Agenda 09/08/2015 Item #16D 29/8/2015 16.D.2.
EXECUTIVE SUMMARY
Recommendation to approve after - the -fact Amendments and Attestation Statements with Area
Agency on Aging for Southwest Florida, Inc. for the Community Care for the Elderly, Alzheimer's
Disease Initiative, and Home Care for the Elderly programs to extend the term of the agreements
and ensure continuous funding for FY 2014/2015.
OBJECTIVE: To provide uninterrupted support services to Collier County Services for Seniors' elderly
clients.
CONSIDERATIONS: The Community and Human Services (CHS) Division Services for Seniors
program has been providing support to Collier County's frail and elderly citizens for over thirty -four
years through the Community Care for the Elderly (CCE), Alzheimer's Disease Initiative (ADI), and
Home Care for the Elderly (HCE) grant programs. These grants are funded by the Florida Department of
Elder Affairs (DOEA) through the Area Agency on Aging of Southwest Florida, Inc. ( "Agency "). These
grants fund services that enable seniors to remain in their homes and live with independence and dignity.
On September 23, 2014, the Board approved the current grant contracts with the Agency (Agenda item
16D16). Numerous amendments have been approved by the Board. The contracts are effective July 1,
2014 through June 30, 2015. The funding for the successor agreements for the Services for Seniors
program is not yet available to the Agency from the Florida Department of Elder Affairs. Each proposed
amendment extends the current contract to August 30, 2015, allowing the programs to continue operation
until renewals are presented. This change does not affect the overall program funding awards. When final
renewal agreements are received they will be prepared and presented to the Board.
The following table provides a detail breakdown of the necessary adjustments to the co- payment budget
for the FY 14 -15 grant programs.
Programs
Original Co- Payment Budget
Co-Payment Received
Difference
ADI
$3,200.00
$6,208.00
$3,008.00
CCE
$20,000.00
$26,883.45
$6,883.45
The Agency routinely sends Collier County Services for Seniors amendments which require a short
turnaround time. This time frame makes it impossible to process the documents for Boards approval in
the time requested by the Agency. The amendments for the CCE, ADI and HCE programs are being
presented as "after- the - fact" because Collier County received the grant contracts on June 18, 2015 with an
effective contract date of August 30, 2015. Consequently, pursuant to CMA 5330 and Resolution No.
2010 -122, the County Manager authorized Steve Carrell, Public Services Department Head to sign the
contracts. These contracts are being presented for Board ratification. Collier County as the Lead Agency
is responsible to respond to seniors needs and manage the spending authority for the CCE, ADI, and HCE
program services.
FISCAL IMPACT: Staff has prepared budget amendments to recognize an increase of the Co-
Payment collected above the goal amount in the Humans Services Grant Fund 707, CCE project
33351 in the amount of $6,883.45 and ADI project 33352 in the amount of $3,008.00.
Packet Page -1358-
9/8/2015 16.D.2.
There is no new fiscal impact associated with the extension of award. Funding resides in Human
Services Grant Fund 707, CCE project 33336, HCE project 33338, and ADI project 33337.
GROWTH MANAGEMENT: There is no growth management impact associated with this action.
LEGAL CONSIDERATIONS: These are standard fonn amendments provided by the Area Agency on
Aging for Southwest Florida. This item has been approved for form and legality and requires a majority
vote for Board approval. — JAB
RECOMMENDATIONS: That the Board of County Commissioners approves the after - the -fact
Amendments and Attestation Statements with Area Agency on Aging for Southwest Florida for the
Community Care for the Elderly, Alzheimer's Disease Initiative, and Home Care for the Elderly programs
and authorize the budget amendments to ensure continuous funding for FY 2014/2015.
Prepared by: Lisa N. Carr, Grants Coordinator, Community and Human Services Division
Attachments:
1. Area Agency on Aging for Southwest Florida, Inc.
a. CCE Contract 203.14
b. CCE Amendments 001, Amendment 002, Amendment 003 and Amendment 004
c. ADI Contract 203.14
d. ADI Amendments 001, Amendment 002 and Amendment 003
e. HCE Contract 203.14
f. HCE Amendments 001, Amendment 002 and Amendment 003
Packet Page -1359-
9/8/2015 16.D.2.
COLLIER. COUNTY
Board of County Commissioners
Item Number: 16.16.D.16.D.2.
Item Summary: Recommendation to approve after - the -fact Amendments and Attestation
Statements with Area Agency on Aging for Southwest Florida, Inc. for the Community Care for
the Elderly, Alzheimer's Disease Initiative, and Home Care for the Elderly programs to extend
the term of the agreements and ensure continuous funding for FY 2014/2015.
Meeting Date: 9/8/2015
Prepared By
Name: CarrLisa
Title: Grants Coordinator, Public Services Department
7/30/2015 11:41:23 AM
Submitted by
Title: Grants Coordinator, Public Services Department
Name: CarrLisa
7/30/2015 11:41:24 AM
Approved By
Name: Bendisa Marku
Title: Supervisor - Accounting, Public Services Department
Date: 7/31/2015 10:35:09 AM
Name: GrantKimberley
Title: Division Director - Cmnty & Human Svc, Public Services Department
Date: 8/10/2015 9:16:21 PM
Name: GrantKimberley
Title: Division Director - Cmnty & Human Svc, Public Services Department
Date: 8/16/2015 6:56:21 PM
Name: TownsendAmanda
Title: Division Director - Operations Support, Public Services Department
Date: 8/21/2015 8:22:14 AM
Packet Page -1360-
9/8/2015 16.D.2.
Name: RobinsonErica
Title: Accountant, Senior, Grants Management Office
Date: 8/21/2015 2:04:46 PM
Name: CarnellSteve
Title: Department Head - Public Services, Public Services Department
Date: 8/21/2015 4:26:23 PM
Name: BelpedioJennifer
Title: Assistant County Attorney, CAO General Services
Date: 8/24/2015 2:32:20 PM
Name: KlatzkowJeff
Title: County Attorney,
Date: 8/24/2015 3:17:31 PM
Name: FinnEd
Title: Management/Budget Analyst, Senior, Office of Management & Budget
Date: 8/25/2015 3:13:13 PM
Name: CasalanguidaNick
Title: Deputy County Manager, County Managers Office
Date: 8/26/2015 8:23:24 AM
Packet Page -1361-
July 2014 to June 2015 9/8/2015 16.D.2.
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
CONTRACT
COMMUNITY CARE FOR THE ELDERLY PROGRAM
THIS CONTRACT is entered into between the Area Agency on Aging for Southwest Florida (Agency)
and Collier County Board of County Commissioners, (Contractor), and collectively referred to as the
"Parties." The term Contractor for this purpose may designate a Vendor, Subgrantee or Subrecipient.
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., Easter 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
The Agency agrees to pay for contracted services according to the terms and conditions of this
contact in an amount not to exceed S720,634.00, 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 fiends.
Packet Page -1362-
July 2014 to June 2015 CCE 203.14
6. Official Pavee and Renresentafives (Names. Addresses. and Telenhone Numbers): 9/8/2015 16.D.2.
7. All Terms and Conditions Included:
This contract and its Attachments, I, III, VII, VIII, IX, X and 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.
INT 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 SOUTHW ' F RIDA, INC.
SIGNED BY t , ,' f' SIGNEE B
NAME: Stephen Y. Carnell
TITLE: Public Services Administrator
DATE: Jul, 31. 2014
Federal Tax ID: 59- 6000558
Fiscal Year Ending Date: 09,30
Packet Page -1363-
NAME: RONALD LUCCHINO. PhD
TiT1.F.• R61ARn PRF.C;TT)F.NT
DATE:
The Contractor name, as shown on page I 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
Kimberly Grant, Director
b
The name of the contact person and street address where
Collier County Housing, Human and Veteran
financial and administrative records are maintained is:
Services
3339 E Tamiami Trail, Building H
Naples, FL 34112
C.
The name, address, and telephone number of the
Kimberly Grant, Director
Collier County Housing, Human and Veteran
representative of the Contractor responsible for
Services
administration of the program under this contract is:
3339 E Tamiami Trail, Building H
Naples, FL 34112
(239) 252 -2273
The section and location within the Agency where
Nancy Dean, Director of Finance
d.
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 1 100
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.
7. All Terms and Conditions Included:
This contract and its Attachments, I, III, VII, VIII, IX, X and 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.
INT 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 SOUTHW ' F RIDA, INC.
SIGNED BY t , ,' f' SIGNEE B
NAME: Stephen Y. Carnell
TITLE: Public Services Administrator
DATE: Jul, 31. 2014
Federal Tax ID: 59- 6000558
Fiscal Year Ending Date: 09,30
Packet Page -1363-
NAME: RONALD LUCCHINO. PhD
TiT1.F.• R61ARn PRF.C;TT)F.NT
DATE:
July 2014 to June 2015
INDEX OF ATTACBMENTS
9/8/2015 16.D.2.
ATTACHMENTI
STATEMENTOF WORK ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .... ... ... ... ... ... ..... ..... 4
ATTACHMENT III
FUNDINGSOURCE ................................................................................................ 15
ATTACHMENT VII
COMMUNITY CARE FOR THE ELDERLY ANNUAL BUDGET AND RATE SUMMARY ........ 16
ATTACHMENT VIII
COMMUNITY CARE FOR THE ELDERLY INVOICE REPORT 17
ATTACHMENT IX
REQUEST FOR PAYMENT . ................................................................ ..................... 18
ATTACHMENT X
RECEIPT AND EXPENDITURE REPORT .................................................................... 19
9
Packet Page -1364-
July 2014 to June 2015
STATEMENT OF WORD
COMMUNITY CARE FOR THE ELDERLY PROGRAM
SECTION I: SERVICES TO BE PROVIDED
1.1. DEFINITIONS OF TERMS AND ACRONYMS
9/8/2015 16.D.2.
ATTACHMENT I
1.1.1 CONTRACT ACRONYMS
Activities of Daily Living (ADL)
Adult Protective Services (APS)
Adult Protective Services Referral Tracking Tool (ARTT)
Assessed Priority Consumer List (APCL)
Comprehensive Assessment and Review for Long -Term Care Services (CARES)
Community Care for the Disabled Adult (CCDA)
Community Care for the Elderly (CCE)
Client Information and Registration Tracking System (CIRTS)
Department of Children and Families (DCF)
Department of Elder Affairs (DOEA)
Home Care for Disabled Adults (HCDA)
Instrumental Activities of Daily Living (IADL)
Planning and Service Area (PSA)
1.1.2 PROGRAM SPECIFIC TERMS
Adult Protective Services Referral Tracking Tool: A system designed to track DCF APS el
referrals to AAAs and CCE Lead Agencies for victims of second party abuse, neglect, and
exploitation who need home and community -based services as identified by APS staff.
Aging Out: The condition of reaching 60 _years of age and being transitioned from the
Department of Children and Families (DCF) 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 area agency on aging outlining a comprehensive and
coordinated service delivery system in its planning and service area in accordance with the Section
306 (42 U.S.C. 3026) of the Older Americans Act 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 area agency on aging enters CCE
specific data in 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
701 B is used by case managers to conduct the functional assessment.
El
Packet Page -1365-
July 2014 to June 2015 9/8/2015 16.D.2.
1.2 GENERAL DESCRIPTION
1.2.1 General Statement
The primary purpose of the CCE program is to prevent, decrease or delay premature or
inappropriate and expensive placement of older persons in nursing homes and other institutions.
1.2.2. Community Care for the Elderly Mission Statement
The CCE Program assists functionally impaired elderly persons in living as independently as
possible in then 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.
1.2.3 Authority
The relevant authority governing CCE program are:
(I) Rule 58C -1, Florida Administrative Code
(2) Sections 430.201 through 430.207, F.S.
1.2.4 Scope of Service
The Contractor is responsible for the programmatic, fiscal, and operational management of
CCE. 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, located on the DOEA website,
http://elderaffairs.state.fl.us/doea/nois.php.
1.2.5 Major Program Goals
The major goals of the program are to preserve the independence of elders and prevent or delay
more costly institutional care through a community care service system that provides case
management and other in -home and community services as needed under the direction of a lead
agency and provide a continuum of service alternatives that meet the diverse needs of
functionally impaired elders.
1.3. INDIVIDUALS TO BE SERVED
1.3.1 General Eligibility
The CCE program provides a continuum of services for functional impaired elders.
1.3.2 Individual Eligibility
In order to receive services under this contract, an applicant must:
(1) Be at least 60 years of age;
(2) Be functionally impaired as determined through the initial comprehensive
assessment; and
(3) Not be dually enrolled in the CCE program and a Medicaid capitated long -term
care program.
1.3.2.1 Targeted Groups
Priority for services provided under this contract shall be given to those eligible persons
assessed to be at risk of placement in an institution or who are abused, neglected or exploited.
5
Packet Page -1366-
July 2014 to June 2015 CCE 203. 9/8/2015 16.D.2.
SECTION II: MANNER OF SERVICE PROVISION
2.1 SERVICE 'TASKS
To achieve the goals of the CCE program, the Contractor shall perform, or ensure the
performance of its Subcontractors, for 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.
2.1.1 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.
