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f BILL NO. 97-48 SPONSORED BY COUNCILMAN Haake ORDINANCE NO. AN ORDINANCE OF THE CITY OF JEFFERSON, MISSOURI AUTHORIZING THE CITY ADMINISTRATOR AND THE DIRECTOR OF THE TRANSPORTATION DIVSION TO EXECUTE AN AGREEMENT WITH THE MISSOURI DEPARTMENT OF SOCIAL SERVICES DIVISION OF MEDICAL SERVICES TO RECEIVE FUNDS FROM THE TITLE XIX TRANSPORTATION OPERATING ASSISTANCE PROGRAM. BE IT ENACTED BY THE COUNCIL OF THE CITY OF JEFFERSON, MISSOURI, AS FOLLOWS: Section 1. The City of Administrator and the Director of the Transportation Division are hereby authorized and directed to execute an Agreement with the Missouri Department of Social Services Division of Medical Services to receive funds from the Title XIX Transportation Operating Assistance Program. Section 2. The agreement shall be substantially the same in form and content as the Agreement attached as Exhibit A. Section 3. The Ordinance shall be in full force and effect from and after July 1, 1997. Passed: Approved: � � 2 s Presiding Offic�r Mayor ATTEST: APPROVED AS TO F M: � ,,.,:.. ity CI C ty Coun for t f li 1 ti, t �. 'i . ' I ty ra•„c .�t.. ., uxd.,.,..H.. a.. .r. t.' 'r. r° � ':1 y�r .3t. i,w1.... t.'..... .. ,. �l'...,. t,. .:t• ..,.�., ..�.. ,tn,.r .t. .fi 'rr jt3 t t' Il J S .. , ue nee sea /a�•I'`/© _ . wwepen MISSOURI MEL CARNAHAN DEPARTMENT OF SOCIAL SERVICES RELAY MISSOURI GOVERNOR DIVISION OF MEDICAL SERVICES for hearing and speech impaired f P.O.BOX 6500 TEXT TELEPHONE JEFFERSON CITY 1.000.735-2%6 I` 65102.6500 VOICE 1.000.735.2466 October 29, 1997 Richard A. Mays, City Administrator City of Jefferson 320 East McCarthy Jefferson City, Missouri 65101 Dear Mr. Mays: The Health Care Financing Administration (HCFA)has approved the Missouri Department of Social services, Division of Medical Services Title XIX Transportation Operating Assistance Agreement with the City of Jefferson. The Division of Medical 4. Services(DMS)is pleased to enter into this agreement with the City of Jefferson for the purpose of ensuring non-emergency medical transportation(NEMT)for individuals eligible for Missouri Medicaid. The effective date of the agreement is July 1, 1997. 1 have enclosed a copy of the approved agreement for your file. Callie Glascock is coordinator for the NEW program. She is available to assist your transportation office. If you have any questions, please call Callie at 573-751-3277. ' is is Sincerely, Betty L. Nash NEW Project Director Enclosure r c Thomas Hood, Director, Division of Transportation Jim Uffmann, DMS, Financial Services Callie Glascock, DMS, Program Management J' ' 1 A "AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER" �J services provided on a nondiscriminatory basis ( '1'rd T>'4•,"it:�..' ..;{Y.a}tl:•, i „5;. ,�. ..} ! ? 'i l '4- Y 3 (r .. t aP:t� Ai'^';'�4 t,},.l...E ✓) i ,i! v .� i+4.firt 1 t .3: �rr- c ! l i:« �' r ?r '`; ?i'Z'�� �Z � .� 1$ 'F•rk t i r J I{!. E. J V • y , s ' ! . I 7T,MENIOfI1EALTII AND HUMAN SrWICES DWINo.P 30010 ronM .� ICAHEFINANCINGADMINIStt7ATION OMON0.091t10101 III ---- 1. TRANSMITTAL NUMBER: 2. STATE: TRANSMITTAL AND NOTICE OF APPROVAL OF g 7 — 0 3 MISSOURI STATE PLAN MATERIAL 3• PROGRAM IDENTIFICATION: TITLE XIX OF THE SOCIAL FOR: HEALTH CARE FINANCING ADMINISTRATION SECURITY ACT(MEDICAID) TO: REGIONAL ADMINISTRATOR 4, PROPOSED EFFECTIVE DATE HEALTH CARE FINANCING ADMINISTRATION JULY 1 1997 DEPARTMENT OF HEALTH AND HUMAN SERVICES 5, TYPE OF PLAN MATERIAL(Check Ono): i ❑ NEW STATE PLAN ❑ AMENDMENT TO BE CONSIDERED AS NEW PLAN AMENDMENT COMPLETE BLOCKS 6 THRU 10 IF THIS IS AN AMENDMENT(Separate Transmittal for each amondment) 6. FEDERAL STATUTE/REGULATION CITATION: 7. FEDERAL BUDGET IMPACT: 0.00 M a.FFY $ j 4?. C1R SUPPART b.FFY $ 8. PAGE NUMBER OF THE PLAN SECTION OR ATTACH 9. PAGE NUMBER OF THE SUPERSEDED PLAN SECTION OR ATTACHMENT(I1 Applicable).;; / ,=•-132 new material f T . .. . ff 'ham UBJ[CTOFAMENDMENT: Cooperative Interagency Agreement between the Department of 4 �• ;ocir;l _,`-vices, Division of Pledical Services and the City of. Jefferson, ;o the provision on Title NIX Non-Emergency Medical Transportation (NEMT) . 11.GOVERNOR'S REVIEW(Check One): Q GOVERNOR'S OFFICE REPORTED NO COMMENT r ❑ OTHER,AS SPECIFIED: ❑ COMMENTS OF GOVERNOR'S OFFICE ENCLOSED ❑ NO REPLY RECEIVED WITHIN 45 DAYS OF SUBMITTAL 12.SIGNATUR STAT CY OFFICIAL: 16.RETURN TO: 13.TYPED NAME-' GARY J. STANGLER DIVISION OF MEDICAL SERVICES 14.TITLE: P.O. BOX 6500 DIRECTOR, DEPT. OF SOCIAL SERVICES JEFFERSON CITY, MO 65102-6500 15.DATE SUBMITTED: :, .:r:. -:�i,.'�*i: •�:!. 'a:;;z;x SLib'-�i'' -`+9i z#'y,(.q•:°'1f[!,.(to{<tin'tiiF�O:»ck*1a .`.-'';:.: I „d.' :. .}9.`,' r,_ ;✓�-••{y: _Pa,P";'•'i']'�+,".r•..�f�1.�V•°i�".'.i.�:jf,�'�• ;; .;._ ..c,. 18 DATE'APpRO 7�5 �.'' iry.•y,;..•_ 17:DATE.RECEIVEDI f :i,,s; , �s - : 09%3 Y i= . 0 I:f I1 L.�1'-rw t.w'.I. ry.•111.,, O-AFP•OVER NIATERIAL`:'�;:r:. :�r.`:: �2 A E 0(11AI:`• ICL4L;: ;, '-Vi��=. �tr +lN�:' 19 EFFE ~TINY DATE Fl :c: �..,T ,,,roi t f,;:t.r?;3.cs141rzal�iL + .TYPED�NAME ' 2 .TI + r Y t�. .j c°�,.[ ;,,. •, ichard`P. Brurritne7 -' ARA =for=Medlcald�andlS te,Operatippsl, ,. ` I L REMARKS: Ir '� ♦ri 'tt t {1 ) t. ,w X V{ .,y i CONTROLtt Stangler . Date.:Submitted 09/29/97,f-`:; .'Vadner Date Received'. 09/30!97 Wait : AAORM/CO3 FORM HCFA-179(07.92) Instructions on Back {—'r rIJ` !t t I Attachment 'SOURI DEPARTMENT OF SOCIAL SERVICES .' DIVISION OF MEDICAL SERVICES TITLE XIX TRANSPORTATION OPERATING ASSISTANCE AGREEMENT STATEMENT OF PURPOSE This Agreement is entered into by the Department of Social Service, Division of Medical Services(DSS/DMS)and ( ;r) of deffer•s,... (know hereafter as the Government Entity)for the administration of scheduled transportation services for Missouri Medicaid eligible individuals served by the Government Entity to obtain nonernergent but medically necessary, Missouri Medicaid covered services. DSS/DMS and the Government Entity will: 1. Make every effort to provide the most efficient and cost effective non- emergency medical transportation (NEMT) services available to Medicaid eligible individuals served by the Government Entity. 2. Assure scheduled transportation services for individuals eligible to receive Medicaid on the day services are provided,who have no other transportation Ft: resources, to and/or from covered scheduled Missouri Medicaid medical services in the most appropriate, least costly manner. II RESPECTIVE RESPONSIBILITIES DSS/DMS agrees to: 1. Reimburse the Government Entity the Title XIX federal share of actual and reasonable costs established for the provision of medically necessary transportation provided by the Government Entity. Reimbursement is based upon the estimated operating cost of The Government Entity as determined from the Government Entity's estimated annual operating budget (Appendix B). The rate of reimbursement for the eligible administration of medically necessary transportation costs will be the Title XIX federal share(50%). The estimated operating cost will be reviewed in March of each year and the estimated cost per unit may be adjusted in March of each year. 2. Provide the Government Entity access to the information necessary to properly 1 provide and seek reimbursement for administration of medically necessary transportation. 1 3. Review administrative payments made to the Government Entity to ensure that � NEW services are provided in the most efficient and cost effective manner and that payments do not duplicate other Medicaid NEW payments. TN. 97-03 Approval Date Supersedes TN. New Material Effective Date 07/01/97 WAUAW 110 -1- 7 I • _ i ' E Attachment 4. Provide written instructions,technical assistance, and necessary consultation to staff of the Government Entity regarding the responsibilities assumed within the terms of this agreement. The Government Entity agrees to: 1. Identify Medicaid eligible individuals and determine those who do not have access to free non-emergency medical transportation for scheduled medically necessary, Medicaid covered services. To be eligible for Medicaid coverage of NEW services, individuals must: A. be Medicaid eligible under a federally matched eligibility category. Individuals eligible under State Only Eligibility Categories: 02, 08, 09, 51, 52, 57, 59 or eligible as Qualified Medicare Beneficiary(QMB)only (eligibility category 55) are not eligible for the Medicaid NEW program. B. have no access to free transportation. 2. Arrange the most cost-effective, non-emergency medical transportation service appropriate for the needs of the Medicaid eligible individual. 3. Provide, as requested by the state Medicaid agency, the information necessary to request federal funds available under the State Medicaid match rate. Information will include at least: Patient/client name; Medicaid departmental client number(DCN); Date of Service; Name of Medicaid provider; Name of Medicaid NEW provider and Actual cost of service; 4. Certify to DSS/DMS the provisions of the non-federal share for transportation services via completion of DSS/DMS"Certification of General Revenue". The Government Entity will be required to include this in its Application for Funds from DSS/DMS Title XIX Transportation Operating Assistance Program and Certification of General Revenue(Appendix A)and on each Invoice for Medicaid Administration of Transportation (Appendix C). 5. Provide professional, technical and clerical staff to conduct administrative functions necessary for the proper and efficient administration of medically necessary transportation; TN. a _n z Approval Date Supersedes TN. Nev material Effective Date 07/01/97 -2- yy t t 4 Attachment 6. Maintain the confidentiality of client records and eligibility information received from DSS/DMS and use that information only in the administration,technical assistance and coordination of activities authorized under this agreement. The Government Entity shall not disclose to third parties confidential factual matter provided by DSS/DMS except as may be required by statute, ordinance, or order of the Court, or as authorized by DSS/DMS. The Government Entity shall notify DSS/DMS immediately of any request of such information. The Government Entity shall provide DSS/DMS with copies of all Medicaid Daily Trip forms with each monthly administrative claim. 7. Submit its estimated operating cost annually as part of its Estimated Operating Budget(Appendix B). An estimated cost per unit is determined by dividing the Total Administrative Operating Expense by the estimated total transportation units (mile, trips, etc.). The Government Entity will be allowed a variance of five f percent between the estimated cost per unit and the actual cost per unit. f I 8. Submit administrative claims via Invoice for Medicaid Administration of Transportation form(Appendix C) monthly. Claims submitted to DSS/DMS must include a certification that costs have been incurred in the performance of the ,? contract and a record of actual costs. These claims will be certified by the t, signature of the authorized agent of the Government Entity 9. Submit in-March of each year a financial status report which includes the actual net operating cost and actual cost per unit for the current fiscal year's activity. The allowed cost per unit may be adjusted if the variance between the estimated cost per unit and the actual cost per unit is greater than five percent. 10. Accept responsibility for disallowances and incur the penalties of same resulting from the activities associated with this agreement. Return to DSS/DMS any federal share which is deferred or ultimately disallowed or both arising from the administrative claims submitted to DSS/DMS by the Government Entity. 