96-22038 RESO
RESOLUTION NUMBER
96-22038
A RESOLUTION AUTHORIZING AND DIRECTING THE MAYOR AND
CITY CLERK TO EXECUTE "AMENDMENT 3" TO CONTRACT NUMBER
KL104 WITH THE DEPARTMENT OF HEALTH AND REHABILITATIVE
SERVICES (HRS), IN ORDER TO COMPLY WITH HRS' NEW
STANDARD CONTRACT PROVISIONS FOR THE LOG CABIN TRAINING
CENTER, AND TO EXECUTE THE RENEWAL OF EXISTING CONTRACT
NUMBER KL 104 THROUGH RENEWAL NUMBER KL201 TO
CONTINUE TO PROVIDE ADULT DAY TRAINING PROGRAM (ADT/DTP),
SUPPORTED EMPLOYMENT, SUPPORTED LIVING, AND
TRANSPORTATION SERVICES TO DEVELOPMENTALLY DISABLED
ADULTS FOR FY 1996/97.
WHEREAS, on June 7, 1995, the City executed Contract Number KL 104 with the State of
Florida Department of Health and Rehabilitative Services (HRS), for funding of the Adult
Developmental Training Program at the City's Log Cabin Training Center; and
WHEREAS, HRS has opted to amend the existing contract rather than prepare a complete
new contract for FY 1996/97; and
WHEREAS, the attached Amendment 3, modifies the existing contract by detailing the
compliance requirements, thus providing the basis for the new contract period for FY 1996/97.
WHEREAS, HRS will not execute a renewal to the current year's contract, unless the City
adopts the attached Amendment 3.
WHEREAS, HRS has assured the City that this action will in no way affect the City's ability
to collect the total funds contemplated in the contract; and
WHEREAS, no other changes to Contract Number KL 104 are being made at this time.
NOW, THEREFORE, BE IT RESOLVED BY THE MAYOR AND CITY COMMISSION OF
THE CITY OF MIAMI BEACH, FLORIDA, that the Mayor and City Commission hereby authorize
the Mayor and City Clerk to execute the attached Amendment Number 3 to Contract Number
KL 104 with the Department of Health and Rehabilitation Services (HRS) for the Log Cabin Training
Center, and Renewal Number KL201 to continue to provide Adult Day Training Program
(ADT/DTP), Supported Employment, Supported Living, and Transportation Services to
Developmentally Disabled Adults for FY 1996/97.
PASSED AND ADOPTED THIS 3rd
FORM APPROVED
IBy~
Date 6 ). & - rjt
A
CITY HALL 1700 CONVENTION CENTER DRIVE MIAMI BEACH FLORIDA 33139
CITY OF MIAMI BEACH
COMMISSION MEMORANDUM NO. 385-Cj{p
TO:
Mayor Seymour Gelber and
Memben of the City Commission
DATE: July 3, 1996
FROM:
Jose Garcia-Pedrosa
City Manager
SUBJECT:
A RESOLUTION A ORIZING AND DIRECTING THE MAYOR AND CITY
CLERK TO EXEC E "AMENDMENT 3" TO CONTRACT NUMBER KL 104
WITH THE DEPARTMENT OF HEALTH AND REHABILITATIVE
SERVICES (HRS), FOR THE LOG CABIN TRAINING CENTER, IN ORDER
TO COMPLY WITH HRS' NEW STANDARD CONTRACT PROVISIONS,
AND TO EXECUTE THE RENEWAL OF EXISTING CONTRACT NUMBER
KL 104 THROUGH RENEWAL NUMBER KL201 TO CONTINUE TO
PROVIDE ADULT DAY TRAINING PROGRAM (ADT/DTP), SUPPORTED
EMPLOYMENT, SUPPORTED LIVING, AND TRANSPORTATION
SERVICES TO DEVELOPMENTALLY DISABLED ADULTS FOR FY
1996/97.
ADMINISTRATION RECOMMENDATION:
The Administration recommends adoption of the attached Resolution authorizing and
directing the Mayor and City Clerk to execute "Amendment 3" to Contract Number KL 104
with the Department of Health and Rehabilitative Services (HRS) in order to comply with
HRS' new Standard Contract Provisions which outline Performance-Based Contracting,
and authorizing the Mayor and City Clerk to execute Contract Renewal Number KL201
to continue to provide Adult Day Training Program (ADT/DTP), Supported Employment,
Supported Living, and Transportation Services to Developmentally Disabled Adults for FY
1996/97 (the period commencing July 1, 1996 through June 30, 1997).
BACKGROUND:
Since 1983, the City's Log Cabin Training Center, located at 8128 Collins Avenue, has
operated an HRS program entitled Adult Developmental Training (independent living skills
training) designed to benefit developmentally disabled adults. Clients participating in this
program are referred from either Health and Rehabilitative Services (HRS) or sponsored
by their own families. The program strives to teach its clients basic living skills, which will
allow them to become self-reliant and no longer entirely dependent upon welfare and social
service agencies for their sustenance.
DATE
c~c..
7- 3-CJ~
AGENDA ITEM
COMMISSION MEMORANDUM
JULY 3, 1996
PAGE 2
ANALYSIS:
On June 7, 1995, Contract number KL 104 with the State of Florida Department of Health
and Rehabilitative Services (HRS), was executed by the Mayor and City Clerk and is in full
force and effect through June 30, 1996. In June of each year, the City Commission
authorizes the execution of the annual grant contract with HRS.
Although the new contract year begins on July 1, 1996, HRS has opted to amend the
existing contract (KL 104) rather than prepare a complete new contract for FY 1996/97.
Amendment Number 3, attached, modifies the existing contract by detailing the
compliance requirements (Le. performance-based contracting), thus providing the basis for
the new contract period for FY 1996/97. HRS will not execute a renewal to the current
year's contract, unless the City adopts Amendment Number 3.
HRS has assured the City that this in no way impacts the total amounts of funds to be
received by the City under the contract, since the renewal will be at the current rates per
each unit of service.
CONCLUSION:
The Administration recommends adoption of the attached Resolution authorizing and
directing the Mayor and City Clerk to execute "Amendment 3" to Contract Number KL 104
with the Department of Health and Rehabilitative Services (HRS) for the Log Cabin
Training Center in order to comply with HRS' new Standard Contract Provisions which
outline Performance-Based Contracting, and authorizing the Mayor and City Clerk to
execute Contract Renewal Number KL201 to continue to provide Adult Day Training
Program (ADT/DTP), Supported Employment, Supported Living, and Transportation
Services to Developmentally Disabled Adults for FY 1996/97 (the period commencing July
1, 1996 through June 30, 1997).
JGP/H~P/AL:lk
Attachments
a:\hrsam'96.#3
7/1/96
Contract No. ~ t ~ 0 I
CFDA No. !SA
Grants and Aids NA
Client" X Non-Client 0
Multi-District 0
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
STANDARD CONTRACT
THIS CONTRACT is entered into between the State of Florida, Department of Health and Rehabilitative Services, hereinafter referred to as the
"department", and CITY OF MIAMI BEACH .hereinafter referred to as the "provider".
THE PARTIES AGREE:
I. THE PROVIDER AGREES:
A. To provide services in accordance with the conditions specified
in Attachment I.
B. Requirements of Section 287.058, FS .
To provide units of deliverables, inclu~ing reports, fmdmgs, and drafts
as specified in Attachment I, to be recelv~ and a~~ted by the contract
manager prior to payment. To comply WIth the ~ntena an? fmal date by
which such criteria must be met for completion of this contract as
specified in Section Ill, Paragraph A. of .this contract. To .submit ~iIls
for fees or other compensation for Services or expenses 10 ~ufficlent
detail for a proper pre-audit and post-audit thereof. Where apphcable, to
submit bills for any travel expenses in accordance with section ~ 12.061,
FS. The department may, if specified in Attachment I, estabhsh rates
lower than the maximum provided in section 112.061, FS. To allow
public access to all documents, papers, letters, or other mate~als subject
to the provisions of Chapter 119, FS, and m~de or received by the
provider in conjunction with this con~ct. . It IS ~xpressly unders~ood
that the provider's refusal to comply WIth this prOVISion shall constitute
an immediate breach of contract.
Co Governing Law
1. State of Florida Law
This contract is executed and entered into in the State of Florida, and
shall be construed, performed, and enforced in all respects in
accordance with the laws, rules, and regulations of the State of
Florida. Each party shall perform its obligations herein in accordance
with the terms and conditions of the contract.
2. Federal Law
a. If this contract contains federal funds, the provider shall comply
with the provisions of 45 CFR, Part 74, and/or 45 CFR, Part 92, and
other applicable regulations as specified in Attachment I.
b.If this contract contains federal funds and is over $100,000, the
provider shall comply with all applicable stan~ards, orders, or
regulations issued under Section 306 of the Clean Air Act, as amended
(42 U.S.C. 1857(h) et seq,), Section 508 of the Clean Water Act, as
amended (33 U.S.C. 1368 et seq.), Executive Order 11738, and
Environmental Protection Agency regulations (40 CFR Part 15). The
provider shall report any violations of the above to the department.
c. If this contract contains federal funding in excess of $100,000, the
provider must, prior to contract execution, complete the Certification
Regarding Lobbying form, Attachment JY.lL_: If a. Disc.losure of
Lobbying Activities form, Standard Form ~LL, IS requIred, It ma~ be
obtained from the contract manager. All diSclosure forms as required
by the Certification Regarding Lobbying form must be completed and
returned to the contract manager.
D. Audits, Records, and Records Retention
1. To establish and maintain books, records, and documents (including
electronic storage media) in accordance with generally accepted
accounting procedures and practices which sufficiently and properly
reflect all revenues and expenditures of funds provided by the
department under this contract.
2. To assure that these records shall be subject at all reasonable times
to inspection, review, or audit by Federal, state, or other personnel
duly authorized by the department.
3. To provide a financial and compliance audit to the department as
specified in Attachment II and t~ ensure that all related party
transactions are disclosed to the auditor.
4 To include these aforementioned audit and record keeping
. requirements in all approved subcontracts and assignments.
5. To retain all client records, fmancial records, supporting documen~,
statistical records, and any other documents (including electrOniC
storage media) pertinent to this con~act for a. period of ~v~ .(5) years
after termination of the contract, or If an audit has been mltlated and
audit fmdings have not been resolved at the end of ~ve (5~ years, the
records shall be retained until resolution of the audit findmgs or any
litigation which may be based on the terms of this contract.
6. Persons duly authorized by the department and federal auditors,
pursuant to 45 CFR, Part 92,36(i)(lO), shall have full access to and
the right to examine any of provider's contract and related records
and documents at all reasonable times for as long as records are
retained.
7.Upon completion or termination of the contract and at the request of
the department, the provider will cooperate with the. department to
facilitate the duplication and transfer of any said records or
documents during the required retention period as specified in
paragraph 0.5. above.
E. Monitoring .
To permit persons duly authorized by the department to I~spect any
records, papers, documents, facilities, and/or g~ and ~ervlces o~ the
provider which are relevant to this contract, and/or mtervlew any chents
and employees of the provider to be assured of satis~actory performaI?ce
of the terms and conditions of this contract. Followmg such evaluation
the department will deliver to the provider a report of its findings and
recommendations with regard to the provider's performance of the
contract terms and conditions. The provider will rectify all noted
deficiencies identified by the department within the specified period of
time set forth in the recommendations. The provider's failure to correct
noted deficiencies may, at the exclusive discretion of the department,
result in the withholding of payments, the provider being deemed in
breach or default, or the termination of this contract.
F. Indemnification
Section I.F. is not applicable to contracts executed between s~te
agencies or subdivisions, as defined in section 768.28, FS. The prOVider
shall be liable for and shall indemnify, defend, and hold harmless the
department and all of its officers, agents, and employees from all claims,
suits, judgments, or damages, consequential or otherwise and 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 contract or any subsequent
modifications thereof whether direct or indirect, and whether to any
person or tangible or ~tangible property except that the provider will not
be liable for damages arising out of injury or damage to persons or
property directly caused or resulting from the sole negligence of the
department or any of its officers, agents, or employees.
7/1196
The provider's obligation to indemnify, defend, and pay for the defense,
or at the department's option, to participate and associate with the
department in the defense and trial of any damage, claim, or suit and any
related settlement negotiations, shall be triggered by the department's
notice of claim for indemnification to provider. The provider's inability
to evaluate liability or its evaluation of liability shall not excuse the
provider's duty to defend and indemnify within seven (7) days after such
notice by the department is given by registered mail. Only adjudication
or judgment after highest appeal is exhausted specifically finding the
department solely negligent shall excuse performance of this provision
by provider. The provider shall pay all costs and fees related to this
obligation and its enforcement by the department. The department's
failure to notify the provider of a claim shall not release the provider of
the above duty to defend.
G. Insurance
To provide adequate liability insurance coverage on a comprehensive
basis and to hold such liability insurance at all times during the existence
of this contract. Upon execution of this contract, unless it is a state
agency or subdivision as defroed by s. 768.28, FS, the provider accepts
full responsibility for identifying and determining the type(s) and extent
of liability insurance necessary to provide reasonable financial
protections for the provider and the clients to be served under this
contract. Upon the execution of this contract, the provider shall furnish
the department written verification supporting both the determination
and existence of such insurance coverage. Such coverage may be
provided by a self-insurance program established and operating under
the laws of the State of Florida. The department reserves the right to
require additional insurance as specified in Attachment I where
appropriate.
H. Safeguarding Information
Not to use or disclose any information concerning a recipient of services
under this contract for any purpose not in conformity with state
regulations and federal regulations (45 CPR, Part 205.50), except upon
written consent of the recipient, or his responsible parent or guardian
when authorized by law.
I. Assignments and Subcontracts
1. To neither assign the responsibility of this contract to another party
nor subcontract for any of the work contemplated under this contract
without prior written approval of the department which shall not be
unreasonably withheld. Any sublicense, assignment, or transfer
otherwise occurring shall be null and void. The State of Florida shall
at all times be entitled to assign or transfer its rights, duties, or
obligations under this contract to another governmental agency in the
State of Florida, upon giving prior written notice to the provider. In
the event the State of Florida approves transfer of the provider's
obligations, the provider remains responsible for all work performed
and all expenses incurred in connection with the contract. In addition,
this contract shall bind the successors, assigns, and legal
representatives of the provider and of any legal entity that succeeds to
the obligations of the State of Florida.
