Agenda 09/23/2014 Item #16D169/23/2014 16.D.16.
EXECUTIVE SUMMARY
Recommendation to approve after - the -fact contracts, attestation statements, and budget
amendments to reflect actual award of the Community Care for the Elderly, Alzheimer's Disease
Initiative, and Home Care for the Elderly grants from Area Agency on Aging for Southwest
Florida, Inc. (Net Fiscal Impact - $41,005)
OBJECTIVE: To provide uninterrupted support services to Collier County Services for Seniors' frail,
elderly clients.
CONSIDERATIONS: Collier County Services for Seniors, managed by the Housing and Human
Services Department, has provided support services to Collier County's qualified seniors for over thirty-
three years through the Community Care for the Elderly (CCE), Home Care for the Elderly (HCE), and
Alzheimer's Disease Initiative (ADI) grant programs. These grants are funded by the Florida Department
of Elder Affairs through the Area Agency on Aging of Southwest Florida, Inc. (Agency). These grants
fund services to seniors and their caregivers, allowing them to remain in their homes and live with
independence and dignity.
On July 8, 2014, the Board approved the current Master Contract for Federal and State Programs (Agenda
item 16D15). The Master Contract provides the Agency's standard terms and conditions for CCE, ADI,
and HCE programs and ends on June 30, 2017.
Under this Master Contract, the Agency has provided program funding allocation contracts for the current
year, July 1, 2014 through June 30, 2015. To prevent a disruption in service, an estimated budget that
included award amounts, Agency retained amounts, and match and copayment amounts, based upon the
previous year's allocation, was presented to the Board and approved May 13, 2014 (Agenda item 16D16).
Actual allocations are less than the estimated budget for award and match, and have increased for co-
payments. The following tables provide a detailed breakdown of the necessary adjustments to the award,
required local match, and co- payment budgets set forth in the proposed amendments:
*10% Match is Award divided by .9, multiplied by .1, per grantor requirements, rounded to nearest dollar
"The estimated HCE Basic Subsidy of $14,416 is to be retained by the grantor agency, and therefore is
not included within Collier County's budget.
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Approved
Actual
Estimated
Awarded
Award
Local Match
Program
Project
Budget
Budget
Difference
Difference*
Community Care for the
Elderly (CCE)
33336
$728,681
$720,634
- $8,047
-$894
Alzheimer's Disease
Initiative (ADI)
33337
$136,587
$104,280
- $32,307
Home Care for the Elderly
(HCE) Case Management
and Special Subsidies
33338
$19,657
$16,420 **
- $3,237
Total
$884,925
$841,334
- $43,591
-$894
HCE Basic Subsidies **
NA
NA
$14,416.00
NA
*10% Match is Award divided by .9, multiplied by .1, per grantor requirements, rounded to nearest dollar
"The estimated HCE Basic Subsidy of $14,416 is to be retained by the grantor agency, and therefore is
not included within Collier County's budget.
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9/23/2014 16.D.16.
Program
Project
Approved
Estimated Budget
Actual Co-
Payment Budget
Difference
CCE Co- Payment Budget
33351
$17,000
$20,000
$3,000
ADI Co- Payment Budget
33352
$2,720
$3,200
$480
Total
$19,720
$23,200
$3,480
The contracts for the CCE, HCE, and ADI programs are being presented as "after -the- fact" because
Collier County received the grant amendment on June 26, 2014 with an effective contract effective date
of July 1, 2014. Consequently, pursuant to CMA 5330 and Resolution No. 2010 -122, the County
Manager authorized Steve Carrell, Public Services Administrator, to sign the contract amendment.
Collier County as the Lead Agency is responsible to respond to seniors needs and manage the spending
authority for the CCE, HCE and ADI program services.
FISCAL IMPACT: Total grant award amount is $841,334. The funding source is the Florida
Department of Elder Affairs. Matching funds of 80,071 (10 %) are required for CCE. The Board
previously approved an estimated budget in Human Services Grant Fund 707, Projects 33336
CCE, 33337 ADI, and 33338 HCE, and Co- Payment Projects 33351 CCE and 33352 ADI. Staff
has prepared budget amendments to recognize a reduction of $43,591 in grant funds, reduce the
local match required by $894, and increase the Co- Payments by $3,480.
GROWTH MANAGEMENT: There is no growth management impact from this recommendation.
LEGAL CONSIDERATIONS: This item is approved for form and legality and requires a majority vote
for Board action. - JAB
RECOMMENDATIONS: That the Board of County Commissioners approves the after - the -fact contract
and attestation statements with Area Agency on Aging for Southwest Florida, Inc. and authorize the
budget amendments.
Prepared by: Lisa N. Carr, Grants Coordinator, Housing and Human Services
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9/23/2014 16.D.16.
COLLIER COUNTY
Board of County Commissioners
Item Number: 16.16.D.16.D.16.
Item Summary: Recommendation to approve after - the -fact contracts, attestation
statements, and budget amendments to reflect actual award of the Community Care for the
Elderly, Alzheimer's Disease Initiative, and Home Care for the Elderly grants from Area Agency
on Aging for Southwest Florida, Inc. (Net Fiscal Impact - $41,005)
Meeting Date: 9/23/2014
Prepared By
Approved By
Name: DeSearJacquelyn
Title: Accountant, Housing, Human & Veteran Services
Date: 8/20/2014 3:05:21 PM
Name: SonntagKristi
Title: Manager - Federal /State Grants Operation, Housing, Human & Veteran Services
Date: 8/20/2014 5:47:50 PM
Name: TownsendAmanda
Title: Director - Operations Support, Public Services Division
Date: 8/21/2014 10:44:46 AM
Name: GrantKimberley
Title: Director - Housing, Human and Veteran S, Housing, Human & Veteran Services
Date: 8/21/2014 12:25:15 PM
Name: MagonGeoffrey
Title: Grants Coordinator, Housing, Human & Veteran Services
Date: 8/21/2014 12:25:24 PM
Name: Bendisa Marku
Title: Supervisor - Accounting, Housing, Human & Veteran Services
Date: 8/21/2014 12:25:34 PM
Name: AlonsoHailey
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9/23/2014 16.D.16.
