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HomeMy WebLinkAboutExhibit 1agency for persons with disabilities State of Florida MEDICAID WAIVER SERVICES AGREEMENT GENERAL TERMS AND CONDITIONS This Agreement is entered into between the Florida Agency for Persons with Disabilities, hereinafter referred to as "APD", and City of Miami -Parks & Recreation, hereinafter referred to as the "Provider". The Provider agrees to provide Transportation Services under the Florida Medicaid Developmental Disabilities Home and Community -Based Waiver Program to eligible recipients. I. AGREEMENT DOCUMENTS A. The Medicaid Waiver Services Agreement consists of the General. Terms and Conditions and the following documents: Core Assurances as described in the current Developmental Disabilities Waiver Services Coverage and Limitations handbook are incorporated into this agreement by reference. Transportation Services Reporting Example (Attachment A). Rate Structure documents are incorporated into this Agreement by reference (Attachment B). The Developmental Disabilities Waiver Services Coverage and Limitations Handbook, listing requirements for specific services, is incorporated into this Agreement, by reference. B. Prior to providing any services the provider must, in order to be compensated by the Developmental Disabilities Horne and Community -Based Waiver Program, execute a Medicaid Provider Agreement with the Agency for Health Care Administration (AHCA), and be issued a Medicaid provider number by AHCA. The provider must at all times maintain a current and valid Medicaid Provider Agreement with AHCA, . The provider. must comply with the terms and conditions of the Medicaid Provider Agreement. II. THE PROVIDER AGREES: To comply with all of the terms and conditions contained within the Agreement documents attached and those contained in the Developmental Disabilities Waiver Services Coverage and Limitations Handbook for specific services rendered by the provider, and to report transportation services data to the APD. The data shall be collected during the first quarter of each calendar year and reported on or before June 1 of each year in the manner and: format determined by APO. A. Monitoring, Audits, Inspections, and investigations 1. To permit persons duly authorized by the Agency for Persons with Disabilities, the Agency for Health Care Administration or rc=']resentatives of either, to monitor, audit, investigate and inspect any recipient records, payroll and exp. •diture records (including electronic storage media) papers, documents, facilities, goods and servicbs of the provider which are relevant to this Agreement, and to interview any recipients receiving services and employees of the provider to assure APD of the satisfactory performance of the terms and conditions of this Agreement. 2. Following such evaluation, the APD or its authorized representative, will furnish to the provider a written report of its findings and request for development, by the provider, of a Quality Improvement Plan (QiP) for needed corrections. The provider hereby agrees to correct ail noted deficiencies identified by the APD, AHCA, or their authorized representatives within the specified period of time identified within the report documentation. Failure to correct noted deficiencies within stated time frames may result in termination of this agreement. 3. Upon demand, at no additional cost to the APD, AHCA, or their authorized representatives, the provider will facilitate the duplication and transfer of any records or documents (including electronic storage media), during the required retention period of five years after termination of the Agreement, or if an audit has been initiated and audit findings have not been resolved at the end of five years, the October 20A3: Revised December 2004;Revised September 29, 2005 1 Agency for Persons with Disabilities Medicaid Waiver Services Agreement records shall be retained until resolution of the audit findings or any litigation which may be based on the terms of this Agreement, at no additional cost to APD. 4. To comply and cooperate immediately with APD requests for information, records, reports, and documents deemed necessary to establish methods to review the rate setting process to ensure that provider rates are based on accurate information and reflect the existing operational requirements of each service. Any individual who knowingly misrepresents the information required in rate setting commits a felony of the third degree, punishable as provided in Chapters 775.082-083, 775.044, F.S. 5. To comply and cooperate immediately with any inspections by APD, reviews, investigations or audits deemed necessary by the Office of the Inspector General (Section 20.055, F,S.). 6. To include the aforementioned audit, inspections, investigations and record keeping requirements in all subcontracts and assignments. B. Indemnification 1. To be liable for and indemnify, defend, and hold the Agency for Persons with Disabilities, the Agency for Health Care Administration and all of their officers, agents, and employees harmless from all claims, suits, judgments, or damages, including attorneys' fees and costs, arising out of any act, actions, neglect, or omissions by the provider, its agents, or employees during the performance or operation of this Agreement or any subsequent modifications thereof, whether direct or indirect, and whether to any person or tangible or intangible property. 2. That its inability to evaluate its liability or its evaluation of liability shall not excuse the provider's duty to defend and to indemnify within seven days after notice by APD by certified mail. After the highest appeal taken is exhausted, only an adjudication or judgment specifically finding the provider not liable shall excuse performance of this provision. The provider shall pay all costs and fees, including attorneys' fees related to these obligations and their enforcement by APD. The APD's failure to notify the provider of a claim shall not release the provider of these duties. The provider shall not be liable for negligence, which is solely that of the Agency for Persons with Disabilities. C. Insurance To obtain and maintain at all times liability insurance coverage, as required by state or federal law or by this Agreement; D. Return of Funds To be responsible for the timely correction of all billing or reimbursement errors resulting in an overpayment, including reimbursement for services not properly authorized or documented, Reimbursement will be made pursuant to the Florida Medicaid Provider Reimbursement Handbook Non -Institutional 081. Federal regulations, 42 CFR 433.312, require refund of overpayments within 60 days of discovery.The AHCA will be the final authority regarding the timeliness of the reimbursement process. III. FINES AND PENALTIES 1. In accordance with the provisions of Section 402.73(7), Florida Statutes, and Section 65-29.001, Florida Administrative Code, penalties may be imposed for failure to implement or to make acceptable progress on such quality improvement plans as specified in Section II. A. of this Agreement. 