11, Maintain all necessary documentation for a minimum of five (5)years that supports the administrative claims, actual operating budget and actual cost per unit, and provide the Health Care Financial Administration (HCFA)any necessary data for auditing purposes. 12. Consult with DSS/DMS on issues arising out of this agreement. Conduct all activities recognizing the authority of the single state Medicaid agency in the administration of the Medicaid State Plan on issues, policies, rules and regulations on program matters, 13. Meet with DSS/DMS on a regular basis,at least annually, to exchange information regarding policy and procedure relating to the efficient administration of medically necessary transportation. TN. 97-03 Approval Date OCT 21 1937 Supersedes TN.New Material Effective Date 07/01/97 -3- T Y Attachment 4.11p -•182 14. Allow DSS/DMS and HCFA, or any of their representatives,full access to and the right to examine,during normal business hours and as often as DSS/DMS or HCFA deems necessary, all of the Government Entity's records with respect to all matters covered by this contract. Such representatives shall be permitted to audit under the guidelines of OMB Circular A-128"Audits of State and Local Governments,"or OMB Circular A-133, "Audits of Institutions of Higher Education and Other Nonprofit Institutions,"and examine and make excerpts or transcripts from such records and other matters covered by this contract, Such rights shall last for five years beyond the longer or the following periods: (a) the period during which any property acquired with funds provided pursuant to this contract is used for purposes for which the federal financial assistance is extended, or for another purpose involving the provisions of similar services or benefits; or(b)the period during which the Government Entity retains ownership or possession of such property. 15. Maintain in amount and form satisfactory to DSS/DMS such insurance as will be adequate to protect the Government Entity in case of accident. If permitted by law, the Government Entity may maintain a self-insurance program in lieu of purchasing insurance coverage. The Government Entity shall verify compliance with this section by submitting a copy of its certificate of insurance, or if self- insured, a copy of its self-insurance plan. 16. Hold harmless and indemnify DSS/DMS, its agents,employees and assigns, from every expense; liability or payment arising out of any negligent act or omission committed in the performance of this contract by the Government Entity, its employees or subcontractors. 17. Nondiscrimination assurance: With regard to work under this agreement,the Government Entity agrees as follows: A. Civil Rights Statutes: The Government Entity shall comply with all state and federal statutes relating to nondiscrimination, including but not limited to Title Vi and Title VII of the Civil Rights Act of 1964, as amended (42 U.S.C. 2000d, 2000e), as well as any applicable titles of the Americans with Disabilities Act. In addition, if the Government Entity is providing services or operating programs on behalf of DSS/DMS, it shall comply with all applicable provisions of Title 11 of the Americans with Disabilities Act. : TN. 97-03 Approval Date CICT 2 Z 1SV Supersedes TN. New Material Effective Date 07/01/97 -4 J i Attachment 4.1 b B. Nondiscrimination: The Government Entity shall not discriminate on grounds of race, color, religion, creed, sex, disability, national origin, age or ancestry of any individual in the selection and retention for subcontractors, including procurement of materials and leases of equipment. The Government Entity shall not participate either directly or indirectly in the discrimination prohibited by 49 CFR Subtitle A, Part 21, Section 21.5 including employment practices. C. Solicitations for Subcontracts, Including Procurement of Material and Equipment: These assurances concerning nondiscrimination also apply to subcontractors and suppliers of the Government Entity. In all solicitations either by competitive bidding or negotiation made by the Government Entity for work to be performed under a subcontract including procurement of materials or equipment, each potential subcontractor or supplier shall be notified by the Government Entity of the requirements of this Agreement relative to nondiscrimination on grounds of the race, color, religion, creed, sex,disability or national origin, age or ancestry of any individual. D. SECTION 504 ASSURANCES AND THE AMERICANS WITH i DISABILITIES ACT OF 1990: The Government Entity shall comply with all the requirements imposed by the U.S. Department of Transportation regulations implementing the Rehabilitation Act of 1973, as amended, and the Americans with Disabilities Act of 1990 (and any subsequent amendments thereto)set forth in 49 CFR Parts 27, 37, and 38, as well as all applicable regulations and directives issued pursuant thereto by other Federal Department or Agencies. 18. The dovernment Entity agrees to accept and abide by the terms and conditions of 49 CFR Parts 40, 651 and 653 mandating drug and alcohol testing. f TN. 9Z-03 Approval Date Supersedes TN. New Material Effective Date- 07/a1 27 -5- q 4r' Attachment 111 TERMS OF THIS AGREEMENT 1. The period of this Operating Assistance Agreement shall begin July 1, 199 7. This agreement may be terminated upon any of the following conditions: A. If, by any cause, the Government Entity shall fail to fulfil!, in a timely and proper manner, its obligations under this Agreement, or if the Government Entity shall violate any of the covenants, agreements, or stipulations contained herein, DSS/DMS shall have the right to terminate this Agreement if such default or violation is not corrected within thirty(30) days after written notice is sent to the Government Entity describing such default or violation. B. The DSS/DMS may terminate this Agreement without recourse in the event that, for any reason,federal/state funds are not appropriated, allotted, or available to DSS/DMS for the purpose of meeting DSS/DMS's obligation hereunder. DSS/DMS will provide written notice of such termination to the Government Entity at least five(5) days prior to the effective date of termination, C. The Government Entity may terminate this Agreement without recourse in the event that,for any reason,state/local funds are not appropriated, allotted, or available to the Government Entity for the purpose of meeting the Government Entity's obligation hereunder. The Government Entity will provide written notice of such termination to DSS/DMS at least five (5) days prior to the effective date of termination. D. Either party may terminate this Agreement at any time by giving written notice to the other party of such termination and specifying the effective date thereof at least forty-five (45)days in advance of such termination date. 2. If the Government Entity fails to comply with the nondiscrimination provisions of this Agreement, DSS/DMS shall impose such contract sanctions as it or HCFA may determine to be appropriate, including but not limited to: A. Withholding of payments to transportation agency under the Agreement until the Government Entity complies; B. Cancellation, termination or suspension of the Agreement, in whole or part,or both. z - TN. 97-03 Approval Date Supersedes TN. New Material Effective Date 07/01/97 -6- J Attachment 4,I(, IR 2 3. Any change in the Agreement,whether by modification or supplementation or both, must be accomplished by a formal contract amendment signed and approved by the duly authorized representative of the Government Entity and DSS/DMS. 4. None of the project activities described in appendixes A or B shall be subcontracted without the prior written consent of DSS/DMS. All subcontracts shall be subject to the terms and conditions of this Agreement. The Government Entity, however, shall remain responsible for the proper completion of the project notwithstanding the subcontract. 5. The Government Entity shall not assign or delegate any interest in the } Agreement and shall not transfer any interest in the Agreement whether by assignment or novation, without the prior written consent of DSS/DMS. 6. The Agreement shall be construed according to the laws of the state of Missouri. the Government Entity shall comply with all local, state and federal laws and regulations relating to the performance of the Agreement. u 7. The Government Entity shall not be reimbursed for administration of medically necessary medical transportation services incurred prior to or after the project period. Post audit activities will be conducted by DSS/DMS. 8. Reimbursement received, as a result of this agreement, shall not be used to reduce the amount the Government Entity has allowed for non-emergency medical transportation of Missouri Medicaid eligible individuals or to reduce its existing transportation program. Pepang ieector Date ent of Social Services �xPD �,, VadnAr, Director Date Division of Medical Services 3 - 13 - a7 Authorized Signer Date The Government Entity OCT TN. 97-03 Approval Date Supersedes TN.New material Effective Date n7 01/97 -7- j y Attachment 4.I6 Appendix A APPLICATION FOR FUNDS FROM THE DEPARTMENT OF SOCIAL SERVICES DIVISION OF MEDICAL SERVICES TITLE XIX TRANSPORTATION OPERATING ASSISTANCE PROGRAM AND CERTIFICATION OF GENERAL REVENUE Fiscal Year July 1, 1997 through June 30, 199 SECTION I. General Information Name of The Government Entity City of Jefferson Address 320 East McCarty Contact Person Tom Hood Jefferson City, MO 65101 Telephone Number (573) 634-6479 SECTION II. Program Description NiA,r)•�- u.;neeis A. Area of Service - Corporate City Limits - Jefferson City B. Days and Hours of Operation C. Estimated total trips, miles for fiscal year cosa.m.r mile 5:30 p.m. cost 1. Estimated total one-way trips to be provided 32,000 2. Estimated Medicaid medical one-way trips ggg r��a3o 3. Estimated total vehicle miles to be operated (for entire transportation program) 100,000 4. Total Administrative&Operating expense (for entire transportation program)(Appendix B, C.) yq, 30 S:o0 5. Estimated Cost per Mile(#4/#3)or Estimated Cost per Trip(#4/#1) Sg gg$17.17,7 6. Estimated Medicaid Miles ^^ I9,g3C- 7. Estimated Operating Cost(Medicaid) (#5 #6) $48,546.00 D. Transportation Sources Handicapped Equipped Passenger Year/Make/Type Yes No Capacity Owned Leased See Attached Total Vehicles Leased and Owned if additional space is needed, attach additional sheet. z TN. 97-03 Approval Date - Supersedes TN. New Pia terial Effective Date OZZ01497 -8- ,,. low Attachment 4•I(,- 182 Section III Description of Transportation Program (i.e. special circumstances, coordination of efforts and other factors which affect your program). Describe how you will assure transportation provided is the least expensive for the level of service required for the patient's condition. If additional space is needed, attach additional sheet. The Jefferson City Transit System (JEFFTRAN) owns eight regular fixed route coaches and eleven tripper route buses for the general public transportation within the city limits. The City also owns four small buses to transport individuals with disabilities. During the winter and fall peak hours, a total of eighteen buses are operated, including three "Handi-Wheels" buses which provide dial-a-ride paratransit service curb-to-curb. SECTION IV. Transportation Operating Expenses, Funding Sources Funding Sources 1.Name of Funding Sources Local 2 3• for Transportation State General Total p Funding Revenue Local contract Senate Bill 40 $ 32,000. $ $_..32,000 Changes for Service $ 184,770. $�_ $ 184,770. State