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HCCBG FY14 AWARD CONTRACTSeptember 25, 2013 Chris Coudriet New Hanover County 230 Government Center Drive, Suite 195 Wilmington, NC 28403 -1732 Dear Mr. Coudriet: I have enclosed your county's fully- executed, original HCCBG contract (DOA -735) for the provision of county -based aging services for Fiscal Year 2014. I would like to extend our thanks, on behalf of the Cape Fear Council of Governments and the North Carolina Division of Aging and Adult Services, for your county's support of services delivered through New Hanover County Senior Resource Center to the older adults of New Hanover County. Sincerely, 1l Ginny Brinson, Aging Program Specialist Cape Fear Council of Governments — Area Agency on Aging Enclosure cc: Jane Jones AJ McClure Brenda Brow Serving Brunswick Columbus, New Hanover and Pender Counties 1480 Harbour Drive • Wilmington, NC 28401 • (910) 395 -4553 • (800) 218 -6575 • Fax (910) 395 -2684 ~ www.capeleamog.org An Equal Op rtun ty /ntflrmatP.-e Acton/ A Empla°,rar(Program i DOA -735 (revised 6113) See Paragraph 8; Monitoring July 1, 2013 Through June 30, 2014 Home and Community Care Block Grant for Older Adults Agreement for the Provision of County -Based Aging Services This Agreement, entered into as of this 28 "' day of August, 2013, by and between the County of New Hanover (hereinafter referred to as the "County ") and the Cape Fear Area Agency on Agin�, (hereinafter referred to as the "Area Agency "). Witnesseth That: WHEREAS, the Area Agency and the County agree to the terms and conditions for provision of aging services in connection with activities financed in part by Older Americans Act grant funds, provided to the Area Agency from the United States Department of Health and Human Services through the North Carolina Division of Aging and Adult Services (DAAS) and state appropriations made available to the Area Agency through the North Carolina Division of Aging and Adult Services, as set forth in a) this document, b) the County Funding Plan, as reviewed by the Area Agency and the Division of Aging and Adult Services, c) the Division of Aging and Adult Services Home and Community Care Block Grant Procedures Manual for Community Service Providers, d) the Division of Aging and Adult Services Service Standards Manual, Volumes I through IV, and, e) the Division of Aging and Adult Services Community Service Providers Monitoring Guidelines. NOW THEREFORE, in consideration of these premises, and mutual covenants and agreements hereinafter contained, the parties hereto agree as follows: As provided in the Area Plan, community service providers specified by the County to encourage maximum collocation and coordination of services for older persons are as follows: Elderhaus Interim Healthcare, Inc 1.(a) The Community Service Provider(s), shall be those specified in the County Funding Plan on the Provider Services Si ary format(s) (DOA -732) for the period ending June 30 for the year stated above. DOA -735 (revised 6/13) See Paragraph 8; Monitoring 2. Availability of Funds. The terms set forth in this Agreement for payment are contingent upon the receipt of Home and Community Care Block Grant funding by the Area Agency. 3. Grant Administration. The grant administrator for the Area Agency shall be Chris May, Executive Director (title). The grant administrator for the County shall be Teresa Hewett, New Hanover County Grants & Projects Analyst (title). It is understood and agreed that the grant administrator for the County shall represent the County in the performance of this Agreement. The County shall notify the Area Agency in writing if the administrator changes during the grant period. Specific responsibilities of the grant administrator for the County are provided in paragraph seven (7) of this Agreement. 4. Services authorized through the County Funding Plan, as specified on the Provider Services Summa format(s) (DOA -732) are to commence no later than July 1 of the state fiscal year and shall be undertaken and pursued in such sequence as to assure their expeditious completion. All services required hereunder shall be completed on or before the end of the Agreement period, June 30 of the state fiscal year. 5. Assignability and Contracting. The County shall not assign all or any portion of its interest in this Agreement. Any purchase of services with Home and Community Care Block Grant for Older Adults funding shall be carried out in accordance with the procurement and contracting policy of the community services provider or, where applicable, the Area Agency, which does not conflict with procurement and contracting requirements contained in 45 CFR 92.36. Federal funds shall not be awarded to any subreceipients who have been suspended or debarred by the Federal government. In addition, Federal funds may not be used to purchase goods or services costing over $100,000 from a vendor that has been suspended or debarred from Federal grant programs. 6. Compensation and Payments to the County. The County shall be compensated for the work and services actually performed under this Agreement by payments to be made monthly by the Area Agency. Total reimbursement to the community service providers under this Agreement may not exceed the grand total of Block Grant funding, as specified on the Provider Services Summary format (DOA -732). (a) Interim Payments to the County Upon receipt of a written request from the County, the Division of Aging and Adult Services, through the Area Agency, will provide the County Finance Officer with an interim payment equivalent to seventy percent (70 %) of one - twelfth (1 /12) of the County's Horne and Community Care Block Grant allocation by the 22nd of each month. 2 DOA -735 (revised 6113) See Paragraph 8; Monitoring (b) Reimbursement of Service Costs Reimbursement of service costs are carried out as provided in Section 3 of the N.C. Division of Aging and Adult Services Home and Community Care Block Grant Procedures Manual for Community Service Providers, revised February 17, 1997. C) Role of the County Finance Director The County Finance Director shall be responsible for disbursing Home and Community Care Block Grant Funding to Community Service Providers in accordance with procedures specified in the N.C. Division of Aging and Adult Services Horne and Community Care Block Grant Manual for Community Service Providers, revised February 17, 1997. (d) Pa ent of Administration on Aging Nutrition Services Incentive Program SIP Subsidy NSIP subsidy for congregate and home delivered meals will be disbursed by the Division of Aging through the Area Agency to the County on a monthly basis, subject to the availability of funds as specified in Section 3 of the N.C. Division of Aging and Adult Services Home and Community Care Block Grant Procedures Manual for Community Services Providers, revised February 17, 1997. If through the US Department of Agriculture Area Agency on Aging Elections Project, the County elects to receive a portion of its USDA entitlement in the form of surplus commodity foods in lieu of cash, the Area Agency will notify the County in writing of its community valuation upon notification from the Division of Aging and Adult Services. The delivery of commodity and bonus foods is subject to availability. The County will not receive cash entitlement in lieu of commodities that are unavailable or undelivered during the Agreement period. 