2.1.1.1 APS Nigh -Risk Referrals
The Contractor shall ensure that for APS high -risk referrals who are enrolled in a Medicaid
long -tern care program at the time of referral the CCE lead agency rejects the referral in ARTT
and enter notes indicating the individual is a Medicaid managed care client.
2.1.1.2 APS Intermediate and Low Risk Referrals
The Contractor shall ensure that APS low and medium referrals who are enrolled in a Medicaid
capitated long -term care program at the time of referral be referred to the long -term care
provider.
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 services in order to
serve new clients being assessed and prioritized for service delivery.
2.1.2.1 Abuse, Neglect and Exploitation
The Contractor shall ensure that pursuant to Section 430.205(5)(a), Florida Statutes, those
elderly persons who are determined by APS to be victnns of abuse, neglect, or exploitation who
are in need of immediate services to prevent further harm and are referred by APS, will be
given primary consideration for receiving CCE services. As used in this subsection, "primary
consideration" means that an assessment and services must commence within 72 hours after
referral to the Agency or as established in accordance with Agency contracts by local
protocols developed between Agency service Contractors and APS.
2.1.2.2 Priority Criteria for Individuals in Nursing Domes in Receivership:
The Contractor shall ensure that pursuant to Section 400.126 (12), Florida Statutes, those
elderly persons determined, through a 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 CCE program in a manner as persons classified to receive such services pursuant to
Section 430.205, Florida Statutes.
Packet Page -1367-
July 2014 to June 2015
2.1.2.3 Priority Criteria for Service Delivery:
CCE 20 9/8/2015 16.D.2.
(1) Individuals in nursing homes under Medicaid who could be transferred to tine community;
(2) Individuals in nursing homes whose Medicare coverage is exhausted and may be diverted
to the conuiiunity;
(3) Individuals in nursing homes that are closing and can be discharged to the community; or
(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;
(5) For the purpose of transitioning individuals receiving CCDA and HCDA services through
the DCF Adult Services to community -based services provided through the Agency,
when services are not currently available, the Contractor shall ensure that "Aging Out"
individuals are prioritized for services only after APS High Risk and Imminent Risk
individuals.
2.1.2.4 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 of
section 2.1.2.3 above, regardless of referral source, will be determined through the
Agency's client assessment form administered to each applicant, to the extent funding is
available. The Contractor shall ensure that first priority is 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.
1.1.2.5 Referrals for Medicaid Waiver Services:
(1) The Contractor must require Subcontractors, through the performance of tine client
assessment, to identify potential .Medicaid eligible CCE clients and to refer these
individuals for application for Medicaid Waiver services.
(2) The Contractor must require individuals who have been identified as being potentially
Medicaid Waiver eligible are required to apply for Medicaid Waiver services in order to
receive CCE services and can only receive CCE services while the Medicaid Waiver
eligibility determination is pending. If the client is found ineligible for Medicaid Waiver
services for any reason other than failure to provide required documentation, then the
individual may continue to receive CCE services.
(3) The Contractor must advise individuals who have been identified as being potentially
Medicaid Waiver eligible must be advised of the responsibility to apply for Medicaid
Waiver services as a condition of receiving CCE services while the eligibility
determination is being processed.
2.1.3 Delivery of Service to EIigible Clients
The Contractor shall ensure the provision of a continuum of services that meet the diverse
needs of functionally impaired elders. The Contractor shall ensure performance and
reporting of the following service provision in accordance with the current DOEA
Programs and Services Handbook. Tine services include the following categories:
(1) Core Services;
(2) Health Maintenance Services; and
(3) Other Support Services.
7
Packet Page -1368-
July 2014 to June 2015
2.1.3.1Core Services for Programmatic Operation
The Contractor shall ensure that core services include a variety of home - delivered
services, day care services, and other basic services that are most needed to prevent
unnecessary institutionalization. Core services, to be provided at the unit rate identified
in the Area Plan, as updated, include the following:
(1) Adult Day Care;
(2) Chore Services;
(3)
Companionship;
(4)
Escort;
(5)
Financial Risk Reduction;
(6)
Home Delivered Meals;
(7)
Homemaker;
(8) Housing Improvement;
(9) Legal Assistance;
(10) Pest Control Services;
(11) Respite Services;
(12) Shopping Assistance; and
(13) Transportation
9/8/2015 16.D.2.
2.1.3.2 Health Maintenance Services
The Contractor shall ensure that health maintenance services are routine health services that
are necessary to help maintain the health of functionally impaired elders. The services are
limited to medical therapeutic services, non - medical prevention services, personal care
services, home health aide services, home nursing services, and emergency response systems.
Typical services to be provided at the unit rate identified in the Area Plan as updated, are the
following:
(1)
Adult Day Health Care;
(2)
Emergency Alert Response;
(3)
Gerontological Counseling;
(4)
Health Support:
(5)
Home Health Aide;
(6) Medication Management;
(7) Mental Health Counseling /Screening;
(8) Nutrition Counseling;
(9) Occupational Therapy;
(10) Personal Care;
(11) Physical Therapy;
(12) Skilled Nursing Services;
(13) Specialized Medical Equipment,
Services and Supplies; and
(14) Speech Therapy.
2.1.3.3 Other Support Services
The Contractor shall ensure that support services expand the continuum of care options to assist
functionally impaired elders and their caregivers. Support services to be provided at the unit
rate identified in the Area Plan as updated, include the following:
(1)
Caregiver Training/Support;
(2)
Case Aid;
(3)
Case Management;
(4)
Intake;
(5)
Material Aid; and
(6)
Other.
.1
Packet Page -1369-
July 20 14 to June 2015
9/8/2015 16.D.2.
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.
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 Master Contract HM014, the Agency will not be responsible or liable for any obligations or
claims resulting from such action.
2.1.4.1 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 contracts. The Contractor
shall perform fiscal, administrative and programmatic monitoring to ensure contractual
compliance, fiscal accountability, programmatic performance and compliance with applicable
state and federal laws and regulations. The Contractor 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
2.2.1 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 5:00pm.
2.3 DELIVERABLES
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 services
tasks described in Section 2.1. ATTACHMENT VII lists the services that can be
performed, the highest reimbursement unit rate and the method of payment. Units of service
will be paid pursuant to the rate established in the Request for Proposal, RFP, and approved by
the Agency.
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.
2.4.1 Client Information and Registration Tracking System ( CIRTS) Reports
The Contractor shall input CCE 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;
0
Packet Page -1370-
July 2014 to June 2015 9/8/2015 16.D.2.
(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
The Contractor shall ensure, on a monthly basis, that client and service information is properly
collected and maintained within the Client Information and Registration Tracking System
(CIRTS) or any such system designated by the Agency. Maintenance includes valid
exports and backups of all data and systems according to Agency and /or Department standards
and the DOEA Programs and Services Handbook.
2.5.1 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 will 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 DOEA Programs and Services Handbook.
(2) The Contractor shall timely submit to the Agency all reports described in
ATTACHMENT I, SECTION 2.4 REPORTS;
(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) Percent of APS referrals who are in need of immediate services to prevent further harm
who are served within 72 hours;
(3) Average monthly savings per consumer for home and community -based care versus
nursing home care for comparable group clients;
10
Packet Page -1371-
July 2014 to June 2015
9/8/2015 16.D.2.
(4) Percent of elders assessed with high or moderate risk environments who improved their
environment score;
(5) Percent of new service recipients with high -risk nutrition scores whose nutritional status
improved;
(6) Percent of new service recipients whose ADL assessment score has been maintained or
improved;
(7) Percent of new service recipients whose IADL assessment score has been maintained or
improved;
(8) Percent of family and family- assisted caregivers who self - report they are likely to provide
care;
(9) 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);
(10) Average time in the CCE Program for Medicaid Waiver probable customers; and
(11) 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 Matching, Level of Effort, and Earmarking Requirement
The Contractor must provide a match of at least 10 percent of the cost for all CCE services.
The match will be made in the form of cash and /or in -kind resources. At the end of the contract
period, all CCE funds expended must be properly matched. State funds cannot be used to snatch
another state - funded program.
2.7.2 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. 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. Co- payments collected in the CCE program can be used as part of the local match.
2.8 AGENCY RESPONSIBILITIES
2.8.1 Program Guidance and Technical Assistance
The Agency will provide to the Contractor 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;
11
Packet Page -1372-
July 2014 to June 2015 9/8/2015 16.D.2.
(2) Scheduled, unscheduled and follow -rip 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 106C (ATTACHMENT IX) and 105C (ATTACHMENT X).
3.1.1 The Contractor agrees to distribute funds as detailed in the area plan update, and the Budget
Summary, ATTACHMENT VII to this contract. Any changes in the total amounts of the
funds identified on the Budget Summary form require a contract amendment.
3.2 Advance Payments
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 finds released to the Agency and the Department by
the State of Florida ( "budget release "). The Contractor shall provide the Contract Manager
documentation justifying the need for an advance and describing how the funds will be
distributed.
3.2.1 The Contractor's requests for an advance require the approval of the Contract Manager. If
sufficient budget is available, the Agency will issue approved advance payments after
July 1, 2014.
3.2.2 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, in accordance with the Invoice
Schedule, ATTACHMENT VIII to this contract.
3.2.3 The Contractor may temporarily place advanced funds in a FDIC insured interest hearing
account. All interest earned on contract fund advances must be returned to the Agency
within thirty (3 0) days of the end of each quarter of the contract period.
12
Packet Page -1373-
July 2014 to June 2015
9/8/2015 16.D.2.
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 106C (ATTACHMENT M and 105C
(ATTACHMENT A'). 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 for 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.
3.11 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 of
the 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 HM014, this paragraph shall have precedence.
3.3.3 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 VIII to this contract.
3.3.4 Payment may be authorized only for allowable expenditures, which are in accordance with the
limits specified in ATTACHMENT VII, Budget Summary.
3.3.5 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 this contract.
3.3.6 Date For Final Request For Budget Revisions
Final requests for budget revisions or adjustments to contract funds based on expenditures for
services provided through .tune 25, 2015, must be submitted to the Contract Manager no later
than June 25, 2015.
3.3.7 Date for Final Request for Payment
The final request for payment for expenditures is due to the Agency no later- than
July 25, 2015.
13
Packet Page -1374-
July 2014 to June 2015
9/8/2015 16.D.2.
3.4 Consequences for Non - Compliance
The Contractor shall ensure 100% of the deliverables identified in Section 1.2.4., Scope of
Services are performed pursuant to contract requirements, and as described in Section 2.3,
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 identified 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 may also
assess a financial consequence for failure to timely submit a CAP. In the event the Contractor
fails to correct an identified deficiency within the approved time period specified in the CAP,
the Agency shall deduct, from the payment for the invoice of the following month, 1% of
the monthly value of the administrative funds in the contract for each day the deficiency is not
corrected. The Agency may also deduct, from the payment for the invoice of the following
month, 1% of the monthly value of the administrative funds in the contract for each day the
Contractor fails to timely submit a CAP, beginning the 11th day after notification by the
Contract Manager of the deficiency. If, or to the extent, there is any conflict between this
paragraph and paragraphs 39 and 39.1 of Master Contract HM014, this paragraph shall have
precedence.
3.5 Documentation for Payment
The Contractor shall maintain documentation to support payment requests that shall be
available to the Agency and /or Department or authorized individuals, such as
Department of Financial Services, upon request.
3.5.1 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.
3.5.2 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.
Remainder of page intentionally left
14
Packet Page -1375-
July 2014 to June 2015
9/8/2015 16.D.2.
ATTACHMENT 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: NIA
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
STATR FYNANC°TAI. AC .qTfiTAN('R crrrz_rVC'T Tn .cnr '774 o7 V c
PROGRAM TITLE
FUNDING SOURCE
CSFA
AMOUNT
Community Care for the Elderly
General Revenue -- Collier
65010
$ 720,634.00
TOTAL AWARD
S 720,634.00
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
15
Packet Page -1376-
July 2014 to June 2015 9/8/2015 16.D.2.
ATTACHMENT VII
COMMUNITY CARE FOR THE ELDERLY PROGRAM
ANNUAL BUDGET SUMMARY
for
Collier County Board of County Commissioners
Collier
CCE Services Allocations $ 720,634.00
RATE SUMMARY
Hobe Hospice and Community Services, Inc.
for
C"nIhAr (minty
Collier County
Total Unit Cost
Reimbursement Rate -90%
Case Management
$60.00
$54.00
Case Aide
$33.88
$30.50
Adult Day Care
$12.83
$11.55
Chore
$23.33
$21.00
Enhanced Chore
$30.33
$27.30
Companion
$23.35
$21.00
Skilled Nursing
$42.00
$37.80
EARS
$ 1.31
$ 1.18
Homemaking
$22.17
$19.35
Personal Care
$25.67
$23.10
Respite-in-Home
$25.67
$23.10
Home Improvement
$ Cost Reimbursement
90% Cost Reimbursement
Material Aid
$ Cost Reimbursement
90% Cost Reimbursement
Specialized Medical Equipment,
Service & Supplies
$ Cost Reimbursement
90% Cost Reimbursement
Transportation
$ Cost Reimbursement
90% Cost Reimbursement
16
Packet Page -1377-
July 2014 to June 2015
Report Number
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
COMMUNITY CARE FOR THE ELDERLY
INVOICE SCHEDULE
Based On
July Advance*
August 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 Report
Closeout Report
Legend: * Advance based on projected cash need.
