Backup Documents 12/12/2023 Item #16D 4 1 6 D 4 A
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attomey Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. Wendy Klopf Community and Human Irk 12/12/23
Services
2. Derek Perry County Attorney's Office
3. Minutes & Records Clerk of Court's Office i i,
4.
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the addressees
above,may need to contact staff for additional or missing information.
Name of Primary Staff Wendy Klopf/CHS Phone Number 252-2901
Contact/ Dept Intent
Agenda Date Item was 12/12/2023 Agenda Item Number 16D4
Approved by the BCC
Type of Document AAA/ENHCE AMENDMENT 203.23.02 Number of Original 1
Attached Documents Attached
PO number or account NA
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature? NA
2. Does the document need to be sent to another agency for additional signatures? If yes, NA
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be WK
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's NA
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the NA
document or the fmal negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's NA
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip NA
should be provided to the County Attorney Office at the time the item is input into SIRE.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on 12/12/23 and all changes made during ,n N/A is not
the meeting have been incorporated in the attached document. The County 11 / an option for
Attorney's Office has reviewed the changes,if applicable. this line.
9. Initials of attorney verifying that the attached document is the version approved by the r N/A is not
BCC,all changes directed by the BCC have been made,and the document is ready for the an option for
Chairman's signature. this line.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
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N DocuSign Envelope ID: 17994089-4E81-4A82-9CDA-76C43605919E ENHCE 203.23.02
AMENDMENT TWO
ENHANCED HCE
This Amendment, entered into between AAASWFL and Collier County Board of County Commissioners (Contractor),
hereby amends contract ENHCE 203.23.
WHEREAS the purpose of this Amendment is to extend the contract term, decrease services and funding,amend
contractual language, and replace attachments. The total contract amount is hereby decreased by$304,665.56
The total contract amount is hereby amended to read$30,000.00,wherever stated throughout the contract.
NOW THEREFORE, in consideration of the mutual covenants and obligations set forth herein, the receipt and
sufficiency of which are hereby acknowledged,the Parties agree to the following:
1. Section 3 of the Standard Contract,Tenn of Contract,is hereby replaced.
This contract shall begin at twelve(12:00)A.M.,Eastern Standard Time November 1,2022,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 March 31,2024.
a. Amendment 1 shall end at eleven fifty-nine(11:59)P.M.,Eastern Standard Time October 31,2023.
Amendment 2 shall begin at twelve(12:00)A.M.,Eastern Standard Time November 1,2023.
2. Section II.C.4. of Attachment I,is hereby replaced.
Ensure completion of a client-centered, home-based needs assessment that is evidence-based or aligned with best
practices. The needs assessment shall include, but not be limited to, the following: the participant's physical
living space (e.g., home modifications, weathering the home, infestation control, prevention of falls, burns, and
injuries), access to technology(e.g.,senior-friendly hardware devices), and connection to additional services such as
caregiver support, community support, and care planning, which may include advanced care planning,if needed.
Occupational therapy,nursing,case management,home safety, and/or licensed contractor/subcontractor services
shall be provided in an amount up to $6,000 per participant as indicated on the needs assessment. If the
participant is enrolled in a Statewide Medicaid Managed Care (SMMC) health plan, then the Contractor will
communicate with the enrollee's health plan case manager and coordinate health plan contribution to home
modifications. The amount spent by the SMMC plan shall be recorded by the Contractor but not counted in the
$6,000 per participant cap. Services are to be prioritized based on clients' needs and the availability of services,to
optimally increase function and independence for healthy living in home settings.All expenditures are to be
reasonable and allowable.
3. Section II.C.5. of Attachment I is hereby replaced.
Complete 701B assessment on all participants prior to any services; and either a 701B assessment or a
701S assessment and all information in Attachment XIX, plus if home modification or installation service
provided complete Attachment XX, between five (5) and forty-five (45) days after completing last
services. The Vendor/Contractor shall upload 701B and 701 S assessment data into eCIRTS and provide Contractor
with Attachment XIX information and Attachment XX. Contractor shall enter Attachment XIX using link to be
provided by DOEA. Attachment XIX is for use in Enhanced HCE only,it is not for use in any other program DOEA
or AHCA administer.
4. Section II.C.15. of Attachment I is hereby replaced.
Submit Program Highlights referencing specific events that occurred during the Contract term by January 10,2024 to
the Depai talent's Contract Manager. The Contractor shall provide a new success story,quote,testimonial,or human-
interest vignette. The highlights shall be written for a general audience, with no acronyms or technical terms. For all
agencies or organizations that are referenced in the highlight,the Contractor shall provide a brief description of their
mission or role.The active tense shall be consistently used in the highlight narrative,to identify the specific individual
or entity that performed the activity described in the highlight. The Contractor shall review and edit Program
Highlights for clarity, readability, relevance, specificity, human interest, and grammar, prior to submitting them to
the Department. These Program Highlights shall be prepared in accordance with section 19 of the contract
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and may not contain any information concerning a recipient of services under this contract except with the recipient's
written consent.