7. Reallocation of Funds and Budget Revisions. Any reallocation of Block Grant funding between counties shall be voluntary on the part of the County and shall be effective only for the period of the Agreement. The reallocation of Block Grant funds between counties will not affect the allocation of future funding to the County. If during the performance period of the Agreement, the Area Agency determines that a portion of the Block Grant will not be expended, the grant administrator for the County shall be notified in writing by the Area Agency and given the opportunity to make funds available for reallocation to other counties in the Planning and Service Area or elsewhere in the state. 3 (revised 6/13) See Paragraph 8; 'Monitoring The County may authorize community service providers to implement budget revisions which do not cause the County to fall below minimum budgeting requirements for access, in -home, congregate, and home delivered meals services, as specified in Division of Aging and Adult Services budget instructions issued to the County. If a budget revision will cause the County to fall below minimum budgeting requirements for any of the aforementioned services, as specified in Division of Aging and Adult Services budgeting instructions issued to the County, the grants administrator for the County shall obtain written approval for the revision from the Area Agency prior to implementation by the community service provider, so as to assure that regional minimum budgeting requirements for the aforementioned services will be met. Unless community services providers have been given the capacity to enter data into the Aging Resources Management System (ARMS), Area Agencies on Aging are responsible for entering amended service data into the Division of Aging Management Information System, as specified in the N.C. Division of Aging and Adult Services Home and Community Care Block Grant Procedures Manual for Community Service Providers, revised February 17, 1997. 8. Monitoring. This Agreement will be monitored to assure that services are being provided as stated in the Division of Aging and Adult Service monitoring Policies and Procedures at hllp:l/www.ncdhhs.jzov/aging/monitor/Mpoligy.htm. The monitoring of services provided under this Agreement shall be- carried out by the Area Agency on Aging in accordance with its Assessment Plan and as specified in Administrative Letter 12 -08 located at http://ncdhbs.gov/aging/admltrs/2012/DAAS-12-08.pd . As of July 1, 2012, DAAS Program Compliance Representatives (PCRs) are no longer monitoring HCCBG services provided through county departments of social services. Counties and community service providers will receive a written report of monitoring findings in accordance with procedures established in Section 308 of the AAA Policies and Procedures Manual (7/1/03 and revised 10/1109). Any areas of non - compliance will be addressed in a written corrective action plan with the community service provider. 9. Disputes and Appeals. Any dispute concerning a question of fact arising under this Agreement shall be identified to the designated grants administrator for the Area Agency. In accordance with Lead Regional Organization (LRO) policy, a written decision shall be promptly furnished to the designated grants administrator for the County. The decision of the LRO is final unless within twenty (20) days of receipt of such decision the Chairman of the Board of Commissioners furnishes a written request for appeal to the Director of the North Carolina Division of Aging and Adult Services, with a copy sent to the Area Agency. The request for appeal shall state the exact nature of the complaint. The Division of Aging and Adult Services will inform the Chairman of the Board of Commissioners of its 4 KIYAWAR (revised 6113) See Paragraph 8; Monitoring appeal procedures and will inform the Area Agency that an appeal has been filed. Procedures thereafter will be determined by the appeals process of the Division of Aging and Adult Services. The state agency address is as follows: Director North Carolina Division of Aging and Adult Services 2101 Mail Service Center 693 Palmer Drive Raleigh, North Carolina 27699 -2101 10. Termination for Cause. If through any cause, the County shall fail to fulfill in a timely and proper manner its obligations under this Agreement, or the County has or shall violate any of the covenants, agreements, representations or stipulations of this Agreement, the Area Agency shall have the right to terminate this Agreement by giving the Chairman of the Board of Commissioners written notice of such termination no fewer than fifteen (15) days prior to the effective date of termination. In such event, all finished documents and other materials collected or produced under this Agreement shall at the option of the Area Agency, become its property. The County shall be entitled to receive just and equitable compensation for any work satisfactorily performed under this Agreement. 11. Audit. The County agrees to have an annual independent audit in accordance with North Carolina General Statutes, North Carolina Local Government Commission requirements, Division of Aging and Adult Services Program Audit Guide for Aging Services and Federal Office of Budget and Management (OMB) Circular A -133. Community service providers, as specified in paragraph one (1), who are not units of local government or otherwise subject to the audit and other reporting requirements of the Local Government Commission are subject to audit and fiscal reporting requirements, as stated in NC General Statute 143C -6 -22 and 23 and OMB Circular A -133, where applicable. Applicable community service providers must send a copy of their yearend financial statements, and any required audit, to the Area Agency on Aging. Home and Community Care Block Grant providers are not required to submit Activities and Accomplishments Reports. For - profit corporations are not subject to the requirements of OMB Circular A -133, but are subject to NC General Statute 143C -6 -22 and 23 and Yellow Book audit requirements, where applicable. Federal funds may not be used to pay for a Single or Yellow Book audit unless it a federal requirement. State funds will not be used to pay for a Single or Yellow Book audit if the provider receives less than $500,000 in state funds. The Department of Health and Human Services will provide confirmation of federal and state expenditures at the close of the state fiscal year. Information on audit and fiscal reporting requirements can be found at hMia.L//www.negrants.gov/NCGrants/PublicReportsRegWations.isp. 5 DOA -'735 (revised 6113) See Paragraph 8; Monitoring The following provides a summary of reporting requirements under NCGS 143 C-6 -22 and 23 and OMB Circular A -133 based upon funding received and expended during the service provider's fiscal year. Annual Expenditures Report Required to AAA Allowable Cost for Reporting Less than $25,000 in Certification form and State NIA State or Federal funds Grants Compliance Re- porting