2. The provider shall be responsible for all work performed and all
expenses incurred with the project. The provider may subcontract as
necessary to perform the services set forth in this contract, including
entering into subcontracts with vendors for services and commodities,
PROVIDED THAT it is understood by the provider that the
department shall not be liable to the subcontractor for any expenses or
liabilities incurred under the subcontract and the provider shall be
solely liable to the subcontractor for all expenses and liabilities
incurred under the subcontract.
J. Unless otherwise stated in the contract between the provider and
subcontractor, payments made by the provider to the subcontractor
must be within seven (7) working days after receipt of full or partial
payments from the department in accordance with section 287.0585,
FS. Failure to pay within seven (7) working days will result in a
penalty charged against the provider and paid to the subcontractor in
the amount of one-half of one (1) percent of the amount due per day
from the expiration of the period allowed herein for payment. Such
penalty shall be in addition to actual payments owed and shall not
exceed fifteen (15) percent of the outstanding balance due.
CONTRACT#~~, .
J.Return of Funds
To return to the department any overpayments due to unearned funds or
funds disallowed pursuant to the terms of this contract that were
disbursed to the provider by the department. The provider shall return
any overpayment to the department within 40 calendar days after either
discovery by the provider, or notification by the department, of the
overpayment. In the event that the provider or its independent auditor
discovers an overpayment has been made, the provider shall repay said
overpayment within 40 calendar days without prior notification from the
department. In the event that the department first discovers an
overpayment has been made, the department will notify the provider by
letter of such a rroding. Should repayment not be made in a timely
manner, the department will charge interest of one (1) percent per month
compounded on the outstanding balance after 40 calendar days after the
date of notification or discovery.
K. Incident Reporting
1. Client Risk Prevention
If services to clients will be provided under this contract, the provider
and any subcontractors shall, in accordance with the client risk
prevention system, report those reportable situations listed in HRSR
215-6 Paragraph 5, in the manner prescribed in HRSR 215-6 or
district operating procedures.
2. Abuse, Neglect, and Exploitation Reporting
In compliance with Chapter 415, FS, an employee of the provider who
knows or has reasonable cause to suspect that a child, aged person, or
disabled adult is or has been abused, neglected, or exploited shall
immediately report such knowledge or suspicion to the central abuse
registry and tracking system of the department on the single statewide
toll-free telephone number (l-800-96ABUSE).
L. Transportation Disadvantaged
If clients are to be transported under this contract, the provider will
comply with the provisions of Chapter 427, FS, and Rule Chapter 41-2,
FAC. The provider shall submit to the department the reports required
pursuant to Volume 10, Chapter 27, HRS Accounting Procedures
Manual.
M. Purchasing
1. PRIDE
It is agreed that any articles which are the subject of, or are required to
carry out this contract shall be purchased from Prison Rehabilitative
Industries and Diversified Enterprises, Inc. (PRIDE) identified under
Chapter 946, FS, in the same manner and under the procedures set
forth in subsections 946.515(2) and (4), FS. For purposes of this
contract, the provider shall be deemed to be substituted for the
department insofar as dealings with PRIDE. This clause is not
applicable to subcontractors unless otherwise required by law, An
abbreviated list of products/services available from PRIDE may be
obtained by contacting PRIDE, (904) 487-3774.
2. Procurement of Materials with Recycled Content
It is expressly understood and agreed that any products or materials
which are the subject of, or are required to carry out this contract shall
be procured in accordance with the provisions of sections 403.7065,
and 287.045, FS.
N. Civil Rights Requirements
Note: N.1. applies only to providers with fifteen (15) or more
employees. N.2. applies only to providers providing direct services to
clients lIllil if fifteen (15) or more individuals are employed.
1. The provider will not discriminate against any employee in the
performance of this contract, or against any applicant for
employment, because of age, race, creed, color, disability, national
origin, or sex. The provider fwther assures that all contractors,
subcontractors, subgrantees, or others with whom it arranges to
provide services or benefits to participants or employees in
connection with any of its programs and activities are not
discriminating against those participants or employees because of age,
race, creed, color, disability, national origin, or sex.
2. Compliance Questionnaire
In accordance with HRSM 220-2, the provider agrees to complete the
Civil Rights Compliance Questionnaire, HRS Forms 946 A and B, if
2
7/1/96
services are directly provided to clients and if 15 or more individuals
are employed.
O. Independent Capacity of the Contractor
The provider, its officers, agents, and employees, in performance of this
contract, shall act in the capacity of an independent contractor and not as
an officer, employee, or agent of the State of Florida. The provider is
responsible for Social Security and Income Tax withholdings. The
provider is not entitled to state retirement or state leave benefits except
where the provider is a state agency. Unless justified by the provider
and agreed to by the department in Attachment I, the department will not
furnish services of support (e.g., office space, office supplies, telephone
service, secretarial, or clerical support). The provider agrees to take
such actions as may be necessary to ensure that each subcontractor of
the provider will be deemed to be an independent contractor and will
not be considered or permitted to be an agent, servant, joint venturer, or
partner of the State of Florida.
P. Sponsorship
As required by section 286.25, FS, if the provider is a nongovernmental
organization which sponsors a program fmanced wholly or in part by
state funds, including any funds obtained through this contract, it shall,
in publicizing, advertising, or describing the sponsorship of the program,
state: "Sponsored by (provider's name) and the State of Florida,
Department of Health and Rehabilitative Services." If the sponsorship
reference is in written material, the words "State of Florida, Department
of Health and Rehabilitative Services" shall appear in the same size
letters or type as the name of the organization.
Q. Final Invoice
To submit the fmal invoice for payment to the department no more than
~days after the contract ends or is terminated. If the provider fails to
do so, all right to payment is forfeited and the department will not honor
any requests submitted after the aforesaid time period. Any payment due
under the terms of this contract may be withheld until all reports due
from the provider and necessary adjustments thereto have been approved
by the department.
R. Use Of Funds For Lobbying Prohibited
To comply with the provisions of section 216.347, FS, which prohibit
the expenditure of contract funds for the purpose of lobbying the
Legislature, judicial branch, or a state agency.
S.Public Entity Crime
As required by section 287.133, FS, the followirig restrictions are placed
on the ability of persons convicted of public entity crimes to transact
business with the department: When a person or affiliate has been
placed on the convicted vendor list following a conviction for a public
entity crime, he/she may not submit a bid on a contract to provide any
goods or services to a public entity, may not submit a bid on a contract
with a public entity for the construction or repair of a public building or
public work, may not submit bids on leases of real property to a public
entity, may not be awarded or perform work: as a contractor, supplier,
subcontractor, or consultant under a contract with any public entity, and
may not transact business with any public entity in excess of the
threshold amount provided in section 287.017, FS, for CATEGORY
TWO for a period of 36 months from the date of being placed on the
convicted vendor list.
T. Patents, Copyrights, and Royalties
1. If any discovery or invention arises or is developed in the course or as
a result of work or services performed under this contract, or in
anyway connected herewith, the provider shall refer the discovery or
invention to the department to be referred to the Department of State
to determine whether patent protection will be sought in the name of
the State of Florida. Any and all patent rights accruing under or in
connection with the performance of this contract are hereby reserved
to the State of Florida. In the event that any books, manuals, films, or
other copyrightable materials are produced, the provider shall notify
the Department of State. Any and all copyrights accruing under or in
connection with the performance under this contract are hereby
reserved to the State of Florida.
2. The provider, without exception, shall indemnify and save harmless
the State of Florida and its employees from liability of any nature or
kind, including cost and expenses for or on account of any
3
CONTRACT #~<:.. L ?-.QL _
copyrighted, patented, or unpatented inVel1tion, process, or article
manufactured by the provider. The provider has no liability when
such claim is solely and exclusively due to the Department of State's
alteration of the article. The State of Florida will provide prompt
written notification of claim of copyright or patent infringement.
Further, if such claim is made or is pending, the provider may, at its
option and expense, procure for the Department of State, the right to
continue use of, replace, or modify the article to render it non-
infringing. If the provider uses any design, device, or materials
covered by letters, patent, or copyright, it is mutually agreed and
understood without exception that the bid prices shall include all
royalties or cost arising from the use of such design, device, or
materials in any way involved in the work:.
II. THE DEPARTMENT AGREES:
A. Contract Amount
To pay for contracted services according to the conditions of Attachment
I in an amount not to exceed SMA, subject to the availability of funds.
The State of Florida's performance and obligation to pay under this
contract is contingent upon an annual appropriation by the Legislature.
The costs of services paid under any other contract or from any other
source are not eligible for reimbursement under this contract.
B. Contract Payment
Pursuant to section 215.422, FS, the department has five (5) working
days to inspect and approve goods and services, unless the bid
specifications, Purchase Order, or this contract specifies otherwise.
With the exception of payments to health care providers for hospital,
medical, or other health care services, if payment is not available within
40 days, measured from the latter of the date the invoice is received or
the goods or services are received, inspected and approved, a separate
interest penalty set by the Comptroller pursuant to section 55.03, FS,
will be due and payable in addition to the invoice amount. To obtain the
applicable interest rate, contact the district fiscal office/contract
administrator. Payments to health care providers for hospitals, medical,
or other health care services, shall be made not more than 35 days from
the date eligibility for payment is determined, at the daily interest rate of
.03333%. Invoices returned to a vendor due to preparation errors will
result in a payment delay. Interest penalties less than one dollar will not
be enforced unless the vendor requests payment. Invoice payment
requirements do not start until a properly completed invoice is provided
to the department.
C. Vendor Ombudsman
A Vendor Ombudsman has been established within the Department of
Banking and Finance. The duties of this individual include acting as an
advocate for vendors who may be experiencing problems in obtaining
timely payment(s) from a state agency. The Vendor Ombudsman may
be contacted at (904) 488-2924 or 1-800-848-3792, the State
Comptroller's Hotline.
III. THE PROVIDER AND DEPARTMENT
MUTUALLY AGREE:
A. Effective and Ending Dates
This contract shall begin on JULY 1. 1996 or on the date on which the
contract has been signed by both parties, whichever is later. It shall end
on JUNE 30. 1997.
B. Termination
1. Termination at Will
This contract may be terminated by either party upon no less than
thirty (30) calendar days notice in writing to the other party, without
cause, 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.
2. Termination Because of Lack of Funds
In the event funds to fmance this contract become unavailable, the
department may terminate the contract upon no less than twenty-four
(24) hours notice in writing to the provider. Said notice shall be
delivered by certified mail, return receipt requested, or in person with
proof of delivery. The department shall be the final authority as to the
availability of funds. In the event of termination of this contract, the
7/1196
provider will be compensated for any work satisfactorily completed
prior to notification of termination.
3. Termination for Breach
This contract may be terminated for the provider's non-performance
upon no less than twenty-four (24) hours notice in writing to the
provider. If applicable, the department may employ the default
provisions in Chapter 6OA-l.OO6 (3), FAC. Waiver of breach of any
provisions of this contract shall not be deemed to be a waiver of any
other breach and shall not be construed to be a modification of the
terms of this contract The provisions herein do not limit the
department's right to remedies at law or in equit)'
C. Name, Mailing, and Street Address of Payee
I. The name (provider name as shown on page 1 of this contract) and
mailing address of the official payee to whom the payment shall be
made is:
CITY OF MIAMI BEACH
8128 COLLINS AVENUE
MIAMI BEACH, FLORIDA 33141
2. The name of the contact person and street address where fmancial and
administrative records are maintained is:
AGI LONG
8128 COLLINS AVENUE
MIAMI BEACH, FLORIDA 33141
D. Renegotiation or Modification
Modifications of provisions of this contract shall only be valid when
they have been reduced to writing and duly signed by both parties. The
rate of payment and the total dollar amount may be adjusted
retroactively to reflect price level increases and changes in the rate of
payment when these have been established through the appropriations
process and subsequently identified in the department's operating
budget
CONTRACT#~_
E. Notice and Contact
1. The name, address, and telephone number of the contract manager for
the department for this contract is:
Don Hill
401 NW 2nd Avenue- Suite S522
Miami, Florida 33128
(305) 377-5969
2. The name, address, and telephone number of the representative of the
provider responsible for administration of the program under this
contract is:
AGI LONG
8128 COLLINS AVENUE
MIAMI BEACH, FLORIDA 33141
3.1n the event that different representatives are designated by either
party after execution of this contract, notice of the names and
addresses of the new representatives will be provided in writing to the
other party and said notification attached to originals of this contract.
F. All Terms and Conditions Included
This contract and its attachments as referenced, ATIACHMENTS I
and II. EXHIBITS A. B. C. D. E. F. G and H. 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 verbal or written between the
parties. If any term or provision of the contract is found to be illegal or
unenforceable, the remainder of the contract shall remain in full force and
effect and such term or provision shall be stricken.
Failure to have performed any contractual obligations with the department in a manner satisfactory to the department will be a sufficient
cause for termination. To be terminated as a provider under this provision, the provider must have: (1) previously failed to satisfactorily
perform in a contract with tbe department, been notified by tbe department of tbe unsatisfactory performance, and failed to correct tbe
unsatisfactory performance to tbe satisfaction of the department; or (2) bad a contract terminated by tbe department for cause.
I have read the above contract and undentand each section and paragraph.
IN WITNESS THEREOF, the parties hereto have caused this 49 page contract to be executed by their undersigned officials as duly authorized.
DATE: tl..uJp I ~J /1tfy
STATE AGENJt 29 DIGIT SAMAS CODE:
Federal EID # (or SSN): VF59600372001
Provider Fiscal Year Ending Date: 06L26
. >,
\,} ~ 't l . :, i {\,..."'~
STATE OF FLORIDA, DEPARTMENT OF
HEALTH AND REHABILITATIVE SERVICES
SIGNED By(
) /
~\ I ,/ I Ie'
,. ,/ /~/< ',). /
:.-.'/./? <<::.Jt';;c.. C-/'
--'"
~~I
NAME: /Anita Bock
/
TITLE: District Administrator
DATE:
7. IS 9'"
LEGAL DEPT.
