HomeMy WebLinkAboutFY17 SRC HCCBG executed contractArea Agency On Aug ;
Cape Fear Council of Governments
October 12, 2016
Teresa Hewett
New Hanover County Finance Department
230 Government Center Drive, Suite 165
Wilmington, NC 28403
Dear Ms. Hewett:
I have enclosed your county's fully- executed, original HCCBG contract (DOA -735)
for the provision of county-based aging services for Fiscal Year 2017.
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,
CU" 0t // -Vomit
Ginny Brinson, Aging Program Specialist
Cape Fear Council of Governments — Area Agency on Aging
Enclosure
cc: Chris Coudriet — letter only
Jane Jones
Cheri Smallwood
Amber Smith
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.capebarcog.org
An Equal Oppoftnihr /Affirmative Action /ADA Employer /Program
OCR ,I 10%
July 1, 2016 through June 30, 2017
Home and Community Care Block Grant for Older Adults
Agreement for the Provision of County -Based Aging Services
ORIGINAL
DAAS -735
(revised 2/16)
This Agreement, entered into as of this 20d day of Member, 2016, by and between the County of
New Hanover (hereinafter referred to as the "County") and the Cane Fear Area Agency on Aging,
(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:
New Hanover County Senior Resource Center
Elderhaus, Inc.
Interim HealthCare of the Eastern Carolinas, Inc.
1(a) The Community Service Provider(s), shall be those specified in the County Funding Plan on the
Provider Services Summary format(s) (DAAS -732) for the period ending June 30 for the year
stated above.
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.
DAAS -735
(revised 2/16)
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 and 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.
Services authorized through the County Funding Plan, as specified on the Provider Services
Summary format(s) (DAAS -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.
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 Part 75,
Subpart D -Post Federal Award Requirements, Procurement Standards. 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.
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 (DAAS -732).
(a) Interim Payments to the Coun
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 Home and Community Care Block Grant allocation by the 22nd of each
month.
(b) Reimbursement of Service Costs
DAAS -735
(revised 2/16)
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.
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 Home and
Community Care Block Grant Manual for Community Service Providers, revised
February 17, 1997.
(d) Payment of Administration on Aging Nutrition Services Incentive Program (NSIP)
Subsidy
NSIP subsidy for congregate and home delivered meals will be disbursed by the
Division of Aging and Adult Services 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.
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.
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
DAAS -735
(revised 2/16)
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 and Adult Services 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.
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
httv: / /www.nedhhs .gov /aging/monitor /mt)olicy.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. 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 (http: / /www.ncdhhs. gov/ aging /monitor /mpolicy.htrn . Any areas of non - compliance
will be addressed in a written corrective action plan with the community service provider.
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
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
DAAS -735
(revised 2/16)
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) Uniform Guidance 2 CFR Part 200.
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 Uniform Guidance CFR 2 Part 200, where
applicable. Applicable community service providers must send a copy of their year -end
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
Uniform Guidance 2 CFR Part 200, 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 is 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
httt)s://www.ncgrants.pov/NCGrants/PublicRepgrtsRegulations.isp
The following provides a summary of reporting requirements under NCGS 143C -6-22 and 23
and OMB Uniform Guidance 2 CFR Part 200 based upon funding received and expended
during the service provider's fiscal year.
Annual Expenditures Report Required to AAA Allowable Cost for Reporting
DAAS -735
(revised 2/16)
• Less than $25,000 in
Certification form and State
N/A
State or Federal funds
Grants Compliance Re-
porting <$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
N/A
and less that $500,000
Grantee Receipts >$25,000 and
in State Funds or
Schedule of Receipts and Expendi-
$750,000 in Federal
tures
Funds
OR
Audited Financial Statements in
Compliance with GAO /GAS
(i.e. Yellow Book)
• $500,000 + in State funds
Audited Financial Statement in
May use State funds, but
but Federal pass through
compliance with GAO /GAS (i.e.
not Federal Funds
in an amount less than
Yellow Book)
$750,000
• $500,000+ in State funds
Audited Financial Statement in
May use State and Federal
and $750,000+ in Federal
compliance with OMB Uniform
funds
pass through funds
Guidance 2 CFR Part 200
(i.e. Single Audit)
• Less than $500,000 in State
Audited Financial Statement in
May use Federal funds,
funds and $750,000+ in
compliance with OMB Uniform
but not State funds.