x$25,000 (item # 11, Activities and Accomplishments does not have to be completed) OR Audited Financial Statements in Compliance with GAO /GAS (i.e. Yellow Book) Greater than $25,000 Certification form and Schedule of and less that $500,000 Grantee Receipts >$25,000 and in State or Federal Funds Schedule of Receipts and Expendi- tures $500,00+ in State funds and Federal pass through in an amount less than $500,000 $500,000+ in State funds and $500,000+ in Federal pass through funds (i.e. at least $1,000,000) Less than $500,000 in State funds and $500,000+ in Federal pass through funds OR Audited Financial Statements in Compliance with GAO /GAS (i.e. Yellow Book) Audited Financial Statement in compliance with GAO /GAS (i.e. Yellow Book) Audited Financial Statement in compliance with OMB Circular A -133 (i.e. Single Audit) Audited Financial Statement in compliance with OMB Circular A -133 (i.e. Single Audit) G N/A May use State funds, but not Federal Funds May use State and Federal funds May use Federal funds, but not State funds. DOA -735 (revised 6113) See Paragraph 8; Monitoring 12. Audit/Assessment Resolutions and Disallowed Cost. It is further understood that the community service providers are responsible to the Area Agency for clarifying any audit exceptions that may arise from any Area Agency assessment, county or community service provider single or financial audit, or audits conducted by the State or Federal Governments. In the event that the Area Agency or the Department of Health and Human Services disallows any expenditure made by the community service provider for any reason, the County shall promptly repay such funds to the Area Agency once any final appeal is exhausted in accordance with paragraph nine (9). The only exceptions are if the Area Agency on Aging is designated as a community service provider through the County Funding Plan or, if as a part of a procurement process, the Area Agency on Aging enters into a contractual agreement for service provision with a provider which is in addition to the required County Funding Plan formats. In these exceptions, the Area Agency is responsible for any disallowed costs. The County or Area Agency on Aging can recoup any required payback from the community service provider in the event that payback is due to a community service provider's failure to meet OMB Circular A- 122-requirements, requirements ofA -110, requirements of 45CFR, Part 1321, and 45CFR, Part 92, or state eligibility requirements as specified in policy. 13. Indemnity. The County agrees to indemnify and save harmless the Area Agency, its agents, and employees from and against and all loss, cost, damages, expenses, and liability arising out of performance under this Agreement to the extent of errors or omissions of the County. 14. Equal Employment Opporturifty and Americans With Disabilities Act Compliance. iance. Both the County and community service providers, as identified in paragraph one (1), shall comply with all federal and state laws relating to equal employment opportunity and accommodation for disability. 15. Data to be Furnished to the_Com1y. All information which is existing, readily available to the Area Agency without cost and reasonably necessary, as determined by the Area Agency's staff, for the performance of this Agreement by the County shall be furnished to the County and community service providers without charge by the Area Agency. The Area Agency, its agents and employees, shall fully cooperate, with the County in the performance of the County's duties under this Agreement. 16. Rights in Documents Materials and Data Produced. The County and community service providers agree that at the discretion of the Area Agency, all reports and other data prepared by or for it under the terms of this Agreement shall be delivered to, become and remain, the property of the Area Agency upon termination or completion of the work. Both the Area Agency and the County shall have the right to use same without restriction or limitation and without compensation to the other. For the purposes of this Agreement, "data" includes 7 DOA -735 (revised 6113) See Paragraph 8; Monitoring writings, sound recordings, or other graphic representations, and works of similar nature. No reports or other documents produced in whole or in part under this Agreement shall be the subject of an application for copyright by or on behalf of the County. 17. Interest of the Board of Commissioners. The Board of Commissioners covenants that neither the Board of Commissioners nor its agents or employees presently has an interest, nor shall acquire an interest, direct or indirect, which conflicts in any manner or degree with the performance of its service hereunder, or which would prevent, or tend to prevent, the satisfactory performance of the service hereunder in an impartial and unbiased manner. 18. Interest of Members of the Area Agency, Lead Regional Organization, and Others. No officer, member or employee of the Area Agency or Lead Regional Organization, and no public official of any local government which is affected in any way by the Project, who exercises any function or responsibilities in the review or approval of the Project or any component part thereof, shall participate in any decisions relating to this Agreement which affects his personal interest or the interest of any corporation, partnership or association in which he is, directly or indirectly, interested; nor shall any such persons have any interest, direct or indirect, in this Agreement or the proceeds arising there from. 19. Officials not to Benefit. No member of or delegate to the Congress of the United States of America, resident Commissioner or employee of the United States Government, shall be entitled to any share or part of this Agreement or any benefits to arise here from. 20. Prohibition Against Use of Funds to Influence Legislation. No part of any funds under this Agreement shall be used to pay the salary or expenses of any employee or agent acting on behalf of the County to engage in any activity designed to influence legislation or appropriations pending before Congress. 8 DOA -735 (revised 6113) See Paragraph S; Monitoring 21. Applicable Law. This Agreement is executed and is to be performed in the State of North Carolina, and all questions of interpretation and construction shall be construed by the laws of such State. In witness whereof, the Area Agency and the County have executed this Agreement as of the day first written above. New Hanover Coun Attest: Area Agency By: lirea Agency Diecto Executive Dire Lead Regional Provision for payment of the monies to fall due under this Agreement within the current fiscal year have been made by appropriation duly authorized as required by the Local Government Budget and Fiscal Control Act. BY: C. ANCE OFFICER, Lead Regional Organization DOA -730 (Rev. 2112) Home and Community Care Block Grant for Older Adults County Funding Plan Identification of Agency or Office with Lead Responsibility for County Funding Plan County New Hanover (NHC) July 1, 2013 through June 30, 2014 The agency or office with lead responsibility for planning and coordinating the County Funding Plan recommends this funding plan to the Board of Commissioners