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HomeMy WebLinkAboutFY16 HCCBG FUNDING DOCUMENTSHome and Community Care Block Grant (HCCBG) Check List (BSRI, Columbus County DOA, New Hanover County SRC, Pender Aduft Services, Inc.) o' Budget Worksheet from HCCBG Meeting signed by Provider Agency (can be obtained from AAA and must be submitted to AAA with form below) Thefollowingforms are required hy AAA hefore Couno� Grant Agreements can be sent to the Coun�v Manager. ffll�� (check for appropriate signatures and date) o/ DAAS 732 (check for appropriate signatures and date) Or'DAAS 732A (check for your approximate unit rate on last page) DA AS 732A1 cj DAAS Standard Assurance & In Home Clients' Rights All of the to forms, with the exception of the Budget Worksheet, can be obtained through the NC Division of Aging and Adult Services website at h!!V:/AvwNv.ncq.� �sov�/ain �/cob�ud e�tl� If you have a subcontractor providing service through HCCBG that agency will have a separate checklist and will have forms to complete. Please check all the above forms for accuracy and compileteness before submitting to the Area Agency on Aging. Thank You!T-1 North Carolina Department of Health and Human Services Division of Aging and Adult Services Pat McCrory Aldona Z. Wos, M.D. Governor Ambassador (Ret.) Secretary DHHS Suzanne P. Merrill Division Director DAAS Administrative Letter No. 15-06 To: County Managers Subject- SFY 15-16 Count's, Funding for the Rome and Community Care Block Grant (HCCBG) Date: June 8,2015 Attached please find the SFY 15-16 Home and Community Care Block Giant firading for your county. SFY 15-16 HCCBG program information is posted on the Division of Aging and Adult Services (DAAS) website at littp:,//ik,ww.iicdlilis.gov/agitip-/cobudget/cobtidgdti.litiii. With the legislative session currently underway by the NC General Assembly, it is possible that county awards, will have to be revised when DAAS receives a certified budget later this sturriner. Intrastate Funding Formula factors and weights remain unchanged from previous years. Formula factors are as follows: Age 60+ general population (50%)"60+ low income (30%)-. 60+ minoi-Ity population (10%), and 60+ rural (10%). Please contact your Area Agency on Aging director with any questions concerning the Home and Conimunity Care Block Grant. 09959 cc: AAA Directors Sincerely, Suzanne P. Merrill ww,A%ncdI-Ais.gov • %mm,.ncdhhs-gov/agu',g Tel 919-855-3400 • Fax 919-733-0443 1-mcation: Taylor Hall, 693 Palmer Drive - Raleigh. NC 27603 Mailing Address: 2 101 Mail Service Center - Raleigh. NC 27699 -'2101 An Equal Opportunity / Affirmative Action Employer -e 7: ATID COMMUNITY CARE BLOCK GRANT SFY 16 REGION 0 Total Loca' COUNTY DOA /AAA ADC In-Hiome, H&CCBG Match aM.. Local H&CCBG Match Total Access Services* 59,350 6,594 65,944 In-Home Services* 49458 5495 54,953 Congregate Nutrition 144,013 16,001 160,014 Home Delivered Meals 122,041 13,560 135,601 2222 South College Road , i Wilmington, • TeLeehone 910-798-6400 Fax 910-798-6411 HCCBG ADVISORY COMMITTEE MEETING MINUTES APRIL 7, 2015 Voting Members Present: Providers Present. Elizabeth "Betty" Grace Heather Taft Dick Hayes Pam Sears, RN lane Jones Robert Shoemake Kathy Rawlings Amber Smith Greg Kennedy Support Member Present; Ellen Connor Teresa Hewett Ben Brow [Mane Berry Suzie Springer 3:00 PM Betty Grace called the meeting to order. Ben Brow reviewed the most recent loss of $12,887 In the 2014- 2015budget, leaving a total of $957,253. The current allocation request is the same as last year's final allocation. She requested prior approval for any additional funds that may be received when f=inal Allocution is released be applied toward Transportation. Transportation has been under funded in the past due to access to other grant funds being received from Department of Transportation (DOT). As a result of a recent audit, DOT is changing their reimbursement policy. Discussions are ongoing regarding the use of taxis with DOT funds. Pending the outcome, the SRC is using DOT funds for WAVE para =transit only. Kathy Rawlings inquired about the possible use of volunteer to transport clients, but Jane Jones, AAA Director, explained that no local centers are using volunteers due to increased liability risks. Suzie wanted to know what the impact would be and Ben said we are transporting nutrition clients, dialysis clients, and case -by -case clients via taxi using existing HCCBG funds. All others will be scheduled with WAVE Transit for DOT funds usage. Dick. Hayes motioned to approve up -to $5000 (if received) In additional funding for transportation and Kathy Rawlings seconded. The HCCBG Advisory Committee will re- convene if additional funding exceeds '$5000. Jane Jones, Area Agency on Aging (AAA) Director, said Division of Aging budget will be bate, probably July _ September. Suzie wanted to know If everyone was using their money. Jane said money can be moved between levels. Nutrition is overspent, Adult daycare is on target, Transportation needs more spending and Senior Center Operations is overspent.. Betty