By -11 ~~/b-
'l.e 2!3/~-_
7/1/96
provider will be compensated for any work satisfactorily completed
prior to notification of termination.
3. Termination Cor Breach
This contract may be tenninated for the provider's non-performance
upon no less than twenty-four (24) hours notice in writing to the
provider. If applicable, the department may employ the default
provisions in Chapter 60A-l.OO6 (3), FAC. Waiver of breach of any
provisions of this contract shall not be deemed to be a waiver of any
other breach and shall not be construed to be a modification of the
terms of this contract. The provisions herein do not limit the
department's right to remedies at law or in equit)l
C. Name, Mailing, and Street Address oCPayee
1. The nwne (provider nwne as shown on page 1 of this contract) and
mailing address of the official payee to whom the payment shall be
made is:
CITY OF MIAMI BEACH
8128 COLLINS AVENUE
MIAMI BEACH, FLORIDA 33141
2. The nwne of the contact person and street address where fmancial and
administrative records are maintained is:
AGI LONG
8128 COLLINS AVENUE
MIAMI BEACH, FLORIDA 33141
D. Renegotiation or Modification
Modifications of provisions of this contract shall only be valid when
they have been reduced to writing and duly signed by both parties. The
rate of payment and the total dollar wnount may be adjusted
retroactively to reflect price level increases and changes in the rate of
payment when these have been established through the appropriations
process and subsequently identified in the department's operating
budget.
CONTRACT#~._
E. Notice and Contact
1. The nwne, address, and telephone number of the contract manager for
the department for this contract is:
Don Hill
401 NW 2nd Avenue- Suite S522
Miwni, Florida 33128
(305) 377-5969
2. The nwne, address, and telephone number of the representative of the
provider responsible for administration of the program under this
contract is:
AGI LONG
8128 COLLINS AVENUE
MIAMI BEACH, FLORIDA 33141
3. In the event that different representatives are designated by either
party after execution of this contract, notice of the nwnes and
addresses of the new representatives will be provided in writing to the
other party and said notification attached to originals of this contract.
F. All Terms and Conditions Included
This contract and its attachments as referenced, ATIACHMENTS I
and II. EXmBITS A. B. C. D. E. F. G and H. 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 verbal or written between the
parties. If any term or provision of the contract is found to be illegal or
unenforceable, the remainder of the contract shall remain in full force and
effect and such term or provision shall be stricken.
Failure to have performed any contractual obligations with the department in a manner satisfactory to the department will be a sufficient
cause for termination. To be terminated as a provider under this provision, the provider must have: (I) previously failed to satisfactorily
perform in a contract with the department, been notified by the department of the unsatisfactory performance, and failed to correct the
unsatisfactory performance to the satisfaction ofthe department; or (2) had a contract terminated by the department for cause.
I have read the above contract and understand each section and paragraph.
IN WITNESS THEREOF, the parties hereto have caused this 49 page contract to be executed by their undersigned officials as duly authorized.
PROVIDER:
CITY OF MIAMI BEAC
SIGNED BY:
Clerk
DATE:
#~
/ 6 /r~k
STATE AGENCY 29 DIGIT SAMAS CODE:
Federal EID # (or SSN): VF59600372001
Provider Fiscal Year Ending Date: Q6L2i
STATE OF FLORIDA, DEPARTMENT OF
HEALTH AND REHABILITATIVE SERVICES
)
SIGNED BY:~_, / -' ,,' V:::_'~>(:4/L/
NAME: Anita Bock
~1'
TITLE:
District Administrator
DATE:
7 (f t} J.~'
'-"'f. r nr.,,<," .
l'Ur{iV: t\e'l f\U \, U
LEGAL DEPT.
/1l! Wt.Vt-
; X3( ~ u'.
8y
r
7/1/96
provider will be compensated for any work satisfactorily completed
prior to notification of termination.
3. Termination Cor Breach
This contract may be tenninated for the provider's non-performance
upon no less than twenty-four (24) hours notice in writing to the
provider. If applicable, the department may employ the default
provisions in Chapter 6OA-l.OO6 (3), FAC. Waiver of breach of any
provisions of this contract shall not be deemed to be a waiver of any
other breach and shall not be construed to be a modification of the
terms of this contract The provisions herein do not limit the
department's right to remedies at law or in equitJC
C. Name, Mailing, and Street Address oCPayee
1. The name (provider name as shown on page 1 of this contract) and
mailing address of the official payee to whom the payment shall be
made is:
CITY OF MIAMI BEACH
8128 COLLINS AVENUE
MIAMI BEACH, FLORIDA 33141
2. The name of the contact person and street address where fmancial and
administrative records are maintained is:
AGI LONG
8128 COLLINS AVENUE
MIAMI BEACH, FLORIDA 33141
D. Renegotiation or Modification
Modifications of provisions of this contract shall only be valid when
they have been reduced to writing and duly signed by both parties. The
rate of payment and the total dollar amount may be adjusted
retroactively to reflect price level increases and changes in the rate of
payment when these have been established through the appropriations
process and subsequently identified in the department's operating
budget
CONTRACT#~_
E. Notice and Contact
1. The name, address, and telephone number of the contract manager for
the department for this contract is:
Don Hill
401 NW 2nd Avenue- Suite S522
Miami, Florida 33128
(305) 377-5969
2. The name, address, and telephone number of the representative of the
provider responsible for administration of the program under this
contract is:
AGI LONG
8128 COLLINS A VENUE
MIAMI BEACH, FLORIDA 33141
3. In the event that different representatives are designated by either
party after execution of this contract, notice of the names and
addresses of the new representatives will be provided in writing to the
other party and said notification attached to originals of this contract
F. All Terms and Conditions Included
This contract and its attachments as referenced, A IT ACBMENTS I
and II. EXHIBITS A. B. C. D. E. F. G and H. 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 verbal or written between the
parties. If any term or provision of the contract is found to be illegal or
unenforceable, the remainder of the contract shall remain in full force and
effect and such term or provision shall be stricken.
Failure to have performed any contractual obligations with the department in a manner satisfactory to the department will be a sufficient
cause for termination. To be terminated as a provider under this provision, the provider must have: (1) previously Cailed to satisfactorily
perform in a contract with the department, been notified by the department of the unsatisfactory performance, and failed to correct the
unsatisfactory performance to the satisfaction of the department; or (2) had a contract terminated by the department for cause.
I have read the above contract and undentand each section and paragraph.
IN WITNESS THEREOF, the parties hereto have caused this 49 page contract to be executed by their undersigned officials as duly authorized.
SIGNED BY:
PROVIDER:
CITY OF MIAMI B
Robert Parcher, City Clerk
DATE: ~J:J /~) I r 90
STATE AGENCY 29 DIGIT SAMAS CODE:
Federal EID ## (or SSN): VFS9600372001
Provider Fiscal Year Ending Date: D6L26
",IV'.. ."
! . ) r,~ ti
STATE OF FLORIDA, DEPARTMENT OF
HEALTH AND REHABILITATIVE SERVICES
" -) /
SIGNED BY\ /" ) /~ ;(jGt:~:/
\. ,~/
NAME: Anita Bock
~11
TITLE: ' District Administrator
DATE:
'7 /f,q~,
:EGAl D~.
~~~J
, 2B/~__,
E;
7/1196
DEVELOPMENTAL SERVICES (0.5.)
ATTACHMENT I - PERFORMANCE CONTRACT
Contract Number j(. L;;< 0 I
STA TEMENT OF WORK
A. SERVICES TO BE PROVIDED
By execution of this contract, the provider hereby acknowledges and agrees that its performance under
the contract must meet the standards set forth and will be bound by the conditions set forth below. If the
provider fails to meet these standards, the department, at its exclusive option, may allow up to six
months for the provider to achieve compliance with the standards. If the department affords the provider
an opportunity to achieve compliance, and the provider fails to achieve compliance within the specified
time frame, the department will terminate the contract in the absence of any extenuating or mitigating
circumstances. The determination of the extenuating or mitigating circumstances is the exclusive
determination of the department.
I.
a.
1.
2.
3.
4.
5.
6.
Definition Of Terms:
Contract Terms:
State - means the state of Florida.
Department - means the Department of Health and Rehabilitative Services (H.R.S.)
Provider - means an individual or organization from which services are procured.
Developmental Disability - means a disorder or syndrome which is attributable to retardation,
cerebral palsy, spina bifida, or autism; and which constitutes a substantial handicap that can
reasonably be expected to continue indefinitely.
District - means a service district of the department.
Retardation - Means significantly subaverage general intellectual functioning existing
concurrently with deficits in adaptive behavior.
b. Program Specific Terms:
1. Contracted Case Management - Means identifying, developing, coordinating, and accessing
supports and services on behalf of an individual, or assisting the individual or family to access
supports and services on their own.
2. Day Training Program (ADT, DTP) - Means a non-residential community based facility open
for service at least six hours per day for at least 230 days a year that provides individuals with
basic training and habilitation.
5
3. Enhanced Residential Habilitation - Means services that includes the analysis, development,
modification and monitoring of behavior. This service is designed for those Individuals requiring
intensive behavioral programming.
4. Home and Community Based Waiver - Provides necessary supports and services to people
who have a developmental disability so that they may remain in the community and avoid
placement in an institution. The Waiver is funded by the federal Health Care Financing
Administration(HCF A) and matching state dollars.
S. H.P.1.0, H.P.2.0 - Means Habilitation Programming.
6. In-Service Training - Means advanced training which improves knowledge, skills, or attitudes.
7. IPP - Means Individual Program Plan.
8. Non-Residential Habilitation - means training activities provided to individuals in
community-integrated settings. These services are limited in amount, duration and scope. An
individual shall receive no more than 12 hours of this service per day or the total number of
days in the month.
9. Residential Habilitation - Means services that involves the development and implementation of
training activities in the residential facility. This programming includes assistance with the
acquisition, retention or improvement of skills related to activities of daily living.
10. Respite - Means appropriate, short-term, temporary care that is provided to a person with
developmental disabilities to meet the planned or emergency needs of the person with
developmental disabilities or the family or other caretaker.
11. Supported Employment - means employment located or provided in a normal employment
setting that provides at least 20 hours employment per week in an integrated work setting, with
earnings paid on a commensurate wage basis, and for which support or follow-along services are
needed for continuing job maintenance.
12. Supported Living - means a category of individually determined services designed and
coordinated in such a manner as to provide assistance to adults who require ongoing supports to
live as independently as possible in their own homes.
13. Special Medical Services - Means nursing services and medical supervision are provided on a
24-hour-basis to customers with complex medical needs.
14. Training - Means a planned sequence of learning events designed to produce a positive change
in performance.
15. Transportation - means rides to and from home and community based services to enable the
individuals to receive supports and services.
6
IL General Description:
a. General Statement:
The provider will provide the following services to eligible HRS Developmentally Disabled customers,
as defmed in Section A, (Services To Be Provided), Paragraph I., (Defmition Of Terms) Section b.
(program Specific Terms):
Transportation
Adult Day Training
Supported Living
Supported Employment
The provider will ensure the provision of services to eligible HRS Developmental Services customers in
accordance with HRS Developmental Services Manuals, Standards and Regulations as identified in
Section II. General Description, Paragraph, b., (Authority). To provide services that are designed to meet
individual customers needs. The services to be provided are intended to fulfill the customers potential as
a human being and to reach the customers maximum level of independent living and to facilitate the
customers ability to achieve hislher maximum level of independent living.
b. Authority:
1. To comply with Florida Statutes 393, the American with Disabilities Act (ADA) and
requirements. All providers must comply with the requirements contained in Developmental
Services 2012, Habilitative Programming Minimum Standards, HRSM 160-1, Behavioral
Management Guidelines, the Customer Services Manual 160-2 , all applicable Federal and State
licensing standards, and all other applicable standards, criteria and guidelines of the Department,
including 10F-ll and 10F-8, LTRC minimum Standards, 2014, 2016, 2018, Developmental
Training Program Standards, HRS-DS Form 2006.
2. To adhere to the guidelines contained in HRSM 160-4 (Behavioral Programming) and HRSM
160-8 (Customer Programming). Manuals may be obtained from the DevelopmentafServices
Program Office upon request.
3. The provider will submit reports and records required to process requests for payment by the
department as specified in the Developmental Services Vouchering Procedures Manual Volume
2, Chapter 6.1 and 6.2, February 1990 or as revised.
c. Scope:
7
All services shall be performed in accordance with the policies, procedures, rules, regulations, and laws
of the State of Florida. All services are to reflect treatment approaches and service delivery as indicated
in HRSM 160-1, 160-2, 160-4, and 160-8. All program and services provided to persons with
Developmental Disabilities are funded through D.S. program and must adhere to all required manuals.
d. Major Program Goals
The aim of this contract is to prevent or reduce the severity of Developmental Disabilities. The
department has as its priority to ensure that all customers achieve their potential for independent living,
productive living, and to experience valued life events as do other citizens.
III. Clients To Be Served:
a. General Description:
Each applicant for services provided by the Developmental Services Program must be determined
eligible to receive services through a screening or evaluation process prior to being accepted as a client.
If the applicant is eligible he or she becomes a client of the Department of Health and Rehabilitative
Services (HRS) and is granted all rights for services contained within Florida Statute, Chapter 393.
b. Client Eligibility:
Services shall be provided to adults if they have a confmned diagnosis of at least one of the following
developmental disabilities: Mental Retardation, Spina Bifida, Autism, and Cerebral Palsy, as defmed in
the HRSM 160-2, 160-3, 160-4,160-5, and all other applicable standards.
If the Provider has knowledge of any circumstances affecting eligibility of any person authorized to
receive services under this contract, the Provider shall notify the HRS Developmental Services Contract
Manager, the appropriate Waiver Support Coordinator or District Support Coordinator immediately.
c. Client Determination:
Services shall be provided to adults who have been determined eligible for services under the
Developmental Services program. This will include but not limited to:
1. Individuals with moderate to severe maladaptive behaviors in need of reduction programs.
2. Individuals with acquisition needs in the areas of communication, daily living skills, human
growth, self care skills, socialization skills, vocational/job related skills and/or any area
identified in the consumer support plan
3. Individuals who are incontinent of bladder or bowel.
4. Individuals who are ambulatory or non-ambulatory.
5. Individuals who have additional disabilities.
8
d. Contract Limits:
Services identified in section B., Manner of Service, Section I., Paragraph a., (Task Limits) shall
be provided to individuals as defined by this agreement, and will be limited, subject to a
availability of funds. The Department will have final authority on the availability of funds.