Title: Operations Analyst, Public Services Division
Date: 8/25/2014 11:42:12 AM
Name: CarnellSteve
Title: Administrator - Public Services, Public Services Division
Date: 8/25/2014 5:20:24 PM
Name: RobinsonErica
Title: Accountant, Senior, Grants Management Office
Date: 8/26/2014 10:49:13 AM
Name: BelpedioJennifer
Title: Assistant County Attorney, CAO General Services
Date: 8/26/2014 3:17:38 PM
Name: KlatzkowJeff
Title: County Attorney,
Date: 8/26/2014 3:46:20 PM
Name: StanleyTherese
Title: Manager - Grants Compliance, Grants Management Office
Date: 8/29/2014 11:32:15 AM
Name: OchsLeo
Title: County Manager, County Managers Office
Date: 9/13/2014 1:24:46 PM
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July 2014 to June 2015 9/23/2014 16.D.16.
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., 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 Amqupt
The Agency agrees to pay for contracted services according to the terms and conditions of this
contract in an amount not to exceed S726,634.00, 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(l)(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.
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July 2014 to June 2015 CCE 203.14
6. Official Pavee and Renresentatives (lames_ Addresses. and Telenhnne Numbers) 9/23/2014 16.D.16.
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.
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: (J
NAME: Stephen Y. Came]1
TITLE: Public Services Administrator
DATE: July 31, 2014
Federal Tax ID: 59- 6000558
Fiscal Year Ending Date: 09/30
2
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AREA AGENCY ON AGING FOR
SOUTHW F RIDA, INC.
SIGNE B .
NAME: RONALD LUCCHINO, PhD
TTTT.F RR
• ROART) PR VENT
DATE: Ai. 1 1 1 , 1 I
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, BuildingH
Naples, FL 34112
C.
The name, address, and telephone number of the
Kimberly Grants Director
Collier County Housing, Human and Veteran
representative of the Contactor responsible for
Services
administration of the program under this contract is:
3339 E Tamiami Trail, Building H
Naples, FL 34112
(239) 252 -2273
d.
The section and location within the Agency where
Nancy Dean, Director of Finance
Requests for Payment and Receipt and Expenditure
Area Agency on Aging for Southwest Florida, Inc.
forms are to be mailed is:
15201 North Cleveland Avenue, Suite 1100
North Fort Myers, FL 33903
Marianne Lorini, Executive Director
e.
The name, address, and telephone number of the
Area Agency on Aging for Southwest Florida, Inc.
Contract Manager for this contract is:
15201 North Cleveland Avenue, Suite 1100
North Fort Myers, FL 33903
239 - 652 -6900
Upon change of representatives (names, addresses, telephone numbers) by either party, notice shall be provided in
writing to the other party and the notification attached to the originals of this contract.
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.
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: (J
NAME: Stephen Y. Came]1
TITLE: Public Services Administrator
DATE: July 31, 2014
Federal Tax ID: 59- 6000558
Fiscal Year Ending Date: 09/30
2
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AREA AGENCY ON AGING FOR
SOUTHW F RIDA, INC.
SIGNE B .
NAME: RONALD LUCCHINO, PhD
TTTT.F RR
• ROART) PR VENT
DATE: Ai. 1 1 1 , 1 I
July 2014 to June 2015
INDEX OF ATTACHMENTS
9/23/2014 16.D.16.
ATTACHMENTI
STATEMENTOF WORK ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .... ... ... ... ... ... ..... ..... 4
ATTACHMENT III
FUNDINGSOURCE ................................................................................................ 15
ATTACHMENT VII
COMMUNITY CARE FOR THE ELDERLY ANN UAL 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
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July 2014 to June 2015
STATEMENT OF WORK
COMMUNITY CARE FOR THE ELDERLY PROGRAM
SECTION I: SERVICES TO BE PROVIDED
1.1. DEFINITIONS OF TERMS AND ACRONYMS
9/23/2014 16.D.16.
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)
Pla►uiing and Service Area (PSA)
1.1.2 PROGRAM SPECIFIC TERMS
Adult Protective Services Referral Tracking Tool: A system designed to track DCF APS
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.
L1
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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 their own homes or in the homes of relatives or caregivers. The program provides
a continuum of care through the development, expansion, reorganization and coordination of
multiple community-based services to assist elders to reside in the least restrictive environment
suitable to their needs.
1.2.3 Authority
The relevant authority governing CCE program are:
(1) 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 eiders.
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.
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July 2014 to June 2015 CCE 2 9/23/2014 16.D.16.
SECTION H: 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 High -Risk Referrals
The Contractor shall ensure that for APS high -risk referrals who are enrolled in a Medicaid
long -term 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 Iong -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 victi ns 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 Homes 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 tine 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.
b
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July 20I4 to June 2015
2.1.2.3 Priority Criteria for Service Delivery:
cc, 9/23/2014 16.D.16.
(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 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.
2.1.2.5 Referrals for Medicaid Waiver Services:
(1) The Contractor must require Subcontractors, through the performance of the 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 Eligible 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. The services include the following categories:
(1) Core Services;
(2) Health Maintenance Services; and
(3) Other Support Services.
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July 2014 to June 2015 9/23/2014 16.D.16.
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;
(8) Housing Improvement;
(2)
Chore Services;
(9) Legal Assistance;
(3)
Companionship;
(10) Pest Control Services;
(4)
Escort;
(11) Respite Services;
(5)
Financial Risk Reduction;
(12) Shopping Assistance; and
(6)
Home Delivered Meals;
(13) Transportation
(7)
Homemaker;
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.
8
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9/23/2014 16.D.16.
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 HMO 14, 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;
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July 2014 to June 2015 9/23/2014 16.D.16.
(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 ofthe 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;
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9/23/2014 16.D.16.
(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
(I1) 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 match
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 hi 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
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July 2014 to June 2015 9/23/2014 16.D.16.
(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 fxed 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).
31.1 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 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 fluids will be
distributed.
3.21 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 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.
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9/23/2014 16.D.16.
3.3 Invoice Submittal and Requests for Payment
All requests for payrnea4documentation and expenditure reports submitted to support requests
for payment shall be on DOEA forms 106C (ATTACHMENT IX) and 105C
(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.
3.1.1 If the Contractor fails to meet the prescribed quality standards for services, such services will
not be reimbursed under this contract. In addition, any nonconforming goods (including home
delivered meals) and /or services not meeting such standards will not be reimbursed under this
contract. The Contractor's signature on the request for payment form certifies maintenance of
supporting documentation and acknowledgement that the Contractor shall solely bear the costs
associated with preparing or providing nonconforming goods and /or set-vices. 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 HMO 14, 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 June 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.