9/8/2015 16.D.2.
ATTACHMENT Vila
Submit to Agency on this Date
July 1
July 1
August 9
September 9
October 9
November 9
December 9
January 9
February 9
March 9
April 9
May 9
June 9
July 9
July 25
August I
Note # 1: Report #1 for Advance Basis Agreements cannot be submitted to the Area on
Aging for Southwest Florida, Inc. prior to July 1 or until the agreement with the
Agency has been executed and a copy sent to the Area on Aging for Southwest
Florida, Inc. Actual submission of the vouchers to the Area on Aging for
Southwest Florida, Inc. is dependent on the accuracy 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 I 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.
17
Packet Page -1378-
July 2014 to June 2015
REQUEST FOR PAYMENT
COMMUNITY CARE FOR THE ELDERLY
9/8/2015 16.D.2.
ATTACHMENT IX
RECIPIENT NAME, ADDRESS, PHONE# and FEID#
TYPE OF PAYMENT:
Regular
Advance
This Request Period: From: To:
Contract Period
Contract #
Report #
PSA #
CERTIFICATION: I hereby certifyto the best of my knowledge that this request is complete and correct and conforms with the terms and the purposes of the above contract.
Prepared by: Date: Approved by: Date:
PARTA: BUDGETSUMMARY
1. Approved Contract Amount
2. Previous Funds Received for Contract Period
3. Contract Balance (line 1 minus line 2)
4. Previous Funds Requested and Not Received for Contract Period
5. CONTRACT BALANCE (line 3 minus line 4)
CCEAdmin.
$ 0.00
$ 0.00
$ 0.00
CCE Services
$ 0.00
$ 0.00
$ D.00
TOTAL
$ 0.00
$ D.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
PART B: CONTRACT FUNDS REQUEST
1. Anticipated Cash Need (1st - 2nd months)
2. Net Expenditures For Month
(DOER Form 105C, Part B, Line 4)
3. TOTAL
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
S 0.00
$ 0.00
$ 0.00
PART C: NET FUNDS REQUESTED
1. Less Advance Applied
2. TOTAL FUNDS REQUESTED (Part B Line 3, minus Part C Line 1)
$ 0.00
S 0.00
$ 0.00
S 0.00
$ 0.00
$ 0.00
List of Services / Units / Rates provided - See attached report.
DOER FORM 106C
Revised 514112
11M
Packet Page -1379-
JulyLU14 to June 2o j,)
RECEIPT AND EXPENDITURE
REPORT COMMUNITY CARE FOR
THE ELDERLY
CCE 203.14
9/8/2015 16.D.2.
ATTACHMENT X
PROVIDER NAME, ADDRESS, PHONE* and FEID#
Program Funding:
THIS REPORT PERIOD:
From To
CCE Admin.
CONTRACT PERIOD:
CCE Services
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 Receipts
3. Total Receipts
4. Percent of
Budget
For This Report
Year to Date
Approved Budget
1. State Funds
$0.00
$0.00
$0.00
#DIV/0!
2. Program Income
$0.00
$0.00
$0.00
#DIV /0!
3. Local Cash Match
$0.00
$0.00
$0.00
#DIV /01
4. SUBTOTAL: CASH RECEIPTS
5. Local In -Kind Match
6. TOTAL RECEIPTS
$0.00
$0.00
$0.00
#DIV /0I
PART B: EXPENDITURES
1. Approved
2. Expenditures
3. Expenditures
4. Percent of
Budget
For This Report
Year to Date
Approved Budget
1. Administrative Services
$0.00
$0.00
$0.00
#DIV /01
2. Service Subcontractor(s)
$0.00
$0.00
$0.00
#DIV /Ol
3. Adult Protective Services
$0.00
$0.00
$0,00
#DIV /0I
4. TOTAL EXPENDITURES
$0.00
$0.00
$0.00
#DIV /O!
PART C: OTHER REVENUE AND EXPENDITURES
11. Interest:
111. Advance Recouped
1. Program Income (Pl)
1. Earned on GR Advance $
$
1. CCE' PI Collected YTD $
2. Return of GR Advance $
(Includes fees collected)
3. Other Earned
$
PART 0: CO- PAYMENTS
CURRENT MONTH
YEAR -TO -DATE
1. Total of Co- payments assessed $
$
2. Total of Co- payments collected $
$
(For Tracking Purposes only)
DOEA FORM 105C
Revlsed 5/25/2010
M
Packet Page -1380-
9/8/2015 16.D.2.
Attestation Statement
Agreement /Contract Number CCE 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.
Signature of Recipient /Contractor representative
Packet Page -1381-
July 31, 2014
Date
Amendment 001 July 2014 to June 2015 1 9/8/2015 16vD.2.
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
COMMUNITY CARE FOR THE ELDERLY PROGRAM
COLLIER COUNTY BOARD OF COUNTY COMMISSIONIRS
THIS AMENDMENT is entered into between the Area Agency on Aging for Southwest Florida, Inc. ( "Agency ") and
Collier County Board of County Commissioners, ( "Contractor "), amends agreement CCE 20B.14`
The purpose of this amendment is to change effective date for rates and revise ATTACHMEjNT VII, RATE
SUMMARY.
Line denotes completion of above summary
This amendment shall be effective September 30, 2014. All provisions in the agreement acid any attachments thereto in
conflict with this amendment shall be and are hereby changed to conform with 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
agreement.
This amendment and all of its attachments are hereby made a part of this agreement.
TN WITNESS WHEREOF, the parties hereto have caused this 2 page amendment to be executed by their officials there
.into duly authorized.
Recipient: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR SOUTHWEST
COUNTY COMMISSIONERS FLORIDA, INC.
SIGNED BY: " SIGNED BY: 7�
NAME: Stephen Y. Carnell
TITLE: Public Services Administrator
DATE: � I (( (1 1
Federal Tax ID: 59- 6000558
Fiscal Year Ending Date: 09/30
NAME: MARIANNE G LORINI
TITLE: PRESIDENT /CEO
DATE:
Packet Page -1382-
Approved as to form and legality
Assistant Cojmty ey
Amendment 001 July 2014 to .Tune 2015 9/8/201-5-16.-D.2.
ATTACHMENT VII
COMMUNITY CARE FOR THE ELDERLY PROGRAM
RATE SUMMARY effective July 1 through August 31, 2014
for
Collier County Board of County Commissioners
Collier County
Total Unit Cost
Reimbursement Rate -90%
Case Management
$58.33
$52.50
Case Aide
$31.50
$30.50
$28.35
Adult Day Care
$12.22
$11.00
Chore
$23.33
$21.00
Enhanced Chore
$30.33
$27.30
Companion
$23.33
$21.00
Skilled Nursing
$40.00
$36.00
EARS
$ 1.31
$ 1.18
Homemaking
$21.50
' $19.35
Personal Care
$25.67
$23.10
Respite-in-Home
$25.67
$23.10
Home Improvement
$ Cost Reimbursement
90% Cost Reimbursement
Material Aid
$ Cost Reimbursement
90% Cost Reimbursement
Specialized Medical Equipment,
Service & Supplies
$ Cost Reimbursement
90% Coat Reimbursement
Transportation
$ Cost Reimbursement
90% Cost Reimbursement
RATE SUMMARY effective September 1, 2014
Collier County
Total Unit Cost
Reimbursement Rate -90%
Case Management
$60.00
$54.00
Case Aide
$33.88
$30.50
Adult Day Care
$12.83
$11.55
Chore
$23.33
$21.00
Enhanced Chore
S30.33
? $27.30
Companion
$23.33
! $21.00
Skilled Nursing
$42.00
$37.80
EARS
$ 1.31
$ 1.18
Homemaking
$21.50
$19.35
Personal Care
$25.67
$23.10
Respite-in-Home
$25.67
! $23.10
Home Improvement
$ Cost Reimbursement
90% Coss Reimbursement
Material Aid
$ Cost Reimbursement
90% Cosa Reimbursement
Specialized Medical Equipment,
Service & Supplies
$ Cost Reimbursement
90% Cosh Reimbursement
Transportation
$ Cost Reimbursement
90% Cost Reimbursement
2
LA"
0i
Packet Page -1383-
9/8/2015 16. D .2 .
Attestation Statement
Agreement/Contract Number CCE 203.14
Amendment Number 001
I, 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,
of RecipiMt /Contractor representative
Approved as to form and legality
Assistant County Att4rjhy
Packet Page -1384-
Amendment 002 July 2014 to June 2015 9/8/2015 16.D.2.
r
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, ) NC.
COMMUNITY CARE FOR THE ELDERLY PROGRAM
COLLIER COUNTY BOARD OF COUNTY COMMISSION19RS
THIS AMENDMENT is entered into between the Area Agency on Aging for Southwest lorida, Inc. ( "Agency ") and
Collier County Board of County Commissioners, ( "Contractor "), amends agreement CCE 201.14.
The purpose of this amendment is to amend ATTACHMENT I, SECTION III: METHOD OF PAYMENT Paragraph
3.1 General Statement of Method of Payment and 3.4 Consequences for Non - Compliance; increase the allocation by
$30,000.00 and revise ATTACHMENT III and ATTACHMENT VII, ANNUAL BUDGM SUMMARY.
Line denotes completion of above summary
i
ATTACHMENT I:
Paragraph 3.1 and 3.4 of the Attachment 1, is hereby amended to read:
i
s
3.1 General Statement of Method of Payment
The method of payment for this contract includes advances, and fixed rate for services. The Contractor shall
ensure fixed rates for services include only those costs that are in accordance with all applicable state and federal
statutes and regulations and are based on audited historical costs in instances where an ndependent audit is
required. The Contractor shall consolidate all requests for payment from Subcontractiors and expenditure
reports that support requests for payment and shall submit to the Agency on fbts 106C (ATTACHMENT
IX) and 105C (ATTACHMENT X).
3.4 Consequences for Non - Compliance I
The Contractor shall ensure 100% of the deliverables identified in Section 1.2.4., Scope of Services are
performed pursuant to contract requirements, and as described in Section 2.3,
Deliverables in this contract. If at any time the Contractor is notified by the Agerlcy's Contract Manager that it
has failed to correctly, completely, or adequately perform these major deliverables, the Contractor will have 10 days
to submit a Corrective Action Plan ( "CAP ") to the Contract Manager that addressesi the identified deficiency and
states how the deficiency will be remedied within a time period approved by the Contr ct Manager. The Agency shall
assess a financial consequence for non - compliance on the Contractor for each deficiency identified in the CAP
which is not corrected pursuant to the CAP. The Agency may also assess a finanal consequence for failure to
timely submit a CAP. In the event the Contractor fails to correct an identified defici$ncy within the approved time
period specified in the CAP, the Agency shall deduct, from the payment for the invoice of the following month, 1%
of the monthly amount billed for each day the deficiency is not corrected. The Agertcy may also deduct, from the
payment for the invoice of the following month, 1 % of the monthly amount billed fori each day the Contractor fails
to timely submit a CAP, beginning the 11th day after notification by the Contradt Manager of the deficiency.
If, or to the extent, there is any conflict between this paragraph and paragraphs 30. and 39.1 of Master Contract
HMO] 4, this paragraph shall have precedence.
This amendment shall be effective October 1, 2014. All provisions in the agreement aid any attachments thereto in
conflict with this amendment shall be and are hereby changed to conform with 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
agreement.
This amendment and all of its attachments are hereby made a part of this agreement. j
a�
Packet Page -1385-
Amendment 002
July 2014 to June 2015 9/8/2015 16.D.2.
IN WITNESS WHEREOF, the parties hereto have caused this 4 page amendment to be ex4cuted by their officials there
unto duly authorized.
Recipient: COLLIER COUNTY BOARD OF AREA AGENCY ON A ING FOR SOUTHWEST
COUNTY COMMISSIONERS FLORIDA, INC.
SIGNED BY: L Ui L ___ _ SIGNED BY: 'J c-
NAME Stephen Y. Carnell
TITLE: Public Services Administrator
DATE: 12 Ll �6 IL-
Federal Tax ID: 59- 6000558
Fiscal Year Ending Date: 09/30
NAME: MARIANNE G LORINI
TITLE: PRESIDEVT /CEO
DATE: la f /�y J
1
I
i
I
i
2
Packet Page -1386-
to form and legality
or
�v
' a�
Amendment 002 ! July 2014 to June 2015 0 9/8/2015 16.D.2.
i ATTACHMENT III
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO
THIS CONTRACT CONSIST OF THE FOLLOWING:
PROGRAM TITLE
FUNDING SOURCE I CFDA I AMOUNT
TOTAL FEDERAL AWARD -
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES
AWARDED PURSUANT TO THIS CONTRACT ARE AS FOLLOWS: N/A I
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANTi TO THIS
CONTRACT CONSIST OF THE FOLLOWING:
i
MATCHING RESOURCES FOR FEDERAL PROGRAMS
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
$0
� TT T '11 G Q7 V Q
IAIk, 1'11'IA1-4% -1 iL t100171t11�14.ii vvy....�
PROGRAM TITLE
Community Care for the Elderly
_ �. _ -. -- -- ) - --
FUNDING SOURCE
General Revenue - Collier
=65010$
TOTAL AWARD
S 750,634.00
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCE$ AWARDED
PURSUANT TO THIS CONTRACT ARE AS FOLLOWS: w
STATE FINANCIAL ASSISTANCE
i
Section 215.97, Fla. Stat.