B. MANNER OF SERVICE PROVISION:
By execution of this contract, the provider hereby acknowledges and agrees that its performance under
the contract must meet the standards set forth above and will be bound by the conditions set forth below.
If the provider fails to meet these standards, the department, at its exclusive option, may allow up to six
months for the provider to achieve compliance with the standards. If the department affords the provider
an opportunity to achieve compliance, and the provider fails to achieve compliance within the specified
time frame, the department will terminate the contract in the absence of any extenuating or mitigating
circumstances. The determination of the extenuating or mitigating circumstances is the exclusive
determination of the department.
1. Service Tasks:
a. Task List:
The provider agrees to provide the following services and adhere to the respective standards as
indicated:
Transportation
Transportation services provides commuting services to and from home and community based services
to enable individuals to receive the supports and services identified on the support plan. All drivers and
drivers aides employed (full or part time) shall be currently certified by the State Of Florida, and
maintain 100% adherence to all Department Of Motor Vehicles rules and regulations concerning safety,
licensure and other standards.
All Vehicles used to transport customers must have the following:
1. Current license plate, current registration, and other licenses as required.
2. Regular maintenance to ensure safety.
3. Insurance against accidents to customers and against public liability.
4. Basic first aid kit.
5. Seat belts, and if required, infants seat or wheelchair floor locks which are used at all times to
secure customers while being transported.
6. A 2 Y2 pound dry chemical extinguisher.
Supported Employment Standard: Supported Employment
Supported Employment is competitive work in an integrated work setting with on-going supports and
services for individuals with disabilities for whom competitive employment has not traditionally
occurred; or has been interrupted or intermittent as a result of a disability. Supported employment
models include individual supported employment, mobile work crews and enclaves.
9
Phase I shall refer to those intense activities that are required to obtain and maintain continued
employment. It is the initial stage of supported employment and concludes with the stabilization of the
individual with disabilities to the mutual satisfaction of the individual and the employer.
Phase II/Follow Along shall refer to the activities both on and off the job site that are required for the
individual with disabilities to maintain employment.
Stabilization shall refer to the demonstrated ability of the person with disabilities to perform his/her job
duties to the satisfaction of the employer with reasonable independence and consistency. More
specifically, in the individual model, stabilization refers to employer acceptable job performance for a
specified period of time (60 continuous or 120 continuous days) during which time, the hours of ongoing
supports do not exceed 20% of the weekly work hours of the individual. For the mobile work crew or
enclave model, stabilization refers to job performance that has been acceptable to all parties for a period
of 60 days.
Services provided will include customer assessment, job development and analysis, customer-job
matching, job placement, job related training on and off the work site; advocacy such as facilitating
natural supports and positive social interactions with co-workers and supervisors and any miscellaneous
training and/or counseling that is needed to acquire and maintain employment.
The provider agrees to ensure the following:
I. Develop individual program plans for each customer that clearly state desired outcomes for that
customer.
2. Document status of desired outcomes for each customer is accurately recorded and documented.
3. Customer satisfaction survey for each customer is current within one (I) year.
4. Ensure that the program participants are receiving the same benefits as other employees with the
same work status (full time or part time) who are employed at the work site.
5. Document contact with the customer at the worksite at least twice a month including date, time,
duration location and pertinent notes.
6. Contact with the customer's supervisor is done on at least on a monthly basis.
7. No more than 20% of the customers co-workers are persons with disabilities except in the case of
mobile work crews or enclaves.
8. Document all efforts utilized to identify and procure employment for all customers who receive
services from the provider.
9. Complete and submit the Supported Employment Monthly Report form (Exhibit G), no later than
five (5) days following the close of each month.
Desired Outcomes (General) Phase I
The provider agrees to ensure the following desired outcomes:
I. Customers who enter the program during the contract period will achieve 60 day stabilization
within six (6) months of entry into the program.
2. Customers who receive Phase I services will have their desired outcomes met, as identified in
their individual program plans.
3. Provider achieves 90% or better compliance when monitored using the Supported Employment
Monitoring Checklist.
Desired Outcomes Phase II I Mobile Work CrewslEnclaves:
10
1. Customers who are placed, will remain successfully placed throughout the contract period.
2. Customers who are employed will have their desired outcomes met, as identified in their
individual program plan.
3. Provider achieves 90% or better compliance when monitored using the Supported Employment
Monitoring Checklist.
Supported Living: Standard - Guide To Supported Living In Florida (F.A.C.
Rule lOF-ll)
Supported living refers to a category of individually determined services designed and coordinated in
such a manner as to provide assistance to adults who require ongoing supports to live as independently
as possible in their own homes, to be integrated into the community, and to participate in community life
to the fullest extent possible.
Supported Living services provided shall include a functional assessment of the individual's capacities in
the community and the individuals preferences. Additionally, assistance to the customer in completing a
quarterly housing survey based on the Housing and Urban Development housing quality standards found
in 24 CFR, Chapter VIII, Subpart F, Section 887.251, and services and/or supports a outlined in the
following section. All supports and services will be provided in accordance and in compliance with the
Chapter 10F-l1, Florida Administrative Code.
The provider agrees to provide support in the following areas:
· Housing procurement
· Household maintenance/management
· Safety/emergency procedures
· 24-hour emergency assistance
· Meal planning/preparation
· Shopping/consumer skills
.. Clothing care
· Self care/manners/sexuality
· money managementlbanking
· Utilizing third party benefits
· Time management
· Recreation/leisure
· Mobility/travel skills
· Civic responsibility
· Advocacy
· Interpersonal communication
· Facilitation of one-to-one relationships
· Support counseling
· Self medication
The Provider agrees to provide or complete the following services or tasks:
1. Facilitate the completion of an annual customer satisfaction survey to be placed on file for each
customer receiving supported living services.
2. Conduct an annual functional assessment that identifies the training and assistance needed by
each recipient of supported living services.
11
3. Identify specific desired outcomes directly related to supported living services.
4. Provide training and/or assistance needed by each recipient of supported living services as
documented in the assessment and/or identified by the individual in the Individual
Program Plan.
5. Ensure that an on call system is maintained which allows their customers to access services for
emergency assistance, 24 hour per day, 7 days per week.
6. Document service delivery by maintaining case notes and time intervention logs.
7. Establish and document face to face contact with the customer preferably at the customers home,
on at least a weekly basis.
Desired Outcomes:
1. Customers will have their desired out comes met as indicated in their Individual Program Plan during
the contract period.
2. Customers will continue living in homes of their own through the entire contract period.
Adult Day Training-Standard: Developmental Training Program Minimum Standards
(Oct. 85)
Adult Day Training refers to training and related services provided to develop skills needed to function
as independently as possible. These services are often designed to prepare individuals to live in less
restrictive settings, work in the competitive labor market, or function more independently in the
community. Services typically includes developmental training in a variety of life skills areas, adult
basic education, behavioral services, and sheltered employment opportunities.
All Adult Day Training (A.D.T.) programs shall employ a full-time CBA to assure proper program
design and implementation. AnT programs will comply with the requirements contained in HRSM 2006
Developmental Training Program Standards.
The provider agrees to ensure that the following services are received:
1. An appropriate annual formal and informal assessment to determine customer's level of
functioning as described in the support plan.
2. The interdisciplinary team responsible for programming will consist of the individual, a social
worker, and a parent or guardian and other members as required and appropriate.
3. Targeted behaviors relate to the Support plan, and are measurable.
4. Maintain documentation that short term objectives are:
a) derived from baseline data
b) written in measurable terms
c) related to targeted behaviors
5. Programmatic changes are made on the basis of progress data.
6. That each customer's program consists of activities throughout the day for the achievement of
the Short term Objectives and target behaviors of the customer's IPP.
7. The activities are age appropriate and culturally normative.
8. Emergency restraints and all programs designed to reduce or eliminate behaviors adhere to the
regulations and procedures outlined in HRSM 160-4 and the Rule on Behavioral Management.
9. An implementation plan is maintained for all customers indicating the following:
a) Implementation plans are derived from baseline data.
::-
12
b) Implementation plan includes a list of reinforcers to be used and when.
c) Implementation plan includes a description of prompt levels
d) Implementation plans includes criteria for changing prompts
e) Implementation plans includes criteria for changing Short Term objectives
b. Task Limits:
All tasks shall be performed in accordance with requirements identified in HRSM 160-1, 160-2, 160-
3, 160-4, 160-5 and all other applicable standards.
II. Staffing Requirements:
a. Staffing Levels
The Provider must maintain sufficient staff, facilities and eq~ipment to deliver the agreed upon services.
The Provider will give written notification to the Department immediately upon being aware of their
inability to provide the required quality or quantity of services.
b. Professional Qualifications:
All staff who may intervene with the customer must be adequately trained. This should include but not
limited to: HRSM 160-4, principles and procedures of behavior analysis, individual customer programs,
data collection, and the Bill of Rights of Persons Who Are Developmentally Disabled.
c. Staff Changes:
Written notification must be submitted to the department when the person who is authorized to bind the
agency is no longer performing such functions.
d. Subcontractor:
Funds made available pursuant to this contract shall not be used by the Provider and/or subcontractor for
the purpose of initiating or pursuing litigation against the Department. The provider must request prior
written approval from the department before subcontracting any service(s). The department must give
written approval before subcontracting can occur.
IlL Service Location & Equipment:
a. Service Delivery Location:
1. Services Shall be provided in the County(ies) of: Dade
2. Services shall be provided by: City of Miami Beach
3. Services shall be at the following location(s) as identified in Section III, Paragraph C.2., of
the Standard Contract.
13
b. Service Times:
All service times are to be in accordance with HRSM 160-1, 160-2, 160-4, 160-5 160-8, and all other
applicable standards.
c. Changes in Location:
The department reserves the right to approve any changes in service provision location prior to moving.
A written request must be submitted to the department 30 days prior to any move. The department must
give a written approval before any move from one location to another can occur., Any emergency
rendering the provider incapable of providing services will require the immediate notification of the
Developmental Services Program Office. The movement of any customer to another facility requires
prior authorization from the department.
d. Equipment:
The facility must be maintained in accordance with HRSM, 160-1, 160-2, 160-4, 160-5 160-8, American
Disabilities Act (ADA) requirements, and all other applicable standards. Provider shall make the
determination as to the appropriate programmatic equipment required to delivery services as defined by
this contractual agreement.
IV. Deliverables:
a. Service Units:
The Department agrees to pay for the service units at the unit price(s) and limits listed
below:
SERVICES
UNIT OF MEASURE
UNIT PRICE
Transportation
Supported Living
Supported Employment
Adult Day Training
Monthly
Monthly
Monthly
Daily
$95.28
$485.00
$426.00
$24.50
b. Reports:
A copy of the annual Compliance Audit prepared by a Certified Public Accountant, as noted in
Attachment IT will be delivered to the Contract Manager no later than one hundred eighty (180)
days after the effective date of this contract.
2. The Provider agrees to submit an actual expenditure report for the six (6) month period from
July 1, 1991 through December 31,1996. Such report shall be submitted no later than March 1,
1997.
3. The provider agrees to complete self monitoring document (Exhibit E) on a quarterly basis.
The checklist, when completed, must be signed by the person authorized to bind the agency, and
14
returned to the appropriate contract manager no later that the fifth (5th) day following the month
of the quarter.
4. Documentation verifying the funding source and amount of the 12 Yz% required local match
shall be submitted no later than December 31,1996 and shall be subject to the approval of the
Department.
5. The provider agrees to submit to the department, a copy of the evacuation plan, thirty (30). days
after the execution of this contract.
6. The provider agrees to submit to the department, a Monthly Supported Employment Report,
(Exhibit G), no later than five (5) days following the close of each month.
c. Records and Documents:
1. The Provider must maintain records documenting the total number of recipients and names (or
unique identifiers) of recipients to whom services were provided and the date(s) on which
services were provided so that an audit trail documenting service provisions can be maintained.
2. The provider must keep accurate records of expenses for the facility and provide an expenditure
report when requested by the department
3. The provider agrees to maintain a current record on each client served in the program which
includes authorization for the provision of services.
J'. Performance SpecifICations:
By execution of this contract, the provider hereby acknowledges and agrees that its performance under
the contract must meet the standards set forth above and will be bound by the conditions set forth below.
If the provider fails to meet these standards, the department, at its exclusive option, may allow up to six
months for the provider to achieve compliance with the standards. If the department affords the provider
an opportunity to achieve compliance, and the provider fails to achieve compliance within the specified
time frame, the department will terminate the contract in the absence of any extenuating or mitigating
circumstances. The determination of the extenuating or mitigating circumstances is the exclusive
determination of the department.
a. Outcomes and Outputs:
The provider agrees to support, be actively involved in and cooperate with all parties involved in
the provision of supports and services to individuals who are receiving services from the
Developmental Services Program Office. The provider also agrees to assist and assure the
individual's community inclusion activities, use of natural supports and generic supports, and to
promote the achievements of the departments desired outcomes as identified in the strategic plan.
The provider will ensure that funds expended by the department for contractual services,
promote efficient use through identification and reduction of ineffective or wasteful services. To
provide information regarding the effectiveness of service delivery, and to ensure that the
services benefit the customers and enable them to meet their maximum level skills, abilities and
independence.
b. Standard Definition:
ADULT DAY TRAINING
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BS%. of individuals served acquire or maintain critical skills, functions and/or outcomes as
identified on each individual's support plan within specified time frames
Achieve satisfactory of better rating on 2D.%. of client satisfaction surveys.
SUPPORTED EMPLOYMENT
.l!lD.%. of individuals in supported employment are earning at or above minimum wage.
.lOO%. of individuals in supported employment are earning at or above minimum wage for ALL
Months
1S.% Of individuals in supported employment have an annual income above federal poverty
guidelines.
.lOO%. of individuals in supported employment program do not need paid supervision from a
provider in excess of2Jl.%. of the individuals average work hours.
.l!lD.%. of individuals in supported employment work an average of at least 20 hours per week for
the past six consecutive months.