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July 2014 to June 2015
9/23/2014 16.D.16.
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 HMO 14, 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 b
14
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July 2014 to June 2015
9/23/2014 16.D.16.
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: N/A
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS CONTRACT
CONSIST OF THE FOLLOWING:
MATCHING RESOURCES FOR FEDERAL PROGRAMS
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT
TOTAL STATE AWARD I , $0 I
STATE FTNANC'TAT, A14STSTAN('R CTTR -YF('T Tn Cnr 714 47 Ti 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
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July 2014 to June 2015 9/23/2014 16.D.16.
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
Hope Hospice and Community Services, Inc.
for
Collier Cn nt-v
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
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July 2014 to June 2015
Report Number
1
4
5
6
7
S
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.
9/23/2014 16.D.16.
ATTACHMENT VIII
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 # 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 f i v 0. The adjustment shall
be recorded in Part C, Line 1 of the report (ATTACHMENT X).
Note #3: Submission of expenditure reports may or may not generate a payment request. If
final expenditure report reflects funds due back to the Agency, payment is to
accompany the report.
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July 2014 to June 2015
REQUEST FOR PAYMENT
COMMUNITY CARE FOR THE ELDERLY
9/23/2014 16.D.16.
ATTACHMENT IX
RECIPIENT NAME, ADDRESS, PHONE* and FEID*
TYPE OF PAYMENT:
Regular
Advance
This Request Period: From: To:
Contract Period
Contract*
Report 9
PSA #t
CERTIFICATION; I hereby certify to the best of my Imowiedge that this request is complete and correct and conforms with the terms and the purposes of the above contracL
Prepared by: Date: Approved by: Date:
PARTA: BUDGETSUMMARY
1. Approved ContractAmount
2. Previous Funds Received for Contract Period
3. Contract Balance (fine 1 minus.line 2)
4. Previous Funds Requested and Not Received for Contract Period
5. CONTRACT BALANCE (line 3 minus One 4)
CCEAdmin.
$ 0.00
CCE Services
$ ]D.00
TOTAL
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$
$
$ D.00
S 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
PART B: CONTRACT FUNDS REQUEST
1. Anticipated Cash Need (1 st - 2nd months)
2. Net Expenditures For Month
(DOEA Form 105C. Part B, Line 4)
3. TOTAL
$ 0.00
$ 0.00
$ 0.00
$ 0.00
S 0.00
$ 0.00
$ 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)
$ O,DO
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
List of Services / Units/ Rates pmvided -See attached report
DOEA FORM 106C
Revised 514!12
18
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.lulylu14 to.lune Lute
RECEIPT AND EXPENDITURE
REPORT COMMUNITY CARE FOR
THE ELDERLY
CCE 203.14
9/23/2014 16.D.16.
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 /01
2. Program Income
$0.00
$0.00
$0.00
#DIV /01
3. Local Cash Match
$0.00
$0.00
$0.00
#DIV /01
4. SUBTOTAL: CASH RECEIPTS
5. Local to -Kind Match
6. TOTAL RECEIPTS
$0.00
$0.00
$0.00
#DIV /01
PART B: EXPENDITURES
1. Approved
2. Expenditures
3. Expenditures
4. Percent of
Budget
For This Report
Year to Date
Approved Budget
$0.00
$0.00
$0.00
#DIV /01
1. Administrative Services
2. Service Subcontractor(s)
$0.00
$0.00
$0.00
#DIV /01
3. Adult Protective Services
$0.00
$0.00
$0.00
#DIV /01
4. TOTAL EXPENDITURES
$0.00
$0.00
$0.00
#DIV /0I
PART C: OTHER REVENUE AND EXPENDITURES
Ii. Interest:
111. Advance Recouped
I. Program Income (PI)
1. Earned on GR Advance $
$
1. CCE: Pl Collected YTD $
2. Return of GR Advance $
(Includes fees collected)
3. Other Earned
$
PART D: 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
Revised 5/251207 0
z
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9/23/2014 16.D.16.
Attestation Statement
Agreement /Contract Number CCF 203.14
Amendment Number n/a
1, Stephen Y. Carrell , 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 -2697-
31, 2014
Date
July 2014 to June 2015
AREA AGENCY ON AGING FOR
SOUTHWEST FLORIDA, INC. CONTRACT
ALZHEIMER'S DISEASE INITIATIVE
9/23/2014 16.D.16.
H1J1 2W, 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).
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:
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 1IM014, as an integral part of the contract, except to the extent that
tine 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 (l 1:59) 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 ni 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(I)(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.
Packet Page -2698-
July 2014 to June 2015
6. Official Pavee and
Add
The Contractor name, as shown on page 1 of this
a. contract, and mailing address of the official payee to
whom the payment shall be made is:
9/23/2014 16.D.16.
r�L1 L VJ.l't
and Telephone Numbers):
Collier County Housing, Human and Veteran
Services
3339 E Tamia ni Trail, Building H
Naples, FL 34112
b The name of the contact person and street address where Kimberly Grant, Director
financial and administrative records are maintained is: Collier County Housing, Human and Veteran
Services
3339 E Tamiami Trail, Building H
Naples, FL 34112
c The name, address, and telephone number of the
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. j The name, address, and telephone number of the
II Contract Manager for this contract is:
Kimberly Grant, Director
Collier County Housing, human and Veteran
Services
3339 E Tamiami Trail, Building H
Naples, FL 34112
(239) 252 -2273
Nancy Dean, Director of Finance
,a Agency on Aging for Southwest Florida, 1
15201 North Cleveland Avenue, Suite 1 I00
North Fort Myers, FL 33903
Marianne Lorini, Executive Director
a Agency on Aging for Southwest Florida, I
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
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July 2014 to June 2015
AD1203.14
9/23/2014 16 D I F
All Terms and Conditions Included
This contract and its Attachments I, 111, 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: 1
NAME: Stephen Y. Carnell
TITLE: Public Services Administrator
DATE: July 31, 2014
Federal Tax ID: 59- 6000555
Fiscal Year Ending Date: 09/30
3
Packet Page -2700-
AREA AGENCY ON AGING FOR
SOUTHWEST L A, INC.
SIGNED
NAME: RONALD LUCCHINO PhD
TITLE: BOARD PRESIDENT
DATE:
July 2014 to June 2015
INDEX OF ATTACHMENTS
9/23/2014 16.D.16.
