the recipient. 2. With the exception of Adult Protective Services (APS) high -risk referrals, consumers may not be dually enrolled in the Community for the Elderly (CCE) program and a Medicaid capitated long - tenn care program. Adult Protective Services (APS) high -risk referrals who are enrolled in a Medicaid capitated long -term care program at the time of referral may receive crisis - resolving CCE - funded services only under the following circumstances: a. The long -term care program provider is contacted regarding the referral as soon as it is received. b. The CCE lead agency receives assurance from the long -term care program provider that the long -term care prog=ram in which the consumer is enrolled will address the consumer's needs. c. The CCi lead agency may only provide services until the crisis is resolved. B. Manner of Service Provision: The services will be provided in a manner consistent with and described in the recipient's service provider application, the agency's area plan update for state fiscal year 2007 and the Department of Elder Affairs Home and Communuty-Bused Sei v;ces Handbook. Iii the event the handbook is revised, such revision will autorriatically be incorporaf d into the contract and the recipient will be given a copy of the revisions. III. METHOD OF PAYMENT A. The method of payment in this contract includes advances and fixed rate for services. The recipient must 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 0 Y"`:ii'_a !:'.;iii ko. `i1 ,.2 ;5_ July 2008 — June 2009 Contract CCE 20 & 1 3 7 independent audit is required. The recipient shall consolidate all requests for payment from subrecipients and expenditure reports that support requests for payment and shall submit to the agency on forms 106C (ATTACHMENT IV) and 105C (ATTACHMENT V). B. The recipient shall maintain documentation to support payment requests which shall be available to the Department of Financial Services or the department upon request. C. The recipient may request a monthly advance for Community Care for the Elderly (CCE) services for each of the first two months of the contract period, based on anticipated cash needs. Detailed documentation justifying the need for cash advances, including a statement of how the advances will be distributed, must be submitted with the signed contract, approved by the agency, and maintained in the grant contract manager's file. The agency will issue approved advance payments to the recipient after July 1, 2008 and no later than August 1, 2008, subsequent to receipt of an invoice and the justifying documentation. All payment requests for the third through the twelfth months 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 is ATTACHMENT II to this contract. All advance payments are subject to the availability of funds. The advance payment amount shall be recovered during the last two months of the contract period, beginning with the invoice submitted for the month of May 2009 through the invoice submitted for June 2009. The amount of the advance payment shall be one -half of the advance payment amount deducted in each month of the recovery period from each monthly invoice described above until the total advance payment amount is recovered. D. Advance funds may be temporarily invested by the recipient in an 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. E. Additional Reporting Conditions: The recipient agrees to implement the distribution of funds as detailed in the service provider application and the Budget Summary, ATTACHMENT III to this contract. Any changes in the total amounts of the funds identified on the Budget Summary form require written confirmation by the agency. 2. The final request for payment will be due to the agency no later than July 25, 2009. F. Client Information and Registration Tracking System (CIRTS) The recipient will ensure that client and service information for the Community Care for the Elderly (CCE) program is entered into the Client Information and Registration T racking System (CIRTS) and maintained in accordance with Section XXVII. F. of the Master Contract. G. Any payment due by the agency under the terms of this contract may be withheld pending the receipt and approval by the agency of complete and accurate financial and programmatic reports due from the recipient and any adjustments thereto, including any disallowance not resolved as outlined in Section XVIII. of the Master Contract. July 2008 — June 2009 IV. SPECIAL PROVISIONS A. State Laws and Regulation: � . .. �7 Contract CCE Zb" i. � Of _37 1. The recipient agrees to comply with applicable parts of Rule Chapter 58C -1, Florida Administrative Code, promulgated for administration of Sections 430.201 through 430.207, Florida Statutes, and the Department of Elder Affairs Home and Community -Based Services Handbook. 2. The recipient agrees to comply with the provisions of Sections 97.021 and 97.058, Florida Statutes, and all rules related thereto in the Florida Administrative Code. B. Assessment and Prioritization for Service Delivery for New Consumers: The following are the criteria to prioritize new consumers for service delivery. It is not the intent of the agency to remove existing consumers from any services in order to serve new consumers being assessed and prioritized for service delivery. 1. Abuse, Neglect and Exploitation: The recipient will ensure that pursuant to Section 430.205(5), Florida Statutes, those elderly persons who are determined by adult protective services to be victims of abuse, neglect, or exploitation who are in need of immediate services to prevent further harm and are referred by adult protective services, will be given primary consideration for receiving Community Care for the Elderly Services. As used in this subsection, "primary consideration" means that an assessment and seimces must commence within 72 hours after referral to the agency or as established in accordance with agency contracts by local protocols developed I. ed bC~J+'eCI'i agency service reCll3lerit5 and adult Protective services. 