HomeMy WebLinkAboutExhibit 1a9d
agency for persons with‘disabilities
State of Florida
MEDICAID WAIVER SERVICES AGREEMENT
This Agreement is entered into between the Florida Agency for Persons with Disabilities, hereinafter referred, to
as "APO', and City of Miami - Department of Parks & Recreation, hereinafter referred to as the "Provider".
Pursuant to the terms and conditions of this Agreement, APD authorizes the Provider to furnish Developmental
Disabilities & Family and Supported Living Home and Community -Based Services (HOBS) Medicaid waiver
services to eligible APD clients, and to receive payment for such services. The services that may be provided in any
one APD service area are limited to the services that the APD area office, pursuant to the standards specified ih
Florida's HCBS waivers, authorizes the Provider to furnish in that service area,
►. AGREEMENT DOCUMENTS;
A. The Medicaid Waiver Services Agreement consists of the terms and conditions specified in this Agreement, any
attachments, and the following documents, which are incorporated by reference:
1. The Developmental Disabilities Waiver Services Coverage and Limitations Handbook, dated July 2007,
and any updates or replacements thereto. The Handbook can be found at the Medicaid fiscal agent's Web
Portal: http:I/mvmedicaid-florida.com. Click on Public Information for Providers, then on Provider Support, and
then on Provider Handbooks. The Handbook lists the requirements for specific services as well as the Core
Assurances, which provide the terms and conditions by which the provider of Developmental Disabilities
HCBS waiver services agrees to be bound.
2. The Family and Supported Living Waiver Services Directory, and any updates or replacements. thereto.
The Directory can be found at the APD website: htto://aod.m yflorida.corn/waiver. The Directory describes
recipient and provider requirements for Family and Supported Living HCBS waiver services.
3.. Attachments A and B providing individually negotiated unit rates of payment for services not already
established and available on APD's website: htto://aod.mvflorida.com/providers, as referenced in II.E, and any
other service or data requirements, as applicable.
B. Prior to executing this Agreement and furnishing any waiver services, the Provider must have executed 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 during the term of this Agreement, maintain a current and valid
Medicaid Provider Agreement with AHCA, and comply with the terms and conditions of the Medicaid Provider
Agreement.
It, THE PROVIDER AGREES:
To comply with all of the terms and conditions contained within this Agreement, including all documents incorporated
by reference and any attachments.
A. Monitoring, Audits, Inspections, and Investigations
To permit persons duly authorized by APD, the:Agency for Health Care Administration (AHCA), or representatives of
either, to monitor, audit, inspect, and investigate any recipient records, payroll and expenditure records (including
electronic storage media), papers, documents, facilities, goods and services 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.
1. Following such monitoring, audit, inspection, or investigation, APD or its authorized representative, will furnish
to the Provider.a written report of its findings and, if deficiencies are found, request for development, by the
Provider, a Quality Improvement Plan (QIP) for needed corrections. The.Provider hereby agrees to correct all
noted deficiencies identified by 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.
2. Upon demand, and 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 six years after termination of the Agreement, or if an audit has been
initiated and audit findings have not been resolved at the end of six years, the 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.
. Revised July 2007 1
KEG I-1 ll- iaif/
D
s for informationrecords,
ports
3. To comply and cooperate immediately with AP totensure that provider rates aere based ondaccuratets
deemed necessary to review the rate setting process
information and reflect the existing operational requirements of each service. Any individual nhsh knowingly
misrepresents the information required in rate setting commits 'a felony of the third degree, p
s
provided in sections 775,082 and 775.083, F.S.
4 To necessary and cooperate byAPD's immediately
ations
Office o theinspector Genreviews,
e al pursuant tosectionv0r audits deemed
20.55, F.S.F S
5. To include the aforementioned audit, inspections, investigations and record keeping requirements in all
subcontracts and assignments.
B. Confidentiality of Client Information
Not to use or disclose any information concerning a client receiving services under this Agreement for any purpose
prohibited by state or federal law or regulation, except with the written consent of a person legally authorized to give
that consent or when authorized by law. This includes compliance with: the Health Insurance Portability and
164; and 42 Accountability R, Part431, Subparof 1996, 42 t F, relating to the disclosure of info)ons information concin 45 erning n ngCFR M Medicaid d applicaarts 160, nnts and
recipients.