Federal pass through funds
Guidance 2 CFR Part
(i.e. Single Audit)
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
6
DAAS -735
(revised 2/16)
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 Uniform
Guidance CFR 2 Part 200, 45 CFR Part 1321 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 any 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 Opportunity and Americans With Disabilities Act Cq liance. 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 County. 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 famished 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
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.
DAAS -735
(revised 2/16)
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.
21. Confidentiality and Security. Any client information received in connection with the
performance of any function of a community service provider or its subcontractors under this
Agreement shall be kept confidential. The community service provider acknowledges that in
receiving, storing, processing, or otherwise handling any confidential information, the agency
and any subcontractors will safeguard and not further disclose the information except as
provided in this Agreement and accompanying documents.
22. Record Retention and Disposition. All state and local government agencies, nongovernmental
entities, and their subrecipients, including applicable vendors, that administer programs funded
by federal sources passed through the NC DHHS and its divisions and offices are expected to
maintain compliance with the NC DHHS record retention and disposition schedule and any
agency- specific program schedules developed jointly with the NC Department of Cultural
Resources, Division of Archives and Records. Retention requirements apply to the community
service providers funded under this Agreement to provide Home and Community Care Block
Grant services. Information on retention requirements is posted at
httv://www.ncdhhs.izov/controVretention/retention.htm and updated semi - annually by the NC
DHHS Controller's Office. By funding source and state fiscal year, this schedule lists the
earliest date that grant records in any format may be destroyed. The Division of Archives and
DAAS -735
(revised 2/16)
Records provides information about destroying confidential data and authorized methods of
record destruction (paper and electronic) at http: / /archives.ncdcr. og v/For-
Govemment/ Retention- Schedules/Authorized- Destruction.
The NC DHHS record retention schedule is based on federal and state regulations and pertains
to the retention of all financial and programmatic records, supporting documents, statistical
records, and all other records supporting the expenditure of a federal grant award. Records
legally required for ongoing official proceedings, such as outstanding litigation, claims, audits,
or other official actions, must be maintained for the duration of that action, notwithstanding the
instructions of the NC DHHS record retention and disposition schedule.
In addition to record retention requirements for records in any format, the long -term and/or
permanent preservation of electronic records require additional commitment and active
management by agencies. The community service provider will comply with all policies,
standards, and best practices published by the Division of Aging and Adult Services regarding
the creation and management of electronic records.
DAAS -735
(revised 2/16)
23. 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 Co ecuted this Agreement as of the
day first written above.
o
1
'A y3 P
l v p,j f <!6� r COlnl
Z �2
Attest:
Chairman, Board of Commissioners
Area Agencv
Attest:
s By:
a Agendybirector Executive Director,
Lead Regional Organization
Provision for payment of the monies to fall due under this Agreement within the current fiscal year
have been made by priation duly au quired by the Local Government Budget and
Fiscal Control A . 'MIS I 7RU EN MA, .EEN VREAUDITED IN
PE 'Al D BY lDOAI GOY
BUDGET A ISDAL DUi1rWL
BY: )
F FFICE egjonw arganization
10
C PY
E AND ADDRESS Home and Communih Cure Block Grant for Older Adults
MUNITY SERVICE PROVIDER DAAS -732 (Rev. 2116)
Senior Resource Center County Funding Plan County_ New Hanover
S. College Rd. Jul 1w2016_ through June 30, _201
Ington, NC 28403 Provider Services Summary REVISION s 0 , .ATE: 6/13/2016
cervices
Set. Delivery
(Check Orc)
Block Grant Funding
Required
Local Matc
Net-
Sery Cost
NSIP
Subsid
Total
Funding
Projected
HCCBG
Units
Projected
Reimburse
Rate
Projected
HCCBG
Clients
Projected
Total
Units
D'uect
wtoh.