Grant MoDCyP $ $ 55,983. $ 55,983. Transfer from General Fund-City $ 423,314. $ * -----__ $_L23,314. Total $ 640,084. $ 55,983. $ 696,067. A. Total revenue used for all transportation (Total#3.) $_ 696,067. B. Estimated operating cost of Medicaid -transportation (Section II.C. 7.) $ 48,546. C. Total revenue certified to be used for medical transportation for Medicaid eligible individuals (Cannot exceed A.) The agency also certifies that costs for which reimbursement will be requested are not being claimed, or used to support requests from any other grant program. AUTHORIZED SIGNATURE March 13, 1997 DATE City Administrator TITLE City of Jefferson AGENCY TN. 97-03 Approval Date OCT 2 11991 Supersedes TN. New Material Effective Date 07`/°7 * Section 18: $262,694. _g_ 1 arm i Appendix B ( ESTIMATED ADMINISTRATIVE OPERATING BUDGE'; �1II ti+mnl 11'Ju-'Je2 I FISCAL YEAR JULY 1, 1996THROUGH JUNE 30, 1997 A. Administrative Expenses: t//,'it'l�� c,',•li r�5 Project Manager's Salary $ 36,634 Fringes -.11,962 Secretary/Bookkeeper Fringes 994 3 Office Supplies 1,317 3 3 Building Utilities (lights, heat,water) Telephone 7,193 Telephone Insurance ti Still Bonding -- Promotion/ Advertising _ s / 1 L S Travel (Mileage) _ Miscellaneous Expenses 23,006 Advertising (notices in newspapers) Total Administrative Expenses $ 106.465 .3 v` r B. Operating Expenses: Driver Salaries /•1 / Dispatcher $377,529 Fringe Benefits 139,822 Dispatcher. -- Maintenance (Labor and Parts) Tire & Tubes 193,146 `/S , Fuel and Oil 80,502 ?c;,/,Z Tires and Tubes -- Misc. Materials and Supplies 2,012 ti u3 Total Operating Expenses $793,011 /}, C. Total Administrative& Operating Expenses $ 305 D. Estimated Operating Cost(Medicaid)* $_48.546 �` tRnth Ccllrrf.'c,� dui, 't PulJl,fal:t � uu41 r , cV/Y es Prepared by Thorns xe,-A Date 03/1�/1997 �6,-5 Title Director Division of Transportation * Estimated Operating Cost(Medicaid)is that part of the Total Administrative &Operating expense to be used for Medical transportation for Missouri Medicaid eligible individuals (Appendix A, Section ll, C.7). This budget page may be modified for your specific needs. Please note any modification with a check mark to the left of your line item. 97-03 OCT ,? z �!� � f TN. Approval Date Supersedes TN. New Material Effective Date 07/01/97 -10- end, NIL— lid ';J � t'C tt SJ o tt t:' .' .. .. . ..± t (. 4....e • r� ..} . f h_:,t� r ..r ,� r , ..`�, �,• i? eF..1�t c,.;i.�A,i`i�.c., l t Appendix C Attachment Invoice# INVOICE FOR MEDICAID ADMINISTRATION OF TRANSPORTATION NAME OF GOVERNMENTAL ENTITY INVOICE FOR PERIOD THROUGH FY _ CONTACT PERSON TELEPHONE NUMBER REMIT MEDICAID REIMBURSEMENT TO: I f ` A. How many Medicaid eligible individuals were transported TO Medicaid covered services during this period? B. What was the total number of trips provided for the Medicaid eligible individuals, reported in letter A? C. What was the cost of providing transportation for the Medicaid eligible individuals reported in letter A? REIMBURSEMENT OF MEDICALLY NECESSARY TRANSPORTATION SERVICES X 50% _ (cost(letter C1) X 50% _ (Total Medicaid Reimbursement) CERTIFICATION OF REVENUE AND COSTS The (Government Entity)certifies that it has expended state and local general funds in an amount sufficient to provide the non-federal share of the expenditures being claimed for federal financial participation. The government entity certifies that the costs for which reimbursement is being requested are not being claimed,or used to support requests from any other grant program. The government entity also certifies that the costs for which reimbursement is being requested are a record of actual costs and were incurred in the performance of the contract. AUTHORIZED SIGNATURE DATE REIMBURSEMENT WILL NOT BE MADE WITHOUT RECEIPT OF COMPLETED FORM. 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Cl) Cl) {- N N N m m m m J O O m v v v X 1 X X M M m 0 0 0 0 0 0 0 0 0 ' w0 m m 0 0 o m m m m ^ ^ m 0 0 0 0 0 0 0 0 0 y S S m m m m N N N N M M N O O O O O O O O O I 0 F^- h 0 m m m LL LL m UM m W W LL M Cl) co M (O Cl) M M M M U U U . LL al o m rn r- m o o o 0 0 0 0 m m m M M as a M M M v v v K v V v 0 N N N N N N N F LL W O J al m m m m m m M in In K K K t(, w m m m U ^ ^ m m m m in m m in in m m m m m m m at m m m m m m m m m w w >-> F a000p - aaoQa000p as ) /A(�/ Nq MISSOURI BOB HOLDEN DEPARTMENT OF SOCIAL SERVICES RELAY MISSOURI GOVERNOR DIVISION OF MEDICAL SERVICES for hearing and speech impaired P.O.BOX 6500 TEXT TELEPHONE JEFFERSON CITY 1-800-735-2966 65102-6500 _ VOICE 1-800-735-2466 July 1, 2002 Mr. Tom Hood City of Jefferson/Jefftran 320 East McCarty Street Jefferson City, MO 65101 Dear Mr. Hood : The Application for Funds from DSS/DMS Title XIX Transportation Operating Assistance Program and Certification of General Revenue and Estimated Administrative Operating Budget for City of Jefferson/Jefftran for Fiscal year 2003 have been reviewed by the Division of Medical Services. Based on this information, the Division of Medical Services approves an estimated cost of$10.74 per trip for each eligible trip billed for each eligible Medicaid recipient. City of Jefferson/Jefftran has certified that $53,700.00 is available to be used for medical transportation of Medicaid eligible individuals and that the amount certified is not being claimed or used to support requests from any other grant program. The Certification of Revenue and Costs must be signed by the authorized agent on each Invoice for Medicaid Administration of Transportation. The Division of Medical Services will not reimburse more than the amount certified. If additional funds are available for match and you wish to certify additional funds, please contact our office at 573-522-9854. Sincerely, � �! , um-� Angela Brenner Accounting Analyst II Managed Care Rate Setting Unit AB/ab CC: Frances Stegemann, Program Management "AN EQUAL OPPORTUNITY1AFFIRMATIVE ACTION EMPLOYER" services provided on a nondiscriminatory basis +r„ 4 ~tet tru « C •' MISSOURI BOB HOLDEN DEPARTMENT OF SOCIAL SERVICES RELAY MISSOURI GOVERNOR DIVISION OF MEDICAL SERVICES for hearing and speech impaired P.O.BOX 6500 TEXT TELEPHONE JEFFERSON CITY 1-800-735-2966 65102-6500 VOICE 1-800-735-2466 June 17, 2003 Mr. Tom Hood City of Jefferson/Jefftran 320 East McCarty Street Jefferson City, MO 65101 Dear Mr. Hood The Application for Funds from--DSS/DMS-Title XIX�nsportatlon Operating Assistance Program and Certification of General Revenue and Estimated Administrative Operating Budget for City of Jefferson/Jefftran for Fiscal year 2004 have been reviewed by the Division of Medical Services. Based on this information, the Division of Medical Services approves an estimated cost of$10.95 per trip for each eligible trip billed for each eligible Medicaid recipient. City of Jefferson/Jefftran has certified that $54,750.00 is available to be used for medical transportation of Medicaid eligible individuals and that the amount certified is not being claimed or used to support requests from any other grant program. The Certification of Revenue and Costs must be signed by the authorized agent on each Invoice for Medicaid Administration of Transportation. The Division of Medical Services will not reimburse more than the amount certified. If additional funds are available for match and you wish to certify additional funds, please contact our office at 573-522-9854. Sincerely, A (0%"A Angela Brenner Senior Auditor ---- -- - Managed Care Rate Setting Unit CC: Frances Stegemann, Program Management •'AN{EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER.'. 'seivices provided ori a nondiscriminatory basis _ _ : MEMORANDUM Date: June 5, 2003 From: TOM HOOD To: PHYLLIS POWELL CC: Regarding: DEPARTMENT OF MENTAL HEALTH, CENTAL MISSOURI REGIONAL CENTER, ORIGINAL MEDICAID WAIVER AGREEMENT AND AMENDMENTS Some of the amendments and follow up agreements have Rich's signature only. They were not good about sending me an executed copy even after I requested one. I am sure the amendments have been executed because they would not be making payments if they were not. .1y�o°�6po> STATE.OF MISSOURI I DEPARTMENT OF MENTAL HEALTH NOTICE OF CONTRACT RENEWAL JULY 1 , 2003 THROUGH JUNE 309 2004 s CITY OF JEFFERSON 6429483 MW029144 820 EAST MILLER 90 _ JEFFERSON CITY, MO 65101 029 The Department of Mental Health'(DMH)hereby exercises its option to renew the above referenced contract for the period of July 1, 2003 through June 30, 2004. All other terms and conditions of your contract remain unchanged. This Notice to Renew does not require your signature or for you to return it by mail to the Department. Please retain this Notice to Renew document for your contract files. This Notice to Renew assures that your contract is renewed and fully established in the Department's system for state fiscal year 2004.This will prevent any lapse in legal contract status due to delays in processing. You are not bound to maintain your contract status with the Department. If you choose to terminate your contract please send a duly authorized letter stating such to the DMH facility responsible for your area. Upon receipt of your notice to terminate we will process your request. DEPARTMENT OF MENTAL HEALTH DATE: AUTHORIZED SIGNATURE: Deputy Director,Administration May 19,2003 MO'-650-2720E(3-97) DMH-88260 CCO FORM: TP3-SUP Cole County Approved: 10/97 (BDG) City of Jefferson City Revised: 1/00 (BDG) Project STP-3100 (509) Modified: MISSOURI HIGHWAYS AND TRANSPORTATION COMMISSION TRANSPORTATION ENHANCEMENT FUNDS SUPPLEMENTAL AGREEMENT THIS SUPPLEMENTAL AGREEMENT is entered into by the Missouri Highways and Transportation Commission (hereinafter, "Commission") and the City of Jefferson City(hereinafter, "City"). WITNESSETH: WHEREAS, on March 13, 2000, the Commission and the City previously entered into a Transportation Enhancement Funds Agreement as to public improvements designated as City of Jefferson City, Cole County, Project No. STP-3100 (509) for the construction of a sidewalk at three different school locations in Jefferson City: Lewis & Clark Middle School, South Elementary School and Trinity Lutheran Elementary School, (hereinafter, "Original Agreement"); and WHEREAS, the Commission and the City now desire to revise the Original Agreement. NOW, THEREFORE, in consideration of the mutual covenants, promises and representations contained herein, the parties agree as follows: (1) REVISION : Paragraph (14)(C) of the Original Agreement is removed and replaced with the following: In the event that the sponsor does not receive final approval for the plans, specifications and estimate for this project by July 31, 2003 the City agrees to reimburse the Commission for any monies previously reimbursed to the City under this Agreement. (2) ORIGINAL AGREEMENT: Except as otherwise modified, amended, or supplemented by this Supplemental Agreement, the Original Agreement and all previous Supplemental Agreements between the parties shall remain in full force and effect. -1- IN WITNESS WHEREOF, the parties have entered into this Agreement on the date last written below. Executed by the City this day of , 20 Executed by the Commission thisday of MaU= 20La. MISSOURI HIGHWAYS AND TRANSPORTATION COMMISSION CITY OF JEFFERSON CITY By i s 8f E Title: t-. iy /-�c�v����. �'�1- r. Title: ' ATTEST: By Secretary to the Commission Title: ed f:o o"nA _46 . �,1,,►_, .� Approved as to Form: Approved as to Form:,vA. Title: omm' ion Counsel Ordinance No. j.UmippdVeifersoncitylatp-31 G9(509)Isuppf#2(TP3)-agreement.doc -2- BOB HOLDEN RICHARD H.STRECKER,M.S. GOVERNOR �'�c>��a�>a REGIONAL CENTER DIRECTOR ROY C.WILSON,M.D. t '^ a DIRECTOR SANDRA WISE ASST.CENTER DIRECTOR(TRTMT) DEPARTMENT OF MENTAL HEALTH • ANNE S.DEATON ` '.