Grace said priorities should be for the dialysis patients and Ben said SRC Is trying to get door to door service for them using taxis due to the extended ride time for these frail individuals with shared' ridership with WAVE.. Report on Interim Healthcare: Robert said budget numbers are fine, units of service are lower and they are trying to keep the level of caretakers up without duplication. They are trying to keep service levels equal to the needs. The more chronic their condition, the more in-home aide is needed. Jane said we should be an advocate for all the clients since many of them have no support system. Ben said as a group, we all work well together. Report on Eldercare: Heather said there is a 23% growth. Ben informed the group that Nutrition services will be going out for bid again this year. Amber said we are serving 55 congregate meals and 295 home delivered meals with 130 on a waiting list, with 12 clients from the waiting list and some dialysis clients receiving frozen meals through a VOCAL grant. Ben announced that she will be retiring as of May 29, 2015. 4:15 PM, Betty Grace adjourned the meeting. Dick Hayes seconded. Respectfully submitted, D. Berry, Administrative Specialist NHC Senior Resource Center 2222 S. 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I 4J qJ aj cu -E m u c �n an m I KI < c 0 u C .0 0 0 �o �o 0 CL cc V, Ln vi Qj 0- OD CL CL CL ai L'I vi cu bo 0 0 CL < CL z 0- CL In C7 a 0 m u u u u 0 > < 0 z LD z z z CL) cu co E E c cr m LU fu C Ln Z cu CL 0 LL 0 (u Ll U ai C� co m E cc 00 -C LM Q (W i z c 06 cu > W Ln Z m 0 13 " County: New Hanover Date: 06/30/2015 STY 2015/2016 Home & Community Care Block Grant Meeting Worksheet Decisions Is this a budget revision? Yes No X_ Federal /State Home & Community Care Block Grant Funding: Total $959,462 FY 2015%2016 What amount of monies should the identified services receive? 15/16 Service Provider Allocation Transportation: General Medical SRC SRC 28,000 49,510 Home Delivered Meals SRC 290,440 Congregate SRC 79,273 Case Assistance /I &R SRC 180,093 Senior Center Operations SRC 28,849 In Home Aide Services SRC (Interim) 204,003 Adult Day Care /Health SRC (Elderhaus, Inc.) 99,294 HCCBG Total 95� 9.462 DOA -730 (Rev. 2/15) 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_ _ July 1, 2015 through June 30, 2016 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. 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" �--� �C t t r- "t M v) vl N x Z "t l� x r- O w m H H z O U � tea: asaww aWwW�...�wa�..aww �p E— a�a: L) p 0 �un 3 un d v 3 w ua z z ¢ W d o cdii V vN W H2O nO�wCA nxaQ H W C7��'„ a:�OdCZdd�pp�d O a, DOA -733 (Rev. 2/15) Home and Community Care Mock Grant for Older Adults County Funding Flan July 1, 2015 through June 30, 2016 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)(L)) Community Service Provider NHC Senior resource Center County New Hanover The Older Americans Act rewires 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. Although 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 15.€ % live below the poverty level. The NHC Senior resource Center (NHC- SRC) has developed a case assistance prograrn (Life Enrichment Program) committed to identifying all the needs of the individuals that come in contact with our staff and volunteers. The mission of the Life Enrichment Program is to provide duality and responsive services to older adults and their families. It is the goal of this program to promote social, physical, economic and emotional well- being, while encouraging maximum independence and improving the duality of life for older adults and their caregivers. Services provided by LEP include five areas of focus: Information Services: The gateway to assistance Horne Based Services: Brinainu resources to the door- Protection 8t the right 1n safety and dignity Bcm|dh Independence Services: Promoting wtlbmcom �Community Enrichment: Enhancing quality oflife Social Workers uuaeam needs and link individuals vvidh the most appropriate services. The intake process begins with an inquiry from a prospective client, family member, u member of the community, oruoagency. Our friendly social workers are very knowledgeable about not only services provided directly by the SRC, but those offered by other community agencies. We act as a community liaison between the client, family and multiple community organizations. ()uctmazo responds to the growing mccda of our Older Adult Cnmomnmi|y, and advocates on their behalf We cxm}matc potential o\icota for pcngrouu eligibility and participate in the development of community resources and The SRC has w Case Worker located ao the building entrance who ie dedicated to providing service mr triao k`1��opprop/�utoin�ivi�m4| to provide /\ kioaktor E-Pass bas been installed im the SRC lobby for senior access and hands-on assistance (if needed) from a case workcr to make the use of the system less frustrating and still private. Home visits are offered to engage and uonint fbnmilicy, who are in the process of planning �for loved ones. The Center continues to maintain connections with