C. Indemnification
1. To be liable for and indemnify, defend, and hold APD, AHCA 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, employees, or subcontractors 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. The Provider shall not be liable for that
portion of any loss or damages proximately caused by the negligent act or omission of APD or AHCA.
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 7 days after notice by APD or AHCA 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 or AHCA. APD or AHCA's failure to notify the Provider of a
claim shall not release the Provider of these duties.
D. Insurance
To obtain and maintain at all times continuous and adequate liability insurance coverage during the term of this
Agreement. The Provider accepts full responsibility for identifying and determining the type and extent of liability
insurance necessary to provide reasonable financial protection for the Provider and APD clients served by the
Provider..
be provided d by asselfl bsue rannce programh s authorized or established andloperating undible to write err Florida lawolicies in .
Such
9 may P Y
E. Payment
To accept payment for goods and services at rates periodically established by AHCA and APD. The most current rates
are available on APD web site: http://apd.myflorida.com/providers. The signatories recognize that APD is limited by.
appropriation and acknowledge that Florida law requires AHCA and APD to make any adjustment necessary to comply
with the availability of moneys and any limitations or directions provided for in the General Appropriations Act,
including but not limited to adjusting fees, reimbursement rates, lengths of stay, number of visits, or number of
services, or limiting enrollment, [See sections 393.0661, 409.906, 409.908, F.S.J
Revised July 2007 2
F. 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, CMS-1500, Federal regulations, 42 CFR § 433.312, require.
refund of overpayments within 60 days of discovery. AHCA will be the final authority regarding the timeliness of the
reimbursement process.
G. Independent Status
That the Provider acts at all times in the capacity of an independent service provider and not as an officer, employee,
or agent of APO, AHCA, or the State of Florida. The Provider shall not represent to others that it has the authority to
bind the to
er, this is also
appllicableto the PD or rovider's der'sCA ess officers,l ageints,authorized
employees, or subcontractors nin performance of thition to the s Agreement.
applicable
111. TERMINATION:
A. This Agreement may be terminated by either party without cause, upon no less than 30 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 unacceptable performance, non-performance or misconduct
Upon no less than 24 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, 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 lay,/ or in equity.
IV. GOVERNING LAW:
This Agreement shall be construed, performed,
med, and
enford in all
regulation pects in accordance with all the laws and rules
of the State of Florida, and any appliead
V. AGREEMENT DURATION:
This Agreement shall be effective 7/1/2011 or the date on which it has been signed by both parties, which ever is later,
and shall terminate on 6/30/2014 which is no later than three years from the effective date.
VI. OFFICIAL REPRESENTATIVES (Names, Address, Telephone Number, and E-mail Address):
1. The Provider's contact person and street address where financial and administrative records are maintained is:
Name:
Telephone Number:
Address:
E-mail Address:
2. The representative of the Provider responsible for administration of the services under this Agreement is:
Name:
Telephone Number:
Address:
E-mail Address:
Revised July 2007 . 3
Name:
Telephone Number:
Address:
E-mall Address:
4. Upon change of the representative's names, addresses, telephone numbers, and e-mail addresses, by either
party, notice shall be provided in writing to the other party and the notification attached to the originals of this
Agreement.
VII. INTEGRATED AGREEMENT: •
Only this Agreement, any attachments referenced, the Medicaid Provider Agreement, the Developmental Disabilities
Waiver Services Coverage and Limitations Handbook, and the Family and Supported Living Waiver Services
Directory, which are 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 parties.
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 such term or provision shall be stricken.
3. The Agency for Persons with Disabilities contact person. for this Agreement is:
Hillary Jackson, Program Operations Administrator
305-808-6251
401 NW 2 Avenue, Suite S-811, Miami, FL 33128
Hillary Jackson(o1apd.state.fl.us
The Provider, by signing below, attests that the Provider has received and read the entire Agreement,
inclusive of its attachment's and documents as referenced in Section 1, A., including the service -specific
requirements and Core Assurances for enrolled providers, contained in the Developmental Disabilities Waiver
Services Coverage and Limitations Handbook and the Family and Supported Living Waiver Services Directory,
and understands each section and paragraph.
IN WITNESS THEREOF, the parties hereto have caused this 4 page Agreement to be executed by their undersigned
officials es duly authorized.