5. Section II.C.19 of Attachment I is hereby replaced.
Submit monthly invoices for review and preliminary approval to the Department's Contract Manager by the 2nd of
the following month.
6. Section II.C.22 of Attachment I is hereby replaced.
The Contractor shall ensure the provision of a continuum of services that meets the diverse needs of functionally
impaired elders and their caregivers. The Contractor shall ensure that performance and reporting of the following
services are in accordance with the current DOEA Handbook, and Section II.A.1.-2. of this contract.Documentation
of service delivery must include but is not limited to the following:number of clients served,number of service units
provided by service,and rate per service unit with calculations that equal the total invoice amount.
7. Section II.D. Table 1 of Attachment I,Deliverable Requirements,is hereby replaced.
TABLE 1—DELIVERABLE REQUIREMENTS
No. Deliverable Supporting Documentation Due Date
Signed consent forms from each new Completed and signed
participant reported on Attachment Attachment IX in PDF files or Uploaded by the second
1 XII and enrolled in the Enhanced other electronic format files with (2nd)calendar day of each
HCE Program that acknowledges the legally binding attestation from month
program's limited scope and duration the HCE participant.
of services.
Report providing the aggregate
number of participants enrolled into Excel spreadsheet showing per Uploaded by the second
2 the Enhanced HCE program,their person information on (2nd)calendar day of each
demographics(e.g.,age,sex,race, month
Attachment XII.
ethnicity,AHCA region), and their
health insurance carrier.
Report documenting all home Uploaded by the second
modifications and Enhanced HCE Excel spreadsheet showing per (2nd) calendar day of each
3 services rendered,their costs, and person information on month
dates of service per person served and Attachment XIII.
Provider Name.
Consolidated Surplus/Deficit Report Completed and signed report in
in accordance with the requirements The 18thcalendar day of
4 listed in Attachment I,Section I,Sub- PDF file or other electronic each month.
Section F,Item 13. format file.
701 B and 701S assessment data with
required supplemental data that will Assessment results in electronic
5 be used by the Agency to quantify the As requested by the Agency.
impact of services on participant and format.
caregiver conditions
Program Highlights referencing a new PDF completed in accordance
6 success story, quote,testimonial, or with Attachment I, Section 1,
human-interest vignette that occurred January 10,2024.
in preceding SFY/FFY. Sub Section F,Item 15.
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8. Section II.D. Table 2 of Attachment I,Deliverables Schedule,is hereby replaced.
TABLE 2—DELIVERABLE SCHEDULE
Source Documentation/Reporting Due Date
• November Demographic Information
• November Services Information
• November Informed Consents December 10,2022
• Invoice for November Services
• November Surplus/Deficit Report December 18,2022
• December Demographic Information
• December Services Information January 10,2023
• December Informed Consents
• Invoice for December Services
• December Surplus/Deficit Report
• Program Highlights January 18,2023
• January Demographic Information
• January Services Information February 10,2023
• January Informed Consents
• Invoice for January Services
• Quarterly Survey Results(November,December,January) February 15,2023
• January Surplus/Deficit Report February 18,2023
• February Demographic Information
• February Services Information March 10,2023
• February Informed Consents
• Invoice for February Services
• February Surplus/Deficit Report March 18,2023
• March Demographic Information
• March Services Information April 2,2023
• March Informed Consents
• Invoice for March Services
• March Surplus/Deficit Report April 18,2023
• April Demographic Information
• April Services Information
• April Informed Consents May 2,2023
• Invoice for April Services
• Quarterly Survey Results(February,March,April) May 15,2023
• April Surplus/Deficit Report May 18,2023
• May Demographic Information
• May Services Information
June 2,2023
• May Informed Consents
• Invoice for May Services
• May Surplus/Deficit Report June 18,2023
• June Demographic Information
• June Services Information July 2,2023
• June Informed Consents
• Invoice for June Services
• June Surplus/Deficit Report July 18, 2023
• July Demographic Information
• July Services Information August 2,2023
• July Informed Consents
• Invoice for July Services completed
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• Quarterly Survey Results(May,June,July) August 15,2023
• July Surplus/Deficit Report August 18,2023
• August Demographic Information
• August Services Information September 2,2023
• August Informed Consents
• Invoice for August Services completed
• August Surplus/Deficit Report September 18,2023
• September Demographic Information
• September Services Information October 2,2023
• September Informed Consents
• Invoice for Services completed
• September Surplus/Deficit Report October 18,2023
• October Demographic Information
• October Services Information
• October Informed Consents November 2,2023
• Invoice for October Services completed
• Quarterly Survey Results(August,September,October) November 15,2023
• October Surplus/Deficit Report November 18,2023
• November Demographic Information
• November Services Information December 2,2023
• November Informed Consents
• Invoice for November Services completed
• November Surplus/Deficit Report December 18,2023
• December Demographic Information
• December Services Information January 2,2024
• December Informed Consents
• Invoice for December Services completed
• December Surplus/Deficit Report
• Program Highlights January 18,2024
• Quarterly Survey Results(November,December,January)
• January Demographic Information February 2,2024
• January Services Information
• Final Invoice for Services completed
*If a due date falls on a weekend or a State observed holiday,the deliverable(s)will be due the prior business day.