Chapter 69I -5, Fla. Admin.
Code
Packet Page -1387-
Amendment 002 July 2014 to June 2015 9/8/2015 16.D.2.
COMMUNITY CARE FOR THE ELDERLY PROGRAM
ANNUAL BUDGET SUMMARY j
for I
Collier County Board of County Commissioners
CCE Services Allocations
Collier
S
Packet Page -1388-
$ 750,63400
i
ATTACHMENT VII
a�
C
9/8/201516. D.2.
Attestation Statement
Agreement/Contract Number: CCE 203.14
Amendment Number 002
i
1, Stephen v Carnell , attest that no changes or revisions ha�e been made to the
(Recipient/Contractor representative)
content of the above referenced agreement /contract or amendment between the Area A�ency 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 th4 differences in
electronic data processing media, which has no affect on the agreement /contract conteni.
d, i
Signature of Recipient/Contractor representative
Approv4d as to form and legality
Assi ; t Coun troy " ��-
ME
Packet Page -1389-
Amendment 003 July 2014 to June 2015
9/8/2015 16. D.2.
i
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDAIINC.
COMMUNITY CARE FOR THE ELDERLY
COLLIER COUNTY BOARD OF COUNTY CO
THIS AMENDMENT is entered into between the Area Agency on Aging for Southwes Florida, Inc. ( "Agency ") and
Collier County Board of County Commissioners, ( "Contractor "), amends agreement CCE 2 13.14.
The purpose of this amendment is to increase the allocation by $25,000 and revise ATTACHMENT III and
ATTACHMENT VII, ANNUAL BUDGET SUMMARY.
Line denotes completion of above summary
This amendment shall be effective April 1, 2015. All provisions in the agreement and any
with this amendment shall be and are hereby changed to conform with this amendment
All provisions not in conflict with this amendment are still in effect and are to be perforrr
agreement.
This amendment and all of its attachments are hereby made a part of this agreement.
IN WITNESS WHEREOF, the parties hereto have caused this 3 page amendment to be
unto duly authorized.
Recipient: COLLIER COUNTY BOARD OF
COUNTY COMMISSIONERS
SIGNED BY:
NAME: Stephen Y. Carrel]
TITLE: Public Services Administrator
DATE: April 9, 2015
Federal Tax ID: 59- 6000558
Fiscal Year Ending Date: 09/30
AREA AGENCY ON
FLORIDA, INC.
SIGNED BY:_ ` A
NAME: MARI
TITLE: PRESL
DATE:
I
Packet Page -1390-
thereto in conflict
at the level specified in the
ited by their officials there
JG FOR SOUTHWEST
G LORINI
/CEO
Amendment 003 July 2014 to June 2015 9/8/2015 16.D.2.
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT
THIS CONTRACT CONSIST OF THE FOLLOWING:
ATTACHMENT III
TO
I PROGRAM TITLE I FUNDING SOURCE I I CFDA I AMOUNT I
TOTAL FEDERAL AWARD I
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RE'.
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 I FUNDING SOURCE CFDA I AMOUNT
$0
STATF. FTNANCTAT, AgQIfiTANC''F, STTR.TFCT TO See. 215.97. F.S.
PROGRAM TITLE
FUNDING SOURCE
CSFA
AMOUNT
—
Community Care for the Elderly
General Revenue - Collier
65010
$ 775,634.00
i
i
TOTAL AWARD
S 775,634.00
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCE AWARDED
PURSUANT TO THIS CONTRACT ARE AS FOLLOWS:
a
STATE FINANCIAL ASSISTANCE j
Section 215.97, Fla. Stat.
Chapter 69I -5, Fla. Admin. f{
Code I
iJ
I
Packet Page -1391-
i -
Amendment 003 July 2014 to June 2015 9/8/2015 16.D.2.
t
i
i
ATTACHMENT `VII
COMMUNITY CARE FOR THE ELDERLY PROGRAM
ANNUAL BUDGET SUMMARY
for
Collier County Board of County Commissioners
Collier
CCE Services Allocations $ 775,63.00
Packet Page -1392-
9/8/2015 16.D.2.
Revised August 2007
Attestation Statement
y
i
Agreement/Contract Number: CCE 203.14
Amendment Number 003
1
1, Stephen Y. Carnell , attest that no changes or revisions hive been made to the
(Recipient/Contractor representative)
content of the above referenced agreement/contract or amendment between the Area A envy on Aging for
Southwest Florida and
Public Services Administrator
(Recipient/Contractor name)
The only exception to this statement would be for changes in page formatting, due to th differences in
electronic data processing media, which has no affect on the agreement/contract conten(
4 r/'�*
Signature of RecipienttYon tractor representative
Revised August 2007
Packet Page -1393-
5
Amendment 004
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA
COMMUNITY CARE FOR THE ELDERLY PROGRAM
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
9/8/2015 16.D.2.
CCE 203.14.004
This AMENDMENT, entered into between the Area Agency on Aging for Southwest Florida hereinafter referred to
as the "Agency," and Collier County Board of County Commissioners, hereinafter referred to as the "Contractor,"
collectively stated as the "Patties" which amends contract CCE 203.14.
This amendment shall be effective July 1, 2015.
RECITALS:
WHEREAS, on August 14, 2014, the parties entered into the Standard Contract for social set-vices to be
provided to Collier County's frail and elderly seniors (hereinafter referred to as "Contract "); and
WHEREAS, on November 12, 201.4, the parties entered into a First Amendment to the Contract; and
WHEREAS, on December lb, 2014, the parties entered into a Second Amendment to the Contract; and
WHEREAS, on May 4, 2015, the parties entered into a Third Amendment to the Contract; and
WHEREAS, Section 3 of the Contract provides that the agreement is to expire on June 30, 2015; and
WHEREAS, the funding source for a successor agreement for senior services is not yet available to the
Agency from the Florida Department of Elder Affairs;
WHEREAS, the Parties are satisfied with the arrangement that they currently enjoy under the Contract so
that both parties wish to extend the Contract to August 30, 2015 while they await notification of funding of a
successor contract.
NOW, THEREFORE, in consideration of the foregoing Recitals, and other good and valuable consideration, the
receipt and sufficiency of which is hereby mutually acknowledged, the Parties agree as follows:
The foregoina Recitals are true and correct and are incorporated by reference herein.
2. Both parties agree to extend the contract to August 30, 2015.
3. All other provisions of the Contract are to remain in effect and are to be performed at the level
specified in the agreement.
SIGNATURE PAGE TO FOLLOW
Packet Page -1394-
Amendment 004
9/8/2015 16. D .2.
CCE 203.14.004
IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be. executed by their
officials there unto duly authorized.
Collier County Board of County
Contractor:
Commissioners
SIGNED BY:
NAME: Stephen Y. Carnell
TITLE: Public Services Department Head
DATE:
Federal Tax ID: 59- 6000588
Fiscal Year Ending Date: 09/30
Area Agency on Aging for Southwest Florida
SIGNED
BY: —47 �..c.c:, -rl..
NAME: Marianne G Lorini
TITLE: President/CEO
DATE:
Approved as to form and legality
2
Packet Page -1395-
Assistant Cn'mty A11"Y
�I-
a
Revised August 2007
Attestation Statement
Agreement/Contract Number 203.14
Amendment Number _004
9/8/2015 16.D.2.
I, 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 Department Head
(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.
�� �J r L-t1I1I1I( :2-7.0
Signature bf Recipi t/Contractor representative Date
Revised August 2007
Packet Page -1396-
Approved as to form and legality
n'r.r'A
Assist-'
July 2014 to June 2015
AREA AGENCY ON AGING FOR
SOUTHWEST FLORIDA, INC. CONTRACT
ALZHEIMER'S DISEASE INITIATIVE
9/8/2015 16.D.2.
1'W LUj.14
THIS CONTRACT is entered into between the Area Agency on Aging for Southwest Florida, Inc. (Agency) and Collier
County Board of County Commissioners (Contractor),
M71TNESSETH 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:
L 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 RMO14, as an integral part of the contract, except to the extent that
the contract explicitly provides to the contrary. hi 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
Packet Page-1397-
July 2014 to June 2015
6. Official Payee and Representatives (Names, Addresses, and T
qTbe Contractor name, as shown on page I of this
ontract, and mailing address of the official payee to
whom the payment shall be made is:
9/8/2015 16.D.2.
1-1 "'t G V 3, 1'+
one Numbers):
uzer I—ounty Housing, Human and Veteran
Services
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 Taniiami Trail, Building H
i Naples, FL 34112
c.
The name, address, and telephone number of the
representative of the Contractor responsible for
administration of the program under this contract is:
d The section and location within the Agency where
Requests for Payment and Receipt and Expenditure
forms are to be mailed is:
e. IThe name, address, and telephone number of the
Contract Manager for this contract is:
Kimberly Grant, Director
Collier County Housing, Human and Veteran
Services
3339 E Tazniami Trail, Building H
Naples, FL 34112
(239) 252 -2273
Nancy Dean, Director of Finance
-a Agency on Aging for Southwest Florida, Inc
15201 North Cleveland Avenue, Suite 1100
North Fort Myers, FL 33903
Marianne Lorini, Executive Director
:a Agency on Aging for Southwest Florida, Inc
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
Packet Page -1398-
July 2014 to June 2015
ADI 203.1.4
9/8/2015 16.D.2.
All Terns and Condition:, Included
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
COUNTY COMMISSIONERS
SIGNED BY: n AK
NAME: Stephen Y. Carrell
TITLE: Public Services Administrator
DATE: July 31, 2014
Federal Tax ID: 59- 6000558
Fiscal Year Ending Date: 09/30
Packet Page -1399-
AREA AGENCY ON AGING FOR
SOUTHWEST A, INC.
SIGNED
NAME: RONALD LUCCHINO. PhD
TITLE: BOARD PRESIDENT
yJ-
DATE: <- ` "� "' (%
July 2014 to June 2015
YN!'Dvly OF r-STTAChWIENTS
9/8/2015 16.D.2.
ALA 203.14
ATTACHMENT L . 5
STATEMENT OF WORK
ATTACHMENT III ..............
..........................
..... ...............................
FUNDING SOURCE
ATTACHMENT VII ...............
.... ............................... .............
INVOICE REPORT SCHEDULE 15
ATTACHMENT VIII ............
..... ...............................
.. ...............................
ANNUAL BUDGET SUMMARY
ATTACHMENT IX............
...............................
REQUEST FOR PAYMENT 17
.................
ATTACHMENT X .................
.......... ............................... .
RECEIPT AND EXPENDITURE REPORT 18
ATTACHMENT K ..............
............................
SERVICE RATE REPORT 19
4
Packet Page -1400-
July 2014 to June 2015
STATEMENT OF WORK
ALZBEIMER'S DISEASE INITIATIVE PROGRAM
SECTION I: SERVICES TO DE PROVIDED
1.1 DEFINITIONS OF CONTRACT TERMS AND ACRONYMS
1.1.1 DEFINITIONS OF ACRONYMS
Alzheimer's Disease (AD)
Alzheimer's Disease Initiative (ADI)
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)
Mernory Disorder Clinic (MDC)
Planning and Service Area (PSA)
1.1.2 PROGRAM SPECIFIC TERMS
9/8/2015 16.D.2.
AW 203.14
ATTACHMENT I
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).. P.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
Packet Page -1401-
July 2014 to .tune 2015 9/8/2015 16.D.2.
AU1 203.14
1.2 GENERAL (DESCRIPTION
1.2.1 General Statemeut
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 EIigibility
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 g
(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 CIients; and
(4) Monitoring the Performance of Subcontractors.
Packet Page -1402-
July 2014 to June 2015 9/8/2015 16.D.2.
2.1.1. 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 1, 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 (Gerontciogicai);
(5) Counseling (Mental Flealth/Screening);
(G) 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
ADI client. related support services to assist them in caring for the
7
Packet Page -1403-
July 2014 to June 2015
9/8/2015 16.D.2.
1 l.tl1 1 VJ.I -t
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 NIDCs 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 Batik.
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 per %rill 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 fi•om 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, programmatic
performance, and compliance with applicable state and federal laws and regulations. The Contractor 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:OOam to 5 :00pm.
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 earl be performed. The highest reimbursement unit rate and the
method of payment are sho«Z t 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.
Packet Page -1404-
July 2014 to June 2015
2.3 DELIVERABLES
Service
Unit of Service
Case Aide
Counseling;
Counseling (Gerontological);
Individual;
Hour
Model Day Care;
Respite In- Facility
Respite In -Home
Caregiver Train /Support (Indv)
Case Management
Education/Training;
Episode
Specialized Medical Equipment, Services
and Supplies
9/8/2015 16.D.2.
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.
.^
Packet Page -1405-
July 2014 to June 2015
9/8/2015 16.D.2.
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 fi•om
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 sarne 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
file 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
Packet Page -1406-
July 2014 to June 2015
9/8/2015 16.D.2.
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
(M) 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 I05Z (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 fiends 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 fiends 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 fiords will be distributed.
11
Packet Page -1407-
July 2014 to June 2015 9/8/2015 16.D.2.