8dJI2Ull4
ATTACHMENTI
.............—.....—.—.......�...-'.,..... �
STATEMENT CAPWORK
ATTACHMENT III `'--.'-----^'^^--'—^-----'—'' l4
FUNDING SOURCE
'------'--^—''---^
ATTACHMENT VII ............................................... ----`-~' 15
UNV{JlCEB��POR7GCl�lD[JIJ� ---'---'—'------�
ATTACHMENT VIII .------ .—
----'—^—^^----� ^—' ''~----'—'''—'—' l6 /NND1LBU}GBTSUMMARY
ATTACHMENT _ __,._,___ _~,__,__,_,__,._..,_, '--'------'--'' l? mEQU6GTFOR PAYMENT
ATTACHMENT --^.--^'—^--.^—^---`—`---^—'^ 18
RECEIPT AND REPORT
----''^--'---'�---'
SERVICE RATE REPORT
ATTACHMENTK ^`'—^--~`'.'---^--'----'—^'—'—'—' 10
M
Packet Page -2701-
July 2014 to June 2015
STATEMENT OF WORK
ALZHEIMER'S DISEASE INITIATIVE PROGRAM
SECTION I: SERVICES TO RE 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)
Memory Disorder Clinic (MDC)
Planning and Service Area (PSA)
1.1.2 PROGRAM SPECIFIC TERMS
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AIJI 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 701 B is used by case managers to conduct
the functional assessment.
Memory Disorder Clinic: Research oriented programs created pursuant to Sections 430.502(1) and (2), F.S., to
provide diagnostic and referral services, conduct basic and service - related multidisciplinary research, and
develop training materials and educational opportunities for lay and professional caregivers of individuals with
AD.
Model Day Care: A program of therapeutic, social and health activities specific to clients with memory
disorders. Services and activities include, but are not limited to, active and quiet games, reminiscence, validation
therapy, pet therapy, water therapy and other failure free activities appropriate to the client's level of functioning.
Model day care centers will also provide training for health care and social service personnel in the care of
persons having AD or related memory disorders.
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1.2 GENERAL DESCRIPTION
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Alit 203.14
1.2.1 General Statement
The ADI program provides a continuum of services addressing the special needs of individuals with AD, their
families and caregivers.
1.2.1.1 Alzheimer's Disease Initiative Program Mission Statement
The ADI program ensures that persons afflicted with AD and other forms of dementia are given essential
services to help them age in place in an elder - friendly environment with security, dignity, and purpose. The
program also provides support to family members and caregivers of persons afflicted with AD.
1.2.2 Authority
The relevant authority governing the Alzheimer's Disease Initiative Program are as follows:
(1) Rule Chapter 58D -1, Florida Administrative Code; and
(2) Sections 430.50I th ough 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 Conti - actor's
Request for Proposal, RFP, and the Agency's current area plan and the current Department of Elder Affairs
Programs and Services Handbook.
1.2.4 Major Program Goal
The major goal of the ADI program is to provide services to meet the needs of caregivers and individuals with
AD and related memory disorders.
1.3 INDIVIDUALS TO BE SERVED
1.3.1 General Eligibility
The ADI Program addresses the special needs of individuals with AD and their caregivers.
1.3.2 Individual Eligibility
Those individuals eligible to receive services under.- this contract must meet the following conditions:
(1) Be 18 years of age or older and have a diagnosis of AD or a related disorder, or be suspected of having AD
or a related disorder; and
(2) Not be enrolled in a Medicaid capitated long -term care program.
1.3.3 Targeted Groups
Priority for services under this contract will be given to those eligible persons assessed to be at risk of placement
in an institution.
SECTION II: MANNER OF SERVICE PROVISION
2.1 SERVICE TASKS
To achieve the goals of the ADI program, the Contractor shall perform or ensure the performance of its
Subcontractors, the following tasks:
(1) Client Eligibility Determination;
(2) Assessment and Prioritization of Service Delivery for New Clients;
(3) Delivery of Services to Eligible Clients; and
(4) Monitoring the Performance of Subcontractors.
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r�Lt [.VJ.1'+
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.
2.1.2 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 tlu•ough 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 perforrmed in accordance with the current
Department of Elder Affairs Programs and Services Handbook. Services categories include:
(1) Caregiver Training/Support;
(2) Case Aid;
(3) Case Management;
(4) Counseling (Gerontological);
(5) Counseling (Mental Health/Screening);
(G) Educatiom7raining;
(7) Intake;
(8) Model Day Care;
(9) Respite (Facility- Based);
(10) Respite (In- Home); and
(11) Specialized Medical Equipment, Services, and Supplies.
Caregivers benefit from receiving training, respite and related Support services to assist them in caring for the
ADI client.
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��JVi 4VJ.lY
2.1.3.1 Memory Disorder Clinics
MDCs are required to provide four (4) hours of in- service training to all respite, in- facility respite and model
day care centers in their designated service areas. In- service training topics may include physiological,
behavioral and emotional aspects of AD and related diseases as well as caregiver techniques, coping strategies
and information regarding Silver Alert. The Contractor shall collaborate with MDCs to assist in this effort and
ill the effort to carry out Silver Alert protocol activities. The Contractor shall respond to requests for evaluation
information and statistical data concerning its consumers, based on information requirements of the MDCs and
Brain Bank.
2.1.4 Use of Subcontractors
If this contract involves the use of a Subcontractor or third party, then the Contractor shall not delay the
implementation of its agreement with the Subcontractor. If any circumstances occur that may result ui 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
perfonance, and compliance with applicable state and federal laws and regulations. The Conti-actor 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:OOpm.
2.2.1 Service Unit
The Contractor shall ensure the provision of the services described in the contract in accordance with the current
Department of Elder Affairs Programs and Services Handbook and the service tasks described in Section 2.1.
The chart below lists the type of services that can be performed. The highest reimbursement unit rate and the
method of payment are shown in ATTACHMENT K Units of service will be paid pursuant to the rate
established in the contract as updated, and approved by the Agency's reporting requirements.
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2.3 DELIVERABLES
Service
Unit of Service
Case Aide
Counseling;
Counseling (Gerontological);
Individual;
Model Day Care;
Hour
Respite In- Facility
Respite In -Home
Caregiver Train /Support (Indv)
Case Management
Education/Training;
Episode
Specialized Medical Equipment, Services
and Supplies
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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 Tracldng 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.