2. Priority Criteria for Individuals in Nursing Homes in Receivership: The recipient will ensure that pursuant to Section 400.126 (12), Florida Statutes, those elderly persons determined, through a Comprehensive Assessment and Review for Long -Term Care Services (CARES) assessment, to be a resident who could be cared for in a less restrictive setting or who do not meet the criteria for skilled or intermediate care in a nursing home, will be referred for such care, as appropriate for the resident, Residents referred pursuant to this subsection shall be given primary consideration for receiving services under the Community Care for the Elderly program in a manner as persons classified to receive such services pursuant to Section 430.205, Florida Statutes. 3. Priority Criteria for Service Delivery: a) individuals in nursing homes under Medicaid who could be transferred to the community; b) individuals in nursing homes whose Medicare coverage is exhausted and may be diverted to the community; c) individuals in nursing homes that are closing and can be discharged to the community; or 6 July 2008 — June 2009 s Contract CCE 203;(R' f d) 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. e) For the purpose of transitioning individuals receiving Community Care for Disabled Adults (CCDA) and Home Care for Disabled Adults (HCDA) services through the Department of Children and Families (DCF) Adult Services to community -based services provided through the department, when services are not currently available, area agency on aging staff and lead agency case managers shall ensure that "Aging Out" individuals are prioritized for services only after Adult Protective Services (APS) High Risk and Imminent Risk individuals. 4. 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. Service priority for individuals not included in groups one, two or three above, regardless of referral source, shall be determined through the department's consumer assessment form administered to each applicant, to the extent funding is available. First priority will be given to applicants at the higher levels of frailty and risk of nursing home placement. For individuals assessed at the same priority and risk of nursing home placement, priority will be given to applicants with the lesser ability to pay for services. 5. Referrals for Medicaid Waiver Services: a. The agency must require recipients, through the consumer assessment, to identify potential Medicaid eligible Community Care for the Elderly (CCE) consumers and to refer these individuals for application for Medicaid Waiver services. b. Individuals who have been identified as being potentially Medicaid Waiver eligible are required to apply for Medicaid Waiver services in order to receive Community Care for the Elderly (CCE) services and can only receive CCE services while the Medicaid Waiver eligibility determination is pending. If the consumer is found ineligible for Medicaid Waiver services for any reason other than failure to provide required documentation, they may continue to receive Community Care for the Elderly (CCE) services. c. Individuals who have been identified as being potentially Medicaid Waiver eligible must be advised of their responsibility to apply for Medicaid Waiver services as a condition of receiving Community Care for the Elderly (CCE) services while the eligibility determination is being processed. C. Co- payment Collections: 1. The agency will ensure recipients establish annual co- payment goals. The agency also has the m option to withhold a portion of the recipient's Request for Payent if goals are not met according to the agency and department's co- payment guidelines. 2. 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. July 2008 — June 2009 Contract CCE 2 '" 08- I Co- payments collected in the CCE program can be used as part of the local match. D. Match: The agency will assure a match requirement of at least 10 percent of the cost for all Community Care for the Elderly services. The match will be made in the form of cash and/or in -kind resources. At the end of the contract period, all Community Care for the Elderly funds expended must be properly matched. E. Service Cost Reports: The agency will require recipients to submit semi- annual service cost reports, which reflect actual costs of providing each service by program. This report provides information for planning and negotiating unit rates. The semi - annual service cost reports are due to the agency by February 15`x` and August 15`h. E July 2008 — June 2009 COMMUNITY CARE FOR THE ELDERLY INVOICE SCHEDULE Report Number Based On 1 July Advance* 2 August Advance* 3 July Expenditure Report 4 August Expenditure Report 5 September Expenditure Report 6 October Expenditure Report 7 November Expenditure Report 8 December Expenditure Report 9 January Expenditure Report 10 February Expenditure Report 11 March Expenditure Report 12 April Expenditure Report 13 May Expenditure Report 14 June Expenditure Report 15 Final Expenditure and Closeout Report Legend: * Advance based on projected cash need. Contract CCE 2�0 3_;918! ;; :, ATTACHMENT II Submit to State On This Date July 1 July 1 August 10 September 10 October 10 November 10 December 10 January 10 February 10 March 10 April 10 May 10 June 10 July 10 July 25 Note # 1: Report #1 for Advance Basis Agreements cannot be submitted to the Agency for submission to the Area Agency on Aging for Southwest Florida, Inc., prior to July 1 or until the agreement with the agency has been executed. Note # 2 Report numbers 13 and 14 shall reflect an adjustment of one half of the total advance amount, on each of the two reports respectively, repaying advances for the first two months of the agreement. The adjustment shall be recorded in Part C, 1 of the report (Attachment IV). Note 43: 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. Revised May 2006 9 July 2008 — June 2009 Cor. *ract CCi �h2 0 COMMUNITY CARE FOR THE ELDERLY PROGRAM BUDGET SUMMARY Collier County Servcies For Seniors I. CCE Spending Authority 2. Lead Agency Services — CM, CA, Intake 3. Lead Agency Operations Total 10 $439,269.00 $113,000.00 $97,459.00 $649,729.00 ATTACHMENT III July 2008 — June 2009 Contract CCE (y3VjA1, J,' ; ATTACHMENT IV REQUEST FOR PAYMENT �d-% AFM My TIkTr'rt7 r AID IV TinlD TTiF. V T11FRI.V i j DOER FORM 106C, Dated May 2006 M: \CONTRACTS\ CONTRACTS & AMENDMENTS \CCE12005 -2006 CCEICCE TEMPLATE 2.2.05.1)OC 11 i r RECIPIENT NAME, ADDRESS, PHONE# and FEID# TYPE OF REPORT: THIS REQUEST PERIOD: FOR A. PAYMENT REQUEST: Regular Supplemental REPORT# B. METHOD OF PAYMENT: CONTRACT# Advance PSI' CERTIFICATION: I hereby certify that this request or refund conforms with the terms of the above contract, Prepared By: Date: Approved By: Date: PART A: BUDGET SUMMARY: (1) CCE Lead Operations (2) CCE CM, CA, Intake (3) CCE Spending Auth (4) Other (6) TOTAL 1. Approved Contract Amount $ $ S S $ $ S 2. Previous Funds Received For Contract Period 3. Contract Balance 4. Previous Funds Requested For Contract Period 5. Contract Balance PART B: CONTRACT FUNDS REQUEST: 1. Anticipated Cash Needs (1st 2nd Months) 2. Net Expenditures For Month (DOER Form 105C, Part B Line 13) 3. Extraordinary Cash Needs (Attach Doc.) 4. Total PART C: NET FUNDS REQUESTED: 1. Less Advance Applied 2. Contract Funds Are Hereby Requested For (Part B Line 4 minus Part C Line 1) i j DOER FORM 106C, Dated May 2006 M: \CONTRACTS\ CONTRACTS & AMENDMENTS \CCE12005 -2006 CCEICCE TEMPLATE 2.2.05.1)OC 11 i r July 2008 — June 2009 Contract CC✓ 1. S - r ATTACHMENT RECEIPTS AND EXPENDITURES COMMUNITY CARE FOR THF. F.T.DEPT V RECIPIENT NAME, ADDRESS, PHONE# PROGRAM FUNDING SOURCE: THIS REPORT PERIOD: FROM TO CCE Lead Operations CCE CM, CA, Intake CONTRACT PERIOD CCE Spending Auth. CONTRACT# REPORT# PSA# CERTIFICATION: I certify 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 contram Prepared By: Date: Approved By: Date: PART A: BUDGETED INCOME/RECEIPTS 1. Approved 2. Actual 3. Total 4. Percent of Budget Receipts for Receipts Approved Budget This Report Year to Date 1. Federal Funds ............ ............................... $ $ $ 2. State Funds... ............................................ $ $ $ i% 3. Program income .......... ............................... $ $ $ 4. Local Cash Match ........ ............................... $ 5. SUBTOTAL: CASH RECEIPTS ..................... $ $ G. Local In -Kind Match ..... ............................... $ 7. TOTAL RECEIPTS ....... ............................... $ $ $ PART B: EXPENDITURES' ! I. Approved 2. Expenditures for 3. Expenditures 4. Percent (cf Budget This Report Year to Date Approved 1. Administrative Seri iecs . ............................... $ $ Budget 2. Service Subcontractor ( s)._ ........................... $ % 3. TOTAL .......................... ............................... $ — $ PART C: Other Expenditures (For Tracking Purposes Only) a. Total Local Match .......................... I $ -% PART D: OTHER REVENUE AND EXPENDITURES IL Interest. � III. Advance Recoupment: I. Program Income (PI): 1. Earned on GR Advance $ I. Recoupment of Advance $ 1. CCE: PI Collected YTD $ 2. Rtn. of GR Advance $ (INCLUDES FEES COLLECTED) 3. Other Earned FPA-RTf'.E: Co- payments II. Total - Current Month III. Total - Year To Date tl Amount of Co- payments Assessed $ _ $ 1 i11. Total Amount of Co- payments Collected I S (FOR TR'iCKING PURPOSES ONL -Y) I *Expenditures of State Funds nnlv on Inr I .. 1 DOER FOWM 105C, REV. NIAY 2007 12 2008 -2009 STANDARD CONTRACT AREA AGENCY ON AGING Collier County Services For Seniors tat `. ctcber A 1'003 Agreement No. ADI Z08:0 "8 THIS CONTRACT is entered into between the Area Agency on Aging for Southwest Florida., Inc., hereinafter referred to as the "agency ", and Collier County Board of Commissioners, hereinafter referred to as the "recipient." This contract is subject to all provisions contained in the MASTER CONTRACT executed between the agency and the recipient, Contract No. 203.M007, and its successor, incorporated herein by reference. The parties agree: I. Recipient Agrees: A. Services to be Provided: To plan, develop, and accomplish the services delineated, or otherwise cause the planning, development, and accomplishment of such services and activities, under the conditions specified and in the manner prescribed in ATTACHMENT I of this contract. B. Final Request for Adjustments and Payment: 1. Final requests for budget revisions or adjustments to contract funds based on expenditures for services provided through June 30, 2009 must be submitted to the AAA contract manager by July 05, 2009. 2. The final request for payment invoice must be submitted by July 25, 2009. 1I. The Agency Agrees: A. Contract Amount: To pay for services according to the conditions of ATTACIMENT I in an amount not to exceed $100,615.00, subject to the availability of funds. B. Obligation to Pay: The State of Florida's performance and obligation to pay under this contract is contingent upon an annual appropriation by the Legislature. C. Source of Funds: The costs of services paid under any other contract or from any other source are not eligible for reimbursement under this contract. The funds awarded to the recipient pursuant to this contract are in the state grants and aids appropriations and consist of the following: 3 2008 -2009 Agreement No. ADI ?v3 08) Services Year Reimbursement Rate Case Management 2008- $50.51 t2009 Program Title Funding Source CFDA/CSFA # Fund Amounts Alzheimer's Disease General Revenue / 65004 $100,415.00 Initiative - Respite Services TSTF Alzheimer's Disease General Revenue / 65004 $200.00 Initiative — Case TSTF Management TOTAL FUNDS CONTAINED IN $100,615.00 THIS CONTRACT: III. Recipient and Department Mutually Agree: A. Effective Date: I. This contract shall becrin on July 1. 2008. 2. This contract shall end on June 30, 2009. B. Termination and /or Enforcement: The causes and remedies for suspension or termination of this contract shall follow the same procedures as outlined in Section XXIV and Section VXV of the Master Contract. C. Recipient Responsibility: Notwithstanding the pass - through language contained in the Assignments and Subcontracts clause of the Master Contract, the recipient maintains responsibility for the performance of all subrecipients and vendors in accordance with all applicable federal and state laws. D. Notice, Contact, and Payee Information: 1. The name, address, and telephone number of the contract manager for the agency for this contract is: Leigh E. Schield, Executive Director Area Agency on Aging of Southwest Florida, Inc. 2285 First Street Fort Myers, Florida 33901 (239) 332 -4233 2. The name, address, and telephone number of the representative of the recipient responsible for administration of the program under this contract is: 2 2008 -2009 Agreement No. ADI 203.08 Marcy Krumbine, Director Collier County Housing and Human Services 3301 East Tamiami Trail, Bldg. H Naples, FL 34112 (239) 774 -8154 3. 