3.2.2 The Contractor's requests for advance require the approval of the Contract Manager. If sufficient 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 VH 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 supportrequests 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- Nonconfoa•ming 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 nonconfonning 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 i % 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, lf, 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 VH to this contract.
3.3.2:' 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. Irate For Final Request For Budget Revisions
Final requests for budget revisions or adjustments to contract nuids based on expenditures for- services provided
through June 25, 2015, must be submitted to the Contract Manager no later than June 25, 2015.
12
Packet Page -1408-
July 2014 to June 2015 9/8/2015 16.D.2.
3A 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
Packet Page -1409-
July 2014 to June 2015
9/8/2015 16.D.2.
ATTACHMENT III
�. FEDERAL RESOURCES AWARDED T O THE SUBicECIPIENT PURSUANT T O THIS
CONTRACT CONSIST OF THE FOLLOWING:
PROGRAM TITLE I FUNDING SOURCE I CFDA I AMOUNT f
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 I FUNDING SOURCE CFDA I AMOUNT
TOTAL STATE AWARD I $0
STATE FINANCIAL ASSISTANCE SUBJECT TO See. 215.97, F.S.
PROGRAM TITLE
FUNDING SOURCE
CSFA
AMOUNT
Alzheimer's Disease Initiative
General Revenue / TSTF- Collier
65004
$ 104,280.00
TOTAL. AWARD
$ 1047280.00
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT
TO THIS CONTRACT ARE AS FOLLOWS:
STATE FINANCIAL ASSISTANCE
Section 21 5.97, Fla. Stat.
Chapter 69I -5, Fla. Admin. Code
14
Packet Page -1410-
July 2014 to June 2015
Report Number
1
2
3
4
5
6
7
8
9
10
11
12
13
14
IS
16
INVOICE REPORT SCHEDULE
ALZHEIMER'S DISEASE INITIATIVE (ADD
INVOICE SCHEDULE
Based On
July Advance*
August 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 Request for Payment
Closeout Report
Legend: 1` Advance based on projected cash need.
9/8/2015 16.D.2.
ATTACHMENT VII
Submit to Agency on This Date
July 1
July 1
August 9
September 9
October 9
November 9
December 9
January 9
February 9
March 9
April 9
May 9
June 9
July 9
July 25
August 1
Note # I: Report #1 for Advance Basis Contracts cannot be submitted to the Area Agency
on Aging for Southwest Florida, Inc. prior to July I 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 — terith 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 finds due back to the Agency, payment is to
accompany the report.
15
Packet Page -1411-
July 2014 to June 2015
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
ANNUAL BUDGET SUMMARY
For
Collier County Board of County Commissioners
Collier
ALLOCATION TOTAL $ 104,280
16
Packet Page -1412-
9/8/2015 16.D.2.
ADI 203.14
ATTACHMENT VIII
July 2,014 to June 2015
9/8/2015 16.D.2.
ADI 203.14
ATTACHMENT IX
REQUEST FOR PAYMENT
ALZH EIMERS DISEASE INITIATIVE PROGRAM
REC ?IFJfif)A ^:iE.ADDRESS.P:iOtlE-' and FED9
TWEOFREPORT:
Tlis Request Period
PSAVI
A PAhcNT RECUEST:
Report _
Regrtar_
Sup.plerr rRal_
Contract:_
B. METHOD OF PAY,t`fli:
Contract Period
Advance
ReimbuQenr_nt
CERTPICATIOfd: I N rebycen yto the best of my 1mwMedge that tlis request is coffv4ete and correct and conforms widrdre terrrms and One purposes of dr. above contract
Prepared by Date
Approved by,
Date:
(1)
(2)
PARTA BUDGETSL1WTM: W
Respite
rv'"odel 0aycare
TOTAL
1 Approved CwmactAmouY
50.00
50.00
S000
2. PieviousFurds Received for Cortract Period
SO.00
50.00
S000
3. CDrtlad Balance (line 1 minus line 2)
50.00
50.00
50.00
J. PieriousFLWs Requested and Not Received for Coraract Period
$000
50.00
SOM
5. Contract Balance (inn 3 rrinus line a)
S000
W00
50.00
PART B: CONTRACT FUICS REQUEST
1.Articipated Cash Needs (1st- 2nd morch,AOachJustdication)
$0.00
$0.00
50.00
2. Nei &,yenditraes For Morgh
SON
S000
$0.00
(DC}_AForm 1052 Part B, Line 3)
3. TOTAL
5000
SO.00
50,00
1 PARTC: IETFLUDSREOLF_STED
a
1 LessAdfanceApplied
5000
SO00
5000
2. Cor'.raci Funds are HerebyRequested tar (Pal S. Line 3
$0 00
SO.00
50.00
rrirn-s Pal C, Line 1)
Litt of Sernces / Un is /Races provided • See aaachad report
DOE- FORrAl 1062
P.t:ii td f 4'1;
17
Packet Page -1413-
July 2014 to June 2015
RECEIPTAND EXPENDITURE REPORT
ALZHEIMERS DISEASE INITIATIVE PROGRAM
9/8/2015 16.D.2.
AU1 2UJ.14
ATTACHMENT X
PROVIDER NAME, ADDRESS, PHONE K and FEID41
Program Funding :
THIS REPORT PERIOD.
From _
To
Respite
CONTRACT PERIOD:
Model Day Care
+_
CONTRACT 4
REPORT 9
PSA;r
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 Receipts
3. Total Receipts
4. Percent of
Budget
For This Report
Year to Date
Approved Budget
1, State Funds
SO.00
50.00
S0.00
9DIV /0t
2. Program Income
S0.00
SO.00
50.00
4DIV /0!
3. Local Cash Match
50.00
50.00
50.00
mDIV101
4. SUBTOTAL: CASH RECEIPTS
5. Local In -Kind Match
6. TOTAL RECEIPTS
50.00
50.00
$0.00
RDIV /O!
PART B: EXPENDITURES
1. Approved
2. Expenditures
3. Expenditures
4. Percent of
Budget
For This Report
Year to Date
Approved Budget
1. Administrative Services
50.00
50.00
SO.00
DIV 10!
2. Service Subcontractor(s)
S0.00
$0,00
50.00
4DIVf0!
3. TOTAL EXPENDITURES
SO.00
$0.00
$0.00
9DIV10!
PART C: OTHER REVENUE AND EXPENDITURES
II. Interest
i
ill. Advance Recouped
1, Program I ncome (PI)
1. Earned on GR
Advance S_
S
1. ADi: PI Collected YTD S
Return of GR Advance S
(Includes co- payments collected)
3. OlherEarned
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
(ForTraciang Purposes only)
41 rOR 1.t ICS-'
18
Packet Page -1414-
July 2014 to June 2015
DELIVERABLES
Case Aide: Collier
Case Management: Collier
Respite In- Facility: Collier
Respite In -Home: Collier
Specialized Medical Equipment, Services and Supplies
19
HIGHEST
REIMBURSEMENT
UNIT RATE
$33.88
$60.00
$12.22
$24.44
Packet Page -1415-
9/8/2015 16. D.2.
ATTACHMENT K
METHOD OF
PAYMENTS
Fixed Fee / Unit Rate
Fixed Fee / Unit Rate
Fixed Fee / Unit Rate
Fixed Fee / Un it Rate
Cost Reimbursement
9/8/2015 16.D.2.
Attestation Statement
Agreement /Contract Number ADI 203.14
Amendment Number n/a
1, Stephen Y. Carneli , attest that no changes or revisions have been made to the
(Recipient /Contractor representative)
content of the above referenced agreement /contract or amendment between the Area Agency on Aging for
Southwest Florida and
Public Services Administrator
(Signature of Recipient /Contractor name)
The only exception to this statement would be for changes in page formatting, due to the differences in
electronic data processing media, which has no affect on the agreement /contract content.
July 31, 2014
Signature of Recipiet&Contractor representative Date
Packet Page -1416-
Amendment 001 July 2014 to June 2015 9/8/2015 16.D.2.
�Ur 'lp
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC. t
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
COLLIER COUNTY BOARD OF COUNTY COMMISSIONtRS
THIS AMENDMENT is entered into between the Area Agency on Aging for Southwest; Florida, Inc. ( "Agency ") and
Collier County Board of County Commissioners, ( "Contractor "), amends agreement ADI 20$.14.
The purpose of this amendment is to amend ATTACHMENT I, SECTION III: METHOD OF PAYMENT Paragraph
3.1 General Statement of Method of Payment and 3.5 Consequences for Non - Compliance; amend ATTACHMENT
K, SERVICE RATE REPORT; and increase the allocation by $132,683.00 and revise ATTACHMENT III and
ATTACHMENT VIII, ANNUAL BUDGET SUMMARY.
Line denotes completion of above summary
ATTACHMENT I:
Paragraph 3.1 and 3.5 of the Attachment I, is hereby amended to read:
3.1 General Statement of Method of Payment
The method of payment for this contract includes advances, 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 iindependent 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 for Ms 106Z (ATTACHMENT
IX) and 105Z (ATTACHMENT X).
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,
Deliverables in this contract. If at any time the Contractor is notified by the Agedcy'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 identified 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 may also assess a financial consequence for failure to
timely submit a CAP. In the event the Contractor fails to correct an identified deficiency within the approved time
period specified in the CAP, the Agency shall deduct, from the payment for the invoice of the following month, l %
of the monthly amount billed for each day the deficiency is not corrected. The Agency may also deduct, from the
payment for the invoice of the following month, I% of the monthly amount billed for !each day the Contractor fails
to timely submit a CAP, beginning the 1 Ith day after notification by the Contractt Manager of the deficiency.
If, or to the extent, there is any conflict between this paragraph and paragraphs 39 and 39.1 of Master Contract
HM014, this paragraph shall have precedence.
This amendment shall be effective July 1, 2014. All provisions in the agreement and any attachments thereto in conflict
with this amendment shall be and are hereby changed to conform with 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
agreement.
This amendment and all of its attachments are hereby made a part of this agreement.
(�D
Packet Page -1417-
Amendment 001 • July 2014 to June 2015 9/8/2015 16.D.2.
IN WITNESS WHEREOF, the parties hereto have caused this 5 page amendment to be e)aecuted by their officials there
unto duly authorized.
Recipient: COLLIER COUNTY BOARD OF AREA AGENCY ON ACING FOR SOUTHWEST
COUNTY COMMISSIONERS FLORIDA, INC.
SIGNED BY: SIGNED BY: Z2A. �u G
MA.RIRnni G t -oa/'0l
NAME: Stephen Y. Carnell NAME: >
P Z �PS l to 2h - Cto
TITLE: Public Services Administrator TITLE:
DATE September 5, 2014
DATE: q /aS�3�ol y
Federal Tax ID: 59- 6000558
Fiscal Year Ending Date: 09/30
Approved as to form and logality
Assistant County Att
2
r..
\F
Packet Page -1418-
t
Amendment 001 � July 2014 to June 2015
9/8/2015 16.D.2.
ATTACHMENT III
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO
THIS CONTRACT CONSIST OF THE FOLLOWING:
PROGRAM TITLE I FUNDING SOURCE CFDA I AMOUNT
TOTAL FEDERAL AWARD I I
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES
AWARDED PURSUANT TO THIS CONTRACT ARE AS FOLLOWS: N/A
i
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 I AMOUNT
$0
QTATF 1PINANC"TAT. AQQTfiTANfF. STiR.WrT TO Sec. 215.97. F.S.
PROGRAM TITLE
FUNDING SOURCE
CSFA
AMOUNT
Alzheimer's Disease Initiative
General Revenue / TSTF- Collier
' 65004
$ 236,963.00
I
TOTAL AWARD
S 236,963.00
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
3
i
Packet Page -1419-
Amendment 001
0 July 2014 to June 2015
. 9/8/2015 16.D.2.
i
f
ATTACHMENT VIII
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
ANNUAL BUDGET SUMMARY
For
Collier County Board of County Commissioners
Collier
ALLOCATION TOTAL
El
Packet Page -1420-
$ 236,963
�1
Amendment 001
July 2014 to June 2015
SERVICE RATE REPORT
9/8/2015 16.D.2.
ATTACHMENT K
5
J
Packet Page -1421- '
HIGHEST
THOD OF
DELIVERABLES
REIMBURSEMENT
PA YMENTS
UNIT RATE .
,l
Case Aide: Collier
$33.88
Fired Fee / Unit Rate
Case Management: Collier
$60.00
Fixed Fee / Unit Rate
Respite In- Facility: Collier
$12.83
Fi�ed Fee / Unit Rate
Respite In -Home: Collier
$25.67
Fi�ed Fee / Unit Rate
Specialized Medical Equipment, Services and Supplies
Cost Reimbursement
5
J
Packet Page -1421- '
9/8/2015 16.D.2.
Attestation Statement
Agreement /Contract Number: ADI 203.14
i
Amendment Number 001
I, Stephen Y. Carnell , attest that no changes or revisions hive 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.
94VI // 9/5/2114
Signature of
ctor representative
Approved as to: form and legality
Assistant County Attorney yo�
4�
Packet Page -1422-
Amendment 002 July 2014 to June 2015 9/8/2015 16.D.2.
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA,!INC.