PROVIDER: STATE OF FLORIDA,
City of Miami - Department of Parks & Recreation AGENCY FOR PERSONS WITH DISABILITIES
SIGNED
BY:
NAME:
TITLE:
DATE:
Medicaid Provider #: 024990496
(DD Waiver)
Revised July 2007 4
SIGNED
BY:
NAME: EveiynAb-varez
TITLE: Area Li Administrator
DATE:
and/or 024990498
(FSL Waiver)
Rick Scott,
Governor
Bryan Vaughan,
Acting Director
Area 11
at ■
401 NW 2nd Avenue
Suite 5-811
Miami,
Florida
33128
P ■
(305) 349-1478
Fax:
(305) 377-5028
Toll Frae:
(866) APD-CARES
(865-273-2273)
Qd
agency' for persons with disobilities
S r a r e o f F l o r i d u
Attachment A
Medicaid Waiver Services Agreement
Agency for Persons with Disabilities
Transportation Data Collection Tool
APD Area Office:
Naine of Provider:
Medicaid Provider Number:
Reporting Period: January 1, 200 through March 31, 20
Complete far cnch billing category ns
appropriate to approved billing '
methodology.
A. Month :. _-
Total # of one.-,,vay trips
Total it of miles associated with.on y @}:trips:,.
Averages? of consumers per:on,e=wa trip • .
Average cost per one-way/trio
1i ncelchlr; Accessib.fc`''
�:Vchielc_:i
Non Wheelchair
':Aecessiblc vehicle
Total
B. Trip
Total # of one-way trips:;:
Total # of miles associate d synth Opp
Average -# of consumers pe(:{iii-e-WAy;tr.iti
Average cost per one-way
C. Mile
Total # of one-way trips
Total # of miles associated with one-ltipy`tritis
Average# of consumers per one-way trip ` ...
Average cost per one-way trip
Grand Total (All billing Categories)
Total # of one-way trips
Total # of -miles associated with one-way trips
Average i! of consumers per one-way trip
Average cost per one-way trip
Signature of Provider:
Title of Provider:
Date of Signature:
Telephone:
PE Transportation Provider Attachment A.nnr.
a d
agency for persons with disabilities
• Stnte of Ylorida
Attachment B
Medicaid Waiver Services Agreement
Transportation Services
City of Miami - Department of Parks & Recreation
The following rates have been approved for use. by the Provider. In order for the Provider to bill for
individual transportation services, the Providers must be in receipt of a current Service
Authorization form from a client's waiver support coordinator. The Service Authorization form will
indicate the rate approved for transportation services, as well as the frequency and intensity of the
service provision.
Billing Method
Non -Specified Rate
Trip
Mile
Month
$120.77
3 Yrs. Potential
SDDC Medicaid Contract
2011-2014
APT
July Aug Sept 1 Oct Nov Dec Jan Feb Mar Apr May June TOTAL
3 Yrs. Projected
41,746
36,210
41,746
36,210
41,746
41,746
41,746
41,746
41,746
41,746
41,746
41,746
41,746
41,746
MEM
36,210
36,210
36,210
36,210
36,210
36,210
36,210
36,210
36,210
36,210
64E
3 Yrs. Potentia 8,303
................ ..............
ADT Transportation
July Aug Sept I Oct Nov Dec Jan Feb Mar Apr May Julie
8,303 8,303
3 Yrs. Projecte 7,474
3 Yrs. Potential
July
8,303
7,474
Aug
8,303
7,474
Sept
8,303
7,474
Oct
7,474 7,474
8,303 8,303
7,474
Combined Income
Nov
Dec
Jan
7,474
Feb
50,048
50,048
50,048
50,048
50,048
50,048
50,048
50,048
..............
8,303
7,474
Mar
8,303
7,474
Apr
8,303
7,474
May
8,303
7,474
June
I TOTAL
NA$9.10111:
TOTAL
50,048
50,048
3 Yrs. Projectei
43,684
43,684
50,048
50,048
IRK,019'F
43,684
43,684
43,684
43,684
43,684
43,684
43,684
43,684
43,684
43,684
C:\Documents and Settings\mmperez\Local Settings\Temporary Internet Files\Content.Outlook\AWF4N3EnSDDC 11-14 Projected Revenues for Commission.xlsx