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 originals of this contract. 4. The name (recipient name as shown on page 1 of this contract) and mailing address of the official payee to whom the payment shall be made: Collier County Housing and Human Services 3301 East Tamiami Trail, Bldg. H Naples, FL 34112 (239) 252 -2273 IN WITNESS THEREOF, the parties hereto have caused this 13 page contract to be executed by their undersigned officials as duly authorized. ATTEST: DWIGHT E. BROCK, Clerk IIn Deputy Clerk Approved as to form and legal s ciency Assistant Count Attorney FEDERAL ID NUMBER: 59- 60000558 FISCAL YEAR -END DATE: 9/30 COLLIER COUNTY HOUSING AND HUMAN SERVICES BY: BOARD OF COUNTY COMMISSIONERS COLLIER COUNTY, FLORIDA I= TOM HENNING, CHAIRMAN Date: October 14, 2008 AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA C ROBERT D. JOHNSON BOARD PRESIDENT Date: June 30, 2008 16D26 2008 -2009 Agreement No. 1 201 `0 ATTACHMENT I ALZHEIMER'S DISEASE INITIATIVE PROGRAM I. STATEMENT OF PURPOSE The Alzheimer's Disease Initiative (ADI) Program is focused on caring for persons 18 + years of age with memory disorders. II. SERVICES TO BE PROVIDED A. Services: 1. The recipient's Service Provider Application for state fiscal year 2006 -2009, and any revisions approved by the agency and located in the grant manager's file, are incorporated by reference in this contract between the agency and the recipient, and prescribe the services to be rendered by the recipient. 2. Consumers may not be dually enrolled in the Alzheimer's Disease Initiative (ADI), and a Medicaid capitated Iong -term care program. B. Manner of Service Provision: The services will be provided in a manner consistent with and described in the recipient's service provider application for 2006 -2009, the agency's area plan update for state fiscal year 2008, and the Department of Elder Affairs Home and Com nunity -Based Services Handbook. In the event the handbook is revised, such revision will automatically be incorporated into the contract and the recipient will be given a copy of the revisions. III. METHOD OF PAYMENT A. The method of payment in this contract is fixed rate for services. The recipient must ensure fixed rates include only those costs that are in accordance with all applicable state and federal statutes and replations and are based on audited historical costs in instances where an independent audit is required. The recipient shall consolidate all requests for payment from subrecipients and expenditure reports that support requests for payment and shall submit to the agency on forms 106Z (_ATTACHMENT N) and 105Z (ATTACHMENT VI). B. The recipient shall maintain documentation to support payment requests, which shall be available to the Department of Financial Services or the department upon request. 4 2008 -2009 Ace; -ida ern No. 16D_25 ✓ Iober 14 2003 Agreement No. A 2Ci 087 C. The recipient may request a monthly advance for administration and service costs for each of the first two months of the contract period, based on anticipated cash needs. Detailed documentation justifying the need for cash advances, including a statement of how the advances will be distributed, must be submitted with the signed contract, approved by the agency, and maintained in the grant manager's file. The agency will issue approved advance payments to the recipient after July 1, 2008 and no later than August 1, 2008, subsequent to receipt of an invoice and the justifying documentation. All payment requests for the third through the twelfth months 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 is ATTACHMENT II to this contract. All advance payments are subject to the availability of funds. The advance payment amount shall be recovered during the last two months of the contract period, beginning with the invoice submitted for the month of May 2009 through the invoice submitted for June 2009. The amount of the advance payment shall be one -half of the advance payment amount deducted in each month of the recovery period from each monthly invoice described above until the total advance payment amount is recovered. D. Advance funds may be temporarily invested by the recipient in an 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. E. Additional Reporting Conditions: 1. The recipient agrees to implement the distribution of funds as detailed in the Budget Summary, ATTACHMENT III to this contract. Any changes in the amounts of the funds identified on the Budget Summary form require written confirmation by the agency. 2. This contract is for services provided during the 2008/2009 State Fiscal year beginning July 1, 2008 through June 30, 2009. 3. The recipient shall submit any final requests for budget changes no later than July 05, 2009. 4. The final expenditure report and request for payment will be due to the agency no later than July 25, 2009. F. Client Information and Registration Tracking System (CIRTS) The recipient will ensure that client and service information for the Alzheimer's Disease Initiative (ADI) program is entered into the Client Information and 2008 -2009 7 A.-b-117-20108 7 Agreement No. 20 Registration Tracking System (CIRTS) and maintained in accordance with Section XXVII. F. of the Master Contract. G. Any payment due by the agency under the terms of this agreement contract may be withheld pending the receipt and approval by the agency of complete and accurate financial and programmatic reports due from the recipient and any adjustments thereto, including any disallowance not resolved as outlined in Section XVIII. of the Master Contract. IV. SPECIAL PROVISIONS A. State Laws and Regulation: The recipient agrees to comply with applicable parts of Rule Chapter 58D -1, Florida Administrative Code, promulgated for administration of Sections 430.501 through 430.504, Florida Statutes, and the Department of Elder Affairs Home and Community -Based Services Handbook. B. Assessment and Prioritization for Service Delivery for New Consumers: The following are the criteria to prioritize new consumers for service delivery. It is not the intent of the agency to remove existing consumers from any services in order to serve new consumers being assessed and prioritized for service delivery. 