� MERRI WENTE=CHAPMAN,MPA DIRECTOR ~ REGIONAL PROGRAM SPECIALIST DIVISION OF MENTAL RETARDATION AND `' •�•.•x DEVELOPMENTAL DISABILITIES ALICIA FULTS State of Missouri ASST.CENTER DIRECTOR(ADM) MELINDA KAYE ELMORE DEPARTMENT OF MENTAL HEALTH CENTRAL DISTRICT DEPUTY DIVISION OF MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES CENTRAL MISSOURI REGIONAL CENTER 1500 Vandiver Drive, Suite 100 June 15,2001 Columbia, Missouri 65202-1921 (573) 882-9835"V/rT' FAX (573) 884-4294 TO: Contractual Pfovider of Central Missouri Regional Center Enclosed please find the annual contract-renewal amendment. This amendment renews your contract with the Department of Mental Health/Developmental Disabilities from July 1,2001 to June 30,2002. Please note that this-year you are not required to sign and return the amendment. If you want to continue your contract with the state,please retain this amendment in your files. If you want to cancel your contract, please return the amendment with a letter stating that you would like to cancel the contract. The letter must by signed by an authorized administrator of your agency. Please send any returns to the attention of Merri Chapman at the address listed. If you have any questions about the amendment,please call Merri at 573-882-9835. In addition,it has recently come to our attention that some contract providers would like a venue for discussion of issues that are important to all of us in supporting individuals with developmental disabilities. We see this as an opportunity for you to discuss your concerns about providing services,ask questions,and to obtain new information from.the Regional Center. As well, such meetings can provide you with an opportunity to network with other service providers for ideas and examples of-quality services that will enhance the lives of the individuals that we all support. At this meeting,we will be sharing with you new information from the Department of Mental Health. Items for discussion include such things as direct care staff increase,FY2002 budget information,new director for CMRC,and guidelines for accounting procedures to mention a few. In addition,we will be asking for your input on how to organize these meetings so they meet your needs and provide the greatest convenience to you. Plenty of time will be allowed for questions and discussion from you. The first opportunity for such a meeting with the Regional Center will be July 10,2001,from 1:00 to 3:00 P.M.at the Columbia office, 1500 Vandiver. The meeting will be in Conference Room A&B. Please RSVP by July 6 to Karen Alexander at 573-882-9835. If you have further questions or need additional information prior to our meeting please do not hesitate to contact me. Sincerely, a Sandra K.Wise Acting Regional Center Director Enclosure The Department of Mental Health does not deny employment or services because of race,sex, creed, marital status,national origin,disability or age of applicants or employees. STATE OF MISSOURI r9 �� DEPARTMENT OF MENTAL HEALTH NOTICE OF CONTRACT RACT RENEWAL JULY 15 2001 THROUGH JUNE 305 2002 I i CITY OF JEFFERSON 6429483 M W 029144 820 EAST MILLER: 90 JEFFERSON CITY. MO 65101 029 i i i I _ I f I The Department of Mental Health (DMH) hereby exercises its option to renew the above referenced contract for the period of July 1, 2001 through June 30, 2002. I All other terms and conditions of your contract remain unchanged. This Notice to Renew does not require your signature or for you to return it by mail to the Department. Please retain this Notice to Renew document for your contract files. i j This Notice to Renew assures that your contract is renewed and fully established in the Department's system for state ' fiscal year 2002.This will prevent any lapse in legal contract status due to delays in processing. You are not bound to maintain your contract status with the Department. If you choose to terminate your contract please I send a duly authorized letter stating such to the DMH facility responsible for your area. Upon receipt of your notice to terminate we will process your request. -i i I I 1 - I I ;DEPARTMENT OF MENTAL HEALTH DATE: AUTHORIZED SIGNATURE: i i .Deputy Director, Administration 06/05/01 I i MO-650-2720E(3-97) DMH-8826C Mg o• °° ••"T STATE OF MISSOURI �• DEPARTMENT OF MENTAL HEALTH CONTRACT AMENDMENT This is an amendment to the awarded contractual agreement, contract number MW0291.44 contract co a,90, for the provision of services in the Home And Community Based Medicaid Waiver Program for the Divisibn-of Dental Retardation And Developmental Disabilities.The provider, referenced below, is hereby notified of the changes in Part II, Scope Of Work, specified in the body of this amendment and is asked to sign, date, and return to the Department of Mental Health, Contracts Unit, PO Box 687, Jefferson City, MO 65102. CITY OF JEFFERSON 6429483 320 E MCCARTY ST MW029144 JEFFERSON CITY, MO 65101 90 008 Part II, Scope Of Work is amended as follows: A. Page 2, paragraph 15, first sentence shall read as: All 5taft providing residential habilitation services 6HALL have a high school diploma or have passed the UED and have received, and successfully completed,training in cardiopulmonary resuscitation and first aid. B. Page 5, paragraph 32 shall be replace with the following: The contractor SHALL administer or obtain immediate emergency medical care whenever the withholding of such care may result in bodily injury or jeopardize the life of a client. This does not apply in the case of terminally ill client(s) who have a Do Not Resusciate (DNR) order from their treating physician that is supported by either their prior competent consent, consent of their guardian, a durable health care power of attorney, or an advanced directive. DNR orders shall be reviewed and renewed every thirty(30) days and shall be specific for the anticipated imminent cause of demise. The contractor SHALL notify the regional center director in writing whenever a DNR order is issued on a client, and every thirty(30) days as the order is renewed. C. Page 9, paragraph 74 shall be replaced with the following: No person who has commited verbal abuse or Class II neglect two (2) or more times in a twelve (12) month period SHALL be employed by the contractor. This amendment shall be effective October 1,2000.All other terms and conditions shall remain unchanged , CONTRACTOR'S NAME: STATE AGENCY'S NAME: CITY OF JEFFERSON DEPARTMENT OF MENTAL HEALTH i AUTHORIZED SIGNATURE: AUTHORIZED SIGNATURE: : TITLE: TITLE: I City Administrator Deputy Director, Administration � I DATE: November 9, 2000 DATE: I l I y. : f3tUl. . NE <. .:: � •;# „ APPR '' A x: xq% r£ AUTHORIZED SIGNATURE: DATE <.... ..... i MO-650-2720E(3-97) DMH-8826C STATE OF MISSOURI DEPARTMENT OF MENTAL HEALTH CONTRACT AMENDMENT VENDOR NUMBER-6429483 RESPONBILE FACILITY ()Aej CONTRACTOR'S NAME&ADDRESS: CONTRACT NUMBER-MW029144 CITY OF JEFFERSON CONTRACT CODE-90 320 E MCCARTY ST JEFFERSON CITY, MO 65101 ---T - SERVICE DESCRIPTION UNITS UNIT COST NEW UNIT TOTAL7 CODE The above referenced contract is hereby amended per the following: 1.The Department of Mental Health exercises its option to renew the contract through June 30, 2001. 2. Part III, General Contractual Requirements is amended and replace with the attached, revised Part III, General Contractual Requirements. 3. All other terms and conditions shall remain unchanged. This is an amendment to your awarded contractual agreement. Please sign, date, and return to: Department of Mental Health Office of Administration- Contracts Unit P:O. Box 687 Jefferson City, MO 65102 *NOTE*Amendment MUST be received at the above address on or before June 30,2000 This amendment shall be effective July 1 ,2000 All other terms and conditions of the contract, or any amendment-=hereto, shall remain unchanged. In witness thereof,the parties hereto execute this agreement. CONTRACTOR'S NAME: = STATE AGENCY'S NAME: CITY OF JEFFERSON DEPARTMENT OF MENTAL HEALTH AUTHORIZED SIGNATURE: AUTHORIZED SIGNATURE: TITLE: jjd TITLE: Deputy Director,Administration DATE: DATE: I it SII). 1r - AUTHORIZED SIGNATURE: DATE: MO-650-2720E(3-97) DMH-882E 4/10/00' PART III GENERAL CONTRACTUAL REQUIREMENTS GENERAL 1, Authorization for the Department of Mental Health (Department) to contract for services is granted each fiscal year by the Office of Administration. Authorization for additional contract periods requires the annual renewal of the authorization. 2. The contract between the Department and the contractor SHALL consist of (1) the Request for Proposal (RFP), any amendments, attachments and/or exhibits thereto and (2) the proposal submitted by the contractor in response to the RFP and approved by the Department . If there is a conflict in language between the two documents, the requirements set forth and/or referenced in the , Request for Proposal SHALL govern. The Department reserves the right to clarify any contractual relationship in writing with the concurrence of the contractor. Such written clarification SHALL govern in case of conflict with requirements of the RFP or the contractor's proposal. The contractor's proposal, when accepted by the Department, is binding on,the contractor without further clarification. , 3: This contract SHALL be construed according to the laws of the.State of Missouri and SHALL govern the terms and conditions of the contracted services provided to clients of the Department by the i contractor. The contractor SHALL comply with all local, state and federal laws and regulations related to the performance of the contract to the extent that these may be applicable. The contractor, SHALL have all licenses and/or certifications current which are required by law, rule or regulation. 4. This contract SHALL constitute an assignment by the contractor to the State of Missouri of all rights, title and interest in and to all causes of action that the contractor may have under the antitrust laws of the United States or the State of Missouri for which causes of action have accrued or will accrue as J the result of or in relation to the particular supplies and/or services purchased or procured by the contractor in the fulfillment of the contract. 5. Unless otherwise specified, the contractor SHALL.be responsible for furnishing all material, labor, facilities, equipment and supplies necessary to perform-the services required. The contractor SHALL comply with the Fair Labor Standard Act, Equal Opportunity Employment Act, and any other federal and state laws, rules, regulations and executive orders to the extent that these may be applicable and further agrees to insert the foregoing provision in all subcontracts awarded. 6. By signing this contract the contractor certifies that the contractor and each of its principals (owners, director and others as defined by 45 CFR 76) are not suspended or debarred from contracting with the federal government. If the contractor or any-of its principals become suspended or debarred . during the contract period, the contractor SHALL immediately send written notification to the Department. 'Suspension or debarment of the contractor, or failure by the contractor to provide written notification to the Department of their suspension or debarment, may result in immediate termination of this contract. .7. The contractor SHALL assume all legal and financial responsibility for taxes, FICA, employee benefits, workers compensation, employee insurance, minimum wage requirements, overtime, etc., and agrees to indemnify, save and hold the State of Missouri, its officers, agents, and employees, harmless from and against, any and all loss; cost (including attorney fees); and damage of any kind related to such matters. The contractor SHALL authorize and direct all custodians of records of their taxes, FICA and other employee benefits to release information to the Department upon request. 