as a coordinated means to utilize community -based resources in the delivery of comprehensive aging services to older adults and their families. NHC Senior Resource Center (NHC -SRC) (Name of agency /office with lead responsibility 0 Authorized signature Brenda "Ben" Brow. NHC- RC Manager (Type name and title of signatory agent) DOA -730 (Rev. 2112) Home and Community Care Block Grant for Older Adults County Funding Plan Identification of Agency or Office with Lead Responsibility for County Funding Plan County New Hanover HC July 1, 2013 through June 30, 2014 The agency or office with lead responsibility for planning and coordinating the County Funding Plan recommends this funding plan to the Board of Commissioners as a coordinated means to utilize community -based resources in the delivery of comprehensive aging services to older adults and their families. NHC Senior Resource Center HC -SRC (Name of agency /office with lead responsibility Vj, � 115113 Authorized signature (date) Ayril Pinder. NHCAssistant County Manager (Type name and title of signatory agent) O LM O O N M N O r n cn cn O N 0 r- ^o d" m x ate a M M N x c c n O Ln a ! 3 €� m m m m 4R m a 2 N Cr Rr co v co dl 0 7. h ul � b M ~ x in 0. 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L-. •G (� M 41 Iv C_ ~ 'O H= U N C o y� �F t L r d -, Or O wME c@ t ❑ -I- F^ m a a1= q rn° N v O N❑ C) ° O j a N �U N 7 tdfl L: ay°yi L: N E •C m O) r � p C C O� CAS V C N V1 Z N r+ G O Z 0 y ,0 � E _ 7 M E 3 M E 7 M E E E E O O$ Q 7� 6 o rn O w°0 49 X� C a+ N H � E 0 040) C @� O : (D N O m 0 C CL E E � w o ° N ' ' jS N 0 O O G N > .O N M [O V �7 Q 0 c w LL H •= C .0 C❑ co _ Cq cc Go oo 68, UD rq cc Cq ON CN 00 CN cn cn C ow _ DOA -733 (Rev. 2113) Home and Community Care Block Grant for Older Adults County Funding Plan July 1, 2013 through June 30, 2014 Methodology to Address Service Needs of Low Income (Including Low - Income Minority Elderly), Rural Elderly and Elderly with Limited English Proficiency (Older Americans Act, Section 305(a)(2)(E)) Community Service Provider NHC. Senior Resource Center County New Hanover The Older Americans Act requires that the service provider attempt to provide services to low- income minority individuals in accordance to their need for aging services. The community service provider shall specify how the service needs of low income, low - income (including low income minority elderly), rural elderly and elderly with limited English proficicncy will be met through the services identified on the Provider Services Summary (DOA -732). This narrative shall address outreach and service delivery methodologies that will ensure that this target population is adequately served and conforms with specific objectives established by the Area Agency on Aging, for providing services to low income minority individuals. Additional pages may be used as necessary. Though New Hanover County is second smallest in area (328 Sq. miles) in the State, it is one of the most populous as its county seat, Wilmington, is one of the state's largest cities. At the 2010 census, the population was 202,667, an increase of 26.4 percent from 160,367 at the 2000 census. The population density equates to approximately 1,058 per square mile and approximately 14.2% over the age of 65 years. According to the 2010 census 159% live below the poverty level. The NHC Senior Resource Center (NHC -SRC) has developed a case assistance program (Life Enrichment Program) committed to identifying all the needs of the individuals that come in contact with our staff and volunteers. We are increasing awareness to the total needs and utilizing Social Workers to evaluate and assist in accessing services provided by the SRC and those available in the community, other agencies, and other resources. Addressing communication, physical, and financial barriers allows seniors to remain involved in the community and to remain in their homes as long as it is safe for them to do so. The Center is increasing the use of sites (churches, senior housing, etc.) in low income and rural communities for presentation and educational events for all outreach programs. Transportation assistance is also publicized for these events when funding is available. The Center is also a site for early voting and primary elections with access to candidate forums and transportation as available for many on -site events. Our website is being re- designed to be more senior friendly and promote the many services offered at the SRC. There is also a powerful effort to remove the stigma often associated with applying for assistance. The SRC has a Case Worker located at the building entrance who is dedicated to providing service or triage to the appropriate individual to provide assistance. A kiosk for E -Pass has been installed in the SRC lobby for senior access and hands -on assistance (if needed) from a case worker to make the use of the system less frustrating and still private. M DOA -734 (revised 2113) July 1, 2013 through June 30, 2014 Home and Community Care Block Grant for Older Adults Community Service Provider Standard Assurances New Hanover County Senior Resource Center agrees to provide services through the (Name of Provider) Home and Community Care Block Grant, as specified on the Provider Services Summary (DOA -732) in accordance with the following: Services shall be provided in accordance with requirements set forth in: a) The County Funding Plan; b) The Division of Aging Home and Community Care Block Grant Procedures Manual for Community Service Providers; and C) The Division of Aging Services Standards Manual, Volumes I through IV or http://www.nedhhs.gov/agin /monitor/inpolicy.htm Community service providers shall monitor any contracts with providers of Block Grant services and take appropriate measures to ensure that services are provided in accordance with the aforementioned documents. 2. Priority shall be given to providing services to those older persons with the greatest economic or social needs. The service needs of low- income minority elderly will be addressed in the manner specified on the Methodology to Address Service Needs of Low - Income (Including Low Income Minority Elderly), Rural elderly and Elderly with limited En lish Proficient format, (DOA -733). 3. The following service authorization activities will be carried out in conjunction with all services provided through the Block Grant: a) Eligibility determination; b) Client intake /registration; c) Client assessment /reassessments and quarterly visits, as appropriate; d) Determining the amount of services to be received by the client; and e) Reviewing cost sharing /voluntary contributions policies with eligible clients. DOA -734 (Revised 2112) 4. All licenses, permits, bonds, and insurance necessary for carrying out Block Grant Services will be maintained by the community service provider and any contracted providers. 5. As specified in 45 CFR 92.36(b)(11), community service providers shall have procedures for settling all contractual and administrative issues arising out of procurement of services through the Block Grant. Community service providers shall have procedures governing the evaluation of bids for services and procedures through which bidders and contracted providers may appeal or dispute a decision made by the community service provider. 