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
THIS AMENDMENT is entered into between the Area Agency on Aging for Southwest; Florida, Inc. ( "Agency ") and
Collier County Board of County Commissioners, ( "Contractor "), amends agreement ADI 203.14.
The purpose of this amendment is to change effective date for rates and revise ATTACHMENT K, SERVICE RATE
REPORT.
Line denotes completion of above summary
i
This amendment shall be effective September 30, 2014. All provisions in the agreement al d any attachments thereto in
conflict with this amendment shall be and are hereby changed to conform with this amendment
All provisions not in conflict with this amendment are still in effect and are to be perforniod at the level specified in the
agreement. 7
This amendment and all of its attachments are hereby made a part of this agreement.
IN WITNESS WHEREOF, the parties hereto have caused this 2 page amendment to be ea ecuted by their officials there
unto duly authorized.
Recipient: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR SOUTHWEST
COUNTY COMMISSIONERS FLORIDA, INC.
SIGNED BY: CAI SIGNED BY
NAME: Stephen Y. Carrell NAME:
TITLE: Public Services Administrator
DATE: ((
Federal Tax ID: 59- 6000558
Fiscal Year Ending Date: 09/30
TITLE
MARIANNE G LORINI
PRESIDLNT /CEO
DATE: /I- /2-/e/
Packet Page -1423-
Approved as to form and legality
---pssjstant Count ttomey
CAO
i
Amendment 002 July 2014 to June 2015 9/8/2015 16.D.2.
ATTACHMENT K
SERVICE RATE REPORT
Rate Summary effective August 1, 2014
2
Packet Page -1424- 00101
HIGHEST
OF
DELIVERABLES
REIMBURSEMENT
P TS
UNIT RATE
Case Aide: Collier
$33.88
Fixed Fee / Unit Rate
Case Management: Collier
$60.00
FiXed Fee / Unit Rate
Respite in- Facility: Collier
$12.83
;
Filed Fee / Unit Rate
Respite In -Home: Collier
$25.67
FiXed Fee / Unit Rate
Specialized Medical Equipment, Services and Supplies
Cost Reimbursement
2
Packet Page -1424- 00101
9/8/2015 16.D.2.
Attestation Statement
Agreement /Contract Number: ADI 203.14
Amendment Number 002
I, Stephen Y. Carnell , attest that no changes or revisions hove 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 th� differences in
electronic data processing media, which has no affect on the agreement/contract contend.
'( 41
Signature of Recipie/Contractor representative
Packet Page -1425-
L
Mte
Approved as to form and legality
Assistant Coun mey
Amendment 003
"t
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
9/8/2015 16.D.2.
ADI 203.14.003
This AMENDMENT, entered into between the Area Agenev on Aging for Southwest Florida. hereinafter referred to
as the "Agency," and Collier County Board of County Commissioners, hereinafter referred to as the "Contractor,"
collectively stated as the "Parties" which amends contract ADI 203. 1.
This amendment shall be effective July 1, 2015. .
RECITALS:
WHEREAS, on August 14, 2014, the parties entered into the Standard Contract for social services to be
provided to Collier County's frail and elderly seniors (hereinafter referred to as "Contract"). and
WHEREAS, on September 25, 2014, the parties entered into a First Amendment to the Contract; and
WHEREAS, on November 12, 2014, the parties entered into a Second Amendment to the Contract; and
WHEREAS, Section 3 of the Contract provides that the agreement is to expire on June 30, 2015; and
WHEREAS, the funding source for a successor agreement for senior services is not yet available to the
Agency from the Florida Department of Elder Affairs;
WHEREAS, the Parties are satisfied with the arrangement that they currently enjoy under the Contract so
that both parties wish to extend the Contract to August 30. 2015 while they await notification of funding of a
successor contract.
NOW, THEREFORE, in consideration of the foregoing Recitals, and other good and valuable consideration, the
receipt and sufficiency of which is hereby mutually acknowledged, the Parties agree as follows:
The foregoing Recitals are true and correct and are incorporated by reference herein.
2. Both parties agree to extend the contract to August 30, 2015.
3. All other provisions of the Contract are to remain in effect and are to be performed at the level
specified in the agreement.
SIGNATURE PAGE TO FOL.,L,OW
IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be executed by their
officials there unto duly authorized.
1 GP
Packet Page -1426-
Amendment 003
Collier County Board of County
Contractor: Commissioners
SIGNED BY: %A�A �4 94
NAME: Stephen Y Carnell
TITLE: Public Services Department Head
DATE: 'Z`� r l IS
Federal Tax ID: 59- 6000588
Fiscal Year Ending Date: 09/30
9/8/2015 16.D.2.
ADI 203.14.003
Area Agency on Aging for Southwest Florida
SIGNED jy
NAME: Marianne G Lorini
TITLE: President/CEO
DATE: �q /
Approved a5 legality
Assistant Count",.,-
7,
2
CC
Packet Page -1427-
t
Revised August 2007
Attestation Statement
Agreement/Contract Number 203.14
Amendment Number 003
9/8/2015 16.D.2.
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 Deaartment Head
(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.
Signature
Revised August 2007
l
Packet Page -1428-
~zg ~I
Date
Approved as to ' -' fir -nd legality
Assistant Court,
GP`
July 2014 — June 2015 HCE 203.14
9/8/2015 16.D.2.
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
CONTRACT
HOME CARE FOR THE ELDERLY PROGRAM
THIS CONTRACT is entered into between the Area Agency on Aging for Southwest Florida, Inc. (Agency) and
Collier County Board of County Commissioners, (Conti-actor), and collectively referred to as the "Parties." The term
Contractor for this purpose may designate a Vendor, Subgrantee or Subrecipient.
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 terns and conditions specified in this
contract including all attachments, forms, exhibits and references incorporated, which constitute the contract
document.
2. Inco►•poration 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 HMO 14, as an integral pate 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
The Agency agrees to pay for contracted services according to the terns and conditions of this contract in an
amount not to exceed $30.836.00, 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.
Renewals
By mutual agreement of the Patties, in accordance with s. 287.058(1)(g), l~ .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.
Packet Page -1429-
6.
)fiicial
PaXeLil,nd. Representatives fNanies. .Addresses, and Tele )hone Num ers : 9/8/2015 16.1
The Contractor name, as shown on page 1 of is
ollier County Housing, Hun.... _.. -__ . _
Services ~
a.
contract, and mailing address of the official payee to
3339 E Tamiami Trail, Building H
whom the payment shall be made is:
Naples, FL 34112
Kimberly Grant, Director
b.
The name of the contact person and street address where
Collier County Housing, Human and Veteran
financial and administrative records are maintained is:
Services
3339 E Tamiami Trail, Building H
Naples, FL 34112
Kimberly Grant, Director
The name, address, and telephone number of the
Collier County Housing, Human and Veteran
C.
representative of the Contractor responsible for
Services
administration of the program under this contract is:
3339 E Tamiami Trail, Building H
Naples, FL 34112
(239) 252 -2273
Nancy Dean, Director of Finance
d
The section and location within the Agency where
Area Agency on Aging for Southwest Florida, Inc.
Requests for Payment and Receipt and Expenditure
15201 North Cleveland Avenue, Suite 1100
forms are to be mailed is:
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, hie.
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 part}, and the notification attached to the originals of this contract.
7. All Ternzs and Conditions Included:
This contract and its Attachments, I, III, VII, VIII, IX, X and 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, teiins, 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 Panics 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 SO€ITI-IWE F RIDA, INC.
r:
SIGNED BY: �1 � ,' .r� _ � G ( �' SIGI�B
NAME: Steuhen Y. Carnell
TITLE: Public Services Administrator
DATE: Tuly 31 `'Old
Federal Tax ID: 59- 6000558
Fiscal Year Endin, Date: 09/30
Packet Page -1430-
NAME: RONALD LUCCHINO. PhD
TITLE: BOARD PRESIDENT
DATE:
D.2.
July 2014 — June 2015
HCE 203.14
9/8/2015 16.D.2.
INDEX OF ATTACHMENTS
ATTACHMENT I
STATEMENT OF WORK ......... ... . 4
ATTACHMENT III
FUNDINGSUMMARY ........................................................................................................ 17
ATTACHMENT VII
HOME CARE FOR THE ELDERLY ANNUAL BUDGET and RATE SUMMARY .............................. 18
ATTACHMENT VIII
HOME CARE, FOR THE ELDERLY INVOICE REPORT SCHEDULE ................................................ 19
ATTACHMENT IX
REQUESTFOR PAYMENT .................................................................................................... 20
ATTACHMENT X
RECEIPT AND EXPENDITURE 21
Packet Page -1431-
July 2014 — June 2015 HCE 20q t d
9/8/2015 16.D.2.
ATTACHMENTI
STATEMENT OF WORK
HOME CARE FOR THE ELDERLY PROGRAM
SECTION I: SERVICES TO BE PROVIDED
1.1 DEFINITION OF CONTRACT TERMS AND ACRONYMS
1.1.1 DEFINITIONS OF ACRONYMS
Adult Protective Services (APS)
Activities of Daily Living (ADL)
Assessed Priority Consumer List (APCL)
Community Care for Disabled Adults (CCDA)
Community Care for the Elderly (CCE)
Client Information and Registration Tracking System (CIRTS)
Department of Children and Families (DCF)
Home Care for Disabled Adults (HCDA)
Home Care for the Elderly (HCE)
Institutional Care Program (ICP)
Instrumental Activities of Daily Living (L DL)
Planning and Service Area (PSA)
1.1.2 PROGRAM SPECIFIC TERMS
Aging Out: The condition of reaching 60 years of age and being transitioned from the Department of
Children and Families (DCF) 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 area agency on aging outlining a comprehensive and coordinated service
delivery system in its planning and service area in accordance with the Section 306 (42 U.S.C. 3026) of the
Older Americans Act and Department instructions. The Area Plan includes performance measures and unit
rates per service offered per county.
Area PIan Update: A revision to the area plan wherein the area agency on aging enters HCE program
specific data in 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 Iiving arrangement. DOEA Form 701B is used by case
managers to conduct the functional assessment.
1.2 GENERAL DESCRIPTION
1.2.1 General Statement
Area Agencies on Aging may contract with CCE lead agencies or other case management entities for the
Provision of the HCE program. Approved caregivers receive a Basic Subsidy to reimburse some of their
expenses each month for caring for the consumer and may receive a Special Subsidy for other necessary
services and essential supplies. Caregivers may be approved for up to three HCE clients in their home.
1.2.2 Home Care for the Elderly Program Mission Statement
The Horne Care for the Elderly Program supports family style living arrangements, on a non -profit basis, as an
alternative to nursing homes or other institutional care. Through the program, a caregiver for three or fewer elders
4
Packet Page -1432-
July 2014 — June 2015
HCE 2012 1
9/8/2015 16.D.2.
Iiving in a private home provides basic services of maintenance and supervision as well as coordinating other
necessary specialized services.
1.2.3 A uthori0,,
The relevant authority governing the HCE program include:
(1) Rule Chapter 58H -1, Florida Administrative Code; and
(2) Sections 430.601 through 430.608, F.S.
1.2.4 Scope of Service
The Contractor is responsible for the programmatic, fiscal, and operational management of HCE. 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, located on the DOEA website, http: / /elder affairs .state.fl.us /doea /nois.php.
1.2.5 Major Program Goals
The major goals of the HCE program are to ensure that:
(1) Basic Subsidy is provided to the caregiver of each client and
(2) Special Subsidy is provided when essential to the well -being of the client.
1.3 INDIVIDUALS TO BE SERVED
1.3.1 General Eligibility
The Home Care for the Elderly program serves elders age 60 and older at risk of placement in a nursing
home or other institutional settings who can remain in a family style setting through the provision of
subsidies.
1.3.2 Client Eligibility
CIients eligible to receive services under this contract must:
(1) Be 60 years of age or older;
(2) Have income no greater than the Institutional Care Program (ICP) standard;
(3) Meet the ICP asset limitation;
(4) Be at risk of nut-sing home placement;
(5) Have an approved adult caregiver living in the home with them who is willing and able to provide
care or assist in arranging for care; and
(6) Not be enrolled in a Medicaid capitated long -term care program.
1.3.3 Caregiver Eligibility
Caregivers eligible to receive services under this contract must:
(1) Be at least 18 years of age;
(2) Be capable of providing a family -type living environment;
(3) Be a relative or a friend who has been accepted by the client as a surrogate family or is a responsible
adult with whom the client has made an arrangement to provide home care services;
(4) Be willing to accept responsibility for the social, physical and emotional needs of the care recipient;
(5) Be physically present and live in the home to provide supervision and to assist in arrangement of services
for the client;
5
Packet Page -1433-
July 2014 — June 2015
HCE 20.q Id
9/8/2015 16.D.2.
(6) Maintain the residential dwelling free of conditions that pose an immediate threat to the life, safety,
health and well -being of the home care client; and
(6) Be without record of conviction of abuse, neglect or exploitation of another person.
1.3.4 Targeted Groups
Priority for services provided under this contract shall be given to those eligible persons assessed to be at
risk of placement in an institution.
SECTION H: MANNER OF SERVICE PROVISION
2.1 SERVICE TASKS
To achieve the goals of the HCE program, the Contractor shall perform or ensure the performance of its
Subcontractors, for 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 its Subcontractors.