Achieve a satisfactory or better rating on 2!l%. of client satisfaction surveys.
SUPPORTED LIVING
.lOO%. of individuals in supported living are the lessor or owner of the home in which they reside
.l!lD.%. of supported living clients who live in housing in which persons with disabilities account
for no more than 1!!%. of the homes or apartments residents in the identifiable area.
Achieve a satisfaction or better rating on 2D.%. of client satisfaction surveys.
TRANSPORTATION
Achieve a satisfactory or better rating on 2!l%. of client satisfaction surveys.
c. Monitoring and Evaluation Methodology:
By execution of this contract, the provider hereby acknowledges and agrees that its performance under
the contract must meet the standards set forth above and will be bound by the conditions set forth below.
If the provider fails to meet these standards, the department, at its exclusive option, may allow up to six
months for the provider to achieve compliance with the standards. If the department affords the provider
an opportunity.to achieve compliance, and the provider fails to achieve compliance within the specified
time frame, the department will terminate the contract in the absence of any extenuating or mitigating
circumstances. The determination of the extenuating or mitigating circumstances is the exclusive
determination of the department.
1. All contracted programs and services will be monitored via on-site visits by district staff at least once
a year. The purpose of the monitoring is to give assurance to the department that funds expended to
purchase services are not and will not be misused or mismanaged, that services are appropriately meet
the needs of the individuals being served, and that documentation will be available and complete upon
inspection.
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2. A team consisting of the Quality Assurance Unit, Budget and Contracts Unit, and the Supported!
Employment/Living Coordinator will conduct the annual monitoring of the facility. The department
will give written notification to the provider when the monitoring will be conducted. Along with the
notification will be a list identifying the appropriate documentation that must be readily available for
inspection at the monitoring location, and a copy of the Annual Monitoring Document that will be
used to perform the review of the agency. A written response regarding the outcome of the monitoring
will be sent to the provider within thirty (30) days after the monitoring. If required, the provider will
be given thirty (30) days in which to submit a written response to the department addressing any
issues or areas of concerns identified in the monitoring report.
3. Within six month of participation in the program, the provider will obtain results from a client
satisfaction survey in which each client is asked to determine hislher level of satisfaction with the
services of the facility. It is the responsibility of the provider to ensure that all client satisfaction
survey are completed by either the consumer, families or other legal guardian. At no time shall the
satisfaction survey be completed by the provider. The provider shall maintain results of the
customer satisfaction forms on file for inspection by the department.
4. Provider must collect and maintain all data, statistics, reports, records, surveys and any other
supporting documentation, relative to the performance standards identified in Section V.,
Performance Specifications, Paragraph B., (Standard Definition). This information must be maintained
in the files for review by the department.
5. In the event the contract is terminated as a result of the provider failing to achieve the standards set
forth in the contract, the provider may not receive any new contracts for the same services within 12
months of the date of termination as the result of a formal competitive procurement or as the result
of a single source procurement.
d. Performance Definitions:
I. Federal Poverty Guideline - Are issued each year in the Federal Register by the Department of
Health and Human Services.
2. Minimum Wage- Rate of pay as defined by the Department of Labor
3. All Months - refers to the length of time the individual is employed
VI. Provider Responsibilities:
1. The provider agrees to provide services to customers as it is defined in this rate agreement.
2. The provider assures that the human rights of all customers as applicable and specified in section
393.13(3), Florida Statutes, are protected and that it will abide by the provisions of Chapter 415,
Florida Statutes, pertaining to protection from abuse, neglect and exploitation of aged and!or
disabled persons and children. The provider will report all suspected cases of abuse or neglect of
children, disabled or elderly individuals to the department's central abuse registry at 1-800-96-
ABUSE.
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30 The provider agrees to provide full access to and cooperate with the District, and Waiver Support
Coordinator(s) in order to provide services identified in the Support Plan, whenever applicable.
40 The Provider agrees to purchase surety bond coverage from a responsible commercial surety
company to cover all officers, employees and agents ofthe Provider authorized to handle funds
received or disbursed under this contract. The bond shall be in an amount commensurate with
he funds handled, the degree of risk (as determined by the surety company) and consistent with
good business practice. Documentation validating insurance purchase, should be provided to the
department within thirty(30) days after execution of this contract.
5. The provider will have in place termination, suspension, or reduction of customer services
policies developed by the provider and approved by the district in accordance with policies set
forth in F AC IOF-8.
6. The Provider will give written notification to the Developmental Services Contract Manager,
Development Services Placement Coordinator, and the appropriate Waiver Support Coordinator
and District Support Coordinator of any customer vacancies and anticipated customer vacancies.
7. The provider agrees to attend training as recommended and required by the department. All staff
will have a current certification in CPR, Heimlich Maneuvers and training in procedures to
handle emergencies. All providers, their staff and clients will complete mv / AIDS training at
least biannually. Documentation of training should be maintained on file for review.
80 The provider agrees to have written admission and discharge criteria in place that has been
approved by the department.
9. The Provider agrees to conform to all local zoning ordinances and land restrictions.
10. The Provider shall establish and maintain a good communication linkage to the surrounding
neighborhood, and provide a mechanism for receiving feedback from the larger community. All
responses, relative to concerns from the community, shall be maintained in a separate file for
review by the Department.
11. The Provider agrees to actively cooperate with the recruitment pf personal advocates for each
customer, providing them with the training needed to help assure the protection of the customer's
human, civil and legal rights.
12. The Provider will cooperate with the Department by supplying such information regarding
customer data as may be needed to complete reports for the Department.
13. The provider will ensure that prompt medical and/or dental attention shall be obtained by the
provider, and coordinated with the support coordinator as warranted for medical and/or dental
injuries or illness, utilizing Medicaid, Medicare, and other insurance as defined in HRSM 160-2
Chapters 8 - 13.
140 The provider will ensure that all customers will be assessed in accordance with the
Department's Habilitative Programming Minimum Standards (HRS-DS Form 2012, October
85), and Developmental Training Program Standards, HRS-DS Form 2006. Such assessment
shall occur within 30 days of placement.
18
15. Individual Program Plans (IPP) will be developed and implemented, for all customers, based on
the results of the assessments. IPP's will be developed within 30 days of placement.
16. Based on a sampling of the IPP's by the Department, the Provider will meet a minimum of
(90%) of the identified goals on the customers' IPP's.
17, The provider will ensure a minimum of 90% compliance with HP 1.0 (program guidelines) and
H.P. 2.0, where applicable.
18, The provider will ensure that all new admission to the program shall have an approved
Authorization Form (Exhibit F) from Developmental Services. The approval form must be
approved and signed by the Placement Coordinator, the contract manager and if required, the
Budget and Contracts Supervisor prior to enrollment for services under this contract. The
provider will not be reimbursed for any services provided prior to such approval.
VII. Department Responsibilities:
1. The department reserves the right to remove customers without notice upon allegations of abuse
or neglect of customers in the facility/program. Confirmed cases of abuse or neglect of
customers in the facility/program is grounds for termination of this contract in accordance with
applicable Florida Statutes, rules and/or agency regulations.
2. The department reserves the right to mediate any disputes that arise between the Provider and the
Waiver Support Coordinator. The Department will have the final authority in all disputes.
3. The department shall not be held liable for payment if the customer is admitted to the facility
without a written authorization form (Exhibit F) from the Developmental Services Program
Office.
4. The Developmental Services Program shall have the right to determine what services shall be
reimbursed under this contract.
C. METHOD OF PAYMENT:
L Invoice Requirements:
a. This is a fixed price (unit cost) contract. The department shall pay the provider for the
delivery of service units provided in accordance with the terms of this contract for a total
dollar amount not to exceed s...M., subject to the availability of funds.
b. The department agrees to pay the provider for services at the unit price(s) and unit(s) of
measure found in Section B (Manner of Service Provision) paragraph IV. a. (Service Units).
c. The provider shall request payment on a monthly basis through the submission of a properly
completed invoice (Exhibit A) and back-up (Exhibit B, C and G ) as appropriate.. Invoices
must be submitted within 10 days following the end of the month of service. If a service is
funded by more than one category, the Provider must submit a separate certification
(Invoice) for each category. The provider is responsible for ensuring the accuracy of unit
count in each category. Upon receipt of a correct invoice, the Department will process an
19
invoice in accordance with HRS Accounting Procedures Manual, Volume 2, Vouchering,
Chapter 6.2 Developmental Services and the Developmental Services ABC System User's
Guide, Invoice Module.
d. Payment for services by the HRS Developmental Services Program Office shall be
considered payment in full. The provider shall not receive or accept payment for the
customers care or training from/or on behalf of a customer in excess of the amount
detennined and authorized by the Department.
e. Vacation, holidays and in-service time is not reimbursable as a service day for computing
units of service under this contract. Hours and days of service shall meet minimum standard
requirements, shall be described and met as per agency proposal, and per any other special
provision or other section of this contract.
f. Payments may be authorized only for service units on the invoice which are in accord with
the above list and other tenns and conditions of this contract. The service and units for
which payment is requested may not either by themselves, or cumulatively by totaling
service units on previous invoices, exceed the total number of units authorized by this
contract.
g. For the purpose of reimbursement, enrollment is related to continuing attendance. No day of
absence will be reimbursed. The provider shall maintain attendance records for each
reimbursable service.
h. In the case of a non-material breach, the Department retains the right to withhold payment of
funds in total or in part, until such time as the breach is corrected.
1. HRS Developmental Services shall not reimburse the Provider for any ineligible person
served.
J. Receipts are required for all expenses incurred, (e.g., office supplies, printing, long distance
telephone calls, etc.) and must be maintained on file by the provider for audit and
monitorine purposes.
k. Travel:
1. An HRS travel voucher ( State of Florida Voucher for Reimbursement of Traveling
Expenses - Fonn C-676), Exhibit H must be completed and maintained on file by the
provider. Original receipts for expenses incurred during officially authorized travel;
items such as car rental and air transportation, parking and lodging, tolls and fares; mIW
be maintained on file by the provider. Section 287.058 (1) (b), F.S., requires that bills
for any travel expense shall be maintained in accordance with Section 112.061, F.S.,
governing payments by the state for traveling expenses. HRSR 40-1 (Official Travel of
HRS Employees and Non-Employees) provides further explanation, clarification, and
instruction regarding the reimbursement of traveling expenses necessarily incurred
during the perfonnance of official state business.
2. Prior approval is required in accordance with Section 112.061 F.S., for conference travel
and must be certified on Fonn C-676C, Exhibit H ( State of Florida Authorization to
Incur Travel Expense) with a copy of the program or agenda of the conference attached.
20
Reimbursement is in accordance with "a." above. See HRSR 40-1 for further
explanation, clarification and instruction.
3. The provider must retain on file documentation of all travel expenses to include the
following data elements: name of the traveler, dates of travel, travel destination, purpose
of travel, hours of departure and return, per diem or meals allowance, map mileage,
incidental expenses, signature of payee and payee's supervisor.
II. INVOICE REQUIREMENTS: Home and Community Based Services(Medicaid
Waiver)
a. The service, units of service and rates found in section B, Manner of SerVice Provision, #4
Service Units, will be used to reimburse the Provider for the provision of services to
Developmental ServiceslHome and Community Based Services Medicaid Waiver (HCBS)
eligible customers who are authorized to receive said services.
b. To receive reimbursement for services, the provider shall submit a separate invoice
(Medicaid Waiver and General Revenue) for all eligible Medicaid Waiver customers on a
monthly basis. Invoices will be sent to the appropriate Waiver Support Coordinator,
( W.S.C.) pursuant to the procedures found in section B, Manner of Service Provision,
Paragraph IV., (Deliverables) Section a., (Service Units). The ( W.S.C.) has the
responsibility of approving and processing payment for all authorized Medicaid Waiver
services within five (5) working days of receipt of an invoice. For General Revenue
Payments, the (W.S.C.) shall initial and approve the invoice indicating that these services are
authorized to be paid, and forward the approved invoices to the Developmental Services
Budget and Contract Unit for payment.
c. During the life of this agreement, the required documents may change due to Developmental
Services/Home and. Community Based Services Medicaid Waiver expansion requirements.
Should documentation requirements be changed, the Department and the Provider agree to
make changes through a memorandum of understanding or a formal amendment to this
agreement at the discretion of the Department.
d. Vacation, holidays and in-service time is not reimbursable as a service day for computing
units of service under this contract. Hours and days of service shall meet minimum standard
requirements, shall be described and met as per agency proposal, and per any other special
provision or other section of this contract.
e. The provider shall request payment on a monthly basis through the submission of a-properly
completed invoice (Exhibit A) and back-up (Exhibit B, C) as appropriate. Invoices must be
submitted within 10 days. The provider is responsible for ensuring the accuracy of unit count
in each category. Upon receipt of a correct invoice, the W.S.C.. will process an invoice in
accordance with HRS Accounting Procedures Manual, Volume 2, Vouchering, Chapter 6.2
Developmental Services and the Developmental Services ABC System User's Guide,
Invoice Module.
f. Payments may be authorized only for service units on the invoice which are in accord with
the above list and other terms and conditions of this contract. The service and units for
21
which payment is requested may not either by themselves, or cumulatively by totaling
service units on previous invoices, exceed the total number of units authorized by this
contract.
g. For the purpose of reimbursement, enrollment is related to continuing attendance. No day of
absence will be reimbursed. The provider shall maintain attendance records for each
reimbursable service.
III. Program SpecifIC Requirements for Payments (Agreements that includes Adult Day
Training Services)
a. Local match for the Developmental Training Program is requires at 12 %010 of the total
program cost. Rule 45-CFR 74 (Exhibit D), identifies matching information.
D. SPECIAL PROVISIONS:
L Grievances and Fair Hearings
The provider shall establish written procedures so that applicants for services and current customers may
present grievances about the operation of the contract. The provider will advise applicants of the right to
appeal a denial or exclusion from the program services, of failure to take account of a customer's choice
of services and of hislher right to a fair hearing to the fmal governing authority of the agency.
II. Human Rights Advocacy Committee (BRAC) Access
a. The provider shall post in a readily accessible location visible to all customers either
procedures or a poster informing customers how they may contact the HRAC.
b. The provider shall allow the HRAC access to the facility and the right to speak with any
person who is developmentally disabled, staff or volunteers, in accordance with Sections
402.165 and 402.166 Florida Statutes.