6. Applicant /Client appeals shall be addressed as specified in Section 7 of the Division of Aging Home and Community Care Block Grant Manual for Community Service Providers, dated February 17, 1997. 7. Community service providers are responsible for providing or arranging for the provision of required local match, as specified on the Provider Services Summary, (DOA -732). Local match shall be expended simultaneously with Block Grant funding. 8. Providers expending $500,000 or more in federal financial assistance through the Home and Community Care Block Grant or in combination with other federal funding shall receive an annual independent audit which meets the requirements of the Division of Aging Program Audit Guide for Aging Services, applicable North Carolina. General Statutes and Local Government Commission requirements, and OMB Circular A -133. For -profit community service providers shall have an annual compliance audit which meets the requirements of A -133. The audit shall be performed within nine (9) months of the close of the provider's fiscal year. Upon completion of the audit, non -profit and for -profit providers shall provide a copy of the audit report and any opinion letter simultaneously to the County and the Area Agency. Federal funds will not reimburse the cost of a single audit if the total of all federal funds expended by the provider is less than $500,000. (Refer to New Audit Requirements section at htT: / /www.nedhhs. .uov /aging /monitor /mRolicy.htm ). 9. Compliance with Equal Employment Opportunity and Americans with Disabilities Act requirements, as specified in paragraph fourteen (14) of the Agreement for the Provision of County Aging -Based Services (DOA -735) shall be maintained. 10. Providers In -Home Aide, Home Health, Housing and Home Improvement, and Adult Day Care or Adult Day Health Care shall sign and return the attached assurance to the area agency on aging indicating that recipients of these services have been informed of their client rights, as required in Section 314 of the 2006 Amendments to the Older Americans Act. DOA -734 (revised 2113) DOA -734 (revised 2113) Signature) Standard Assurance To Comply with Older Americans Act Requirements Regarding Clients Rights For Agencies • • ing In-Home Services through e Home and Community Care Block for Older Adults As a provider of one or more of the services listed below, our agency agrees to notify all Home and Community Care Block Grant clients receiving any of the below listed services provided by this agency of their rights as a service recipient. Services in this assurance include: In -Home Aide • Home Care (home health) • Housing and Home Improvement • Adult Day Care or Adult Day Health Care Notification will include, at a minimum, an oral review of the information outlined below as well as providing each service recipient with a copy of the information in written form. In addition, providers of in -home services will establish a procedure to document that client rights information has been discussed with in -home services clients (e.g. copy of signed Client Bill of Rights statement). Clients Rights information to be communicated to service recipients will include, at a minimum, the right to: be fully informed, in advance, about each in -home service to be provided and any change and any change in service(s) that may affect the wellbeing of the participant; participate in planning and changing any in -home service provided unless the client is adjudicated incompetent; voice a grievance with respect to service that is or fails to be provided, without discrimination or reprisal as a result of voicing a grievance; 0 confidentiality of records relating to the individual; have property treated with respect; and Q be fully informed both orally and in writing, in advance of receiving an in -home service, of the individual's rights and obligations. Client Rights will be distributed to, and discussed with, each new client receiving one or more of the above listed services prior to the onset of service. For all existing clients, the above information will be provided no later than the next regularly scheduled service reassessment. Agency Name: AJ H C 1S.rn�:Rd-S UkCe CZCAW Name of Agency Administrator: Sig Date: R1 i c (Please return this form to your Area Agency on Aging and retain a copy for your files.) Standard Assurance To Comply with Older Americans Act Requirements Regarding Clients Rights For Agencies Providing In -Home Services through the Home and Community Care Block Grant for Older Adults As a provider of one or more of the services listed below, our agency agrees to notify all Home and Community Care Block Grant clients receiving any of the below listed services provided by this agency of their rights as a service recipient. Services in this assurance include: • In -Home Aide Home Care (home health) Housing and Home Improvement Adult Day Care or Adult Day Health Care Notification will include, at a minimum, an oral review of the information outlined below as well as providing each service recipient with a copy of the information in written form. In addition, providers of in -home services will establish a procedure to document that client rights information has been discussed with in -home services clients (e.g. copy of signed Client Bill of Rights statement). Clients Rights information to be communicated to service recipients will include, at a minimum, the right to: be fully informed, in advance, about each in -home service to be provided and any change and any change in service(s) that may affect the wellbeing of the participant; • participate in planning and changing any in -home service provided unless the client is adjudicated incompetent; voice a grievance with respect to service that is or fails to be provided, without discrimination or reprisal as a result of voicing a grievance; confidentiality of records relating to the individual; have property treated with respect; and be fully informed both orally and in writing, in advance of receiving an in -home service, of the individual's rights and obligations. Client Rights will be distributed to, and discussed with, each new client receiving one or more of the above listed services prior to the onset of service. For all existing clients, the above information will be provided no later than the next regularly scheduled service reassessment. Agency Name: Name of Agency Administrator: 6 ko AjUA Signature, 8-114113 (Please return this form to your Area Agency on Aging and retain a copy for your files.) CLIENT /PATIENT RIGHTS 1: You have the right to be fully informed of all your rights and responsibilities as a client/patient of the program. 2. You have the right to appropriate and professional care relating to your needs. 3. You have the right to be fully informed in advance about the care to be provided by the program. 4. You have the right to be fully informed in advance of any changes in the care that you may be receiving and to give informed consent to the provision of the amended care. 5. You have the right to participate in determining the care that you will receive and in altering the nature of the care as your needs change. 