1. Priority Criteria for Service Delivery: a) individuals in nursing homes under Medicaid who could be transferred to the community; b) individuals in nursing homes whose Medicare coverage is exhausted and may be diverted to the community; C) individuals in nursing homes that are closing and can be discharged to the community; or d) 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. e) For the purpose of tr ansitioning individuals receiving Community Care for Disabled Adults (CODA) and Home Care for Disabled Adults (HCDA) services through the Department of Children and Families (DCF) Adult Services to community -based services provided through the department, when services are not currently available, area agency on aging staff and lead agency case managers shall ensure that "Aging Out" individuals are 2008 -2009 Agreement No.'. t 1 203.08' prioritized for services only after Adult Protective Services (APS) High Risk and Imminent Risk individuals. 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 shall be determined through the department's consumer assessment form administered to each applicant. The most frail individuals not prioritized in Section N.B.1. above will receive services to the extent funding is available. C. Co- payment Collections: 1. The agency will ensure recipients establish annual co- payment goals. The agency also has the option to withhold a portion of the recipient's Request for Payment if goals are not met according to the agency /department's co- payment guidelines. 2. 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. D. Evaluation, Statistics, and Reports: If applicable, the recipient agrees to respond to requests for evaluation infonnation and statistical data concerning its consumers based on information requirements of the Memory Disorder Clinics and Brain Bank. The recipient will ensure Model Day Care Centers supported by this contract develop innovative therapies and interventions which can be shared with other Alzheimer's Disease Initiative health and social services personnel via training. Model Day Care Centers supported by this contract must report to the recipient all training activities provided to health care and social service personnel and caregivers, as well as serve as a natural laboratory for service related applied research by Memory Disorder Clinics. An annual Model Day Care Center Training Report, ATTACHMENT IV, is due by July 16, 2009. E. Collaboration with Memory Disorder Clinics: Memory Disorder Clinics are required to provide four hours of in- service training to all respite and model day care centers in their designated service areas. The recipient agrees to collaborate with Memory Disorder Clinics to assist in this effort. 7 2008 -2009 F. Service Cost Reports: M' �? pa :� r 7 Ag ; ? reement No. AM 2013 .08' The agency will require recipients to submit semi - annual service cost reports, which reflect actual costs of providing each service by program. This report provides information for planning and negotiating unit rates. Service costs reports are due to the AAA on February 15th and August 15th. 0 a. %u03 2008 -2009 Agreement No. ti01,-TfG;3 -.�)8 ATTACHMENT II ALZHEIMER'S DISEASE INITIATIVE (ADI) INVOICE SCHEDULE Revised July 2006 -Form 1 E Submit to AAA On This Report Number Based On Date 1 July Advance* July 1 2 August Advance* July 1 3 July Expenditure Report August 10 4 August Expenditure Report September 10 5 September Expenditure Report October 10 6 October Expenditure Report November 10 7 November Expenditure Report December 10 g December Expenditure Report January 10 9 January Expenditure Report February 10 10 February Expenditure Report March 10 11 March Expenditure Report April 10 12 April Expenditure Report May 10 13 May Expenditure Report June 10 14 June Expenditure Report July 10 15 Final Expenditure and Closeout Report July 25th Legend:* Advance based on projected cash need. Note # l: Report #1 for Advance Basis Agreements cannot be submitted to the Area Agency on Aging for Southwest Florida, Inc., prior to July 1 or until the agreement with the agency has been executed. Actual submission of the vouchers to the agency is dependent on the accuracy of the expenditure Note # 2: report. Report numbers 13 and 14 shall reflect an adjustment of one half of the total advance amount, on each of the two reports respectively, repaying advances for the first two months of the agreement. The adjustment shall be recorded in Part C, 1 of the report (Attachment V). 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. Revised July 2006 -Form 1 E 2008 -2009 Agreement No AL1 u3 08? ATTACHMENT III ALZHEIMER'S DISEASE INITIATIVE PROGRAM BUDGET SUMMARY PSA: S AGENCY: Collier County Services for Seniors 1. Respite 2. Case Management 3. Total 10 $ 100,415.00 S 200.00 S 100,615.00 Ager, la tarn No. 15D25 October 14, 2008 2008 -2009 Agreement No.. -�06.68 , ATTACHMENT IV ALZHEIMER'S DISEASE INITIATIVE PROGRAM ANNUAL MODEL DAY CARE CENTER TRAINING REPORT Model Day Care Center Name: Print name of person completing report Signature of person completing report Date The purpose of the model day care program must be to provide service delivery to persons suffering from Alzheimer's disease or a related memory disorder and training for health care and social service personnel in the care of persons having Alzheimer's disease or related memory disorders. This report documents the required training for the State Fiscal Year July 1 st through June 30th. Actual Training Events Number Health Care Professionals Trained Number Social Services Personnel Trained Total People Trained Training Title: Date: Training summary: I 11 2008 -2009 Agreement No. ADI Page of ATTACHMENT V REQUEST FOR PAYMENT ALZHEIMER'S DIS EASE INITIATIVE PROGRAM PROVIDER NAME, ADDRESS, PHONE# and FED ID# TYPE OF REPORT: REQUEST PERIOD: A. PAYMENT REQUEST: Regular Supplemental TREPORT# B. METHOD OF PAYMENT: RACT# Advance PSA# CERTIFICATION: I hereby certify that this request or refund conforms with the terms of the above contract. Prepared By: Date: Approved By: Date PART A: BUDGET (1) (2) (3) (4) (5) (6) TOTAL SUMMARY: CM, CA Respite