local community sites (churches, senior housing, ctu.)im low income and rural communities for presentations and educational events for all outreach progruomy. Transportation assistance is also publicized for these events when funding isavailable, The Center is also a site for early voting and primary elections with access {m candidate fbrurna and transportation aaavuUablcfo many on-site events. Our website is being re-designed tobe more senior friendly and promote the many services offered at the SRC. DOA-734 (revised 5115) (Paragraph 8 revised; paragraphs 11, 12 & 13 added) July 1, 2015 through June 30, 2016 Home and Community Care Block Grant for Older Adults Community Service Provider Standard Assurances New Hanover County_agrees to provide services through the Home and (Name of Provider) 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 littp://www.ncdhlis.gov/aging/inonitor,im.policy.litm . Community service providers shall monitor any subcontracts 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-7331). The following service authorization activities will be carried out in conjunction with all services provided through the Block Grant: a) Eligibility deten-nination, 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 C) Reviewing cost sharing/voluntary contributions policies with eligible clients. 4. All licenses, permits, bonds, and insurance necessary for carrying out Block Grant DOA -734 (revised 5/15) (Paragraph 8 revised; paragraphs 11, 12 & 13 added) 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 Surnnnary, (DOA -732). Local match shall be expended simultaneously with Block Grant funding. 8. Community service providers agree to comply with audit and fiscal reporting requirements as specified in the Agreement for the Provision of County- Based Aging_ Services (DOA- 735). 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 -Based Aging Services (DOA -735) shall be maintained. 10. Providers In -Home Aide, Horne Health, Housing and Home hrlprovement, 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. 11. Subcontractir19 - All HCCBG community service providers roust assure that subcontractors (for- profit and non -profit entities only) meet the following requirements: a. The subcontractor has not been suspended or debarred. (N.C.G.S. S 1430 - (5 -23, 09 NCAC 03M) b. The subcontractor has not been barred from doing, business at the federal level. c. The subcontractor is able to produce a notarized -State Grant Certification of No Overdue Tax Debts." DOA -734 (revised 5/15) (Paragraph 8 revised; paragraphs 11, 12 & 13 added) d. All licenses, permits, bonds and insurance necessary for carrying out Home and Community Care Block Grant services will be maintained by both the community service provider and any subcontractors. e. The subcontractor has provided a copy of their business license (for -profit subcontractors only). f. The subcontractor is registered as a charitable, tax - exempt (501 c3) organization with the Internal Revenue Service (non -profit subcontractors only). 12. Confidentiality and Security. Per the requirements in l 0A NCAC 05J and Section 6 of the Home and Community Care Block Grant Procedures Manual, client information in any format and whether recorded or not shall be kept confidential and not disclosed in a form that identifies the person without the informed consent of the person or legal representative. 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N 00 r'1 N o0 d' { O t� O, N as h o a N N oo . r• N Dv M D1 V' Ch h n 00 N M oo N 100 M CA N O h ',,, C1 h N x Ca ¢ -- z U V]i �' j� N o0i0 0 00 O o0 O�� O M 41 N o to 07 00 00 O � � M I �t ^ V� 00 N 00 n: 't "C� 00 N .N. O N 00 p M Ol It N M N O rt' '-. Q1 '... O W) In t� N N oo u- I W W ww Way E E E E O O w w w d d C13 U U i r�U Otz z O z z z z ,Z O a0i W LmQ U� w �',� cdiE 8'C,3 o� ¢� ����WI��za� N CID a DOA -733 (Rev. 2/15) Marne and Community Care Block Grant for Older .Adults County Funding Plan July 1, _2015 through dune 3h, _2016 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)fl) 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 English proficiency by utilizing; the following methods: • Place brochures in the various Churches in New Hanover. Pender & Brunswick counties. We advertise our services monthly in a minority owned paper that is distributed in the African - American community. Outreach to the Hispanic community through advertisements /brochures, promotion at local festivals. Continually work with Dept. of Social Services and Adult Protective Services to provide solutions whenever needed. • Have a community outreach coordinator that meets with different groups on an ongoing basis to pass out information and assist with questions. DOA-734 ,:revised 5115) (Paragraph 8 revised; paragraphs 11, 12 & 13 added) July 1, 2015 through June 30, 2016 Home and Community Care Block Grant for Older Adults Community Service Provider Standard Assurances Elderhaus, Inc. agrees to provide services through the Home and (Name of Provider) 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 W or at httt)://www.ncdhhs.gov/agingLmonitor/mpolicy.htm . Community service providers shall monitor any subcontracts with provid'-.rs 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/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. 