Access
In -Home
Other
Tend
&R Case Assist
X
180093
\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\
20010
200103
200103
2100
;ong Nutrition
X
79273
\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\
8808
88081
10875
98956
9431
9.34 1
450
14170
IDM Nutrition
X
290440
\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\
32271
322711
56063
378774
50402
6.4
517
1 74644
36500
ITransoortation- Medicall IX 1 647521 1 I \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ 1 71951 719471 1 719471 79271 9.081 251 1 106001
-Adult Day Care & Adult Day Health Care Net Service Cost
ADC ADHC
Daily Care
Transportation
Administrative
Net Ser. Cost Total
01 01 1 0
01 0 0
0 1 0 0
kL•:St7tf�U: ?!1
Certification of required minimum local match availability.
Required local match will be expended simultaneously Autherr9d Signature, Title 441ZAk LJ*� tr7__i!'dtCl)ate
with Block Grant Funding. Community Service Provider 'k�
s ly U��I Iz a (.
Signature, County Finance Officer Date Signature, Chairman, Board of Commissioners Date
Usa lr)u��LQZ,:cl , e�O C�it�icMnn cEh�tilSr
COO p�
DAAS -731 (Rev. 2(16)
Home and Community Care Block Grant for Older Adults
County New Hanover
County Funding Plan July 1, 2016 through June 30, 2017
County Services Summary
A
B C D E F G H I
Services
Block Grant Fundino
Required
Local Match
Net
service Cost
NSIP
Subsid
Total
Funding
Projected
HCCBG
Units
Projected
Reimbursemen
Rate
Projected
HCCBG
Clients
Projected
Total
Units
Access
In -Home
Other
Total
I &R Case Assist
1800931
\\\\\\AVA
20010
200103
200103
2100
Congregate Nut.
79273
\ \ \ \ \ \ \ \ \ \ \\
8808
88081
10875
98956
9431
9.34
450
14170
HDM Nutrition
290440
\ \ \ \ \ \ \ \ \ \ \\
32271
322711
56063
378774
50402
6.4
517
74644
Sr. Center O s
28849
\ \ \ \ \ \ \ \ \ \ \\
3205
32054
32054
Trans: General
36500
\ \ \ \ \ \ \ \ \ \ \\
4056
40556
405561
4835
8.39
142
11650
Trans.- Medical
64752
\ \ \ \ \ \ \ \ \ \ \\
7195
71947
71947
7927
9.08
251
10600
Adult Day Care
62158
\ \ \ \ \ \ \ \ \ \ \\
6906
69064
69064
Adult Day Health
30401
\ \ \ \ \ \ \ \ \ \ \\
3378
33779
33779
Trans.-ADC
701
\ \ \ \ \ \ \ \ \ \ \\
78
779
779
Trans. -ADH
140
\ \ \ \ \ \ \ \ \ \ \\
16
156
156
In -Home Aide 1
19234
\ \ \ \ \ \ \ \ \ \ \\
2137
21371
21371
In -Home Aide II
75510
\ \ \ \ \ \ \ \ \ \ \\
8390
83900
83900
In -Home Aide III
109259
\ \ \ \ \ \ \ \ \ \ \\
12140
121399
121399
\ \ \ \ \ \ \ \ \ \ \\
0
0
0
Total 1
281345
296562
399403
977310
108590
1085900
66938
1152838
72595
\ \ \ \ \ \ \ \ \ \ \ \ \\
3460
111064
f
Signature, Chairman, Board of Commissioners Date
'NAME AND ADDRESS
COMMUNITY SERVICE PROVIDER
Elderhaus,Inc.
1950 Amphiteater Dr.
Wilmington, NC 28401
Sec Delivery
(Check One)
Services Direct JPureh.