6. You have the right to voice you grievances with respect to care that is provided and to expect that there will be no reprisal for the grievance expressed. 7. You have the right to expect that the information you share with the agency will be respected and held in strict confidence, to be shared only with your written consent and as it relates to the obtaining of other needed community services. 8. You have the right to expect the preservation of your privacy and respect for your property. 9. You have the right to receive a timely response to you request for service. 10. You shall be admitted for service only if the agency has the ability to provide safe and professional care at the level of intensity needed. 11. You have the right to be informed of agency policies, changes, and costs for services. 12. If you are denied service solely on you inability to pay, you have the right to be referred elsewhere. 13. You have the right to honest, accurate information regarding the industry, agency and of the program in particular. 14. You have the right to be fully informed about other services provided by this agency. Ln tl- ko ks 14 C% %o OK cq co 'y c-I 5:4 cn Go In %0 c3 (D c. c� c;3 Cj cn �D ca: r4 cn C. C) cD oo tn tr t— C> ci co ca r3 0 > CL 9 ow in. 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A4 U a4. 0 E ipgx4m� 0 -MM� > AL4 an DOA -733 (Rev. 2/13) Home and Community Care Block Grant for Older Adults County Funding Plan July 1, 2013 through June 30, 2014 Methodology to Address Service Needs of Low Income (Including Low - Income Minority Elderly), Rural Elderly and Elderly with Limited English Proficiency (Older Americans Act, Section 305(a)(2)(E)) Community Service Provider Elderhaus, Inc. County New Hanover The Older Americans Act requires that the service provider attempt to provide services to low - income minority individuals in accordance to their need for aging services. The community service provider shall specify how the service needs of low income, low - income (including low income minority elderly), rural elderly and elderly with limited English proficiency will be met through the services identified on the Provider Services Summary (DOA -732). This narrative shall address outreach and service delivery methodologies that will ensure that this target population is adequately served and conform with specific objectives established by the Area Agency on Aging, for providing services to low income minority individuals. Additional pages may be used as necessary. Elderhaus, Inc. will make every attempt to locate and provide services for low income, minority elderly, rural elderly and elderly with limited English proficiency by utilizing the following methods: We advertise our services in the Wilmington Journal, a weekly minority -owned paper that is distributed in the African - American community. We place brochures in the various Clinics in the region including the New Hanover Community Health Center and the Tileston Clinic. We place brochures in the various churches in New Hanover, Pender and Brunswick counties. We use the city /county access channels to share information about our program. DOA -734 (revised 2/13) July 1, 2013 through June 30, 2014 Home and Community Care Block Grant for Older Adults Elderhaus, Inc. (Name of Provider) Community Care Block Grant, as specified on the Provider Services Summa (DOA -732) in accordance with the following: Community Service Provider Standard Assurances agrees to provide services through the Home and Services shall be provided in accordance with requirements set forth in: a) The County Funding Plan; b) The Division of Aging Home and Community Care Block Grant Procedures Manual for Community Service Providers; and c) The Division of Aging Services Standards Manual, Volumes I through IV or at httl2://www.ncdhhs.gov/agingLmonitor/mpolia.htm. Community service providers shall monitor any contracts with providers of Block Grant services and take appropriate measures to ensure that services are provided in accordance with the aforementioned documents. 2. Priority shall be given to providing services to those older persons with the greatest economic or social needs. The service needs of low- income minority elderly will be addressed in the manner specified on the Methodology to Address Service Needs of Low - Income (Including Low Income Minority ElderW. Rural elderly and Elderly with limited English Proficient format, (DOA -733). a 4. The following service authorization activities will be carried out in conjunction with 1 services provided through the Block Grant: a) Eligibility determination; b) Client intake /registration; c) Client assessment/reassessments and quarterly visits, as appropriate; d) Determining the amount of services to be received by the client; and e) Reviewing cost sharing/voluntary contributions policies with eligible clients. All licenses, permits, bonds, and insurance necessary for carrying out Block Grant Services will be maintained by the community service provider and any contracted providers. DOA -734 (Revised 2112) As specified in 45 CFR 92.36(b)(11), community service providers shall have procedures for settling all contractual and administrative issues arising out of procurement of services through the BIock Grant. Community service providers shall have procedures governing the evaluation of bids for services and procedures through which bidders and contracted providers may appeal or dispute a decision made by the community service provider. 6. Applicant/CIient appeals shall be addressed as specified in Section 7 of the Division of Aging Home and Community Care Block Grant Manual for Community Service Providers, dated February 17, 1997. 7. Community service providers are responsible for providing or arranging for the provision of required local match, as specified on the Provider Services Summ , (DOA -732). Local match shall be expended simultaneously with Block Grant funding. 8. Providers expending $500,000 or more in federal financial assistance through the Home and Community Care Block Grant or in combination with other federal funding shall receive an annual independent audit which meets the requirements of the Division of Aging Program Audit Guide for Aging Services, applicable North Carolina General Statutes and Local Government Commission requirements, and OMB Circular A -133. For -profit community service providers shall have an annual compliance audit which meets the requirements of A -133. The audit shall be performed within nine (9) months of the close of the provider's fiscal year. Upon completion of the audit, non- profit and for -profit providers shall provide a copy of the audit report and any opinion letter simultaneously to the County and the Area Agency. Federal funds will not reimburse the cost of a single audit if the total of all federal funds expended by the provider is less than $500,000. (Refer to New Audit Requirements section at http://www.ncdhhs.gov/aging/monitor/mpolia.htm ). 9. Compliance with Equal Employment Opportunity and Americans with Disabilities Act requirements, as specified in paragraph fourteen (14) of the Agreement for the Provision of CogM Aging-Based Services (DOA -735) shall be maintained. 