Model Day Memory 1. Approved Contract Care Disorder Amount $ $ $ Clinic $ 2. Previous Funds Received For Contract Period 3. Contract Balance 4. Previous Funds Requested For Contract Period 5. Contract Balance PART B: CONTRACT FUNDS REQUEST: 1. Anticipated Cash Needs (Ist -2nd Months) 2. Net Expenditures For Month i (DOEA Form 105Z, Part B Line 13) 3. Extraordinary Cash Needs (Attach Doc.) — 4. Total PART C: NET FUNDS REQUESTED: { 1. Less Advance Applied 2. Contract Funds Are Hereby Requested For (Part B Line 4 minus Par t C Line i) I DOEA FORM 1062, Revised May 2006 12 2008 -2009 Agreement No. ADI X010 � a� yr a. 4 16 ���$ C Page 27 of 37 ATTACHMENT VI RECEIPTS AND EXPENDITURES ALZHEIMER'S DIS EASE INITIATIVE PROGRAM RECIPIENT NAME, ADDRESS, PHONE# and FEID# PROGRAM FUNDING SOURCE: THIS REPORT PERIOD: FROM TO Respite Model Day Care I Brain Bank Registry CONTRACT PERIOD Memory Disorder Clininc CONTRACT# REPORT# PSA# CERTIFICATION: I certify 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 3. Total 4. Percent of Budget Receipts for Receipts Approved Budget This Report Year to Date 1. State Funds ................ ............................... $ $ $ 2. Program Income .......... ............................... $ $ $ 3. Local Cash Match ........ ............................... $ $ 4. SUBTOTAL: CASH RECEIPTS ..................... $ $ $ _� 5. Local In-Kind Match ..... ............................... $ $ $ 6. TOTAL RECEIPTS ....... ............................... $ $ $ _9b ART B: EXPENDITURES 1. Approved 2. Expenditures for 3. Expenditures 4. Percent of Budget This Report Year to Date Approved Budget 1. Administrative Services . ............................... $ $ $ —% 2. Service Subcontractor ( s ) .............................. $ $ $ —% 3. Recoupment of Advance $ $ 4. TOTAL .................... ............................... $ $ $ _� PART C: OTHER REVENUE AND EXPENDITURES II. Interest: 1. Earned on GR Advance $ I. Program Income (PI): 2. Rtn. of GR Advance $ 1. ADI: PI Collected YTD $ 3. Other Earned $ (INCLUDES CO- PAYMENTS COLLECTED) PART D: Co- Payments II. Total- Current Month III. Total - Year To Date 1. Total Amount of Co- payments Assessed $ $ II. Total Amount of Co- payments Collected $ $ (FOR TRACKING PURPOSES ONLY) DOEA FORlv1 105Z, Dated April 2006 13 2008 -2009 STANDARD CONTRACT AREA AGENCY ON AGING Collier County Services for Seniors u ;L-rn f Jo. 13D2 5 Contrwc;�-;t�C. � 08 THIS CONTRACT is entered into between the Area agency on Aging for Southwest Florida, Inc., hereinafter referred to as the "agency ", and Collier County Board of Commissioners, hereinafter referred to as the "recipient." This contract is subject to all provisions contained in the MASTER CONTRACT executed between the agency and the recipient, Contract No. 203.M007, and its successor, incorporated herein by reference. The parties agree: I. Recipient Agrees: A. Services to be Provided: To plan, develop, and accomplish the services delineated, or otherwise cause the planning, development, and accomplishment of such services and activities, under the conditions specified and in the manner prescribed in ATTACHMENT I of this contract. B. Final Request for Adjustments and Payment: 1. Final requests for budget revisions or adjustments to contract funds based on expenditures for services provided through June 30, 2009 must be submitted to the Agency's grant manager by July 05, 2009. 2. The fma1 request for payment invoice must be submitted by July 25, 2009. II. The Agency Agrees: A. Contract Amount: To pay for services according to the conditions of ATTACHMENT I in an amount not to exceed $77,371.00, subject to the availability of funds. B. Obligation to Pay: The State of Florida's performance and obligation to pay under this contract is contingent upon an annual appropriation by the Legislature. C. Source of Funds: The costs of services paid under any other contract or from any other source are not eligible for reimbursement under this contract. The funds awarded to the recipient pursuant to this contract are in the state grants and aids appropriations and consist of the following: Services Case Management Case Aid Year 1 Reimbursement Date 2008- 2009 $50,51 525.81 2008 -2009 P,gerida (tern lJo. 15D25 October 14. 2008 Contra 1_I C " 3.08 Program Title Source CFDAlCSFA Fund Amount --Funding HCE Subsidies General Revenue 65001 $71,428.00 HCE Case Management General Revenue 65001 $5,943.00 TOTAL FUNDS CONTAINED IN THIS CONTRACT $77,371.00 III. Recipient and Agency Mutually Agree: A. Effective Date: 1. This contract shall begin on July 1, 2008. 2. This contract shall end on June 30, 2009. B. Termination and /or Enforcement: The causes and remedies for suspension or termination of this contract shall follow the same procedures as outlined in Section XXIV and Section XXV of the Master Contract. C. Recipient Responsibility: Notwithstanding the pass - through language contained in the Assignments and Subcontracts clause of the Master Contract, the recipient maintains responsibility for the performance of all subrecipients and vendors in accordance with all applicable federal and state laws. D. Notice, Contact, and Payee Information: 1. The name, address, and telephone number of the grant manager for the agency for this contract is: Leigh E. Schield, Executive Director Area Agency on Aging for Southwest Florida, Inc. 2285 First Street Fort Myers, Florida 33901 (239) 332 -4233 2. The name, address, and telephone number of the representative of the recipient responsible for administration of the program under this contract is: Marcy Krumbine, Director Collier County Housing and Human Services 3301 East Tamiami Trail Naples, FL 34112 (239) 252 -2273 3. 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 originals of this contract. 