8. The contractor agrees that this contract is predicated, in part, on the utilization .of the specific resources, individual(s) and/or personnel qualifications as identified and /or described in the contractor's Department approved proposal and, when applicable, Department approved Uniform Budget packet (schedules A, B & C) or any other financial reporting tool prescribed by the Department. The contractor agrees that no personnel and/or individuals will be utilized in the M0650-1644(4/00) Page 1 of 10 DMH-9501 4/10/00 performance of this contract who fail to meet specific provider qualifications as set out in the Department's service catalog and specified herein. No substitution of provider qualifications SHALL be made by the contractor without written notification to the Department and the Department's written approval. The contractor agrees that substitutions made pursuant to this paragraph SHALL be equal to or better than originally proposed. 9. Department approved staffing ratios and/or patterns are essential for providing the services identified. The contractor SHALLmaintain all Department approved staff ratios, hours of services and/or patterns or request a written waiver from the Department. The contractor SHALL maintain time; salary or hourly pay rate data and personnel records as specified by the Department. Downward deviation of staff/resources upon which the'unit price is based may require a downward adjustment of unit price(s). Recovery of fees paid on which there has been a downward deviation in staff/resources for the contract year per (a) Department approved Uniform Budget Form (DMH- 8836) and its Expense Categories (b) Department approved staffing ratios, or (c) any other financial reporting tool prescribed and approved by the Department SHALL be required and may be retroactive to the date of occurrence. 10. The contract will be read and enforced as though every provision of law and clause required by law to be inserted herein were included. If any such. provision is not inserted, then upon the notification of either party the contract will be amended to make such correction. 11. The contractor agrees to consolidate all or portions of related service contracts into a single contract at the request of the Department. 12. The contractor SHALL understand and agree that this contract may involve the expenditure of federal funds. Therefore, pursuant to federal government requirements, all contracts, subcontracts, and subgrants of amounts in excess of $100,000 SHALL contain a provision which requires compliance with all applicable standards, orders, or requirements issued under Section 306 of the Clean Air Act (42 U.S.C. 1857(h), Section 508 of the Clean Air Act (83 U.S.C. 1368), Executive Order 11738, and Environmental Protection Agency regulations (40 CFR Part 15), which,prohibit the use under non- exempt federal contracts, grants or loans of facilities included on the EPA list of Violating Facilities. The provision SHALL require reporting of violations to the grant or agency and to the U.S.E.P.A. Assistant Administrator for Enforcement (EN0329). Contractors SHALL recognize mandatory standards and policies relating to energy efficiency which 'are contained in the state energy conservation plan issued in compliance with the Energy Policy and Conservation Act(P.L. 94-163). SUBCONTRACTING 13. The contractor SHALL not transfer any interest in the contract, whether by assignment or otherwise, without the prior written consent of the Department. The contractor SHALL agree and understand that, in the event the Department consents to a financial assignment of the contract in whole or in part to a third party, any payments made by the State of Missouri pursuant to the contract, including all of those payments assigned to the third party, SHALL be contingent upon the performance of the prime contractor in accordance with all terms and conditions, requirements and specifications of the contract. 14. Upon receiving written approval from the Department to subcontract the contractor may establish a subcontract for services described herein. Any subcontracts for the services/products described herein SHALL be in writing and SHALL include appropriate provisions and contractual obligations, including all terms and conditions of this contract's Part III, General Contractual Requirements, to ensure the successful fulfillment of all contractual obligations agreed,to by the contractor and the Department. The subcontract SHALL ensure that the Department is indemnified, saved and, held harmless from and against any and all claims of damage;loss, and cost (including attorney fees) of any kind related to a subcontract in those matters described in the contract between the Department and the contractor. The contractor SHALL expressly understand and agree that he/she SHALL M0650-1644(4/00) Page 2 of 10 DMH-9501 d , 4/10/00 assume and be solely responsible for all legal and financial responsibilities related to the execution of a subcontract. The contractor-SHALL agree and understand thaf utilization of a sub-contractor to provide any of the services in the contract SHALL in no way relieve the contractor of the responsibility for providing the services as described and set forth herein. MINORITY BUSINESS ENTERPRISE (MBE) AND WOMEN BUSINESS ENTERPRISE (WBE) PARTICIPATION REQUIREMENTS 15. In accordance with Executive Order 98-21, state agencies SHALL make every feasible effort to increase the percentage of goods and services procured from state certified minority and women- owned. businesses (MBE's and WBE's) to ten percent (10%) and five percent (5%), respectively. Desirable goals for state procurement are set at twenty percent (20%) MBE and ten percent (10%) WBE. 15.1 MBE or WBE means a business that is a sole proprietorship, partnership, joint venture or corporation in which at least fifty-one percent (51%) of the ownership interest is held by minorities or women and the management and daily business operations of which are controlled by one or more minorities or women who own it. Minority is defined in RSMo 33.750 as belonging to one of the following racial minority groups: African Americans, Native Americans, Hispanic Americans,Asian Americans, or another similar racial groups. 15.2 The contractor SHALL make a good faith effort to obtain twenty percent (20%) and/or ten percent (10%) MBE and W BE participation, respectively, in any subcontracting activity related to the performance of this contract. Contractors who utilize MBE/WBE subcontractors SHALL report their MBE and WBE expenditures to the Department on a quarterly basis. J.._ CONFLICT OF INTEREST 16. The contractor hereby agrees that at the time of the submission of their proposal the contractor has no other contractual relationships which creates any actual conflict of interest. The contractor agrees that during the term of the contract neither the contractor nor any of its employees SHALL acquire any other contractual relationships which would create such a conflict. 17. In accordance with the Revised Statutes of the State of Missouri, no official or employee of the Department or public official of-the State of Missouri who exercises any functions or responsibilities in the review or-approval of the Scope of Work covered by the contract SHALL acquire any personal interest, directly or indirectly, in the contract or proposed contract. 18. In accordance with state and federal laws and regulations,-state executive order or regulations, the contractor agrees that it presently-has no interest and SHALL not acquire any interest, directly or indirectly, which would conflict in any manner or degree with their performance of the contracted services. The contractor agrees that no person having such interest SHALL be employed or conveyed an interest, directly or indirectly, in the contract. 19. The contractor agrees that no Missouri state employee SHALL help the contractor obtain this contract or participate in the performance of this contract if such involvement will,constitute a conflict of interest. Before any state employee may be involved in the performance of this contract written approval SHALL be obtained from the director of the Department. 20. The contractor agrees that no Missouri state employee SHALL be compensated under this contract for duties performed in the course of his/her state employment. A state employee SHALL not use state facilities or materials for personal gain relating to the performance of this contract. M0650-1644(4/00) Page 3 of 10 DMH-9501 4/10/00 21. The contractor represents itself to be an independent contractor offering such services to the general public,and SHALL not represent itself or its employees as employees of the State of Missouri. 22. If the contractor is a not-for-profit agency, board members must abstain from voting on any funding proposal in which they have administrative control or a monetary interest with the proposed grantee. Board members.who have such an interest and participate in discussion prior to a vote must disclose such interest in a meeting of the board prior to such discussion. FINANCIAL REQUIREMENTS 23. The availability of funding for this contract SHALL be determined solely by the Department and such determination SHALL be final and without recourse by the contractor. The Department does not give any assurances under the terms of this contract that the maximum calculated reimbursement for service(s) specified herein will be purchased. 24. Moneys received from the Department under this contract SHALL not be used to supplant local funds or subsidize services provided to other agencies, organizations, or individuals. 25. Payment due under the terms of the contract SHALL be made by the Department upon receipt of a properly itemized invoice. The contractor SHALL utilize the fiscal reimbursement system required by the Department. The contractor SHALL not invoice federal or state tax. The State of Missouri's tax- exempt certificate number is 43-750026K. 26. The contractor. SHALL submit their invoices in a timely fashion and no later than the time period specified in 33.120 RSMo, unless more restrictive requirements are established by state or federal law or regulation. 27. The contractor SHALL invoice for services provided at the contracted unit price(s). Unit prices charged the Department SHALL be no greater than those charged to the general public for the same service. 28. The Department reserves the right to audit all invoices and to reject any invoice for good cause. 29. The Department reserves the right to deduct from an invoice any overpayment made by the Department. All overpayments SHALL be collected in accordance with 630.460 RSMo. Overpayment is defined by 630.460 RSMo as any payment by the Department to a vendor providing care, treatment, habilitation or rehabilitation services to clients under contract with the Department which is: 29.1 In excess of the contracted rate less payments by the client, or on his behalf, as required to be made by'the Standard Means Test, contained in 9 CSR 10-31.011; 29.2 In payment of services not provided; 29.3 In payment for any service not authorized in the contract with the Department; or 29.4 In payment for services provided contrary to the provisions of the contract with the Department. 