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2.5.2 Each Contractor and Subcontractor, among other requirements, must anticipate and prepare for the loss of
information processing capabilities. The routine backing up of all data and software is required to recover from
losses or outages of the computer system. Data and software essential to the continued operation of Contractor
functions must be backed up. The security controls over the backup resources shall be as stringent as the
protection required of the primary resources. It is recommended that a copy of the backed up data be stored in
a secure, offsite location. The Contractor shall maintain written policies and procedures for computer system
backup and recovery and shall have the same requirement in its contracts and/or agreements with Subcontractors.
These policies and procedures shall be made available to the Agency upon request.
2.6 PERFORMANCE SPECIFICATIONS
2.6.1 Outcomes
(1) The Contractor shall ensure services provided under this contract are in accordance with the current
Department of Elder Affairs Programs and Services Handbook;
(2) The Contractor shall timely submit to the Agency all reports described in ATTACHMENT I,
SECTION 2.4, REPORTS.; and
(3) The Contractor shall timely submit to the Agency all information described in ATTACHMENT I,
SECTION 2.5, RECORDS AND DOCUMENTATION.
2.6.2 The Contractor shall develop and document strategies in the area plan, to support performance achievement of
the following:
(1) Percent of most frail elders who remain at home or in the community instead of going into a nursing
home;
(2) Average monthly savings per consumer for home and community -based care versus nursing home care
for comparable client groups;
(3) Percent of elders assessed with high or moderate risk environments who improved their environment
score;
(4) Percent of new service recipients with high -risk nutrition scores whose nutritional status improved;
(5) Percent of new service recipients whose ADL assessment score has been maintained or improved;
(6) Percent of new service recipients whose IADL assessment score has been maintained or improved;
(7) Percent of family and family- assisted caregivers who self -report they are very likely to provide care;
(8) Percent of caregivers whose ability to provide care is maintained or improved after one year of service
intervention (as determined by the caregiver and the assessor); and
(9) Percent of customers who are at imminent risk of nursing home placement who are served with
community -based services.
The Contractor's performance of these measures will be documented in the Agency's annual
monitoring reports.
2.7 CONTRACTOR'S FINANCIAL OBLIGATIONS
2.7.1 Cost Sharing and Co- payments
The Contractor must establish annual co-payment goals. The Agency has the option to withhold a portion of
the Contractor's request for payment if goals are not met according to the Agency and the Department of
Elder Affairs' co- payment guidelines.
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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 fiiIfillment 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;
(G) 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
fiom Subcontractors and expenditure reports that support requests for payment and shall submit to the
Agency on forms 106Z (ATTACHMENT IX) and 105Z (ATTACHMENT X).
3.1.1 The Contractor agrees to distribute funds as detailed in the area plan update and the Budget Summary,
ATTACHMENT VIII to this contract. Any changes in the total amounts of funds identified on the Budget
Summary require a contract amendment. .
3.2 Advance Payments
3.2.1 The Contractor may request up to two months of advances at the start of the contract period to cover program
administrative and service costs. The payment of an advance will be contingent upon the sufficiency and amount
of funds released to the Agency by the State of Florida Department of Elder Affairs ("budget release "). The
Contractor shall provide the Contract Manager documentation justifying the need for an advance and
describing how the funds will be distributed.
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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 VII to this contract.
3.2.4 The Contractor may temporarily place advanced finds in a FDIC insured interest bearing account. All interest
earned on contract fund advances must be returned to the Agency within thirty (30) days of the end of each
quarter of the contract period.
3.3 Invoice Submittal and Requests for Payment
All requests for payment documentation and expenditure reports submitted to support requests for payment shall
be on DOEA forms 106Z (ATTACHMENT IX) and 105Z (ATTACHMENT X).. The Contractor shall
include with its request for payment documentation of services provided, the units of services provided, and the
rates for the services provided in conformance with the requirements as described in the deliverables and service
tasks.
3.3.1 Remedies - Nonconforming Services
The Contractor shall ensure that all goods and/or services provided under this contract are delivered timely,
completely and commensurate with required standards of quality. Such goods and/or services will only be
delivered to eligible program participants.
3.3.1.1 If the Contractor fails to meet the prescribed quality standards for services, such services will not be reimbursed
under this contract. In addition, any nonconforming goods (including home delivered meals) and/or services
not meeting such standards will not be reimbursed under this contract. The Contractor's signature on the request
for payment form certifies maintenance of supporting documentation and acknowledgement that the Contractor
shall solely bear the costs associated with preparing or providing nonconforming goods and/or services. The
Agency requires immediate notice of any significant and /or systemic infractions that compromise the
quality, security or continuity of services to clients.
3.3.2 Financial Consequences
Contractor shall ensure the provision of services to the projected number of clients in accordance with the Area
Plan as updated and within the contract amount. The Contractor shall ensure expenditure of 100% of the contract
amount budgeted for services to clients at the unit rates established in the Area Plan. In the event the Contractor
has a surplus of I% 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 39.1 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 rnonthly expenditure reports beginning with the
first month of the contract. The schedule for submission of advance requests (when available) and invoices is
ATTACHMENT VII to this contract.
3.3.2.2 Payment may be authorized only for allowable expenditures, which are in accordance with the limits specified
in ATTACHMENT VIII, Budget Summary.
3.3.2.3 Any payment due by the Agency under the terms of this contract may be withheld pending the receipt and
approval by the Agency of all financial and programmatic reports due from the Contractor and any
adjustments thereto, including any disallowance not resolved as outlined in Section 26 of the Master Contract.
3.3. Date For Final Request For Budget Revisions
Final requests for budget revisions or adjustments to contract fluids based on expenditures for services provided
through June 25, 2015, must be submitted to the Contract Manager no later than June 25, 2015.
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3.4 Date for Final Request for Payment
The final request for payment is due to the Agency no later than July 25, 2015,
3.5 Consequences for Non - Compliance
The Contractor shall ensure 100% of the deliverables identified in Section 1.2.3 Scope of Services are performed
pursuant to contract requirements, and as described in Section 2.3 are identified as major deliverables in this
contract. If at any time the Contractor is notified by the Agency's Contract Manager that it has failed to
correctly, completely, or adequately perform these major deliverables, the Contractor will have 10 days to
submit a Corrective Action Plan ( "CAP") to the Contract Manager that addresses the deficiency and states how
the deficiency will be remedied within a time period approved by the Contract Manager. The Agency shall
assess a Financial Consequence for Non - Compliance on the Contractor for each deficiency identified in the
CAP which is not corrected pursuant to the CAP. The Agency will also assess a Financial Consequence for
failure to timely submit a CAP. In the event Contractor fails to correct an identified deficiency within the
approved time period specified in the CAP, the Agency shall deduct, from the payment of the invoice for the
following month, 1% of the monthly value of the contract funds for each day the deficiency is not corrected.