4. The name (recipient name as shown on page 1 of this contract) and mailing address of the official payee to whom the payment shall be made: 2 2008 -2009 Collier County Housing and Human Services 3301 East Tamiami Trail Naples, FL 34112 (239) 252 -2273 -1 J? Contract HCE 203.08 IN WITNESS THEREOF, the parties hereto have caused this 10 page contract to be executed by their undersigned officials as duly authorized. ATTEST: DWIGHT E. BROCK, Clerk .0 Deputy Clerk Approved as to form and legal sufficiency sistant Coun Attorney FEDERAL iD NUMBER: 59- 600000558 FISCAL YEAR -END DATE: 9/30 COLLIER COUNTY HOUSING AND HUMAN SERVICES BY: BOARD OF COUNTY COMMISSIONERS COLLIER COUNTY, FLORIDA By: TOM HENNING, CHAIRMAN Date: October 14, 2008 AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA By: ROBERT D. JOHNSON BOARD PRESIDENT Date: June 30, 2008 3 2008 -2009 HOME CARE FOR THE ELDERLY PROGRAM I. STATEMENT OF PURPOSE A erts�a Item No. 157-1.25 October 1,1 2003 C o n tr rqji c7--:z o —08 ATTACHMENT I The Home Care for the Elderly (HCE) Program encourages the provision of care in family -type living arrangements in private homes on a not - for - profit basis as an alternative to nursing home or other institutional care. II. SERVICES TO BE PROVIDED A. Services: The recipient's service provider application for state fiscal year 2006 -2009, and any revisions approved by the agency and located in the grant manager's file, are incorporated by reference in this contract between the agency and the recipient, and prescribe the services to be rendered by the recipient. 2. Consumers may not be dually enrolled in the Home Care for the Elderly (HCE) program, and a Medicaid capitated long -term care program. B. Manner of Service Provision: The services will be provided in a manner consistent with and described in the recipient's 2006 -2009 service provider application, the area plan update for state fiscal year 2008 and the Department of Elder Affairs Home and Community -Based Services Handbook. In the event the handbook is revised, such revision will automatically be incorporated into the contract and the recipient will be given a copy of the revisions. III. METHOD OF PAYMENT A. The method of payment in this contract includes advances, payment for subsidies, and fixed rate for case management services. The recipient must ensure fixed rates 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 recipient shall consolidate all requests for payment from subrecipients and expenditure reports that support requests for payment and shall submit to the agency on forms 106H (ATTACHMENT IV) and 105H (ATTACHMENT V). B. The recipient shall maintain documentation to support payment requests, which shall be available to the Department of Financial Services or the agency or the department upon request. C. The recipient may request a monthly advance for service costs for each of the first three months of the contract period, based on anticipated cash needs. Detailed documentation justifying the need for cash advances, including a statement of how the advance funding will be distributed, must be submitted with the signed contract, approved by the agency, and maintained in the grant manager's file. The agency will issue approved advance payments to the recipient after July 1, 2008 and no later than August 1, 2008, subsequent to receipt of an invoice and the justifying documentation. All payment requests for the 4 2008 -2009 Contra t xli��c2�;.�.0$ fourth through the twelfth months 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 is ATTACHMENT II to this contract. All advance payments are subject to the availability of funds. The advance payment amount shall be recovered during the last three months of the contract period, beginning with the invoice submitted for the month of April 2009 through the invoice submitted for June 2009. The amount of the advance recoupment shall be one -third of the advance payment amount deducted in each month of the recovery period from each monthly invoice described above until the total advance payment amount is recovered. D. Advance funds may be temporarily invested by the recipient in an insured interest bearing account. All interest earned on contract fund advances must be returned to the agency!department within thirty (30) days of the end of each quarter of the contract period. E. Additional Reporting Conditions: 1. The recipient agrees to implement the distribution of funds as detailed in the Budget Summary, ATTACHMENT III to this contract. Any changes moving funds between budget categories that do not exceed the total contract amount require written confirmation by the agency. Changes to budget categories that change the total contract amount require a formal amendment. 2. The final request for payment will be due to the agency no later than July 25, 2009. F. Client Information and Registration Tracking System (CIRTS) 1. The recipient will ensure the collection and maintenance of Home Care for the Elderly (HCE) subsidies and case management information on a monthly basis from the Client information and Registration Tracking System (CIRTS). Maintenance includes valid exports and backups of all data and systems according to agencyidepartmcnt standards. 2. The recipient must ensure all data for HCE subsidies are entered in the Client Information and Registration Tracking System (CIRTS) by the 15th of each month. Home Care for the Elderly (HCE) subsidy data entered into the CIRTS by the 15th of the month will be for payments incurred between the 16th of the previous rnorth and the 15th of the current month. Case management data entered into the CIRTS by the 15th of the month «vill be for units of service provided during the previous month from the 16th and up to and including the 15th of the current month or case management units of scn ice may be entered according to the recipient schedule, in aggregate on the 31st or daily, weekly or monthly. 3. The recipient will ensure data entry for HCE subsidies will cease on the 15th of the month and the CIRTS Monthly Service Utilization Report, by consumer and by worker identification is generated. 4. The recipient will ensure the Monthly utilization Report, by consumcr and by worker identification is verified, corrected, certified no later than the 20th of the month in which the report is generated. 5. The recipient will ensure copies of receipts for all HCE special subsidies $150.00 and over will accompany the Monthly Utilization Report. Pal"Mer_t of HCE special subsidies will not be processed until supporting documentation is received by the agency no later than the 7.0`" of the month in which the report is generated. 