30. In accordance with 9 CSR 10-31.011, the contractor SHALL apply to the costs incurred for providing services to the client the benefits received or available on behalf of or to the client from private and public health insurance, health services corporation and health maintenance organization plans, policies and contracts including individual, company, fraternal, group, Medicare, Medicaid and similar plans to the extent and limits of the coverage for the recipient. M0650-1644(4/00) Page 4 of 10 DMH-9501 4/10/00 31. The Department SHALL deduct from the contractor's invoice, if not deducted by the contractor, all amounts to be collected by the contractor from the client or other payment sources. 32. The Department reserves the right to make invoice corrections and/or changes with appropriate notification'to the contractor. 33. The contractor SHALL not make any collection for Title XIX Medicaid covered services from the recipient, his or her spouse, parent, guardian, relative or anyone else receiving public assistance, and if any payment is received or assured from any other source on the recipient's account, that amount will be deducted from the claim filed with Title XIX Medicaid. REPORTING REQUIREMENTS 34. The contractor SHALL fully coordinate all contract activities with those activities of the Department. As the work of the contractor progresses information on matters covered by the contract SHALL be made available by the contractor to the Department throughout the effective period of the contract. 35. The contractor SHALL retain all records pertaining to the contract for seven years after the close of the contract year unless audit questions have arisen within the seven year limitation and have not been resolved. All records SHALL be retained until all audit questions have been resolved. 36. The contractor SHALL immediately notify the Department, in accordance with guidelines established by the Divisions,when there is a death of a client. 37. The contractor shall notify the Department in accordance with 9 CSR 10-5.200 when there are allegations of physical abuse,sexual abuse, verbal abuse or neglect of a client. 38. The contractor SHALL provide written notification to the Department when there is any change in the contractor's licensure or certification/accreditation status, official name, address, Executive Director, or change in ownership and/or control of the contractor's organization. 39. Upon filing for any bankruptcy or insolvency proceeding by or against the contractor, whether voluntary or involuntary, or upon the appointment of a receiver, trustee, or assignee for the benefit of creditors, the contractor SHALL notify the Department immediately. Upon learning of any such actions the Department reserves the right, at its sole discretion,to either cancel the contract or affirm the contract and hold the contractor responsible for damages. 40. The contractor SHALL maintain auditable records for all activities performed under this contract. Financial records SHALL conform to Generally Accepted Accounting Principles (GAAP). Such records SHALL reflect, at a minimum, the specific number and type of service units provided, the number and type of clients served, client,progress and other relevant records. The contractor SHALL submit itemized reports, records and information at the request of the Department. 41. The contractor SHALL allow the Department or its authorized representative to inspect and examine the contractor's premises and/or records which relate to the performance of the contract at any time during the period of the contract and within the period specified herein for the contractor's retention of records. 42. The Department SHALL have access to its clients and client records without limitation. If access is denied or limited, the Department SHALL terminate payment from the day access is denied or limited. 43. If the contractor receives notice of a Class I license violation from the Department of Health and Human Services or the Division of Aging or a notice under certification that a condition of jeopardy exists, the contractor SHALL immediately notify the authorizing Department facility. Verbal MO650-1644(4/00) Page 5 of 10 DMH-9501 4/10/00 notification SHALL be followed by written notification mailed within 48 hours. The contractor SHALL send a copy of any plan of corrections for Class I deficiencies which has.been approved by the Division of Aging, the Department, Health Care Financing Administration or other license certification or accreditation authority to the head of the Department facility who has authorized services to be delivered by the contractor. 44. The contractor SHALL conduct criminal record reviews for its employees, volunteers and household members in accordance with 9 CSR 10-5.190. CLIENT BASED INFORMATION REQUIREMENTS 45. If required, the contractor SHALL submit client data and invoicing information via its computer network with the Department's on-line computerized client based information system. 46. The Department has sole authority in determining the compatibility of the contractor's computer system. 47. At the sole option of the Department,,termination of this contract may result if the contractor fails to maintain accurate and complete information or misuses the Department's computer network. GENERAL AUDIT GUIDELINES 48. If during the contractor's fiscal year the contractor expends $300,000 or more in federal grant funds received from the Department, the contractor SHALL have-an annual audit conducted in accordance with United States Office of Management and Budget (OMB) Circular A-133. The audit SHALL be conducted by an individual of firm licensed by the Missouri ,State Board of Accountancy. The due date for filing the audit with the Department SHALL be.the same as the due date for filing the audit with the federal clearinghouse specified, in OMB Circular A-133. The. items to be filed with the Department SHALL consist of the reporting package specified in OMB A-133. Failure to comply with these requirements may result in reduction of available allocation of funds, reduction or suspension of payments to the contractor or cancellation of this contract between the Department and the contractor. STANDARD MEANS TEST 49. For all clients whose services are paid by the Department, the contractor SHALL apply the Department's Standard Means Test in accordance with 9 CSR 10-31.011, when not applied by the Department. Nothing in this contract SHALL deny the right of a client or his responsible person to appeal to the Department for re-determination of the amounts payable by them to the contractor under 9 CSR 10-31.011. 50. The contractor SHALL charge and become responsible for the collection of client payments as determined by the Standard Means Test, in accordance with 9 CSR 10-31.011. Amounts charged to clients, whether or not collected, SHALL be shown as a credit on the invoice. 51. The contractor SHALL not impose or increase fees for service for Department clients without the written consent of the Department except as permitted by the Standard Means Test. 52. Nothing in this contract SHALL impair the statutory rights of the Department to charge a Department client, a client's estate or the person(s) obligated to pay for services rendered to the client for expenditures made by the Department for the client. M0650-1644(4/00) Page 6 of 10 DMH-9501 4/10/00 AMENDMENT,TERMINATION AND RENEWAL 53. The contractor understands and agrees that funds required to fund the contract must be appropriated by the General Assembly of the State of Missouri for each fiscal year included within the contract period. The contract SHALL not be binding upon the State for any period in which funds have not been appropriated, and the State SHALL not be liable for any costs associated with termination caused by lack of appropriations. The contract SHALL be terminated by the Department, without penalty or termination costs if such funds are not appropriated or available. If funds are not appropriated or available for the contract,the contractor SHALL not prohibit or limit the Department's right to pursue alternate contracts as necessary for the conduct of state governmental affairs. The requirements stated in this paragraph SHALL apply to any amendment or the execution of any option to extend the contract. 54. Any change, whether by modification and/or supplementation, SHALL be accomplished by a formal contract amendment signed and approved by and between the duly authorized representatives of the contractor and the Department. The contractor expressly and explicitly understands and agrees that no other method and/or no other document, including correspondence, acts, and oral communications by or from any person, SHALL be used or construed as an amendment to the contract. 55. The Department may terminate the contract for breach of contract by providing the contractor with a written notice of termination. The termination SHALL become effective on the date specified in the notice. At its sole,discretion, the Department may give the contractor an opportunity to cure the breach or to explain how the breach will be cured. Payments for services SHALL not be made beyond the date of termination. 56. This contract may be terminated by either party, by giving sixty (60) days advance written notice to the other parry at its principal address. The termination SHALL be effective sixty(60) days from the date of notice or the date specified in the notice; however, the Department may withdraw any or all of its clients before the end of the sixty(60) day period. 57. Any written notice to the contractor SHALL be deemed sufficient when deposited in the United States mail postage prepaid, transmitted by facsimile, or hand-carried and presented to an authorized employee of the contractor at the contractor's address as listed in the contract. 58. In the event of termination all client records., documentation, data, reports, supplies, equipment and accomplishments prepared, furnished, acquired or developed by the contractor as a direct requirement specified in the contract SHALL become the property of the Department. Upon termination of the contract the Department may require the contractor to return to the Department all client records in their possession. The contractor SHALL agree and understand that all discussions with the contractor and all information gained by the contractor as a result of the contractor's performance under the contract SHALL be confidential and that no reports, documentation or material prepared as required by the contract SHALL be released to the public without the prior written consent of the Department. 59. This contract SHALL not bind, nor purport to bind, the State of. Missouri for any commitment in excess of the original contract period. The Department SHALL have the right, at its sole option, to renew the contract. If the Department exercises its options, all terms, conditions and provisions of the.original contract and any amendments SHALL remain the same and apply during the renewal period. MO650-1644(4/00) Page 7 of 10 DMH-9501 4/10/00 HUMAN RIGHTS 60. The contractor SHALL establish a system satisfactory to the Department through which recipients of services under this contract may present grievances. The contractor SHALL maintain at the facility a file of all Department client grievances of an alleged violation of rights and how the grievance has been or is proposed to be resolved. The person in charge SHALL cooperate fully with any subsequent Department investigation of the grievance. 