The Agency may also deduct, fi•om the payment of the invoice for the following month, I% 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.
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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: N/A
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS CONTRACT
CONSIST OF THE FOLLOWING:
PROGRAM TITLE FUNDING SOURCE CFDA AMOUNT 1
TOTAL STATE AWARD I s0
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
$ 104,280.00
COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT
TO THIS CONTRACT ARE AS FOLLOWS:
STATE FINANCIAL ASSISTANCE
Section 215.97, Fla. Stat.
Chapter 69I -5, Fla. Admin. Code
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Report Number
1
2
3
4
5
6
7
9
10
11
12
13
14
15
16
INVOICE REPORT SCHEDULE
ALZHEIMER'S DISEASE INITIATIVE (ADI)
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: * Advance based on projected cash need.
9/23/2014 16.D.16.
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 # 1: Report #1 for Advance Basis Contracts cannot be submitted to the Area Agency
on Aging for Southwest Florida, Inc. prior to July 1 or until the contract with the
Agency has been executed and a copy sent to the Agency on Aging for Southwest
Florida, Inc. Actual submission of the vouchers to the Agency is dependent on the
of the expenditure report.
Note # 2: All advance payments made to the Contractor shall be returned to the Agency as
follows: one — tenth of the advance payment received shall be reported as an advance
recoupment on each request for payment, starting with report number five. The
adjustment shall be recorded in Part C, Line 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.
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ALZHEIMER'S DISEASE INITIATIVE PROGRAM
ANNUAL BUDGET SUMMARY
For
Collier County Board of County Commissioners
Collier
ALLOCATION TOTAL $ 104,280
Irel
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AD1203.14
ATTACHMENT VIII
July 2014 to June 2015
9/23/2014 16.D.16.
ADI 203.14
ATTACHMENT IX
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REQUEST FOR PAYMENT
ALZHEIMERS DISEASE INITIATIVE
PROGRAM
RECRE, iIUA"tEADDRESS,PNOtlE;4 and FED,,
7)?E OF REPORT:
Tlis Request Period
PSAI
A PAWENT REQUEST:
Report: _
Regular
SW.plerrvrial
Contract
B. r.-!ETHOD OF PAY- 01ENT:
Contrail Period
Advance
Reimbursement
C ERTFICATICtd: I herebyc ertify to the be sl of my lotoeAedge that tlis request is complete and correct and conforms with the terra and the purposes of the above contract
Prepared by Date:
Approved by,
Dale:
PARTA• BUDGETSUT,TA4RY
Respite
MIDdelDayCare
TOTAL
1. Approwed CortraclAmourt
50.00
$0.00
$0.00
2. Previous Funds Received for Cortraci Period
50.00
50.00
SD.DD
3. Contract Balance (Erie 1 rrinus litre 2)
SOHO
50.00
50.00
d.PreriousFunds Requested and Not Received for Contract Period
S000
50.00
50.00
5. Contract Balance (ine 3 rrinus lire 4)
S0,00
SOW
50.00
PARTS: CONTRACTFUfhDSREQUEST
1.Artieipated Cash Needs (1st- 2nd nnrth, Attach Justifica5on)
50.00
$0.00
50.00
2. Nei Erpendhures For htor0h
SO 00
SON
$0.00
(DOEAForm 1052 Pad B. Line 3)
3. TOTAL
50.00
50.00
SO 00
PART C: IET FUNDS REOI.icy$
i LessAdanceApplied
SO 00
$000
$0.00
2. Contract Furds are HeretriPequesled' or (Part S. Line 3
50.00
50.00
SON
rrint* Pail C. Line 1)
List of Services l Unts /Rates provided - See attached report
DOEA FORM 1062
Re:a ed 5 Cl:
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RECEIPTAND EXPENDITURE REPORT
ALZHEIMERS DISEASE INITIATIVE PROGRAM
9/23/2014 16.D.16.
AU1 2UJ.14
ATTACHMENT X
PROVIDER NAME, ADDRESS, PHONE* and FEID'
Program Funding:
THIS REPORT PERIOD:
From _
To _
Respite
CONTRACT PERIOD:
Model Day Care
_
CONTRACT
REPORT m
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: _Dale :
_ _ Approved by:
Date
PARTA: BUDGETED INCOME/ RECEIPTS
1. Approved
2, Actual Receipts
3. Total Receipts
4, Percent of
Budget
For This Report
Year to Date
Approved Budget
50.00
50.00
50.00
9DIVl01
1, State Funds
2. Program Income
50.00
50.00
50.00
#DIVI01
3. Local Cash Match
50.00
50.00
50.00
RDIVJ01
4. SUBTOTAL: CASH RECEIPTS
5. Local In -Kind Match
6. TOTAL RECEIPTS
S0.00
$0.00
$0.00
RDIV101
PART B: EXPENDITURES
1. Approved
2. Expenditures
3. Expenditures
4. Percent of
Budget
For This Report
Year to Date
Approved Budget
$0.00
50.00
S0.00
4DIV 101
1. Administrative Services
2. Service Subconlractor(s)
50.00
S0.00
50.00
9DIV101
3. TOTAL EXPENDITURES
S0.00
$0.00
$0.00
9D1V101
PART C: OTHER REVENUE AND EXPENDITURES
II.lnterest
Ill. Advance Recouped
I. Program Income (PI)
1. Earned on GR
Advance S
S
1. ADI: PI Collected YTD S_
2. Return of GR Advance S
(includes co- payments collected)
3. Other Earned
S_
PART D: CO- PAYME14TS CURRENT MONTH
YEAR -TO -DATE
1. Total of Co- payments assessed S
S_
2. Total of Co- payments collected S
S
(ForTraciang Purposes only)
Do EA F0AW 1053
Reused V25rolo
18
Packet Page -2715-
July 2014 to June 2015
SERVICE RATE REPORT
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
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9/23/2014 16. D.16.
ATTACHMENT K
METHOD OF
PAYMENTS
Fixed Fee / Unit Rate
Fixed Fee / Unit Rate
Fixed Fee / Unit Rate
Fixed Fee / Unit Rate
Cost Reimbursement
9/23/2014 16.D.16.