5 2008 -2009 �: �a:;nl ^iQ C? ✓�J Contr�ch,c.r +t?CE 08 ?01, G. Any payment due by the agency under the terms of this contract may be withheld pending the receipt and approval by the agency of complete and accurate financial and programmatic reports due from the recipient and any adjustments thereto, including any disallowance not resolved as outlined in Section XVIII. of the Master Contract. IV. SPECIAL PROVISIONS A. State Laws and Regulation: 1. The recipient agrees to comply with applicable parts of Rule Chapter 58H -1, Florida Administrative Code, promulgated for administration of Sections 430.601 through 430.608, Florida Statutes, and the Department of Elder Affairs Home and Community -Based Services Handbook. 2. The recipient agrees to comply with the provisions of Sections 97.021 and 97.058, Florida Statutes, and all rules related thereto in the Florida Administrative Code. B. Assessment and Prioritization for Service Delivery for New Consumers The following are the criteria to prioritize new consumers for service delivery. It is not the intent of the department to remove existing consumers from any services in order to serve new consumers being assessed and prioritized for service delivery. 1. Priority Criteria for Service Delivery: a. individuals in nursing homes under Medicaid who could be transferred to the community; b. individuals in nursing homes whose Medicare coverage is exhausted and may be diverted to the community; c. individuals in nursing homes that are closing and can be discharged to the community; or d. 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. e. For the purpose of transitioning individuals receiving Community Care for Disabled Adults (CCDA) and Home Care for Disabled Adults (HCDA) services through the Department of Children and Families (DCF) Adult Services to community -based services provided through the department, when services are not currently available, area agency on aging staff and lead agency case managers shall ensure that "Aging Out" individuals are prioritized for services only after Adult Protective Services (APS) High Risk and Imminent Risk individuals. 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 shall be determined through the department's consumer assessment form administered to each applicant. The most frail individuals not prioritized in Section IV.B.L above will receive services to the extent funding is available. 6 2008 -2009 Report Number 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Legend: Note # 1: Note #2 Note #3 Revised May 2006 HOME CARE FOR THE ELDERLY INVOICE REPORT SCHEDULE Based On July Advance* August Advance* September Advance* July Expenditure Report August Expenditure Report September Expenditure Report October Expenditure Report November Expenditure Report December Expenditure Report January Expenditure Report February Expenditure Report March Expenditure Report April Expenditure Report May Expenditure Report June Expenditure Report Final Expenditure and Closeout Report * Advance based on projected cash need. Contrac-x T7C 203 08 ATTACHMENT II Submit to State on this Date July 1 July 1 July 1 August 20 September 20 October 20 November 20 December 20 January 20 February 20 March 20 April 20 May 20 June 20 July 20 July 25 Report #1 for Advance Basis Agreements cannot be submitted to the agency for submission to DOER and the Department of Financial Services (DFS) prior to July 1 or until the agreement with the agency has been executed and a copy sent to DOER. Actual submission of the vouchers to DOEA is dependent on the accuracy of the expenditure report. Report numbers 13, 14, and 15 shall reflect an adjustment of one third of the total advance amount, on each of the three reports respectively, repaying advances for the first three months of the agreement. The adjustment shall be recorded in Part C, I of the report (Attachment IV). 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. 7 2008 -2009 HOME CARE FOR THE ELDERLY PROGRAM BUDGET SUMMARY 1. HCE Subsidies 2. HCE Case Management 3. Total 0 $ 71,428.00 $ 5,943.00 $ 77,371.00 No. 1,GD25 -cto` er 14. 2008 Contr4 lyC :)?03.08 ATTACHMENT III 2008 -2009 REQUEST FOR PAYMENT HOME CARE FOR THE ELDERLY PROGRAM RECIPIENT NAME, ADDRESS, PHONE# and FEID# TYPE OF REPORT: A. PAYMENT REQUEST: Regular Supplemental B. METHOD OF PAYMENT: Advance CERTIFICATION: I hereby certify that this request or refund conforms with the terms of the above contract. Contra6 YIC� :f?.08 ATTACHMENT THIS REQUEST PERIOD: FOR REPORT# CONTRACT# PART A: BUDGET (1) (2) TOTAL SUMMARY: Case Mgmt Subsidies 1. Approved Contract $ $ $ $ $ Amount 2. Previous Funds Received For Contract Period 3. Contract Balance 4. Previous Funds Requested For Contract Period 5. Contract Balance PART 8: CONTRACT FUNDS REQUEST: 1. Anticipated Cash Needs 0st, 2nd, & 3rd months) 2. Net Expenditures For Month (DOEA Form 105H, Part B Line 12) 3. Extraordinary Cash Needs (Attach Doc.) 4. Total I I I I i PART C: NET FUNDS REQUESTED: 1. Less Advance Applied 2. Contract Funds Are Hereby Requested For (Part B Line 4 minus Part C Line 1) DOEA FORM 106H, Revised May 2006 RI:\CONTRACTS \CONTRACTS & ANIENDMENTSIHCE12,005 -06 HCEIHCE TEMPLATE 12.05.DOC E 2008 -2009 D` Contra. +;uC 20108 ATTACHMENT V RECEIPTS AND EXPENDITURES HOME CARE FOR THE ELDERLY PROGRAM RECIPIENT NAME, ADDRESS, PHONE# and FEID# PROGRAM FUNDING SOURCE: RO REPORT PERT OD: CONTRACT Case Management: PERIOD Subsidies: CONTRACT# Basic: Special: REPORT# PSA# CERTIFICATION: I certify 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. PART A: BUDGETED INCOME/RECEIPTS 1. State Funds ................ ............................... 2. TOTAL RECEIPTS ....... ............................... PART B: EXPENDITURES 1. Service Subcontractor: Case Management... 2. Service Subcontractor (s) - Subsidy Pmt. 2a. Basic Subsidy .......................... 2b. Special Subsidy ....................... f 3. Total Expenditures .... ............................... PART C: OTHER REVENUE AND EXPENDITURES I. Interest: 1. Earned on GR Advance $ 2. Rtn. of GR Advance $ 3. Other Earned $ DOEA FORM 105H, Revised May 2006 1. Approved Budget 1, Approved Budget $ 2. Actual Receipts for This Report II. Advance Recoupment 1. Advance Recouped $_ 10 $ 2. Expenditures For This Report $ $ 3. Total Receipts Year to Date $ 3. Expenditures Year to Date $ Date: 4 Percent of Approved Budget 4. Percent of Approved Budget