61. if this contract is federally funded, the contractor SHALL abide by the provisions of the Pro-Children Act of 1994 (PL 103-227) regarding environmental tobacco smoke, which is incorporated herein as if fully set out. 62. The contractor SHALL comply with all applicable provisions of the Civil Rights Act (45 CFR 80) and the Age Discrimination in Employment Act of 1967 (45 CFR 90). 63. In compliance with Governor's Executive Order#87-6 (Art. XIII); Federal Executive Order 11246 as amended; Section 503 of the Rehabilitation Act (45 CFR 84) as amended; Vietnam-Era Veterans Readjustment Assistance Act as amended, 38 U.S.C. 4212 (formerly 2012); and the Americans with Disabilities Act of 1990; contractors that employ fifty (50) or more persons SHALL comply with the above state and federal regulations which require non-discrimination in employment and delivery of services. 63.1 In addition to the above,the contractor SHALL make the following human rights assurances: a. Not to discriminate against recipients of services on the basis of race, color, religion, national origin,sex, physical ability,veteran status or age. b. Not to discriminate against any employee or applicant for employment on the basis of race, color, religion, national origin, sex c. Not to discriminate against any applicant for employment or employee on the basis of age, where such applicant or employee is between the ages of forty (40) and seventy (70) and where such contractor employs at least twenty(20) persons. d. Not to discriminate against any applicant for employment or employee on the basis of that person's status as a disabled or Vietnam-era veteran, if the compensation payable to-the contractor or subcontractor is at least$10,000 within a fiscal year. e. To develop, implement and maintain an affirmative action program if at least fifty (50) persons in the aggregate are employed. For the purpose of this contract, an "affirmative action program" means positive action to influence all employment practices (including, but not limited to, recruiting, hiring, promoting and training) in providing equal employment opportunity regardless of race, color, sex, origin, religion, age, physical ability and Vietnam-era veteran status, Such an Affirmative Action Program SHALL include: 1. A written policy statement committing the total organization to affirmative action and assigning management responsibilities and procedures for evaluation and dissemination; 2. The identification of a person designated to handle affirmative action; 3. The establishment of non-discriminatory selection standards, objective measures to analyze recruitment, an upward mobility system, a wage and salary structure and standards applicable to layoff, recall, discharge, demotion and discipline; 4. The exclusion of discrimination from all collective bargaining agreements; and MO650-1644(4/00) Page 8 of 10 DMH-9501 i . 4/10/00 5. Performance of an internal audit of the reporting system to monitor execution and to provide for future planning. f. If the contractor uses any funds of this contract in a subcontract, then the contractor SHALL require such a subcontractor to comply with the applicable human rights clauses above. 63.2 The Department SHALL have the right to enforce all applicable clauses by appropriate procedures, including but not limited to, requests, reports, site visits and inspection of relevant documentation of the contractor. 64. The contractor SHALL comply with all applicable requirements and provisions of the Americans with Disabilities Act (Public Law 101-336) (28 CFR 35), which prohibits discrimination against people with disabilities in employment, services, transportation, public accommodations, communications and activities of state and local government. The contractor's failure to comply with this act may result in termination of the contract. The contractor SHALL notify the Department immediately of any allegations, claims, disputes, or challenges made against the contractor concerning this act. INSURANCE 65. The contractor SHALL understand and agree that the State of Missouri cannot save and hold harmless and/or indemnify the contractor or employees against any liability incurred or arising as a result of any activity of the contractor or any activity of the contractor's employees related to the contractor's performance under the contract. Therefore, the contractor SHALL acquire and maintain adequate liability insurance in,the form(s) and amount(s) sufficient to protect the State of Missouri, its agencies, its clients, its employees and the general public against any.ioss, damage and/or expense related to his/her performance under the contract. The insurance coverage,SHALL include, but not be limited to, general liability, errors and omissions, professional liability, etc. 66. The contractor SHALL be responsible for all injury or damage as a result of the contractor's negligence, or any future negligent act, involving any equipment or service provided under the terms and conditions, requirements and specifications of the contract. In addition to the liability imposed upon the contractor on account of personal injury, bodily injury(including death), or property damage suffered as a result of the contractor's negligence,the contractor assumes the obligation to save the State of Missouri, including its agencies, employees, and assigns, from every expense, liability, or payment arising out of such negligent act. The contractor also agrees to hold the State of Missouri, including its agencies, employees, and assigns, harmless for any negligent act or omission committed by any subcontractor or other person employed by or under the supervision of the contractor under the terms of the contract. 67. Automobile liability coverage for the operations of any motor vehicle SHALL be maintained if the terms of the contract require any form of transportation services. 68. If the contract requires the performance of medical services of any type, the contractor SHALL maintain adequate liability insurance to cover all medical services rendered. 69. Proof of the insurance coverage SHALL include, but not be limited to, effective dates of coverage, limits of liability, insurers' names, policy numbers, company, etc. Proof of self-insurance coverage or another alternative risk financing mechanism may be utilized provided that such coverage is verifiable and irrevocably reliable. Proof of insurance coverage SHALL be submitted upon request. MO650-1644(4/00) Page 9 of 10 DMH-9501 4/10/00 MISCELLANEOUS 70. The Department may require the attendance of the contractor's personnel at training activities and may require the cooperation.of the contractor's personnel where the Department provides technical assistance. 71. By signing this contract the contractor enters into an affiliation agreement with the Department to coordinate a delivery system of accessible services. The contractor agrees to integrate community- based programs into the Department system and to avoid duplication of state provided or supported services. 72. Disclosure by any party of information concerning a client for any purpose-not directly related to the performance of this contract is prohibited except as specified by applicable state and federal laws and regulations. 73. Under circumstances, as referenced in 632.300 RSMo, in which a client's conduct is jeopardizing the safety of the client himself or others in the community, the contractor SHALL immediately notify first the mental health coordinator and secondly the authorizing Department facility. If an immediate response is needed to insure the health and/or safety of the client or others, the local law enforcement officials SHALL also be notified. 74. The Department may place a monitor with the contractor, given any situation as described in Section 630.763 RSMo or when the Department-determines that the health, safety or welfare of the clients cannot be adequately assured. 75. The.Department enters into this contract by the authority of its director. The contractor enters into this contract individually or, if incorporated, pursuant to and by authority of its board of directors. 76. The contractor SHALL fully cooperate with all investigations conducted by the Department, or its agents, which relate,directly or indirectly,with the performance of this contract. 77. Contractors that are required by state law to be registered and in good standing with the State's Secretary of State SHALL submit their State Certificate of Good Standing to the Department,. upon request. 78. The Department.endorses a drug free environment and the absence of substance abuse. The contractor SHALL support and enforce these philosophies in their performance of the contract. APPEALS 79. The offeror or contractor may appeal an action or decision made by the Department regarding the Request for Proposal (RFP) process, the award of a contract or other related, Purchase of Service issues by submitting a written appeal in accordance with the procedures and regulations contained in 9 CSR 25-2.505. M0650-1644(4/00) Page 10 of 10 DMH-9501 MEL CARNAHAN RICHARD H.STRECKER,M.S. GOVERNOR r '= REGIONAL CENTER DIRECTOR :- c;,c'_;. ROY C.WILSON,M.D. f W -j � DENNIS B.HARE DIRECTOR ASST.CENTER DIRECTOR(TRTMT) DEPARTMENT OF MENTAL HEALTH JOHN SOLOMON TERRY L•.JACKSON,Ph.D. DIRECTOR -7 REGIONAL PROGRAM SPECIALIST DIVISION OF MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES EMILY L.LEONARD State of Missouri ASST.CENTER DIRECTOR(ADM) MELINDA KAYE ELMORE DEPARTMENT OF MENTAL HEALTH CENTRAL DISTRICT DEPUTY DIVISION OF MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES CENTRAL MISSOURI REGIONAL CENTER 1500 Vandiver Drive, Suite 100 Columbia, Mlssouri 65202-1921 (573) 882-9835"VITT' FAX(573) 884-4294 July 20, 1999 Mr. Tom Hood Jefferson City Transit City of Jefferson 320 E. McCarty St. Jefferson City, MO 65101 Dear Mr. Hood: Enclosed please find the form for certification of the Medicaid Waiver match which we discussed. Please sign and return this format your earliest convenience. If you have any questions, please do not hesitate to contact US . Thank you for your assistance. Sincerely, glv��4-1 "0,4 Emil,,/Leonard The Department of Mental Health does not deny employment or services because of race,sex, creed,marital status,national origin,disability or age of applicants or employees. r t MISSOURI DEPARTMENT OF SOCIAL SERVICES . " DIVISION OF MEDICAL SERVICES ADDENDUM TO PROVIDER ENROLLMENT AGREEMENT: FOR LOCAL PUBLIC ENTITIES TO CERTIFY MATCH FOR SELECT MEDICAID PROGRAMS This addendum pertains to any public entity which will use state and/or local funds under its control to certify the expenditure of the non-federal share of reimbursements claimed by it as a provider under the following Medicaid programs (check appropriate selection(s)): - ❑ Targeted Case Management for Persons with Developmental Disabilities. © The Medicaid Home and Community Based Waiver for Persons with Developmental Disabilities. ASSURANCES OF THE PUBLIC ENTITY: For the programs marked above, the public entity assures the following: The public entity agrees to take financial responsibility for audited claims in which any federal funds are deferred and/or ultimately disallowed arising from its failure to comply with federal requirement(s). The public entity certifies that it will expend state and local general funds in the amount sufficient to provide the non-federal share of the expenditures which will be claimed for federal financial participation.The public entity also certifies that costs for which reimbursement is being requested will not be claimed, or used to support requests for any other grant program. NAME OF PUBLIC ENTITY City of Jefferson SIGNATURE OF ORIZED OFFICIAL FOR THE PUBLIC ENTITY DATE X c x ASSURANCE OF THE MISSOURI DEPARTMENT OF MENTAL HEALTH ` The public entity named above meets the conditions of participation as defined by the Department of Mental Health for the above selected program(s). - SIGNATURE OF AUTHORIZED OFFICIAL FOR THE DEPARTMENT OF MENTAL HEALTH 'DATE MO 886.3616(8-98) MEL CARNAHAN RICHARD H.STRECKER,M.S. REGIONAL CENTER DIRECTOR GOVERNOR ROY C.WILSON,M.D. DENNIS B.HARE DIRECTOR yc?