IlL Copyrights
a. Where activities supported by this contract produce original writing, sound recordings,
pictorial reproductions, drawings or other graphic representations and works of any similar
nature, the department has the right to use duplicate and disclose such materials in whole or
in part, in any manner, for any purpose whatsoever and to have others acting on behalf of the
department to do so. If the materials so developed are subject to copyright, trademark, or
patent, legal title and every right, interest, claim, or demand of any kind in and to any patent,
trademark or copyright or application for the same, will vest in the State of Florida,
Department of State, for the exclusive use and benefit of the state. Pursuant to section
286.021, Florida Statutes, no person, firm or corporation, including parties to this contract
shall be entitled to use the copyright, patent or trademark without the prior written consent of
the Department of State.
22
b. Any earnings realized by the Provider as a result of contract-related and supported activities,
including royalties received from copyrights on publications or other works developed under
this contract, interest income from fees, or sale of assets purchased with contract funds shall
not be expended without the prior written approval of the Department. The Department
reserves the right to require those funds to be used to reduce costs borne by Federal
Government or the Department or both.
IV. Project Independence
a. The department has implemented Project Independence, an initiative to assist public
assistance recipients to enter and remain in gainful employment. Employment of Project
Independence participants is a mutually beneficial goal for the providers and the department
in that it provides qualified entry level employees needed by many providers and provides
substantial savings to the citizens of Florida.
b. The provider or its agent agrees to notify the department of entry level employment
opportunities associated with this contract that require a high school education or less. The
department will provide infonnation to the provider identifying Project Independence
customers that are referred to the provider. In the event that the provider or its agent
employs a person who was referred by the department's Project Independence office, the
provider will notify the department.
V. Multi-district Rate Agreement
Other HRS districts may participate in this agreement at the rates specified in (Section IV) Swnmary of
Rates and Services. Each of the HRS districts is responsible for its own payment to the provider for the
services provided to customers. of that district. The district that is fmancially responsible for the
customer will prepare the invoice (HRS-DS-3029A) and forward it to the provider. The provider will
return the signed invoice with corrections noted to the responsible district for processing.
VI. Access to Records
All customers records including, but not limited to medical, psychiatric and psychological records, any
and all other customers records shall be the sole property of the Department and shall remain at the
providers facility upon tennination of this contract. The Department shall have reasonable access to all
manuals, policies, procedures, personal records, and other written materials produced or developed by
the Provider pursuant to this contract at any time during the course of this contract. Upon tenniiiation of
this contract, said material shall remain at the providers facility until the Department, or any subsequent
Provider has had reasonable opportunity to reproduce and duplicate said materials.
VIL Right To Inspect
The Provider agrees that the Department may enter the premises where services are provided, at any time
deemed appropriate during the tenn of this contract.
23
VIII. Use of Funds for Lobbying Prohibited
The Provider agrees to comply with the provisions of section 216.347, F.S., which prohibits the
expenditure of contract funds for the purpose of lobbying the Legislature or a state age
IX. Emergency Preparedness
The Provider agrees to be responsible for the care, maintenance and, if necessary, the relocation of
customers during any natural disaster or period of civil unrest. The provider shall submit their
evacuation plan to the department for approval. The plan should be submitted thirty (30) days after the
execution of this contract. The department shall, within thirty (30) days of receipt, give a written
response to the provider regarding the status of the evacuation plan.
X Non-expendable Properly
a. Non-expendable property is defmed as tangible personal property of a nonconsumable nature that has
an acquisition cost of $500 or more per unit and an expected useful life of at least one year, and
hardback bound books that are not circulated to students or the general public, the value or cost of
which is $100. Hardback books with a value or cost of$25 or more should be classified as an oeo
expenditure only if they are circulated to students or to the general public.
b. All such property, purchased under this contract, shall be listed on the property records of the
provider. Said listing shall include a description of the property, model number, manufacturer's serial
number, date of acquisition, unit cost, property inventory number and information on the condition,
transfer, replacement or disposition of the property.
c. All such property, purchased under this contract, shall be inventoried, and an inventory report shall
be submitted to the department along with the final expenditure report. A report of non-expendable
property shall be submitted to the department along with the expenditure report for the period it was
purchased.
d. Title/ownership to all non-expendable property acquired with funds from this contract shall be vested
in the Department upon completion or termination of this contract.
e. At no time shall this provider dispose of non-expendable property purchased under this contract
except with permission of, and in accordance with instructions from the department.
f. A formal contract amendment is required prior to the purchase of any item of nonexpendable
property not specifically listed in the approved contract budget.
24
Title to Vehicles (TRANSPORTATION DISADVANTAGED).
a. Procedures for acquisition of vehicles for transportation of HRS clients acquired directly by the
department or a contracted provider are contained in HRSR 40-5. The following clause must be
used in all cost reimbursement contracts which provide for the purchase of vehicles for
transportation ofHRS clients (transportation disadvantaged), using HRS funds:
b. Title to Vehicle (TRANSPORTATION DISADVANTAGED): Title (ownership) to all vehicles
acquired with funds from this contract shall be vested in the department upon completion or
termination of the contract. The provider will retain custody and control during the contract
period, including extensions and renewals.
XI. Insurance
The Provider will obtain and maintain adequate liability insurance on all motor vehicles owned and
operated by the Provider, and used in conjunction with the operation of the group home or program. The
Provider will also obtain and maintain adequate liability insurance coverage on residents, staff, and
visitors, as required by the Division of Risk Management, and Department of Insurance. Documentation
of liability insurance should be submitted to the department within thirty (30) days of execution of this
contract.
XIL Board Members
The department encourages the provider to develop and maintain a culturally diversified board,
representative of the diverse population in Dade county.
XIIL Background Screening
All personnel including volunteers and other relatives, must comply with section 393.0655, Florida
Statute, regarding background screening requirements. The provider shall, within five (5) working days
after starting work at a facility, submit to the facility for submission, within forty-eight (48) hours to the
department a complete set of fmgerprints taken by an authorized law enforcement agency or an
employee of the department who is trained to take fmgerprints. The provider will ensure that a re-
screening of all personnel including volunteers and other relatives, is conducted after a five year period,
in accordance with Chapter 95-228, Section 50, Laws of Florida (Oct. 95).
2S
XlV. Impact Zone Planning
The provider will make available to HRS District 11 zip code data on where their service recipients
reside as well as certain other client identifying information as requested. This information will be used
to facilitate HRS impact zone planning.
V. Multi-Year Contract Renewal Option
This contract may be renewed on a yearly basis not to exceed one (1) year beyond the initial contract (or
for a period no longer than the term of the original contract whichever is longer). Such renewal shall be
subject to the performance evaluations as determined by the department and shall be subject to the
availability of funds. The total cost of the contract under the first renewal will not exceed an increase of
5% and the second renewal will not exceed an additional increase of 5%, providing the scope of work
and dollar amount of the original contract remain constant. Each renewal shall be confirmed in writing
and shall be subject to the terms and conditions set forth in the initial contract.
26
ATTACHMENT II
FINANCIAL AND COMPLIANCE AUDIT
This attachment is applicable if the provider or grantee, hereinafter rekrred to as
provider, is any local govem~1ent entity, nonprofit organization, or for-profit ,
orgaI}.ization. An audIt perfonned by the Auditor General shall satIsfy the requirements
o {-thIs attachment.
PART I: FEDERALLY FUNDED
This part is applicable if the provider is a local government entity or nOflprofit
organization and receives a total of $25,000 or more in federal funds passed through the
department during its fiscal year. Thc provider has "rcccived" federal funds when it has
obtained the cash from the department or when it has incurred reimbursable expenses,
Local governments shall comply with the audit requirements contained in Office of
Office ofManag~ment and Budget (OMB) Circular A-128 Audits of State and Local
Governments. Nonprofit providers shall comply with OMS Circular A-133, Audits of
Institutions of Higher Learning and Other Nonprofit Institutions, except as modified
herein. Such audits shall cover the entire organization for the organization's fiscal year,
The audit report shall include a schedule of financial assistance that discloses each state
contract by number.
Compliance findings related to contracts with the department shall be based on the
contract r~uirements, including any rules, regulations, or statutes referenced in the
contract. Tbe financial statements shall disclose whether or not the matching req!lirement
was met for each applicable contract All questioned costs and liabilities due to the
departm~ntal shall be fully disclosed in the audit report with reference to the department
contract Involved.
[f.the provider.has recei~ed any fun~ from a grants apd aids approQriation, tJle provider
wIll afso subrrut a complIance report m accordance WIth the rules or the Auditor General,
Chapter 10.600, and inaicate on The schedule of fmancial assistance which contracts are
funded from state grants and aids appropriati9ns.
The provider agrees to submit the, required reports as shown in Part IV.
PART II: STATE FUNDED
This part is applicable if the provider is a nonprofit organization that receives a total of
$100,000 or more from the department during its fiscal year, which is not gaid on a set
state or area-wide fixed rate for service, and of which less than $25,000 is tederally
funded. The provider has "received" funds when it has obtained the cash from the
department or when it has incurred reimbursable expenses.
The provider agJ;"ees to have an annual financial audit performed by independent auditors
in accordance with the current Government Auditing Standards issued by the Comptroller
General of the United States. Such audits shall cover the entire organization for the
organization's fiscal year. The scope of the audit performed shall cover the financial
statements and include reports on internal control and compliance. The audit report shall
include a schedule of financial assistance that discloses eacb state contract by number,
Compliance findings related to contracts with the department shall be based on the
contract r~uirements, including any rules, regulations, or statutes referenced in thc
contract The financial statements shall disclose whether or not the matching requirement
was met for each apgIicable contract. All questioned costs and liabilities due to the
departm~nt shall be fully disclosed in the audit report with reference to the department
contract Involved.
If the provider has received any funds from a grants and aids approQriation, the provider
will also submit a compliance report in accordance with the rules otthe Auditor General,
Chapter 10.600, and indicate on the schedule of financial assistance which contracts are
funded from state grants and aids appropriations.
n/tnl/or:.
27
ATTACHMENT II
ril~ provider agrees to subrllir the reqUired reports as shoWIl ill P:lrt 1\'
PART III: CIlAPTEI~ 10.GOO, Ol{ NO AUDIT REQlIIIU':I\lENT
This part is applicable if the provider is either (I) a Cor-profit organi?..Jtiol1, (2) a local
government entity receiving Icss than $25 000 Il1 federal funds tram thc dCRartmcnt
during its fiscal ye.ar, (3) a nonRrofit orga~izatian receiving less. thap $100,000 from the
department, ofwluch less than $25,000 is federally funded, dunng Its fiscal year, or (4) a
nonprofit organi7..atian recei ving a total of $100,000 or more from the dcpartment based
on a set state or area-wide fixed ratc for service, of which less than $2~OOO is federally
funded. The provider has "receivcd" funds when it has obtaincd cash 1rom the
department or when it has incurrcd reimbursable expenses, '
If the provider receives funds from a grants and aids approjJriation, the providcr shall
have. an audit, or submit an attestation statement, in acca~dance with the rules of the .
AudItor General, Chapter 10.600. The audit report shall IOclude a schedule of finanCIal
assistance which discfoses each state contract by numbcr and indicatcs which contracts
are funded from state grants and aids appropriations,
The provider agrees to submit the required reports as shown in Part IV,
Othe.rwise, if the provider does not receive funds from a grants and aids appropriation, the
proVider has no audit or attestation requirement required by this attachment
PART IV: SUBMISSION OF REPORTS
Copies .of the audit report and any management lettcr by the independent auditors, or
attestatIOn statement required by this attachment shall be submitted within 180 da~s after
the end of the provider's fiscal year to the following, unless otherwise required byFlorida
Statutes:
A. Officeof Internal Audit (OSIA)
13 17 Winewood Boulevard
Building I, Room 304A
Tallahassee, - Florida 32399-0700
Contract manager for this contract
Submit to this address only those reQorts prepared in
accordance with OMB Circular A-133:
B.
-C.
Federal Audit Clearinghouse
P. O. Box 5000
Jeffersonville, Indiana 47199-5000
D. Submit to this address only those reports l?repared in
accordance with the rules of the Auaitor General,
Chapter 10.600:
Jim Dwxer
Office of the Auditor General
P.O. Box 1735
Tallahassee, Florida 32302
Th~ provider shall cnsure that audit workingjJapers are made available to the department,
9r Its deSignee, upon request fqr a period ortive years from the date the audit report is
Issued, unless exfended 10 wntlOg by the departmenL
02/0 1/96
28
EXHIBIT A
DISTRICT ELEVEN
H.R.S. DEVELOPMENTAL SERVICES PROGRAM
INVOICE REQUEST FOR SUBSIDIES/SERVICES RENDERED
VENDOR NAME:
CONTRACT NUMBER:
ADDRESS:
MONTH OF SERVICE:
SERVICE PROVIDED:
VENDOR 10 #:
FUNDING CATEGORY:
I CLIENT NAME I SOCIAL SECURITY IRATE I NUMBER I AMOUNT
NUMBER I PER UNIT OF UNITS REQUESTED
I +~--+~- ---+-
H- ---
12 I 1---- I -+----
r--t. - ------------ ______n____ __n ---- I ----
I I
I I
'3 !
I i -..- -- --- ---- ------------- I -t--- I ---. -. I
4
----- -
5
--
I I
6 I
"----- --- -l
i ,
7
--
8
9
10
11
12
13
TOTAL
I CERTIFY THAT GOODS AND SERVICES ITEMIZED ON THIS AUTHORIZATION INVOICE, HAVE BEEN RECEIVED AND
ARE A PROPER CHARGE AGAINST THE STATE FUNDS APPROPRIATED FOR THIS PROGRAM. SUPPORT RECEIVED FOR
IN HOME SUBSIDY OR SUPPORTED LIVING STIPEND Will BE USED FOR THE PURPOSES PREVIOUSLY AGREED
UPON IN WRITING,
HRS AUTHORITY SIGNATURE DATE
PROVIDER/CUSTOMER SIGNATURE
DATE
29
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EXHIBIT 0
SUBPART G
Cost Sharing or Matching
S 74.50 Scope of subpart.