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N DocuSign Envelope ID:17994089-4E81-4A82-9CDA-76C43605919E ENHCE 203.23.02
9. Section III.B. of Attachment I,Monthly Payments,is hereby replaced.
The Contractor shall submit all invoices and all supporting documentation for services provided during the reporting
month to the Department for preliminary approval by the 2nd of the following month. The Agency will pay the
invoiced amount for services completed each month and after all deliverables are submitted and approved.
TABLE 3
PAYMENT SCHEDULE
# State Fiscal Year Deliverable/Service Description Unit Cost Number
- SFY of Units
Year 1 Operations
(December 1,2022—June 30,2023)
The Vendor shall provide proactive,client- Per Monthly
directed,time-limited home modifications, Invoiced Amount for
1 SFY 2022/2023 self-management support, and caregiver Services Delivered 7
support in accordance with the terms in this
Contract. The required reports are the
supporting documentation the Agency will
use to verify the completion of services.
Year 2 Operations
(July 1, 2023 —February 2, 2024)
• The Vendor shall provide proactive, client- Per Monthly
2 SFY 2023/2024 directed,time-limited home modifications, Invoiced Amount for
self-management support, and caregiver Services Delivered
support in accordance with the terms in this
Contract. The required reports are the
supporting documentation the Agency will
use to verify the completion of services.
10. Section III.C.2.of Attachment I,Method of Invoice Payment,is hereby replaced.
Request payment monthly for the services provided in conformance with the requirements as described in the current
DOEA Handbook and in accordance with the Payment Schedule in Table 3 above, at the rates established in
Attachment 1 Section II.A.1 and II.A.2. Documentation of service delivery must include a report consisting of the
following: name of each client served, all home modifications and services provided with their cost and dates of
service, and with calculations that equal the total invoice amount (Attachment XIII). Reimbursement amounts for
administrative costs must be reflected on the Cost Reimbursement Summary form(Attachment XVI)and include only
items contained on the Contractor's Cost Analysis form.Only direct costs that can be clearly attributed to this program
are allowable to be reported as administrative costs. All costs charged to this funding must be properly supported.
Any requested changes to the approved budget subsequent to the execution of the contract must be submitted to the
Department's Contract Manager for written approval. Any change to the total contract amount requires a formal
contract amendment.
11. Section III.C. of Attachment I,Return of Funds,is hereby replaced.
The Contractor shall be permitted to encumber an amount of$6,000.00 per person who has given informed consent
to participate and whose needs and services have been identified on the Department's functional needs assessment
completed by the Contractor.The Contractor shall be permitted to unencumber any amount of funds as needed.Funds
must be encumbered no later than December 31, 2023. Any unencumbered funds by December 31, 2023 shall be
returned to the Agency by March 31,2024.All services must be completed by the Contractor no later than February
2,2024,with final invoices due February 2,2024. The Agency's Contract Manager will provide the Contractor with
details on the process for returning unencumbered funds.
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12. Section III.E. of Attachment I,Final Invoice Instructions, is hereby replaced.
The Contractor shall submit the final Request for Payment to the Department no later than February 2,2024.
13.Attachment II,Exhibit 2,Funding Summary(2022-2023),is hereby replaced.
14. Attachment XVII,Budget Summary,is hereby replaced.
15. Attachment XIX,Post Services Environment Questions,has been added.
16.Attachment XX,Improvement Attestation,has been added.
All provisions in the contract and any attachments there to in conflict with this Amendment shall be and are hereby
changed to conform to this Amendment.
All provisions not in conflict with this Amendment are still in effect and are to be performed at the level specified in the
contract.
This Amendment and all its attachments are hereby made part of the contract.
IN WITNESS THEREOF, the Parties have caused this ten (10) page Amendment to be executed by their officials as
duly authorized, and agree to abide by the terms, conditions and provisions of Contract AE022 as amended. This
Amendment is effective on the last date the Amendment has been signed by both Parties.
