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Backup Documents 02/26/2019 Item #16D3 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO Lk 0 3 THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNAT Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later than Monday preceding the Board meeting. **NEW** ROUTING SLIP Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office. Route to Addressee(s) (List in routing order) Office Initials Date 1. 2. 3. County Attorney Office County Attorney Office JAB 2/28/19 4. BCC Office Board of County Commissioners \/j1 7-..\7q\I C\ 5. Minutes and Records Clerk of Court's Office ag,( 1.9 -LA PRIMARY CONTACT INFORMATION Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the addressees above,may need to contact staff for additional or missing information. Name of Primary Staff Louise Pel tier/CHS Phone Number 252-2696 Contact/Department q� Agenda Date Item was 2/26/19 Agenda Item Number 16-D-3 1i' Approved by the BCC Type of Document Resolution—Co-Payment Waiver Number of Original One Attached Documents Attached PO number or account n/a number if document is —2 to be recorded INSTRUCTIONS& CHECKLIST Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not appropriate. (Initial) Applicable) 1. Does the document require the chairman's original signature STAMP OK JAB 2. Does the document need to be sent to another agency for additional signatures? If yes, JAB provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet. 3. Original document has been signed/initialed for legal sufficiency. (All documents to be JAB signed by the Chairman,with the exception of most letters,must be reviewed and signed by the Office of the County Attorney. 4. All handwritten strike-through and revisions have been initialed by the County Attorney's JAB Office and all other parties except the BCC Chairman and the Clerk to the Board 5. The Chairman's signature line date has been entered as the date of BCC approval of the JAB document or the final negotiated contract date whichever is applicable. 6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's JAB signature and initials are required. 7. In most cases(some contracts are an exception),the original document and this JAB routing slip should be provided to the County Attorney Office at the time the item is input into MinuteTraq. Some documents are time sensitive and require forwarding to Tallahassee within a certain time frame or the BCC's actions are nullified. Be aware of your deadlines! 8. The document was approved by the BCC on 2/26/19 and all changes made during the JAB N/A is not meeting have been incorporated in the attached document. The County Attorney's an option for Office has reviewed the changes,if applicable. / this line. 9. Initials of attorney verifying that the attached document is the version approved by the I *A is not BCC,all changes directed by the BCC have been made,and the document is ready for the � � an'option for Chairman's`ysignature. 99 �jj,, ` this line. PreiVaO)$' Str"rJ1nlITe' ct Res, l(x 4 t.�lr ho4- 1GNI /er%?Sevs4d d a evi d.a , Cdi C+- Peso LJ-ri y%()4) a Ho( ed . - i CC_O [04eOA-01081/1344830/1]I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05; Revised 11/30/12 c. tc-i 16 ©3 RESOLUTION NO.2019- 29 A RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS OF COLLIER COUNTY, FLORIDA TO ESTABLISH A CO-PAYMENT WAIVER PROCEDURE FOR SENIORS WHO ARE ENROLLED IN THE COMMUNITY CARE FOR THE ELDERLY AND THE ALZHEIMER'S DISEASE INITIATIVES STATE GRANT ADMINISTERED BY THE COMMUNITY AND HUMAN SERVICE DIVISION WHEREAS, The Services for Seniors Program, is the lead case management agency in Collier County that serves seniors with in home services. WHEREAS, The Community and Human Services Division (CHS) provides case management services to seniors enrolled in two grant programs funded by Area Agency on Aging of Southwest Florida (AAASWFL), the Community Care for the Elderly (CCE) and the Alzheimer's Disease Initiative(ADI). WHEREAS, Sections 430.204(8) and 430.503, Florida Statutes require copayment to be collected for CCE and ADI services. WHEREAS, Copayment is collected to offset some of the cost of the services received by the client. WHEREAS, the copayment amount is established by the financial worksheet that is completed between the case manager and the client at the time of intake and is in accordance with the schedule published annually by the Department of Elder Affairs(DOEA). WHEREAS, non-payment of copayments and the failure to pay when billed may result in termination of client services. WHEREAS, this Resolution is intended to establish a process to waive any outstanding copayments for clients who can no longer pay their outstanding copayment due to circumstances beyond their control including death, placement in a facility, relocation without a forwarding address and the senior's family refusal to pay the outstanding debt. WHEREAS, The Department of Elder Affairs (DOEA) Programs and Services Handbook Appendix B instructs that the Provider agencies in conjunction with AAASWFL establish an annual co-payment target goal to collect from clients. Provider agencies will project an annual copayment goal using data from the monthly income amount of all active clients. - t — 1603 WHEREAS, AAASWFL holds back contract funds until fifty percent (50%) of the annual goal is collected. WHEREAS, Provider agencies may waive up to ten percent (10%) of the annualized goal in co-payments for clients. The remaining ninety percent (90%) is the provider's annual co- payment target goal amount to be collected. NOW, THEREFORE, BE IT RESOLVED, BY THE BOARD OF COUNTY COMMISSIONERS OF COLLIER COUNTY, FLORIDA that: 1. In the event, past due copayments cannot be collected, CHS may waive the amount past due provided it does not exceed the DOEA allowable ten percent (10%) total copayment waiver. 2. Clients who leave the program are still responsible for the copayments owed, with the exception of those who die, placed in a facility, relocate without a forwarding address and families who refuse to pay, in all other cases CHS may determine what course of action to take to recoup what is owed or to waive the copayment fee up to an amount not to exceed the allowable 10%. 3. Collections of accounts receivable will be handled in accordance of Resolution 2006- 252. 4. This Resolution shall go into effect immediately upon its passage and adoption. THIS RESOLUTION ADOPTED after motion; second and majority vote thisZ(k\-Nday of \-"t = ---\ , 2019. Attest: BOARD OF COUNTY COMMISSIONERS CRYSTAL KINZEL, Clerk COLLIER CO NTY,FLORIDA 61) 4.1, By A..,4L. . , C`l .0 By: '�' rk Astastos . � .L. McDaniel, Jr., Chairman -signatuIe only. Approve as,to Form and Legality: i ym# 1621 -3 Agend - 0.... pc,e Jennifer A. BelpediolUsistant County Attorney ,-..,C6)' $\'' � Q Rec' mac.) Deputy ler