(a) This subpart contains rules for satisfying Fed-
eral rcquircmcnts for coSt-Sh.HlDg or matching, TIlc>c
ruks apply whcthcr [hc cost sharing or matching IS
required by Federal statute or by ower terms of !1JC
gram.
(b) HHS and a grantec may enter into an inslJ[~-
lional cost-sharing agrecment covering all of HHS s
research project grants to that grantee in Lhe aggregate.
Except as provided by the instiruuonal cost-sharing
agreement, this subpart applies to ,he satisfaction ot
Lhe grantee's obligation under the agreement, as well as
to the satisfaction of rost-sbaring or matching requIre-
ments that apply only to a single grant.
S 74.51 Definitions..
For purposes of this subpart:
"Cost sharing or matching" means the value at
third-party in-bnd contributions and that portion ot
the costs of a grant-supported project or program not
borne by the Federal Government.
"Equipment'. has the same meaning given to that
term in S 74.132. except that instead of "acquisit..ioo
cost:' the words "market value at the time of donal.loo"
shall be substituted.
"Supplies'. means all tangible personal proper=y
other than "equipment'. as defined in this section.
"Third-par1Y in-kind contributions" means propen:-
-2I ~ which benefit a grant-suppor-cd project or
program and which arc contributed by non-Feder:J
:hlrd partics without C~2[gc (0 the 5~antec, t~e su~
g~Jntee. or a cost-t::pe con~ractor u:1der the gnnt or
sUbgrJ;1,.
~ 7.J,52 Basic rule: Casls Jnd cunlriburions JCCepl-
able.
\Viti"! Ih-: qUJlificauons ..:r.d o:ce;>uoru Its,cd ,:)
" ;~ 53. <! (os:-)ha!if'g O! T2'::;:~g. 'e~I:::~~enl'''-'
32
be satisfied by cHllcr or both of (he follOwing:
(a) .-\ Ilowaolc COSIS Incurred by (he &raotce, SI
crantec, or J CO,;(.(ype contr;Jctor under the gram
;ubgrant. ThiS If1Clud<."s .1/lowable COSts borne by oc
Fcderal granlS or by Olller cash donations fTOm nc
Federal third parlles
(b) The value of dJlrd-pany in-kiod Contribulic
dpplicablc 10 the pCflod 10 whicb the COSt-sbaring
malching requirement applies.
S 7~.5J Qualifications and el:ception5.
(a) Costs borne by ocher Federal granu. (1) E
cept as prOVided by Federal statute, a cost-sharing
malching requIremcot may oot be met by COSts bar
by another Federal graoL This prohibition docs 0
apply to costs borne by general program income earn,
from a COnlfaC! awarded under another Federal grar
(2) For thi- pu rposes ot"rlus par:, general reVenl
sharing funds uoder 31 U.s.e. 1221 arc not considerl
a Federal graot Therefore, in the absence of any pr
vision of Federal statu!e to the contrary, allowable cm
borne by these funds may count towards satisfying
cosl-sharing or matchlUg requiremeoL
(b) COSlJ or contribucions counted IOwards om
Federal cost-shartng requirements. Neither costs n<
lbe values of !hlId-pany in-kind contributions m,
couot IOwards samfying a cost-sharing or malchli
requirement of 3D HHS grant it they hav~ been or w
be cQuoted low2fds satisfying .3 cost-sharIng or matcl
109 requir<:mcQ! ci 300ther Federal gram. a Feder
procurem<:~! ':OG(r3Cl. or aoy otn<:r award of F::dcr
:uods,
(c) COStS -=;r:,;r:cec bv -ger.ua[ prOfJrcm lnc~m,
C)SlS 1nJr.ccd ~\ ~~:1C:[Jl ?rog:.::~ :r:co:ne, JS ~~::.ne
10 ~ 1.J~2, )~1JII ;-:,)[ .:ounl 10\Na:-ds ~allsiy;ng a ':os'
Sha~lng or :11JI(:1I..-,Z :~q~.llfem~n~ of :~c HHS 5r::!Dt iUf
iJor.mg :.b<: 3C!IVlf"- ~Ivlng r;,e ~o ".;1C :r.come uoJe~~ !t:
I . '~"-""'-',-.. b
IC~;"!)$ ~: tt>-=: ~~3Di ,,<?rciS y ?C~'.-_!l ,;1e..: _0_.. .
used [or cosr sharing or marching, (This is rhe alterna-
tive [or use o[ general progr:lm inc~me described in
j7442(d))
(d) R.ecords, COSIS and (bird-parry lll-\dnd COnlrl-
bu(ioos couallog tov.-:lrds sallstying a cosl-;!larl:1g or
matc;'lDg requircme:1! must be vcrifiable frolIl tbe rec.
ords ot recipieots or COsHype cootraclOrs, These rec-
ords must show how ule value placed on rhird-pa..ny
In-bnd contributions was arrived at To the e:nent
ie3sible. volunteer services ~all be supponed by the
;aIDe methods lhar the organization uses to suppoC! che
allocabiliry at its regular personnel costs.
(e) Special standards for third-party in-kind contrI-
butions. (1) Third-pa[ty in-kind conr.rib.utiQID shall
COuar rowards satisfying' a cos~~sb~n~ or marching
requ~meDt ooly where, if !..be pany receiving thc,fQn-
tributioos were to pay for them, the payrr.eotS would
be allowable costS.
(2) A thirrl-p;lrty in vinri rnntriburioo sbaU oat
count as direct cost sharing' or matching where, if rhe
2am receivin~ the conrrihmion were to pay for i!._!pe
payment would be an indirect cost Cost-sharing or
matc~ing credit for such contributions shall be givea
only if the" recipient or contractor has cstablished,
along with its regular indirect cost rare, a special rate
tor allocating to individual projects or programs the
value of the contributions. (Information on bow to
establish these ratcs can be obtained from the Division
of Cost Allocation in any HHS regional offic~'s
Region21 Administrative Suppon Center.)
(3) The values placed on third-pany in-kind coo-
tributions for cost;;.sharing or matching purposes shall
conform [Q the rules in the succeeding sections of this
subpan. If a third-party in-kind conrributioo is of a
type not trcared in those sections, the value placed
upon jt shall be fair and reasonable.
S 74.54 Valuation of donaled sen.ices.
(a) Vo{untur suvias. Unpaid services provided
ro a recipient by individuals shaU be valued at rares
consisrcD( wi th those ordinarily paid for similar work:
io the recipient's organization. II the recipient does
not ha..e employees performing similar work:, tbe rates
shall be consistenr with those ordinarily paid by ocher
:mp/oyers for similar work in the same labor CD.1Iket.
In ei!ber C2..Se, a reasonable amount for fringe beneols
::12Y b: included in :.he valualion.
(b) Emp{oyas of other Organz:.ar'-ons, When ~
:r:Jp'o:-=r other ;hJn a re::Jolenr cr cost-r~..tJe .:on.r3crcr
~r!lls:-tes fre: :)f c;'Jqe ;r.e sef\"'c:s 0f :l1l ::nplo~ e:
,.] (,~: ~mplo~ee's :lOr:nal hned work, the sC:-'Jices
;hall b~ vaiued at lje emp/o:ee.s regular ralC at pay
:Acluslve ot L'1e cn:;ploycr's [rlnge beneols and over.
h:::;d ':("",r.~ l! '.he servic:,s :tr,. 1-.') a di1iercot linc 'oi
-"ark, ).!. 4gr~;J,1 ..l: '-It thIS ~C::lIoa shall JC:'p:y
EXHIBIT D
9 74.55 Valuation ,of donaled supplics and loanc(
cquipmcnt or Sp:1CC.
(J) If a third p:Jny dunal,:s supplies. the conrribu
lion shall be valued al lhe CIl3rkcl value of lhe Supplie:
Jl clle lime at donation,
(b) If a cblJ"d party dOIl3(CS (hc llse o[ equlprnen
or space 10 a building but retains uuc, the conrribu
tion sball be valued at the fair rental rale of the equip-
ment or space.
S 74.56 Valuation of dooated eqwpmcot. buildings,
and land.
U a third parry dooares eqUlpmeot, buildings, or
land, and title passes lo a recipicD!. rbe trcacmeot of
tbe donated property shaLJ depend upon the purpose ot
the grant or subgrant, as foUows:
(a) A wards for capital expenditures. U the pllIpQse
of the grant or subgrant is to assist the recipient in thc
acquisition of propcrty, rhe market value of that
property at the rime of donarion may be counted as
cost sharing or matching.
(b) Qrhu awards. If assisting in thc acquisition of
property is not the purpose of the grant or subgrant,
the (allowing rules apply:
(1) If approval is obtained tram the awarding
parry, the market value at the time of donation of the
donated equipment or, buildings aod the fair rental
rate of the donated land may c.: counted as COSt shar-
ing or matching. In the case of a subgrant, the terms
of the HEW grant may require iliat the approval be
obtained from the granting agency as well as the
grantee. In all cases, the approval may be given ocJy
if a purchase of the equipmcnt or rental of the land
would bc approvcd as an allowable direct cost.
(2) If approval is not obtained under paragraph
(b) (1) of this section, no amouot may be counred
for dooatc;d land. and only depreciation or us.e allow-
ances may be couoted for donated equipment an_d
buildings. The depreciation or use allowances for this
property are not treated as tnird-party in-~d con-
tributiODS. Instead, thcy are treatef! as costS LDcurred
by the recipient. They are compured and allocated
(usually as indirect coSts) in accordance with tb,e cosr
principles specified in su bpan Q of lhis part, LQ the
same way as depreciation or use allowanc::s for ?UI-
chased equipment and buildings, The amount ,of de-
preciation or use allowances for donaled equlpc:ot
2.::Jd buildings is based cn l.b.: ;)(openy"s markel vcJue
at tbe rime it was don.:!lcd,
33
~ 7~.57 :\ppraisal of real property.
." - - -6 il will be
In some ;:JSCS under -3 ,4.)5 and ,j) .
, oJ ( :aod or a
necessary (0 ~s;ab!..Jsh Lte market value 0, " ,
. -:>i space LQ ~
building or th.: f~tr ro:ot~ r:w:: of lana or ...."'v
. ~a,.nrv
buildi.lH!, La rbc~e ':asc\ rh~ o-F.,n,..,a
..
Exhibit E
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
DISTRICT XI DEVELOPMENTAL SERVICES PROGRAM
PROVIDER SELF-MONITORING CHECK LIST
Name Of Service Provider:
Date:
SIGNATURE:
NAME (print):
TITLE:
.
34
INSTRUCTION FOR COMPLETING SELF-MONITORING CHECKLIST
The self-monitoring checklist is not a substitute for the department annual
monitoring. It should be used as a tool to remind the provider of the
requirements needed to maintain compliance with the contract. Before the
department conducts its annual monitoring, the more comprehensive
monitoring tool will be shared with all providers prior ,to the actual
monitoring.
1) The checklist must be completed by all providers on a monthly basis.
When completed, it must be signed by the authorized individual, and
submitted to the contract manager.
2) ALL providers must complete the General Monitoring Requirements and
the Financial/Budget monitoring, as it applies to all programs.
3) Providers must complete the section of the self-monitoring checklist that
contains those services that they provide. For those services that do not
apply, please mark "N/A" on the form.
4) Please return the entire package to the contract manager upon
completion of the appropriate sections.
* * *PLEASE NOTE: Some sections of the self-monitoring checklist have
multiple pages.
35
..
Page 1 of 2
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
DISTRICT XI DEVELOPMENTAL SERVICES PROGRAM
GENERAL MONITORING - ALL SERVICES
PROVIDER SELF- MONITORING CHECKLIST
CONTRACT NAME:
CONTRACT MANAGER:
ADDRESS:
CONTACT PERSON:
PHONE NUMBER:
DATE OF MONITORING:
GENERAL REQUIREMENTS / IvES ....
ALL SERVICES NO COMMENTS ,
1) Are records available that documents that all statt
trained to meet the customers needs, and that training is
updated as needed?
2) Does provider maintain personnel files indicating the
required qualifications of all statt interacting with the
consumer? .._~-
3) Is time and attendance record kept for, and signed by
all staff?
4) Does the provider maintain documentation of training and
information given to direct statt regarding customers?
5) Does the provider maintain documented evidence that staff
is trained and knowlegeable in all emergency procedures
including, but not limited to CPR, first aid, and emergency
evacuation?
6) Are all records organized in a systematic manner?
7) Are customer's record and files confidentially maintianed?
-
8) Does provider maintain a current Support Plan for each
in their files?
9) Is staffing pattem met if required by the contract?
( see attached matrix for medical services only)
36
Page 2 of 2
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
DISTRICT XI DEVELOPMENTAL SERVICES PROGRAM
GENERAL MONITORING - ALL SERVICES
PROVIDER SELF - MONITORING CHECKLIST
CONTRACT NAME:
CONTRACT MANAGER:
ADDRESS:
CONTACT PERSON:
PHONE NUMBER:
DATE OF MONITORING:
GENERALR EO UIREMENTS I
ALL SERVICES YES NO COMMENTS
10) Does provider maintain records documenting:
1) What services are provided to each customer?
2) Date that services were provided? "
3) That records are maintained in customer's files?
11 ) Are there records available that documents that background
screening is completed for all personnel, and is in
accordance with section 393.0655, Florida Statutes, and
updated as needed?
37
..
Page 1 01 1
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
DISTRICT XI DEVELOPMENTAL SERVICES PROGRAM
FINANCIAljBUDGET ISSUES
PROVIDER SELF-MONITORING CHECKLIST
CONTRACT NAME:
CONTRACT MANAGER:
ADDRESS:
CONTACT PERSON:
PHONE NUMBER:
DATE OF MONITORING:
FINANCIAljBUDGET l YES/NO
ISSUES COMMENTS
1) Does the provider have in place an accounting mechanism
for tracking receipts and expenditures for this contract?
If so, is there documented evidence that the system is
updated on a current basis?
2) Does the provider maintain documentation that the positions
in payroll agree with the budgeVprogram requirements?
3) Is the rate per service charged on the provider's
monthly invoices, the same as the rate specified in the
executed contract?