4. All licenses, permits, bonds, and insurance necessary for carrying out Block Grant DOA-734 'revised 5115) (Paragraph 8 revised; paragraphs 11, 12 & 13 added) 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 :lave 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 proced-,ires 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 tLe Division of Aging Home and Community Care Block Grant Manual for Community: 3ervice Providers, dated February 17, 1997. 7. Community service providers are responsible for providing or arranging Jbr the provision of required local match, as specified on the Provider Services SUMMAU (DOA-732). Local match shall be expended simultaneously with Block Grant funding. 8. Community service providers agree to comply with audit and fiscal reporting requirements as specified in the Agreement for the Provision of County -Based Aging Services (DOA-735). 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 -Based Aging Services (DOA-735) shall be maintain,,-d. 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 ass.irance 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. 11. Subcontracting — All HCCBG community service providers must assure that subcontractors (for-profit and non-profit entities only) meet the following requirements: a. The subcontractor has not been suspended or debarred. (N.C.G.S. §14.3C-6-23 09 NCACR3M) b. The subcontractor has not been barred from doing business at the fedcral level. c. The subcontractor is able to produce a notarized "State Grant Certific tion of No Overdue Tax Debts." DOA-734 ,'revised 5/15) (Paragraph 8 revised; paragraphs 11, 12 & 13 added) d. All licenses, permits, bonds and insurance necessary for carrying out :Home and Community Care Block Grant services will be maintained by both the community service provider and any subcontractors. e. The subcontractor has provided a copy of their business license (for-profit subcontractors only). f. The subcontractor is registered as a charitable, tax-exempt (5016) or.:,ranization with the Internal Revenue Service (non-profit subcontractors only). 12. Confidentiality and Securijy. Per the requirements in I OA NCAC, 05J an-i Section 6 of the Home and Community Care Block Grant Procedures Manual, client information in any format and whether recorded or not shall be kept confidential and nol disclosed in a form that identifies the person without the informed consent of the person or legal representative. Information must be maintained in a secure environment with restricted access, and community service providers must establish proceclares to prevent accidental disclosures from data processing systems. Community service providers, including subcontractors and vendors, must adhere to requirerrents for protecting the security and confidentiality of client information. 13. Record Retention and Disposition. All community service providers are responsible for maintaining custody of records and documentation to support the allavable expenditure of funds, service provision, and the reimbursement of services. Service providers must adhere to the approved record retention and disposition schedule posted semiannually on the website of the NC Department of Health and Human Services Controller at httr2; / /www.ncdhhs.gov /control /ret ntior retention.htm. 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N o CA O O 64 69 W o0 r- o o O U 01) 0� 0 0 00 CT 00 W (7 > d d W 10 N v" o0 a W w C4 W E- O o 0 U O W W v3' (A o'O' U U ° th U (Iq ' sn wl j C) z c > > W x' Q Q W o 0 0 Gn GI) o'o N a Q,Q oc C"i o0 I�O M N CT N l� M U j ^ rl) M N CT N N M \O o0 ,� > 69 N \D Efj Ic O o0 CT CG In 0 0 O N M CO N d ON 69 N N r- ¢ V] Cn CG to Q Ga oc Cl 00 W ¢ O > so!) N o CA O O 64 69 ^ o0 r- 0 0 00 CT 00 W (7 > d d co N O O^ 10 N v" o0 a W w C4 E- O cn cn O W W W W W W U U ° th wl C) z c W x' 0 0 C] a O N M CO N d ON 69 N N r- ¢ V] Cn CG to Q Ga oc Cl 00 O O O O O O 64 69 ^ o0 r- 0 0 00 CT 00 a W w C4 E- O U U C] a d U ¢ V] Cn CG to Q Ga C] a DOA -733 (Rev. 2114) Home and Community Care Block Grant for Older Adults County Funding Plan July 1, 2015 through June 30, 2016 Methodology to Address Service Needs of Love Income (Including Low- Income; Minority Elderly), Dural Elderly and Elderly with Limited English Proficiency (Older Americans Act, Section 305(a)(2)(E)) Community Service Provider Interim I-IcalthCare of the Eastern Carolinas, Inc. County New Hanover The Older Americans Act requires that the service provider attempt to provide services to low - incorne minority individuals in accordance to their need for a�(ing services. The community service provider shall specify° hove the service needs of love 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 love income minority individuals. Additional pages may be used as necessary. Interim HealthCare of the Eastern Carolinas, Inc. shall provide In Home Aide Level services to qualified consumers in New Hanover County as outlined in the Home and Community Care Block Grant for Older Adults. 