2.1.1. 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 in 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; or
(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;
(5) 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.
2.1.2.2 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 shall be determined through the Agency's consumer assessment form
administered to each applicant. The most frail individuals not prioritized above will receive services to the
extent funding is available.
0
Packet Page -1434-
July 2014 — June 2015
2.1.3 Delivery of Services to Eligible Clients
HCE 203.14
9/8/2015 16.D.2.
The Contractor shall ensure the provision of a continuum of services that meet the diverse needs of the
functionally impaired elders and their caregivers. The Contractor shall ensure Basic Subsidy and Special
Subsidy services are performed in accordance with the current Department of Elder Affairs Programs and
Services Handbook.
2.1.3.1 Basic Subsidy
The Basic Subsidy is a cash payment made to an approved caregiver each month to reimburse some expenses
incurred in caring for the client. The Basic Subsidy is provided for support and maintenance of the care
recipient, including housing, food, clothing, and medical costs not covered by Medicaid, Medicare or any
other insurance. A Basic Subsidy shall be paid to approved caregivers when the client is in the home for any
part of the month. I.f the client is hospitalized or in any other temporary institution for 30 days or less, the
full Basic Subsidy shall be provided to the caregiver as if the client were in the home.
2.1.3.1.1 Calculating the Basic Subsidy
The Basic Subsidy shall be based on the financial status of the client receiving care. In the event that both
a husband and wife are clients, their combined financial status shall be used to determine the amount of the
Basic Subsidy.
2.1.3.2 Special Subsidy Services
Though every eligible HCE client receives a Basic Subsidy, Special Subsidy payments are pre - authorized and
are based on additional specialized medical or health care services, supplies or equipment needed to maintain
the health and well -being of the individual elder. The Special Subsidy for additional medical support and
special services is a cash payment to reimburse the costs of any other service or special care not covered by
Medicaid, Medicare, or private insurance when these services are determined to be essential to maintain the
well -being of the home care recipient. A Special Subsidy shall be paid to the approved caregivers when the
client is in the home for any part of the month. Special Subsidy Services may be authorized through a vendor
agreement. All Special Subsidy services must be perforred in accordance with the Department of Elder Affairs
Programs and Services Handbook. Special Subsidy services include:
(1) Adult Day Care;
(2) Adult Day Health Care;
(3) Caregiver Training/Support;
(4) Chore;
(5) Chore (Enhanced);
(6) Counseling (Gerontological);
(7) Counseling (Mental Health/Screening);
(8) Horne Delivered Meals;
(9) Home Health Aide Service;
(10) Homemaker;
(11) Housing Improvement;
(12) Vendor Payment;
(13) Material Aid;
(14) Occupational Therapy;
(15) Otber;
(16) Outreach;
(17) Personal Care;
(18) Physical Therapy;
(19) Respite (Facility Based or hi- Home);
(20) Skilled Nursing Services;
(21) Specialized Medical Equipment, Services and Supplies;
(22) Speech Therapy; and
(23) Transportation.
Packet Page -1435-
July 2014 — June 2015 HCE 203.14
9/8/2015 16.D.2.
2.1.3.3 ACCESS TO AND COORDINATION OF SERVICES
The contractor shall ensure through case management and case aide services, that the HCE clients' needs
are documented and needed services are planned, arranged and coordinated for the client and caregiver.
2.1.4 Use of Subcontractors
If this contract involves the use of a Subcontractor or a 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,
programmatic performance, and compliance with applicable state and federal laws and regulations. The
Contractor 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
2.2.1 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 5:00pm.
2.3 DELIVERABLES
2.3.1 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 types of services allowed and the unit of measurement. Units of
service will be paid pursuant to the rate established in the Area Plan as updated and shown in
ATTACHMENT VII and approved by the Agency's reporting requirements.
Remainder of page intentionally left
Packet Page -1436-
July 2014 — June 2015
HCE 2M 14
9/8/2015 16.D.2.
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 pennits the Contractor to meet the Agency's reporting
requirements.
2.4.1 Client Information and Registration Tracking System (CIRTS) Reports
The Contractor shall input HCE 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
The Contractor shall ensure the collection and maintenance of client and service information on a
monthly basis from the Client Information and Registration Tracking System (CIRTS) or any such
system designated by the Agency. Maintenance includes valid exports and backups of all data and
systems according to Agency standards.
2.5.1 The Contractor must ensure all data for HCE subsidies are entered in the Client information and Registration
Tracking System (CIRTS) by the 15th of each month. HCE subsidy data entered into the CIRTS by the 15th
of the month will be for payments incurred between the 16th of the previous month and the 15th of the current
month. Case management data entered into the CIRTS by_the 9th of the month will be for units of service
provided during the previous month from the 1 st and up to and including the last day of the month. The
Contractor 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, verified,
corrected, certified and submitted to the Agency no later than the 20th of the month along with copies of
receipts /services over $150.
W
Packet Page -1437-
Service
Unit of Service
Case Aide
Housing Improvement
Case Management
Physical Therapy
Hoerr
Chore
Respite (Facility Based or ht -Home)
Homemaker
Other
Personal Care
Material Aid
Episode
Specialized Medical Equipment, Services and Supplies
Transportation
One -Way Trip
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 pennits the Contractor to meet the Agency's reporting
requirements.
2.4.1 Client Information and Registration Tracking System (CIRTS) Reports
The Contractor shall input HCE 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
The Contractor shall ensure the collection and maintenance of client and service information on a
monthly basis from the Client Information and Registration Tracking System (CIRTS) or any such
system designated by the Agency. Maintenance includes valid exports and backups of all data and
systems according to Agency standards.
2.5.1 The Contractor must ensure all data for HCE subsidies are entered in the Client information and Registration
Tracking System (CIRTS) by the 15th of each month. HCE subsidy data entered into the CIRTS by the 15th
of the month will be for payments incurred between the 16th of the previous month and the 15th of the current
month. Case management data entered into the CIRTS by_the 9th of the month will be for units of service
provided during the previous month from the 1 st and up to and including the last day of the month. The
Contractor 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, verified,
corrected, certified and submitted to the Agency no later than the 20th of the month along with copies of
receipts /services over $150.
W
Packet Page -1437-
July 2014 — June 2015
HCE 203.14
9/8/2015 16.D.2.
2.5.2 The Contractor- and each 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
DOEA Programs and Services Handbook;
(2) The Contractor shall timely submit to the Agency all reports described in SECTION 2.4,
REPORTS; and
(3) The Contractor shall timely submit to the Agency all information described in 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 group clients;
(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 likely to provide care;
10
Packet Page -1438-
July 2014 — June 2015
HCE 203.14
9/8/2015 16.D.2.
(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 inuninent 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
Subsidy payments for each client and for the program overall must be maintained within the amount of
program funding available.
2.8 AGENCY RESPONSIBILITIES
2.8.1 Program Guidance and Technical Assistance
The Agency will provide to the Contractor 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 onsite visit. The Agency's determination of acceptable perfonmance 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 Iimited 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 106H (ATTACHMENT LX) and 105H (ATTACHMENT X).
3.1.1 The Contractor agrees to distribute funds as detailed in the area plan update and the Budget Summary,
ATTACHMENT VU to this contract. To request a budget line item change between the budget categories
of Case Management and Subsidies, the Contractor must submit the request in writing with a revised contract
11
Packet Page -1439-
July 2014 — June 2015
HCE 203.14
budget and receive written approval from the Agency's Cont 9/8/2015 16.D.2.
Contract Manager. Any changes
amounts of the funds identified on the Budget Summary form 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 and the Department by the State of Florida ( "budget release "). The
Contractor shall provide the Contract Manager documentation justifying the need for an advance and
describing how the funds will be distributed.
3.2.2 The Contractor's requests for advance require the approval of the Contract Manager. If sufficient 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 advance recoupment on each request for
payment, starting with report number five (5), in accordance with the invoice schedule as shown on
ATTACHMENT VIII 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 106H (ATTACHMENT IX) and 105H (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 for 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.
3.3.2 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 infi•actions that compromise the quality,
security or continuity of services to clients.
3.3.3 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 I% 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
and 39.1 of the Master Contract, this paragraph shall have precedence.
3.3.4 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 and invoices is
ATTACHMENT VIII to this contract.
12
Packet Page -1440-
July 2014 — June 2015
HCE 203.14
9/8/2015 16.D.2.
3.3.5 Any payment due by the Agency under the terns 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 this contract.
3.3.6 Payment may be authorized only for allowable expenditures, which are in accordance with the limits
specified in ATTACHNIIJNT VII, Budget Summary.
3.3.7 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.
3.3.8 Date for Final Request for Payment
The final request for payment is due to the Contract Manager no later than August 1, 2015.
3.4 Consequences for Non - Compliance
The Contractor shall ensure 100% of the deliverables identified in Section 1.2.4. Scope of Services are
performed pursuant to contract requirements, and as described in Section 2.3., Deliverable 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
identified 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 may 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 administrative funds in the contract 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 administrative funds in the contract for each day the Contractor- fails to timely
submit a CAP, beginning the 11th day after notification by the Contract Manager of the deficiency. If,,
or to the extent, there is any conflict between this paragraph and paragraphs 39 and 39.1 of the Master
Contract, this paragraph shall have precedence.
3.5 Documentation for Payment
The Contractor shall maintain documentation to support payment requests that shall be available to the
Agency or authorized individuals, such as Department of Financial Services, upon request.
3.5.1 The Contractor must ensure all data for HCE subsidies are entered in the Client Information and Registration
Tracking System ( CIRTS) by the 15th of each month. HCE subsidy data entered into the CIRTS by the 15th
of the month will be for payments incurred between the 16th of the previous month and the 15th of tine current
month. Case management data entered into the CIRTS by the 9th of the month will be for units of service
provided during the previous month from the 1st and up to and 'including the last day of the month. The
Contractor 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, verified,
corrected, certified and submitted to the Agenev no later than the 20th of the month along with copies of
receipts /services over $150.
13
Packet Page -1441-
July 2014 — June 2015
HCE 203.14
9/8/2015 16.D.2.
3.5.2 The Agency requires the Contractor to 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
the Contractor submits 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,
3.5.3 The Contractor must run monthly CIRTS reports and verify client and set-vice 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.
Remainder of page intentionally left
Packet Page -1442-
July 2014 — June 2015
HCE 203.14
9/8/2015 16.D.2.
ATTACHMENT III
1. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS
CONTRACT CONSIST OF THE FOLLOWING:
PROGRAM TITLE I FUNDING SOURCE I CFDA I AMOUNT
TOTAL FEDERAL AWARD I
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 I FUNDING SOURCE I CFDA I AMOUNT
I TOTAL STATE AWARD 1 $0
STATE FINANCIAL ASSISTANCE SUBJECT TO See. 215.97. F.S.
PROGRAM TITLE
FUNDING SOURCE
CSFA
AMOUNT
Home Care for the Elderly
General Revenue - Collier
65010
$30,836.00
TOTAL AWARD
$30,836.130
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
i "/
Packet Page -1443-
July 2014 — June 2015
HCE 2 9/8/2015 16.D.2.
ATTACHMENT VII
HOME CARE FOR THE ELDERLY PROGRAM
BUDGET SUMMARY
Collier County Board of County Commissioners
Collier
HCE Case Management/Case Aide $ 2,400.00
HCE Basic and Special Subsidies 28,436.00
Total $ 30,836.00
RATE SUMMARY
Collier County Board of County Commissioners
Collier
SERVICES REIMBURSEMENT RATE
Collier
Case Management $60.00
Case Aide $33.88
Packet Page -1444-
July 2014 — June 2015
HOME CARE FOR THE ELDERLY
INVOICE SCHEDULE
Report Number
Based On
I
July Advance*
2
August Advance*
Monthly Utilization Report (7/1 -7/15)
3
July Expenditure Reports (105 & 106)
Monthly Utilization Report (7/16 -8/15)
4
August Expenditure Report (105 & 106)
Monthly Utilization Report (8/16 -9/15)
5
September Expenditure Report (105 & 106)
Monthly Utilization Report (9/16 - 10/15)
6
October Expenditure Report (105 & 106)
Monthly Utilization Report (10/16 - 11/15)
7
November Expenditure Report (105 & 106)
Monthly Utilization Report (11/16 -12/15
8
December Expenditure Report (105 & 106)
Monthly Utilization Report (12/16 -1/15)
9
January Expenditure Report (105 & 106)
Monthly Utilization Report (1/16 -2/15)
10
February Expenditure Report (105 & 106)
Monthly Utilization Report (2/16 -3/15)
11
March Expenditure Report (105 & 106)
Monthly Utilization Report (3/16 -4/15)
12
April Expenditure Report (105 & 106)
Monthly Utilization Report (4/16 -5/15)
13
May Expenditure Report (105 & 106)
Monthly Utilization Report (5/16 -6/15)
14
June Expenditure Report (105 & 10 6)
Monthly Utilization Report (6/15 -6/30)
15
Final Expenditure Report (105 & 106)
16
Closeout Repots (105 & 106)
Legend. * Advance
based on projected cash need.
HUE 203.14
ATI 9/8/2015 16.D.2.