Attestation Statement
Agreement /Contract Number ADI 203.14
Amendment Number n/a
I, SteRhen 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.
�. /17 n
Signature of Recipient %Contractor representative
Packet Page -2717-
2014
Date
July 2014 — June 2015 HCE 203.14
9/23/2014 16.D.16.
AREA AGENCY ON AGING FOR SOUTHWEST FLORIDA, INC.
XI7►� - 4, TWA-
HOME E 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, (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 terns 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 attaclunents, proposal(s), state plan(s), grant agreements, relevant Department
handbooks, manuals or desk books and Master Contract number HMO 14, as an integral pall 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.
,. 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.
5. Renewal s
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 terns and conditions as the original contract and contingent upon
satisfactory performance evaluations by the Agency and the availability of funds.
Packet Page -2718-
6. Official Payee and Representatives (Names, Addresses. and Telephone Numhersl:
9/23/2014 16.D.16.
7. All Ternis 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.
IN WITNESS THEREOF, the Parties hereto have caused this contract, to be executed by their undersigned officials
as duly authorized.
Contractor: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR
COUNTY COMMISSIONER,{S SOUTHWE F RIDA, INC.
SIGNED BY: _ x /� SIGNE.�
NAME: Stephen Y. Carnell
TITLE: Public Services Administrator
DATE: Julv 31, 2014
Federal Tax ID: 59- 6000558
Fiscal Year Ending Date: 09/30
N
Packet Page -2719-
NAME: RONALD LUCCHINO. PhD
TITLE: BOARD PRESIDENT f
DATE:
The Contractor name,
e, as shown on page 1 of this
ollier County Housing,
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, Inc.
Contract Manager for this contract is:
15201 North Cleveland Avenue, Suite 1100
North Fort Myers, FL 33903
239 - 652 -6900
Upon change of representatives (names, addresses, telephone numbers) by either party, notice shall be provided in
writing to the other party and the notification attached to the originals of this contract.
7. All Ternis 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.
IN WITNESS THEREOF, the Parties hereto have caused this contract, to be executed by their undersigned officials
as duly authorized.
Contractor: COLLIER COUNTY BOARD OF AREA AGENCY ON AGING FOR
COUNTY COMMISSIONER,{S SOUTHWE F RIDA, INC.
SIGNED BY: _ x /� SIGNE.�
NAME: Stephen Y. Carnell
TITLE: Public Services Administrator
DATE: Julv 31, 2014
Federal Tax ID: 59- 6000558
Fiscal Year Ending Date: 09/30
N
Packet Page -2719-
NAME: RONALD LUCCHINO. PhD
TITLE: BOARD PRESIDENT f
DATE:
July 2014 — June 2015
HCE 203.14
9/23/2014 16.D.16.
INDEX OF ATTACHMENTS
ATTACl-M4ENT I
STATEMENTOF WORK ...................................................... ............................................................. 4
ATTACHMENT 1.11
FUNDINGSUMMARY ........................................................................................................ 17
ATTACHMENT VII
HOME CARE FOR THE ELDERLY ANNUAL BUDGET and RATE SUMMARY .............................. 18
ATTACHMENT VIII
HOME CARE FOR T14E ELDERLY INVOICE REPORT SCHEDULE ................................................ 19
ATTACHMENT IX
REQUESTFOR PAYMENT .................................................................................................... 20
ATTACHMENT X
RECEIPT AND EXPENDITURE 21
91
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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 (IADL)
Planning and Service Area (PSA)
HCF M -A 1A
9/23/2014 16.D.16.
ATTACHMENT I
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 Plan 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
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9/23/2014 16.D.16.
living in a private home provides basic services of maintenance and supervision as well as coordinating other
necessary specialized services.
1.2.3 Authority
The relevant authority governing the HCE program include:
(1) Rule Chapter 5814-1, 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:// elderaffairs .state.fl.us/doea/nois.pbp.
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
Clients 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 nursing 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;
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9/23/2014 16.D.16.
(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 II: 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 perfornance 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.
G
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July 2014 — June 2015
2.1.3 Delivery of Services to Eligible Clients
HCE 203.14
9/23/2014 16.D.16.
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 Eider 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. If 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 performed 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);
(G) Counseling (Gerontological);
(7) Counseling (Mental Health/Screening);
(8) Home Delivered Meals;
(9) Home Health Aide Service;
(10) Homemaker;
(11) Housing Improvement;
(12) Vendor Payment;
7
(13) Material Aid;
(14) Occupational Therapy;
(15) Other,
(16) Outreach;
(17) Personal Care;
(18) Physical Therapy;
(19) Respite (Facility Based or In- Home);
(20) Skilled Nursing Services;
(21) Specialized Medical Equipment, Services and Supplies;
(22) Speech Therapy, and
(23) Transportation.
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2.1.3.3 ACCESS TO AND COORDINATION OF SERVICES
The contractor shall ensure through case management and case aide services, that the 14CE 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 231 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 busniess 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
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HCF WR 14
9/23/2014 16.D.16.
2.4 REPORTS
The Contractor shall respond to additional routine and /or special requests for infonnation 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 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)
Service
Unit of Service
Case Aide
Housing Improvement
Miscellaneous Reports;
Case Management
Physical Therapy
Hour
Chore
Respite (Facility Based or In -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 infonnation 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 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 accordnig 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 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 Agency no later than the 20th of the month along with copies of
receipts /services over $150.
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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;
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(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 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 tbird -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 IX) and IOSH (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. To request a budget line item change between the budget categories
of Case Management and Subsidies, the Contractor roust submit the request in writing with a revised contract
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budget and receive written approval from the Agency's Contract Manager. Any char %b a AAA «A., auAaA
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 beat 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.
3.3.3 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 sin-plus of 1% or more at the end of the contract term, the Agency will reallocate 1% of the
budget for the next year contract term to other area agencies found to be serving clients to the fullest extent of
their allocated budgets. If, or to the extent, there is any conflict between this paragraph and paragraphs 39
and 39.1 of the Master Contact, 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
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July 2014 — June 2015 HCE 203.14
9/23/2014 16.D.16.
3.3.5 Any payment due by the Agency under the teens 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 ATTACEUdENT 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 tune 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- cornpliance 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 Contactor fails to timely
submit a CAP, beginning the l lth 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 1 5th 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 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 idmitification 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.
13
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July 2014 — June 2015
HCE 203.14
9/23/2014 16.D.16.