4) Is there documentation that the provider maintains
a fidelity bond covering the activities of all officers,
employees, and agents authorized to handle funds?
5} Is there documented evidence that the provider maintain
appropriate property. liability and other insurance as required
by the contract?
6) Does the provider maintain documentation indicating
customers attendance in the program, as it rela~es to
the billing?
-
7) If applicable, Is there documented evidence indicating that
client's trust funds are updated at least on a monthly basis?
8) Are records available that document the receipt and
expenditure of client funds?
38
Page 1 of 3
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
DISTRICT XI DEVELOPMENTAL SERVICES PROGRAM
ADULT DAY TRAINING SERVICES
PROVIDER SELF-MONITORING CHECKLIST
CONTRACT NAME:
CONTRACT MANAGER:
ADDRESS:
CONTACT PERSON:
PHONE NUMBER:
DATE OF MONITORING:
ADUL T DAY TRAINING I
SERVICES YES NO COMMENTS
1) Are records available which document that all customer file
contain an Individualized Program Plan (IPP)?
2) Does provider maintain files indicating that an appropriate
formal and informal assessment to determine cuctomer's
level of functioning as described on the Support Plan?
3) Does the provider maintain documentation regarding the
the team responsible for programming? If so, does
interdisplanary team consist of the social worker, therapist
and parent or guardian?
4) Does the provider maintian documentation of targeted
behaviors that relate to barriers in the Support Plan? Are they
measurable?
5) Does the provider maintain documentation of the short term
ojectives? If so, are:
A - Short term objectives derived from baseline data?
B - Short term ojectives written in measurable terms?
-
C - Do the short term objectives relate to target behaviors?
6) Are progress data maintained in customer's record and files?
7) Does provider maintain a record of programatic changes that
are made on the basis of progress data?
8) Does the provider maintain records indicating that each
customer vocational and educational program consists of
activities throughout the day for the achievement of the Short
Term Objectives and target behaviors in the customer's IPP?
39
Page 2 of 3
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
DISTRICT XI DEVELOPMENTAL SERVICES PROGRAM
ADULT DAY TRAINING SERVICES
PROVIDER SELF - MONITORING CHECKLIST
CONTRACT NAME:
CONTRACT MANAGER:
ADDRESS:
CONTACT PERSON:
PHONE NUMBER:
DATE OF MONITORING:
ADULT DAYTRAINING
SERVICES YES NO COMMENTS
9) It so, are these activities age appropriate and culturally
normative?
-----
10) Does the provider maintain documentation regarding the use
of emergency constraints? It so, is the use of emergency
restraints and all program designed to reduce or eliminate
behaviors adhere to the regulations and procedures outlined
in HRSM 160-4 and the Rule on behavioral management? .
11 ) Are there records available that document that the customer
can demonstrate the skill that the IPP says were achieved
through programming?
12) Does the provider maintain an implementation plan for each
customer? It so,
A - Are the implementation plans derived from baseline data?
B - Do the implementation plans include a list of reinforcers
to be used and when?
C - Do the implementation plans include a description of
prompt?
o - 00 the implementation plans include a description of
prompt levels?
E - Do the implementation plans include a criteria for -c-
changing prompt levels?
F - 00 the implementation plans include a criteria for
changing Short Term Objectives?
G- Are the short term objectives that have been achieved
dated and signed by a staff member?
40
Page 3 of 3
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
DISTRICT XI DEVELOPMENTAL SERVICES PROGRAM
ADULT DAY TRAINING SERVICES
PROVIDER SELF-MONITORING CHE:CKLlST
CONTRACT NAME:
CONTRACT MANAGER:
ADDRESS:
CONTACT PERSON:
PHONE NUMBER:
DATE OF MONITORING:
ADUl T DAY TRAINING I
SERVICES YES NO COMMENTS
13) Are there records available that documents that the customer
is regularly using the new skill?
14) Are there records available that documents that prograrnmin~
has enabled the customer to advance to a setting which .
allows him or her to function more independently?
41
Page I of 1
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
DISffilCT XI DEVELOPMENTAL SERVICES PROGRAM
ffiANSPORTATION SERVICES
PROVIDER SELF-MONITORING CHECKLIST
CONTRACT NAME:
CONTRACT MANAGER:
ADDRESS:
CONTACT PERSON:
PHONE NUMBER:
DATE OF MONITORING:
TRANSPORTATION: I , ...'
'.. YES NO COMMENTS
1) Is there documented evidence indicating that the vehicles
used to transport customers have current registration. licenSE
plate and all other license as appropriate?
2) Does provider maintain documentation indicating that all
drivers and drivers aides are certified by the State of Rorida
and maninlain 100% adherence to all Department of Motor
Vehiclo rules and regulations concerning saftey. licensure.
and other standard?
3) Does provider maintain documentation indicating that all
vehicles used to transport customers are maintained to
ensure sattey?
4) Are all vehicles used to transport customers equipped with
seat belts, and if required .infant seat, and wheel chair locks.
5) Is there documented evidence that all vehicles used to
transport customers are properly insured against accidents
to customers and against public liability
6) Does provider maintain a transportation log of vehicles used
to transport customers?
7) Does log indicate: \: ..........,... ".'
.. .'.
,...... )>
.., ..,:.,
A - Date Of Travel
B - Mileage:
Beginning
Ending
C- Destination
o - Name(s) of Client Transported
8) Are all vehicles used to transport customers equipped with a
a basic first aid kit and a fire extinguisher?
42'
Page 1 of 2
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
DISTRICT XI DEVELOPMENTAL SERVICES PROGRAM
SUPPORTED EMPLOYMENT SERVICES
PROVIDER SELF-MONITORING CHECKLIST
CONTRACT NAME:
CONTRACT MANAGER:
ADDRESS:
CONTACT PERSON:
PHONE NUMBER:
DATE OF MONITORING:
SUP POBT E[) EMPLOYMENT I .,".
EMPLOYMENT YES NO COMMENTS
1) Does the provider have a written agency employment
program that addresses job development, job placement,
on site training and stabilization strategies?
2) Does the provider have individual program plans for
each customer that clearly state the desired outcomes for
that customer?
3) Does the provider have a temporary alternate
programming plan available for customers when a
placement Is unsuccesful?
4) Are records available to document the status of the
desired outcomes for the customer?
5) Are records available to document the status of the
agency.s desired outcomes?
6) Are program participants receiving at least minimum
wages as established by the Department of Labor?
7) Are all program participants currently employed?
(If not. list the number who are in the program and the
number of participants who are unemployed) -
8) Are program participants receiving the same benefits
as other employees with the Sdme work status(full time
or part time) who are employed at the work site?
9) Are records available that document contact with the
customer at the work site at the req uired frequency
Including date, time. duration. location and notes?
43
Page 2 of 2
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
DISTRICT XI DEVELOPMENTAL SERVICES PROGRAM
SUPPORTED EMPLOYMENT SERVICES
PROVIDER SELF - MONITORING CHECKLIST
CONTRACT NAME:
CONTRACT MANAGER:
ADDRESS:
CONTACT PERSON:
PHONE NUMBER:
DATE OF MONITORING:
SUPPORTED EMPLOYMENT I IYES
EMPLOYMENT NO COMMENTS
'P -. -~
10) Does the provider have records that document contact
with the customer's supervisor on at least a monthly basis?
44
HRS
EXHIBIT F
CLIENT SERVICES AUTHORIZATION FORM
I----u---~ - --- .. --- --.- - --- -- -- --
-
ISeCTlON" I
(1) CUSTOMER NAME: (2) O,O.0:_I___J________(3) ::;S ,_______ - --
--
(4) CURRENT PLACEMENT: (5) PROPOSED PLACEMEN1: -
--
(G) CURRENT D_T.P.: (7) PROPOSED D.T.P,: ------. -----
(8) VENDOR NAME: VENDOR NUMOER:
(9) REASON FOR SERVICES:
(10) L.T.RC. REPLACEMENT NAME: (11) D.T.P. REPLACEMENT NAME:
(12) REASON FOR D.T.PJ L T.RC. REPLACEMENT:
I SECTION B I . ,--:< --
.. .'. .'
FINANCIAL INFORMATION
FUNDING SOURCES IYES NO AMOUNT I REPRESENTATIVE PAYEE OTHER PARTICIPATING AGENCY/FUNDING SOURCE
MED/WAIVER PARTICIPANl
S.S.I. RECIPIENT
S.S.A RECIPIENT
OTHER
..... .... ""':"<.' ..... '-""....,... ),i,,:.. SECTION C I ., <........, .........:::<
.', .'.
SERVICES RA TE AND UNIT FUNDING ONGOING ONE TIME NON CONTRACT ANTICIPATED EFFECTIVE
OF MEASURE CATEGORY EXPENSE EXPENSE CONTRACT PLACEMENT PLACEMEN"
DATE DATE
LT.RC. ROOM AND BOARD
D.T.P. I.F.S. MEOW
TRANS. I.F.S. MEOW
MEDICAL I.F.S. MEOW
RES. HAB. I.F.S. MEOW
SUP. EMP. . I.F.S.
S.L. COACH I.F.SJ C.S.LA.! MEOW,
OTHER S.B. / I.F.S. / MEOW.
....,,'.. ',. SECTION D ,I '.":..:',.;;' .....;;.:.:,:...,
1) c:: fED BY (2) HSPS PLACEMENT (3) CONTRACT MANAGER (4) HSPS II BUDGET
(NEW CUSTOMER/ONE TlME EXP.)
UAIt:. DATE DATE DATE
5) OMC 11 DAlE
CC: I SECTION E I
HSPS II (BUDGET)
HSPS (PLACEMENT)
(1) CONTRACT MANAGER
(2) FIELD UNIT INPlIT INTO ABC IMMEDIATELY
(3) I.S,C, INPlIT INTO ABC IMMEDIATELY
110POS (err 10/09/90 R~VrS~D 02/16/91 f'EVISCO 10112/'2
Rl:VI,[:D 2f2f9S
45
INSTRUCTIOl'~ FOH COMPLETING CUSTOMER l\UTIlOJ~I :~I\TION FORM
I. IF PROVIDER INITIATES AUTHORIZATION REQUEST FOR SERVICES OTHER
THAN SUPPORTED LIVING AND SUPPORTED EMPLOYMENT:
COMPLETE:
MAIL COMPLETED FORM TO
1-
2.
J .
4 .
5.
section A - Questions 1 - 12
section B - Complete as Appropriate
Section C - Not Applicable
section 0 - Signature Line #1
section E - Not Applicable
PLACEHENT COORDINATOR
HRS DEVELOPMENTAL SERVICES
401 N.W. ,2ND AVE - 5518
MIAMI, FLORIDA 33128
II. IF PLACEMENT COORDINATOR INITIATES AUTHORIZATION REQUEST FOR
SERVICES OTHER THAN SUPPORTED LIVING AND SUPPORTED EMPLOYMENT:
COMPLETE:
1. section A - Question l-l2
2. section 8 - Complete as Appropriate
3. Section C - Complete as Appropriate
4. section D - Signature Lines #1 and #3
5. section E - Lines 1,2 and 3
III. CONTRACT MANAGER COMPLETES FOR ALL SERVICES:
1. Section C - Complete As Appropriate
2. section 0 - Signature Line #3
IV. BUDGET MANAGER COMPLETES:
1. section D - Signature #4 (for one time exp and new customers)
V. FOR SUPPORTED LIVING AND SUPPORTED EMPLOYMENT
1-
2 _
3 .
4 .
SECTION A -
SECTION B -
SECTION C -
SECTION D -
Special Projects completes section A items 1-5 &9
Special Projects will complete as appropriate
Special Projects will complete as appropriate
Special Projects will complete signature line #1
and # 5, and Budget/Contracts section will
complete signature line #3 for individuals who
receive services through CSLA, Medicaid Waiver or
General Revenue.
46
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Contract N0.
JL l :;? 0 I
CERTIFICATION REGARDING
DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION
CONTRACTS/SUBCONTRACTS
This certification is required by the regulations implementing Executive
Order 12549, Debarment and Suspension, signed February 18, 1986. The
guidelines were published in the May 29, 1987 Federal Register (52 Fed.
Reg., pages 20360-20369).
INSTRUCTIONS
1. Each provider whose contract/subcontract equals or exceeds $25,000 in federal monies
must sign this certification prior to execution of each contract/subcontract. Additionally
providers who audit federal programs must also sign, regardless of the contract amount.
HRS cannot contract with the~e tvpes of providers if thev are debarred or suspended bv the
federal qovernment.
2. This certification is a material representation of fact upon which reliance is placed
when this contract/subcontract io entered into. If it is later determined that the signer
knowingly rendered an erroneous certification, the Federal Government may pursue available
remedies, including suspension and/or debarment.
3. The provider shall provide immediate written notice to the contract manager at any
time the provider learns that ita certification was erroneous when submitted or has become
erroneous by reason of changed circumstances.
4. The terms "debarred," "suspended," "ineligible," "person," "principal," and
"voluntarily excluded," as used in this certification, have the meanings set out in the
Definitions and Coverage sections of rules implementing Executive Order 12549. You may
contact the contract manager for assistance in obtaining a copy of those regulations.
5. The provider agrees by zub~nitting this certification that, it shall not knowingly
enter into any subcontract with a person who is debarred, suspended, declared ineligible,
or voluntarily excluded from par~icipation in this contract/subcontract unless authorized
by the Federal Government.
6. The provider further agrees b~ submitting this certification that it will require each
subcontractor of this contract/subcontract, whose payment will equal or exceed $25,000 in
federal monies, ~o submit a signed copy of this certification.
7. The Department of Health and Rehabilitative Services may rely upon a certification of
a provider that it is not debarred, suspended, ineligible, or voluntarily excluded from
contracting/subcontracting unless it knows that the certification is erroneous.
8. This signed certification must be kept in the contract manager's contract file.
Subcontractor's certifications must be kept at the contractor's business location
CERTIFICATION
(1) The prospective provider certifies, by signing this certification, that neither he
nor his principals is presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from participation in this contract/subcontract by any
federal department or agency.
(2) Where the prospective provider is unable to certify to any of the statements in this
certification, such prospective provider shall attach an explanation to this
certification.
signature
Date
Seymour Gelber, Mayor
Name and Title of Authorized signee