10. Providers In -Home Aide, Home Health, Housing and Home Improvement, and Adult Day Care or Adult Day Health Care shall sign and return the attached assurance to the area agency on aging indicating that recipients of these services have been informed of their client rights, as required in Section 314 of the 2006 Amendments to the Older Americans Act. ignature) (Date) /3 Standard Assurance To Comply with Older Americans Act Requirements Regarding Clients Rights For Agencies Providing In -Home Services through the Home and Community Care Block Grant for Older Adults As a provider of one or more of the services listed below, our agency agrees to notify all Home and Community Care Block Grant clients receiving any of the below listed services provided by this agency of their rights as a service recipient. Services in this assurance include: • In -Home Aide • Home Care (home health) • Housing and Home Improvement o Adult Day Care or Adult Day Health Care Notification will include, at a minimum, an oral review of the information outlined below as well as providing each service recipient with a copy of the information in written form. In addition, providers of in -home services will establish a procedure to document that client rights information has been discussed with in -home services clients (e.g. copy of signed Client Bill of Rights statement). Clients Rights information to be communicated to service recipients will include, at a minimum, the right to: • be fully informed, in advance, about each in -home service to be provided and any change and any change in service(s) that may affect the wellbeing of the participant; • participate in planning and changing any in -home service provided unless the client is adjudicated incompetent; • voice a grievance with respect to service that is or fails to be provided, without discrimination or reprisal as a result of voicing a grievance; confidentiality of records relating to the individual; ® have property treated with respect; and • be fully informed both orally and in writing, in advance of receiving an in -home service, of the individual's rights and obligations. Client Rights will be distributed to, and discussed with, each new client receiving one or more of the above listed services prior to the onset of service. For all existing clients, the above information will be provided no later than the next regularly scheduled service reassessment. Agency Name: E I der kaKs n L• Name of Ag erpy A ministr or: --�' Pe- c, c C 6 Si 9 nature: I �` Date: In CLIENT/PATIENT RIGHTS 1. You have the right to be fully informed of all your rights and responsibilities as a client/patient of the program. 2. You have the right to appropriate and professional care relating to your needs. 3. You have the right to be fully informed in advance about the care to be provided by the program. 4. You have the right to be fully informed in advance of any changes in the care that you may be receiving and to give informed consent to the provision of the amended care. 5. You have the right to participate in determining the care that you will receive and in altering the nature of the care as your needs change. 6. You have the right to voice you grievances with respect to care that is provided and to expect that there will be no reprisal for the grievance expressed. 7. You have the right to expect that the information you share with the agency will be respected and held in strict confidence, to be shared only with your written consent and as it relates to the obtaining of other needed community services. 8. You have the right to expect the preservation of your privacy and respect for your property. 9. You have the right to receive a timely response to you request for service. 10. You shall be admitted for service only if the agency has the ability to provide safe and professional care at the level of intensity needed. 11. You have the right to be informed of agency policies, changes, and costs for services. 12. If you are denied service solely on you inability to pay, you have the right to be referred elsewhere. 13. 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County: New Hanover The Older Americans Act requires that the service provider attempt to provide services to low- income minority individuals in accordance to their need for aging services. The community service provider shall specify how the service needs of low income, low - income (including low income minority elderly), rural elderly and elderly with limited English proficiency will be met through the services identified on the Provider Services Summary (DOA -732). This narrative shall address outreach and service delivery methodologies that will ensure that this target population is adequately served and conform with specific objectives established by the Area Agency on Aging, for providing services to low income minority individuals. Additional pages may be used as necessary. Interim Healthcare shall provide In Home Aide services (Level III and III) to qualified consumers New Hanover County as outlined in the Home and Community Care Block Grant for Older Adults manual. Those determined to be in need of In Home Aide services will be eligible for services regardless of their income although some recipients will be asked to voluntarily participate in the consumer contributions program. Interim HealthCare, as the provider agency, will admit low- income, minority consumers, and rural elderly consumers taking into account the following priorities: * Older adults for whom the need for Adult Protective Services has been substantiated by the Department of Social Services and the service is needed as part of the adult protective service plan. * Older adults who are at risk of abuse, neglect, and/or exploitation. * Older adults with extensive impairments in activities of daily living (ADL's), or instrumental activities of daily living (IADL's), who are at risk of placement or substitute care. * Older adults with extensive ADL or IADL impairments. * Well, older adults. DOA -734 (revised 2113) July 1, 2013 through June 30, 2014 Home and Community Care Block Grant for Older Adults Community Service Provider Standard Assurances Interim HealthCare of the Eastern Carolinas, Inc. agrees to provide services through the Home and Community Care Block Grant, as specified on the Provider Services Summary (DOA - 732) in accordance with the following: Services shall be provided in accordance with requirements set forth in: a) The County Funding Plan; b) The Division of Aging Home and Community Care Block Grant Procedures Manual for Community Service Providers; and c) The Division of Aging Services Standards Manual, Volumes I through IV or at http://www.ncdhbs.gov/aging/monitoL/mpoligy.httn. Community service providers shall monitor any contracts with providers of Block Grant services and take appropriate measures to ensure that services are provided in accordance with the aforementioned documents. 2. Priority shall be given to providing services to those older persons with the greatest economic or social needs. The service needs of low- income minority elderly will be addressed in the manner specified on the Methodology to Address Service Needs of Low - Income (Including Low Income Minority Elderly), Rural elderly and Elderly with limited English Proficiency format, (DOA -733). 