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 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 blank
I ("
Packet Page -2731-
July 2014 — June 2015
HCE 203.14
9/23/2014 16.D.16.
ATTACHMENT III
I. FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS
CONTRACT CONSIST OF THE FOLLOWING:
PROGRAM TITLE I FUNDING SOURCE I CFDA AMOUNT
TOTAL FEDERAL AWARD J
COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED
PURSUANT TO THIS CONTRACT ARE AS FOLLOWS: N/A
2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS CONTRACT
CONSIST OF THE FOLLOWING:
MATCHING RESOURCES FOR FEDERAL PROGRAMS
PROGRAM TITLE FUNDING SOURCE I CFDA I AMOUNT
TOTAL STATE AWARD 1 -$0
STATE FINANCIAL ASSISTANC".E RT1R.IRC'T TO CP.- 711; 07 F C
PROGRAM TITLE
FUNDING SOURCE
CSFA
AMOUNT
Home Care for the Elderly
General Revenue - Collier
65010
$30,836.00
TOTAL AWARD
$30,836.00
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
17
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July 2014 — June 2015
HC: 9/23/2014 16.D.16.
ATTACHMENT VI{
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
1.8
Packet Page -2733-
July 2014 — June 2015 HCE 203.14
A 9/23/2014 16.D.16.
HOME CARE FOR THE ELDERLY
INVOICE SCHEDULE
Report Number
Based On
Submit to Agency on this Date
1
July Advance*
July 1
2
August Advance*
July 1
Monthly Utilization Report (7/1 -7/15)
July 20
3
July Expenditure Reports (105 & 106)
August 9
Monthly Utilization Report (7/16 -8/15)
August 20
4
August Expenditure Report (105 & 106)
September 9
Monthly Utilization Report (8/16 -9/15)
September 20
5
September Expenditure Report (105 & 106)
October 9
Monthly Utilization Report (9/16- 10 /I5)
October 20
6
October Expenditure Report (105 & 106)
November 9
Monthly Utilization Report (10/16 - 11/15)
November 20
7
November Expenditure Report (105 & 106)
December 9
Monthly Utilization Report (11/16 -12/15
December 20
8
December Expenditure Report (105 & 106)
January 9
Monthly Utilization Report (12/16 -1/15)
January 20
9
January Expenditure Report (105 & 106)
February 9
Monthly Utilization Report (1/16 -2/15)
February 20
10
February Expenditure Report (105 & 106)
March 9
Monthly Utilization Report (2/16 -3/15)
March 20
11
March Expenditure Report (105 & 106)
April 9
Monthly Utilization Report (3/16 -4/15)
April 20
12
April Expenditure Report (105 & 106)
May 9
Monthly Utilization Report (4116 -5115)
May 20
13
May Expenditure Report (105 & 106)
June 9
Monthly Utilization Report (5/16 -6/15)
June 20
14
June Expenditure Report (105 & 106)
July 9
Monthly Utilization Report (6/15 -6/30)
July 20
15
Final Expenditure Report (105 & 106)
August 1
16
Closeout Report (105 & 106)
August 15
Legend: * Advance based on projected cash need.
Note # 1: Report #I 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 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 f i v e. 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.
19
Packet Page -2734-
July 2014 - June 2015
REQUEST FOR PAYMENT
HOME CARE FOR THE ELDERLY PROGRAM
HCE 203.14
A 9/23/2014 16.D.16.
RECIPIENT NAME, ADDRESS, PHONE# and FEID#
TYPE OF PAYMENT :
This Request Period: From: To:
Regular
Contract Period
Contract#
Advance _ _ _ -
Report#
PSA#
CERTIFICATION: Ihereby 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: BUDGET SUMMARY
AAAAdmin.
Case Management
Subsidies
TOTAL
tApproved Contract Amount
$0.00
$000
$0.00
$0.00
2. Previous Funds Received for Contract Period
$0.00
$0.00
$0.00
$0.00
3. Contract Balance Qine 1 minus line 2)
$0.00
$0.00
$0.00
$0.00
4. Previous Funds Requested and Not Received for Contract Period
$ODO
$0.00
$0.00
$O.DO
5.CONTRACT BALANCE Qine 3 minus line 4)
$0.00
$0.00
$0.00
$0.00
PART & CONTRACT FUNDS REQUEST
(.Anticipated Cash Need (1st2nd months)
$0.00
$0.00
$0.00
$0.00
2. Net Expenditures For Month
$0.00
$DDO
$0.00
$0.00
(DOEA Form 1054 Part B, Line 4)
3.TOTAL
$ODO
$0.00
$0.D0
$0.00
PART C: NET FINDS REQUESTED
1. Less Advance Applied
$ODO
$ODO
$DDO
$0.00
2 TOTAL FUNDS REQUESTED (Part B Line 3, Hums Part C Lire 1)
$0.00
$0.00
$0.00
$0.00
Listof ServiceslUnits /Rates provided -See attached report.
DOEA FORM 106H
Reeked 514/ 12
,A)
Packet Page -2735-
July 2U14 -June 1015
RECEIPTAND EXPENDITURE REPORT HOME CARE
FOR THE ELDERLY PROGRAM
HUE 203.14
9/23/2014 16.D.16.
ATTACHMENT X
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. 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'
PARTA: BUDGETED INCOME/ RECEIPTS
1. Approved
2.Actual Receipts
3. Totat Receipts
4. Percent of
Budqet
For Thi s Report
Year to Date
Approved Budget
1. State Funds
$0.00
$0.00
$0.00
#DIV 101
2. TOTAL RECEIPTS
$0.00
$000
$0.00
#DIVIO f
PART B: EXPENDITURES
1.Approved
2. Expenditures
3.Expendtures
4. Percent of
Budqet
For This Report
Year to Date
Approved Budget
$0.00
$0.00
$0.00
#DIV 101
1. AAA Program Administration
2. Service Subcontractors: Case Management
$0.00
$0.00
$0.00
#DIV/0 f
3. Service Subcontractors: Subsidy
$0.00
$0.00
$0.00
#DIVIO i
a. Basic Subsidy
$0.00
$0.00
$0.00
#DIV /01
b. Special Subsidy
$0.00
$0.00
$0.00
#DIV 101
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 $
POEA FORM 105H
R-1sed 612 61 201 0
1i
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9/23/2014 16.D.16.
Attestation Statement
Agreement /Contract Number HCE 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 -2737-
31, 2014
Date