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 will share information about the In Home Aide program with local doctors, hospital discharge planners, hospice agencies, skilled agencies, senior advocacy groups, Adult [protective Services and the Community Alternatives Program agency (CAI'). The program information will be disseminated via written and oral education as well as through weekly marketing visits and phone calls made by Interim. Interim will admit low - income, including low income minority elderly consumers, rural elderly and rural elderly and elderly with limited English proficiency as well older adults (age 60 and over) using 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 services plan. Older adults who are at risk of abuse, neglect, and/or exploitation. R 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. r Older adults with extensive ADL or IADL impairments. * Older adults with less extensive (1 -2) ADL or IADL impairments. Well older adults. Interim HealthCare of the Eastern Carolinas, Inc. complies with Title VI of the Civil Rights Act of 1964, the Rehabilitation Act of 1973. And the Americans with Disabilities Act of 1990. DOA -734 (revised 2/14) July 1, 2015 through June 30, 2016 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.ncdhlis.gov /aging /monitor /mpolicy.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 English Proficiency format, (DOA -733). 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. 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 DOA -734 (revised 2114) providers. 5. As specified in 45 CFR 92.36(b)(I 1), 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. 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 Ne1v Audit Requirements section at http: / /www.ncdhhs.gov /aging /monitor /mpolictm ). 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. DOA -734 (revised 2/14) 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. &- (Authorized Signature) (Date) Standard Assurance To Comply with Older Americans Acl 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 afFmome and Community Care Blonk'GraM cbents 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 Cal e Notification will include, at a minimum, an oral review of the information outlined below as w as providing each service recipient with a copy of the information in written form. In addition, providers o ome services will establish a procedure to document that client rights information has been discussed with in-home services clients (e.g. copy I • signed Client Bill 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: Interim HealthCare of the Eastern Carolinas Inc Name of Agency Administrator: Donna "Lou" Byrd Signature: 'P, Date: --05/14/2015 (Please return this form to your Area Agency on Aging and retain a copy for your files.) CLIENTIPATIENT RIGHTS 1. You have the right to be fully informed of all your rights and responsibilities ag-q client/patient of the program. 3. You have the right to be fully informed in advance about the care to be provided by the program. .J 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. 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 ij relates to the obtaining of other needed community services. 11 Ill %il MINIMUM M � 9. You have the right to receive a timely response to you request for service. 10. Tou 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 ser=631 12. -ff 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 agencl Grant Document Routing VU Start date: 7/30/2015 From: Teresa Hewett, Finance Department (7408) Signatures required: Lisa Wurtzbacher, Chief Financial Officer Avril Pinder, Deputy County Manager ZJonathan Barfield, Jr., Chairman Return to Teresa Hewett, Finance Department (7408) Type(s) of documents attached: 1 original — FYI SRC Home and Community Care Block Grant (HCCBG) Explanation of document(s): Attached are the required documents for the FYI HCCBG award. The estimated HCCBG program revenues and expenditures were part of the adopted budget. After the State approves the final allocation, a BA will be placed on the consent agenda to adjust the budget. Please let me know if you have any questions. Thank you, Teresa ' C Print Name & Date Signature Hewett, Teresa From- Hewett, Teresa Sent Wednesday, July 29�, 2015 9:40 AM To: ' Smith, Amber' Subject: FY15H[CBGBA Attachments: FV16H[[8GBAx|sx I am routing the FY16 HCCBG documents for signature today. Attached is a spreadsheet showing the FY1G adopted budget vs. the actual award. | need to doaBA (probably omthe September agenda) to reduce revenues and expenditures, except transportation that increased a little. Please add a column on the spreadsheet to let me know what expenditure account should be decreased/increase. Thanks U U U Z Z Z M �o O rn ro 00 p rn m m O a in p ft p m r4 n `.-o °o Q o rte., a N Q 0o a rn O h� rn d` of O 01 N Q O W Z J W ,. '., '.. 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