3. The following service authorization activities will be carried out in conjunction with all services provided through the Block Grant: a) Eligibility determination; b) Client intake /registration; c) Client assessment/reasscssments and quarterly visits, as appropriate; d) Determining the amount of services to be received by the client; and e) Reviewing cost sharing/voluntary contributions policies with eligible clients. 4. All licenses, permits, bonds, and insurance necessary for carrying out Block Grant Services will be maintained by the community service provider and any contracted providers. DOA -734 (Revised 2112) 5. As specified in 45 CFR 92.36(b)(11), community service providers shall have procedures for settling all 'contractual and administrative issues arising out of procurement of services through the Block Grant. Community service providers shall have procedures governing the evaluation of bids for services and procedures through which bidders and contracted providers may appeal or dispute a decision made by the community service provider. 6. Applicant/Client appeals shall be addressed as specified in Section 7 of the Division of Aging Home and Community Care Block Grant Manual for Community Service Providers, dated February 17, 1997. 7. Community service providers are responsible for providing or arranging for the provision of required local match, as specified on the Provider Services Summary, (DOA -732). Local match shall be expended simultaneously with Block Grant funding. 8. Providers expending $500,000 or more in federal financial assistance through the Home and Community Care Block Grant or in combination with other federal funding shall receive an annual independent audit which meets the requirements of the Division of Aging Program Audit Guide for Aging Services, applicable North Carolina General Statutes and Local Government Commission requirements, and OMB Circular A -133. For -profit community service providers shall have an annual compliance audit which meets the requirements of A -133. The audit shall be performed within nine (9) months of the close of the provider's fiscal year. Upon completion of the audit, non- profit and for -profit providers shall provide a copy of the audit report and any opinion letter simultaneously to the County and the Area Agency. Federal funds will not reimburse the cost of a single audit if the total of all federal funds expended by the provider is less than $500,000. (Refer to New Audit Requirements section at h!W://www.ncdhhs.gov/aging/mopiigr/mpolicy.htm). 9. Compliance with Equal Employment Opportunity and Americans with Disabilities Act requirements, as specified in paragraph fourteen (14) of the Agreement for the Provision of Co= Aging-Based Services (DOA -735) shall be maintained. 10. Providers In -Home Aide, Home Health, Housing and Home Improvement, and Adult Day Care or Adult Day Health Care shall sign and return the attached assurance to the area agency on aging indicating that recipients of these services have been informed of their client rights, as required in Section 314 of the 2006 Amendments to the Older Americans Act. Standard Assurance To Comply with Older Americans Act Requirements Regarding Clients Rights For Agencies Providing In -Home Services through the Home and Community Care Block Grant for Older Adults As a provider of one or more of the services listed below, our agency agrees to notify all Home and Community Care Block Grant clients receiving any of the below listed services provided by this agency of their rights as a service recipient. Services in this assurance include: • In -Home Aide • Home Care (home health) • Housing and Home Improvement • Adult Day Care or Adult Day Health Care Notification will include, at a minimum, an oral review of the information outlined below as well as providing each service recipient with a copy of the information in written form. In addition, providers of in -home services will establish a procedure to document that client rights information has been discussed with in -home services clients (e.g. copy of signed Client Bill of Rights statement). Clients Rights information to be communicated to service recipients will include, at a minimum, the right to: • be. fully informed, in advance, about each in -home service to be provided and any change and any change in service(s) that may affect the wellbeing of the participant; • participate in planning and changing any in -home service provided Unless the client is adjudicated incompetent; • voice a grievance with respect to service that is or fails to be provided, without discrimination or reprisal as a result of voicing a grievance;. • confidentiality of records relating to the individual; • have property treated with respect; and • be fully informed both orally and in writing, in advance of receiving an in -home service, of the individual's rights and obligations. Client Rights will be distributed to, and discussed with, each new client receiving one or more of the above listed services prior to the onset of service. For all existing clients, the above information will be provided no later than the next regularly scheduled service reassessment. Agency Name: i'� eri m Healthtare 6f th6'Eastern Carolinas, Inc Name of Agency Administrator: Donna L. Byrd Signature Date: (Please return this form to your Area Agency on Aging and retain a copy for your files.) CLIENT /PATIENT RIGHTS 1. You have the right to be fully informed of all your rights and responsibilities as a client/patient of the program. 2. You have the right to appropriate and professional care relating to your needs. 3. You have the right to be fully informed in advance about the care to be provided by the program. 4. You have the right to be fully informed in advance of any changes in the care that you may be receiving and to give informed consent to the provision of the amended care. 5. You have the right to participate in determining the care that you will receive and in altering the nature of the care as your needs change. 6. You have the right to voice you' grievances with respect to care that is provided and to expect that there will be no reprisal for the grievance expressed. 7. You have the right to expect that the information you share with the agency will be respected and held in strict confidence, to be shared only with your written consent and as it relates to the obtaining of other needed community services. 8. You have the right to expect the preservation of your privacy and respect for your property. 9. You have the right to receive a timely response to you request for service. 1 o. You shall be admitted for service only if the agency has the ability to provide safe and professional care at the level of intensity needed. 11. You haye,the right to be informed, o #.agency policies, changes, and costs for services. 12. If you are denied service solely on you inability to pay, you have the right to be referred elsewhere. 13. You have the right to honest, -accurate information regarding the industry, agency and of the program in particular. 14. You have the right to be fully informed about other services provided by this agency.