COLLIER COUNTY BOARD OF COUNTY AREA AGENCY ON AGING FOR SOUTHWEST
COMMISSIONERS FLORIDA,INC.
SIGNED: SIGNED: ,sy„„,by,
William STa n ya Digitally signed by WilliamsTanya
Date:2023.10.31 09:53:24-04'00'
NAME: NAME: 57cc9e4ec0e24e7...
Tanya R Williams Maricella Morado
TITLE: TITLE:
Public Service Department Head Chief Executive Officer/President
DATE: DATE:
10.31.2023 Nov-01-2023
As designee of the County Manager,
pursuant to Resolution No. 2018-202.
App,•ved .s to Foiuu L lity:
_/I /vim`►
Derek D. Perry ,r
Assistant County Attorney ^�
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ATTACHMENT II
EXHIBIT 2
FUNDING SUMMARY(2022-2023)
Note: Title 2 CFR, as revised, and Section 215.97,F.S.,require that the information about Federal Programs and State
Projects included in Attachment II,Exhibit 1,be provided to the recipient. Information contained herein is a prediction
of funding sources and related amounts based on the contract budget.
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS CONTRACT
CONSIST OF THE FOLLOWING:
GRANT AWARD(FAIN#): FEDERAL AWARD DATE:
DUNS NUMBER:
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL FEDERAL AWARD
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED
PURSUANT TO THIS CONTRACT ARE AS FOLLOWS:
FEDERAL FUNDS:
2 CFR Part 200—Uniform Administrative Requirements,Cost Principles,and Audit Requirements for Federal Awards.
OMB Circular A-133—Audits of States,Local Governments,and Non-Profit Organizations
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
STATE FINANCIAL ASSISTANCE SUBJECT TO SECTION 215.97,F.S.
PROGRAM TITLE FUNDING SOURCE CSFA AMOUNT
ARP Enhanced FMAP Medical Care Trust Fund 65.001 $30,000.00
TOTAL AWARD $30,000.00
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO
THIS CONTRACT ARE AS FOLLOWS:
STATE FINANCIAL ASSISTANCE
Sections 215.97&215.971,F.S., Chapter 691-5,F.A.C., State Projects Compliance Supplement
Reference Guide for State Expenditures
Other fiscal requirements set forth in program laws,rules,and regulations
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ATTACHMENT XVII
BUDGET SUMMARY
Contracted budget to be allocated to administrative costs and services not to exceed the following amounts:
Services $30,000.00
Total: $30,000.00
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ATTACHMENT 9
POST SERVICES ENVIRONMENT QUESTIONS
RESIDENTIAL LIVING ENVIRONMENT
Client Name: DOB:
Residence issues are directly observed by you,use the list below to check off the
specific issue(s)with the potential for safety or accessibility problems.
Check all that apply:
a. Exterior issue(s): ❑ Road I I Driveway C Yard ❑ Ramp E Windows Li Roof
b. Interior issue(s): Li Doors ❑ Stairs I I Floor ❑ Walls ❑ Ceiling ❑ Lights
c. Restroom issue(s): U Door ❑ Handrails n Tub ❑ Shower C. Toilet
d. Utility issue(s): ❑ Plumbing ❑ Water ❑ Electric ❑ Gas
e. Furniture issue(s): ❑ Chair n Couch n Bed ❑ Table
f. Telephone issue(s): ❑ Broken ❑ No phone ❑ Disconnected/No service
g.Temperature issue(s): ❑ Heat 1 Smoke detector C Air conditioning
h. Unsanitary condition(s): ❑ Odors ❑ Insects ❑ Rodents
❑ Accumulating items or garbage Floors or pathways
cluttered
i.Other hazards:
Is there a pet in your home or yard? I I No n Yes
a. Please specify the type and size:
b. Pet comments/concerns:
Please rate the level of risk in the client's residential living environment:
❑ No/low apparent risk from current living conditions.
n Minor risk(One or more aspects are substandard and should be addressed in the following year to avoid potential
injury.)
n Moderate risk(Major 7spects are su standard and must be addressed in the next few mom hs to remain in h me
safely.)
❑ High risk(Serious hazards are present. The client must change dwellings or immediate corrective action must be taken
to correct the issues noted above.)
Notes&Summary:
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ATTACHMENT 10
IMPROVEMENT ATTESTATION
I,the undersigned, attest to the following:
Name of Homeowner/Renter:
First Name Last Name
Address
City County Zip Code
I, or my agent/representative , visited the residence of the
homeowner/renter listed above.
I or my agent/representative examined the work performed by the contractor/service provider at the
address listed above.
I verify that the repairs,additions,modifications,or enhancements,appear to be completed satisfactorily.
Under penalties of perjury,I declare that this information is true and correct to the best of my knowledge.
Signature Date
Print Name
Aging and Disability Resource Center
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