Submit to Agency on this Bate
July 1
July 1
July 20
August 9
August 20
September 9
September 20
October 9
October 20
November 9
November 20
December 9
December 20
January 9
January 20
February 9
February 20
March 9
March 20
April 9
April 20
May 9
May 20
June 9
June 20
July 9
July 20
August 1
August 15
Note # 1: Report 41 for Advance Basis Contracts cannot be submitted to the Area Agency on Aging
for Southwest Florida, Inc. prior to July I or until the contract with the Agency has been
executed and a copy sent to the Agency on Aging for Southwest Florida, hie. Actual submission
of the vouchers to the Agency is dependent on the of the expenditure report.
Note # 2: All advance payments made to the Conti-actor 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 f i v e. The adjustment shall be recorded in Part C, Line 1 of
the report (ATTACHMENT X).
Note 443: 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.
Packet Page -1445-
July 2014 - June 2015
REQUEST FOR PAYMENT
HOME CARE FOR THE ELDERLY PROGRAM
HCE 203.14
ATT 9/8/2015 16.D.2.
RECIPIENT NAME, ADDRESS, PHONE# and FEID#
TYPE OF PAYMENT.
This Request Period: From: To:
Regular
Contract Period
Contract#
Advance _ _ _ _
Report#
PSA#
CERTIFICATION: thereby certify to the best of my knowledge that this request is complete and correct and conforms with the terms and the purposes of the above contract.
Prepared by: Date Approved by: Date:
PARTA: BUDGETSUMMARY
AAAAdmin.
Case Management
Subsidies
TOTAL
1.Approved Contract Amount
$0.00
$0D0
$0.00
$0.00
2. Previous Funds Received for Contract Period
$0.00
$0.00
$0.00
$0.00
3. Contract Balance (line 1 minus line 2)
$0.00
$0.00
$0.00
$0.00
4. Previous Funds Requested and Not Received for Contract Period
$000
$0.00
$0.00
$0.00
S.CCNTRACT BALANCE Qine 3 minus line 4)
$O.OD
$0.00
$0.00
$0.00
PART B: CONTRACT FUNDS REQUEST
1.Anticipated Cash Need (1st2nd months)
$0.00
$0.00
$0.00
$0.00
2. Net Expenditures For Month
$0.00
$0D0
$0.00
$0.00
(DOER Form 1054 Part B, Line 4)
370TAL
$000
$0.00
$0.00
$0.00
PART C: NET FUNDS REQUESTED
1. Less Advance Applied
$ODO
$0D0
$000
$0.00
2 TOTAL FUNDS REQUESTED (Part B Line 3, minus Part C Line 1)
$0.00
.$0.00
$0.00
$0.00
Lis1of Services/ Units 1Rales provided -See attached report.
DOEA FORM 106H
Revised 514112
Packet Page -1446-
July 2(114 - June 2015
RECEIPTAND EXPENDITURE REPORT HOME CARE
FORTHE ELDERLY PROGRAM
HC E 203.14
9/8/2015 16.D.2.
A'T'TACHMENT A
PROVIDER NAME,ADDRESS, PHONE* and FEID#
Program Funding :
THIS REPORT PERIOD:
From To
AAAAdmin.
CONTRACT PERIOD:
Case Management
CONTRACT#
Subsidies:
REPORT#
Basic
Special
PSA#
CERTIFICATION. Icertify 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:
PARTA: BUDGETED INCOMEI RECEIPTS
1. Approved
2.Actual Receipts
3. Total Receipts
4. Percent of
Budqet
For This Report
Year to Date
Approved Budqet
1. State Funds
$0.00
$0.00
$0.00
#DIV /O!
2. TOTAL RECEIPTS
$0.00
$000
$0.00
#DIV10 I
PART B: EXPENDITURES
1.Approved
2. Expenditures
3.Expendtures
4. Percent of
Budqet
For This Report
Year to Date
Approved Budget
$0.00
$ODD
$0.00
#DiViO!
I. AAA Program Administration
2. Service Subcontractors: Case Management
$0.00
$0.00
$0.00
#DIVIO t
3. Service Subcontractors: Subsidy
$O.DO
$0.00
$0.00
#DIVIO 1
a. Basic Subsidy
$0.00
$0.00
$0.00
#DIV /O!
b. Special Subsidy
$000
$DDO
$0.00
#DIV /O!
4. TOTAL EXPENDITURES
$0.00
$0.00
$0.00
#DIV /01
(PART C:OTHER REVENUEAND EXPENDITURES
I. Irterest:
II. Advance Recoupment
1 Earned on GRAdvance $
2. Return of GR Advance $
1. Advance Recouped $
3. Other Earned $
n'kA FORM t75H
P.cvised 5;2512010
Packet Page -1447-
9/8/2015 16.D.2.
Attestation Statement
Agreement /Contract Number HCE 203.14
Amendment Number n/a
I, Stephcn Y. Carvell , 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.
r
a ,
July 31, 2014
Signature of Recipient /Contractor representative Bate
Packet Page -1448-
Amendment 001 July 2014 to June 2015 9/8/2015 16.D.2.
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
HOME CARE FOR THE ELDERLY PROGRAM
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
THIS AMENDMENT is entered into between the Area Agency on Aging for Southwest: Florida, Inc. ( "Agency ") and
Collier County Board of County Commissioners, ( "Contractor "), amends agreement HCE 263.14.
The purpose of this amendment is to amend ATTACHMENT I, SECTION III: METHOD OF PAYMENT Paragraph
3.1 General Statement of Method of Payment and 3.4 Consequences for Non - Compliance, and correct the CSFA #
on ATTACHMENT III to 65001.
Line denotes completion of above summary
ATTACHMENT I:
Paragraph 3.1 and 3.4 of the Attachment 1, is hereby amended to read:
3.1 General Statement of Method of Payment
The method of payment for this contract includes advances, 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 106H (ATTACHMENT
IX) and 105H (ATTACHMENT X).
3.4 Consequences for Non - Compliance
The Contractor shall ensure 100% of the deliverables identified in Section 1.2:4., Scope of Services are
performed pursuant to contract requirements, and as described in Section 2.3, 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 identified 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 may also assess a financial consequence for
failure to timely submit a CAP. In the event the Contractor fails to correct an identified deficiency within the
approved time period specified in the CAP, the Agency shall deduct, from the payment for the invoice of the
following month, 1% of the monthly amount billed for each day the deficiency is not Corrected. The Agency may
also deduct, from the payment for the invoice of the following month, 1% of the monthly amount billed for each
day the Contractor fails to timely submit a CAP, beginning the 11th day after notification by the Contract
Manager of the deficiency. If, or to the extent, there is any conflict between this paragraph and paragraphs 39
and 39.1 of Master Contract HM014, this paragraph shall have precedence.
ATTACHMENT III:
Correct the CSFA# to 65001.
This amendment shall be effective July 1, 2014. All provisions in the agreement and any attachments thereto in conflict
with this amendment shall be and are hereby changed to conform with 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
agreement.
This amendment and all of its attachments are hereby made a part of this agreement.
Packet Page - 1449 -"
Amendment 001 July 2014 to June 2015 9/8/2015 16.D.2.
IN WITNESS WHEREOF, the parties hereto have caused this 2 page amendment to be eiecuted by their officials there
unto duly authorized.
Recipient: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR SOUTHWEST
COUNTY COMMISSIONERS FLORIDA, INC.
i
SIGNED BY:
NAME: Stephen Y. Carrell
TITLE: Public Services Administrator
DATE: September 5, 2014
Federal Tax ID: 59- 6000558
Fiscal Year Ending Date: 09/30
SIGNED BY: //c A44L 6 tL
NAME: MARIANNE G. LORINI
TITLE: PRESIDENT /CEO
DATE: 9 21
Packet Page -1450-
Approved as to form and legality
Assistant County Atto e �,\"�
yG
9/8/2015 16.D.2.
Attestation Statement
Agreement /Contract Number: HCE 203.14
Amendment Number 001
I, Stenhen Y. Carnell , attest that no changes or revisions halve 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.
ter[ e — - v
Signature of RecipienilContractor representative
Approved as 10 form and legality ��✓
LP
v
C�
ssistant Cou ttotney
Packet Page -1451-
Amendment 002 July 2014 to June 2015 9/8/2015 16.D.2.
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
HOME CARE FOR THE ELDERLY PROGRAM
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
THIS AMENDMENT is entered into between the Area Agency on Aging for Southwest Florida, Inc. ( "Agency ") and
Collier County Board of County Commissioners, ( "Contractor "), amends agreement HCE 20.14.
s
The purpose of this amendment is to change effective date for rates and revise ATTACHME! 'T VII, RATE
SUMMARY
Line denotes completion of above summary
I
This amendment shall be effective September 30, 2014. All provisions in the agreement and any attachments thereto in
conflict with this amendment shall be and are hereby changed to conform with 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
agreement.
This amendment and all of its attachments are hereby made a part of this agreement.
IN WITNESS WHEREOF, the parties hereto have caused this 2 page amendment to be executed by their officials there
unto duly authorized.
Recipient: COLLIER COUNTY BOARD OF AREA AGENCY ON AG" NG FOR SOUTHWEST
COUNTY COMMISSIONERS FLORIDA, INC.
SIGNED BY: f , < SIGNED BY: >)&/aC s�I c
NAME: Stephen Y. Carrell NAME: MARIANNE G. LORINI
TITLE: Public Services Administrator
DATE: ( l (6 (1 j
Federal Tax ID: 59- 6000558
Fiscal Year Ending Date: 09/30
TITLE: PRESIDENT /CEO
DATE:
Packet Page -1452-
Approved as to form and legality
I
AssistantCount- l�ocney
9
Amendment 002 July 2014 to June 2015 9/8/2015 16.D.2.
ATTACHMENT VII
RATE SUMMARY effective July 1 through August 31, 2014
for
Collier County Board of County Commissioners
Charlotte
SERVICES REIMBURSEMENT RATE
Collier
Case Management $5$.56
Case Aide $30.00
RATE SUMMARY effective September 1, 2014
SERVICES
Case Management
Case Aide
2
Packet Page -1453-
REIMBURSEMENT RATE
Collie
$60.00
$33.88
Ov-
9/8/2015 16.D.2.
Attestation Statement
Agreement/Contract Number: HCE 203.14
Amendment Number 002
i
I, Stephen Y. Carnell , attest that no changes or revisions ha' a been made to the
(Recipient/Contractor representative)
content of the above referenced agreement/contract or amendment between the Area AOency 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 contend
4 (:7jI11tV 11 (� ((
Signature of Recipient/Contractor representative
Approved as to form and legality
Assistant Clounty Cy
Packet Page -1454-
� J
Amendment UO3
9/8/2015 16.D.2.
HCE 203.14.003
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
HOME CARE FOR THE ELDERLY PROGRAM
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
This AMENDMENT, entered into between the Area Agency on Aging for Southwest Florida hereinafter referred to
as the "Agency," and Collier Countv Board of Countv Commissioners, hereinafter referred to as the "Contractor,"
collectively stated as the "Patties" which amends contract HCE 203.14.
This amendment shall be effective July 1, 2015.
RECITALS:
WHEREAS, on August 14, 2014, the parties entered into the Standard Contract for social services to be
provided to Collier County's frail and elderly seniors (hereinafter referred to as "Contract "); and
WHEREAS, on September 25, 2014, the parties entered into a First Amendment to the Contract; and
WHEREAS, on November 12, 2014, the parties entered into a Second Amendment to the Contract; and
WHEREAS, Section 3 of the Contract provides that the agreement is to expire on June 30, 2015;
and
WHEREAS, the funding source for a successor agreement for senior services is not yet available to the
Agency from the Florida Department of Elder Affairs;
WHEREAS, the Parties are satisfied with the arrangement that they currently enjoy tinder the Contract so
that both parties wish to extend the Contract to August 30, 2015 while they await notification of funding of a
successor contract.
NOW, THEREFORE, in consideration of the foregoing .Recitals, and other good and valuable consideration, the
receipt and sufficiency of which is hereby mutually acknowledged, the Parties agree as follows:
The forccoina Recitals are true and correct and are incorporated by reference herein.
2. Both parties agree to extend the contract. to August 30, 2015.
All other provisions of the Contract are to remain in effect and are to be performed at the level
specified in the agreement.
SIGNATURE PAGE TO FOLLOW
IN WI"T"NESS WHEREOF, the parties hereto have caused this Amendment to be executed by their
officials there unto duly authorized.
Packet Page -1455-
Amendment,t03
Collier County Board of County
Contractor: Commissioners
SIGNED BY:
NAME: Stephen Y. Carrell
TITLE: Public Services Department Head
DATE: Z%
Federal Tax ID: 59- 6000588
Fiscal Year Ending Date: 09/30
9/8/2015 16.D.2.
HCE 203.14.003
Area Agency on Aging for Southwest Florida
SIGNED
BY:
NAME: Marianne G Lorini
TITLE: President/CEO
DATE:
. ,.
r
Approved as to form and legality 1
Assistant County Attorney � ^�
2
Packet Page -1456-
Revised August 2007
Attestation Statement
Agreement/Contract Number 203.14
Amendment Number 003
9/8/2015 16.D.2. -
I, 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 Deuartment Head
(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.
Signature of Recipient{ ntractor
Revised August 2007
N- /1-
Date
_Approved as to form and legality
Assistant County Attorney
C-)
Packet Page -1457-