2. The increments of penalty imposition that shall apply, unless APD determines that extenuating circumstances exist, shall be based upon the severity of the non-compliance, non-performance or unacceptable performance that generated the need for a quality improvement plan. The penalty, if imposed, shall not exceed ten percent of the total billed by the provider for services during the period in which the quality improvement plan has not been implemented, or In which acceptable progress toward implementation has not been made. This period is defined, as the tirne period from receipt of the report of findings to the time of the follow-up determination that correction or progress toward improvement has not been made. 3. Non-compliance that is determined to have a direct effect on individual health and safety shall result in the imposition of a ten percent penalty of the total payments billed by the provider during the period in 2 October 2003; Revised December 2004 Revised September 29, 2005 Agency for Persons with Disabilities Medicaid Waiver Services Agreement which the quality improvement plan has not been implemented or in which acceptable progress toward implementation has not been made. 4. Non-compliance involving the provision of training responsibilities or direct service to the individual not having a direct effect on individual health and safety shall result in the imposition of a five percent penalty. Non-compliance as a result of unacceptable performance of administrative tasks, such as policy and procedure development, shall result in the imposition of a two percent penalty. 5. In the event of non-payment, APD will request the AHCA deduct the amount of the penalty from claims submitted by the provider for the covered time period. IV. TERMINATION A. This Agreement may be terminated by either party without cause, upon no less than thirty calendar days notice in writing to the other party unless a lesser time is mutually agreed upon in writing by both parties. Said notice shall be delivered by certified mail, return receipt requested, or in person with proof of delivery. B. This Agreement may be terminated for the provider's non-performance or misconduct upon no less than twenty-four hours notice in writing to the provider. Waiver by either party of any breach of any term or condition of this Agreement shall not be construed as a waiver of any subsequent breach of any term or condition of this Agreement. If APD determines that the provider is not performing in accordance with any term or condition in this agreement, the APD may, at its exclusive option, allow the provider a period of time to achieve compliance. The provisions herein do not limit APD's right to any other remedies at law or in equity. V. GOVERNING LAW This Agreement shall be construed, performed, and enforced in all respects in accordance with all the laws, rules, and regulations of the State of Florida, and any applicable federal laws, rules, and regulations. VI. AGREEMENT DURATION This Agreement shall be effective. November 1, 2005, or the date on which it has been signed by both parties, whichever is later, and shall terminate on 06/30/08 which is no later than three years from the effective date. VII. INDEPENDENT STATUS The provider agrees that it acts at all times in the capacity of an independent service provider and not as an officer, employee, or agent of the Agency for Persons with Disabilities or the Agency for Health Care Administration or the State of Florida. The provider shall not represent to others that it has the authority to bind the APD or AHCA unless specifically authorized in writing to do so. In addition to the provider, this is also applicable to the provider's officers, agents, or employees in performance of this Agreement. VIII. OFFICIAL REPRESENTATIVES (Names, Addresses, and Telephone Numbers): 1. The name and telephone number of the provider's contact person and street address where financial and administrative records are maintained is: Name: Telephone Number: Address: October 2003; Revised December 2004, Revised September 29, 2005 3 Agency for Persons with Disabilities Medicaid Waiver Services Agreement 2. The name, address, and telephone number of the representative of the provider responsible for administration of the service(s) under this Agreement is: Name: Telephone Number: Address: 3. The name, address, and telephone number of the Agency for Persons with Disabilities contact person for this Agreement is: Name: Hillary Jackson, Operations & Management Consultant— Medwaiver Telephone Number: (305) 808-6251 Address: 401 NW 2nd Avenue, Suite S —811, Miami FL 33128 4. Upon change of representative's names, addresses, and telephone numbers, by either party, notice shall be provided in writing to the other party and the notification attached to the originals of this Agreement. X. INTEGRATED AGREEMENT Only these General Terms and Conditions, the Core Assurances, attachment as referenced, the Medicaid Provider Agreement and the Developmental Disabilities Waiver Services Coverage and Limitations Handbook, which is incorporated into this Agreement 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 Agreement shall supersede all previous communications, representations, or agreements, either verbal or written between the par es. If any_term or provision of the Agreement is found to be illegal or unenforceable, the remainder of the Agreement shall remain in full force and effect and suclf term -or provision shall be stricken. If an existing Medicaid Waiver Services Agreement includes other services in addition to Transportation Services, this Agreement will only supersede the Transportation Services portion of the previous Agreement. All other services will continue under the terms of the previous Agreement. The provider, by signing below, attests that the provider has received and read the entire Agreement, , the service -specific inclusive of Its attachment's and documents as referenced, listed in Section 1, A. requirements for enrolled providers, contained in the Developmental Disabilities Waiver Services Coverage and Limitations Handbook, and understands each section and paragraph. IN WITNESS THEREOF, the parties hereto have caused this a page Agreement to be executed by their undersigned officials as duly authorized. STATE OF FLORIDA, AGENCY FOR PERSONS WITH DISABILITIES SIGNED BY: NAME: Evelyn ALvarez TITLE: Program Administrator DATE: 4 r October 2003; Revised December 2004 Revised September 29, 2005 PROVIDER: City of Miami Executive Officer Joe Arriola Name (typed) ATTEST: By: Name/Title Priscilla A. Thompson, City Clerk Name (typed) APPROVED AS TO INSURANCE REQUIREMENTS By: l j d'of' is�� trator City Risk Management Admi Dania Carrillo Name (typed) By: City Manager Title By: (Corporate Seal) APPROVED AS TO FORM AND CORRECTNESS By: City Attorney Jorge L. Fernandez Name (typed)