Adult Day Care
Adult Day Health
Transportation- ADC
Transportation - ADH
Home and Community Care Block Grant for Older Adults
County Funding Plan
Provider Services Summary
B C D
Required Net* NSIP
Total Local Mallet Sery Cost Subsid
\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ 6906 69064
\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ 3378 33779
701 \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ 78 779
140 \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ 16 156
0 0
\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ 0 0
\ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ 0 0
\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ 0 0
\\ 0 0
\ \ \ \ \ \ \ \ \ \ \ \ \ \\ \ \\ 0 0
\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ 0 0
\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ 0 0
\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ 0 0
\ \ \\ 0 0
841 93400 10378 103778
Block Grant Funding
n -Home Other
62158
30401
'Total
I \ \ \ \ \ \\ 1 \ \ \ \ \ \\ 1 0 1
*Adult Day Care & Adult
Day Health Care Net Service Cost
I
ADC ADHC
Daily Care
33.07
40.00
Transportation
69064
1109
Administrative
29.18
33.10
Net Set. Cost Total
62.25
73.10
Certification of required minimum local match availability.
Required local match will be expended simultaneously
with Block Grant Funding.
e
toa W 711,2
Signature, County Finance Officer Date
L�--ALj.' +ZbaClw. C.FC
C�Oo p�
DOA -732 (Rev. 4/14)
County_ New Hanover
July 1, 2016 through June 30, 2017
REVISION # . DATE : 6/16
E
I F
G
I H
I
Total
Funding
Projected
HCCBG
Units
Projected
Reimburse
Rate
Projected
HCCBG
Clients
Projected
Total
Units
69064
1109
62.25
33779
462
73.1
779
1 519
1.50
156
104
1.50
0
0
0
0
0
0
0
0
0
0
OT 103778
1 2194
\ \ \ \ \ \ \ \ \ \ \ \ \\
0
0
�A� DW2 CEO i
Authorized Signature, Title Date
Community Service Provider
Chairman, Board of Commissioners Date
COPY
NAME AND ADDRESS Home and Community Care Block Grant for Older Adults
COMMUNITY SERVICE PROVIDER DAAS -732 (Rev. 2/16)
Interim Healthcare of the Emtem Carolinas, Inc. County Funding Plan County New Hanover
PO Box 2249 July 1, 2016 through June 30, 2017
Whiteville, NC 28472 Provider Services Summary IREVISIONN , DATE: 06/10/2016
A
B
C
D
E
F
G
H
I
Services
Ser. Delmar
(Cheek oae)
Block Grant Funding
Required
Local March
Net•
Sery Cost
NSIP
Subsidy
Total
Funding
Projected
HCCBG
Units
Projected
Reimburse
Rate
Projected
HCCBG
Clients
Projected
Total
Units
M hec.
P..oh.
Access
In -Home
Other
Total
In -Home Aide Lev 1
19234
\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\
2137
21371
21371
1259
16.9788
15
1259
In -Home Aide Lev 2
75510
\ \ \ \ \ \ \ \ \ \ \\\\\\\
8390
83900
83900
4862
17.2576
30
4862
In -Home Aide Lev 3
109259
\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\
12140
121399
1
121399
6958
17.4476
25
6958
\\\%%\\\\\\\A
0
0
0
\ \ \ \ \ \ \ \ \ \ \\ \ \ \ \ \\
0
0
0
o\\\a\\\\\\\\\\\
0
0
0
oo\ \u\\\\\\\
0
0
0
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0
0
0
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0
0
1
0
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0
0
0
\\\\\\\\\\\\\\\\
0
0
0
e\e\\\\\\\\\\\0
0
0
0
a\\a\e\\\\o\u
o
0
0
0
0
0
Total
\ \ \ \ \ \\
\ \ \ \ \ \\
0
204003
0
204003
22667 1
226670 1
0
226670
13079
\ \ \ \ \ \ \ \ \ \ \ \ \\
70
13079
*Adult Day Care & Adult Day Health Care Net Service Cost
ADC ADHC
Daily Cam Certification of required minimum local match availability.
Transportation Required local match will be expended simultaneously Authorized S' ature, Tide Date '
Administrative wrth ock Grant Funding. Community Servi rovider
Net Set. Cost Total
Inn,
Signature, County Finance Officer Date Signature, Chairman, Board of Commissioners Dale
z r