�9 ebb ASST.CENTER DIRECTOR(TRTMT) DEPARTMENT OF MENTAL HEALTH JOHN SOLOMONY TERRY L.JACKSON,M.Ed. DIRECTOR N� REGIONAL PROGRAM SPECIALIST DIVISION OF MENTAL RETARDATION AND «<.. DEVELOPMENTAL DISABILITIES State of Missouri MELINDA KAYE ELMORE DEPARTMENT OF MENTAL HEALTH CENTRAL DISTRICT DEPUTY DIVISION OF MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES CENTRAL MISSOURI REGIONAL CENTER 101 B Park De Ville Dr. Columbia, Missouri 65203 June 21, 1999 (573) 882-9835"V/TT" FAX (573) 884-4294 Mr. Tom Hood Jefferson City Transit City of Jefferson 320 E. McCarty Jefferson City, MO. 65101 RE: Handi Wheels contract Dear Mr. Hood: Enclosed is a contract which will allow the City of Jefferson to provide City tax dollars as the 400 local match for Medicaid Waiver for the transportation contract between your city and the Department of Mental Health. The easiest way for this to work would be for us to bill Cole County Residential Services for all of the match until their $30,000 annual commitment is met, and then bill the City of Jefferson for match beyond that point. _ Thus, you would not need to start paying match until well into the fiscal year. Once CCRS had met their commitment, then the City of Jefferson would be responsible for all match for the remainder of the fiscal year. If you have any questions about the contract or about the logistics of how this would work, please contact Terry Jackson at the above number and he will be able to clarify any issues. Thank you for your help, cooperation, and patience as we get this new project worked out. Sincerely yours, CENTRAL MISSOURI REGIONAL CENTER 4Ds� 1500 VANDIVER DRIVE B. Hare, SUITE 100 Asst. Director COLUMBIA MO 65202-1921 ATTN.: TERRY JACKSON cc: Terry Jackson Jim Casey., CORS Provider file Dana Goings, The Department of Mental Health does not deny employment or services because of race,sex, creed,marital status,national origin,disability or age of applicants or employees. MEMORANDUM OF AGREEMENT BETWEEN THE CITY OF JEFFERSON AND THE DEPARTMENT OF MENTAL HEALTH DIVISION OF MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES FUNDING OF MEDICAID WAIVER MATCH FOR TRANSPORTATION (Effective July 1, 1999) WHEREAS, the City of Jefferson (hereinafter "The City" ) ' and the Department of Mental Health, Division of Mental Retardation and Developmental Disabilities (hereinafter "DMH") , desire to affect improved community-based services for Jefferson City citizens with developmental disabilities; and WHEREAS, The City is agreeable to contributing matching funds under the Missouri Home and Community-Based Waiver for services for eligible Jefferson City residents with developmental disabilities, subject to the following conditions and guidelines . NOW, THEREFORE, it is hereby agreed as follows : 1 . CREATION AND USE OF THE FUND During the term of the Agreement, the City shall deposit certain sums of money monthly, as provided in paragraph 5 hereof, in the Mental Health Trust Fund (hereinafter "Trust Fund" ) , said money to be used by the DMH to obtain matching federal funds pursuant to the authority granted the DMH in House Bill 10, passed by the General Assembly in 1991. Thereafter, the DMH shall use such combined City and Federal matching funds to provide transportation services for Jefferson City residents with developmental disabilities A (hereinafter "Clients" ) in accordance with the guidelines hereinafter set forth. 2. ELIGIBILITY (a) Clients shall be those persons who are Jefferson City residents as determined by law in the State of Missouri, and who have developmental disabilities as defined in Section 205 . 968 RSMd. 3 . SERVICES (a) Services shall be provided in accordance with the Medicaid Waiver contract currently in force between The City and DMH. (b) The services shall be delivered within the limits of the transportation serviceb of The City. MEMORANDUM OF AGREEMENT BETWEEN THE CITY OF JEFFERSON AND THE DEPARTMENT OF MENTAL HEALTH DIVISION OF MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES FUNDING OF MEDICAID WAIVER MATCH FOR TRANSPORTATION (Effective July 1, 1999) WHEREAS, the City of Jefferson (hereinafter "The City" ) and the Department of Mental Health, Division of Mental Retardation and Developmental Disabilities (hereinafter "DMH") , desire to affect improved community-based services for Jefferson City citizens with developmental disabilities; and WHEREAS, The City is agreeable to ,contributing matching funds under the Missouri Home and Community-Based Waiver for services for eligible Jefferson City residents with developmental disabilities, subject to the following conditions and guidelines . NOW, THEREFORE, it is hereby agreed as follows : 1 . CREATION AND USE OF THE FUND During the term of the Agreement, the City shall deposit certain sums of money monthly, as provided in paragraph 5 hereof, in the Mental Health Trust Fund (hereinafter "Trust Fund" ) , -said money to be used by the DMH to obtain matching federal funds pursuant to the authority granted the DMH in House Bill 10, passed by the General Assembly in 1991. Thereafter, the DMH shall use such combined City and Federal matching funds to provide transportation services for Jefferson City residents with developmental disabilities A (hereinafter "Clients" ) in accordance with the guidelines hereinafter set forth. 2.. ELIGIBILITY (a) Clients shall be those persons who are Jefferson City +!i ^f MA.cc tai t-r_.i DMH originally required that the local match (approximately 40%of the total cost of providing a trip)be deposited in the Mental Health Trust Fund (would have been the$2,500 per month that CCSS pays the City annually to support Handi-Wheels service for their clients and the remainder to be paid by the City)to obtain matching federal funds with this amount to be paid back to the City. We did this until DMH decided to allow the City to certify the local match. . Page 2 (c) Clients receiving services must be active clients of the Central Missouri Regional Center, Division of MR/DD, DMH. Eligibility will be determined by the Regional Center. Minimal documentation will be required to determine eligibility. 4. FUNDING (a) Payment of The City funds shall be limited to those expenses attributable to transportation approved in the Missouri Home and community-Based Waiver. (b) Cale County Residential Services his made an annual commitment of $30,000 (Thirty Thousand Dollars) , to be made in monthly payments. Each month, City funds payment will commence after Cole County has expended $2,500 (Two Thousand Five Hundred Dollars) in the purchase of transportation services from The City. (c) Payment for services shall not exceed the Medicaid Waiver cap established in a given fiscal year for Missouri. 5. PAYMENT (a) At the end of each service month, the DMH will calculate the match funds required. The City shall deposit at the end of each service month, sufficient match funds into the Mental Health Trust Fund. The amount of this deposit shall be based upon actual client use of the services . 6. MONITORING (a) The city will, on a monthly basis,- furnish documentation that lists each client and the amount of service provided to that client. (b) The DMH shall provide to The City documents relative to the implementation/monitoring of this Agreement at the request of the County Board, including but not limited to, Medicaid Waiver provider audits, Medicaid Waiver certification verification, and Federal Medicaid Waiver is state audits. 7. TERMS ,AND TERMINATION This agreement shall be effective until June 30, 2000. Alterations may be made at any time with the written approval of both parties. If The City elects to terminate funding s under this agreement, it shall provide written notice to DMR at least 60 days in advance. �t TOTAL P.02 Page 3 IN WITNESS WHEREOF, the undersigned have executed this Agreement the day and year first above written. Richard Strecker, Director Date Central Missouri Regional Center Melinda Elmore, Deputy District Date Director, Central District, Division of Mental Retardation/Developmental Disabilities John Solomon, Director Date Division of Mental Retardation/ Developmental Disabilities Jackie D. White,, Deputy Director Date Administration, Department of Mental Health Richard A. Mays, City Administrator Date City of Jefferson, Missouri ��-uo-i a�� en•vis u'�t�t 573 -884 42134 P.01/02 �� •�s STAF'E OF MISSOURI FACSWILE TRANSMITTAL F�Trz To FROM ow Aab ��f'woe e,C-f- el 7 1/ 7x-*W5 r FAXNUMffffl FAKNU -W a 2-f a del ,' �of�� R 49d,4 6oW ANY PROBLENS WffH TRMSMOTTAL, CALL f �y CITY OF JEFFERSON AMENDMENT TO GRANT AGREEMENT WHEREAS,the City of Jefferson,Missouri,a municipal corporation,hereinafter designated"City,"entered into an Agreement with Cole County Special Services hereinafter referred to as"CCSS," on May 22, 1997; WHEREAS, the Agreement was for a grant of CCSS funds to operate in connection with its purposed and function of providing services and benefitting citizens who are disabled;and WHEREAS,both parties wish to renew the Agreement for a final one (1)year period. NOW,THEREFORE,be it agreed as follows: A. Paragraph 2 of the Agreement dated May 22, 1997 as previously amended, is hereby amended to read as follows: 2. Description of Payment. In consideration of Handiwheel's performance, CCSS grants to the City the sum of Thirty Thousand Dollars($30,000.00). B. Paragraph 3 of the Agreement dated May 22, 1997 as previously amended, is hereby amended to read as follows: S. Method of Payment. Two Thousand Five Hundred Dollars ($2,500.00) will be issued to the City for each of twelve(12)months beginning July 1, 1999 through June 30, 2000. The City agrees to and understands that these funds are intended to help maintain the present level of serviceoffered by Handiwheel and are not intended to replace existing City funds. C. Paragraph 8 of the Agreement dated May 22, 1997,is hereby amended to read as follows: 8. Renewal. No additional renewals are authorized under this agreement. D. All other sections of the Agreement dated May 22, 1997, shall remain in effect as stated. i vy)04f IN TESTIMONYWHEREOF,the parties have hereunto set their hands and seals this 1 day of App-1,1999. CITY OF JEFFERSON,MISSOURI CONTRACTOR COLE COUNTY SPECIAL SERVICES Mayof Chairman ATTEST: ATTEST: City Cl4rk Secretary APPROVED AS TO FO r Ci un A:\Sandy\con cts\service\cote county spec sys\amendment 1999-OO.wpd JUN 1*3 [DEPARTi FMedicaid Waiver Services to be Purchased by: Home and Community Based Services DEPARTMENT OF MENTAL HEALTH Request for Proposal DIVISION OF MENTAL RETARDATION AND DEVELOPMENTAL'DISABILITIES Contract Period: �-1_) - 9.9 through[)630GCC) Date of Issue: The Department of Mental Health desires to contract with licensed,certified or accredited individuals and agencies to provide services for citizens of Missouri with mental retardation or developmental disabilities who will be participating in the Medicaid Home and Community Based Waiver Program. This document constitutes a request for proposal,including prices from qualified individuals and/or organizations. Return this proposal to the appropriate Regional Center's Administration. Service Title(s): _ A-N5 pG A -i—�,4�r:G (as they appear in the DMH's Programs and Services Catalog. See Part I,paragraph 4) Responsible DMH Facility#: ooZ Ql DMH's Community Placement Residential'Type and Bed Capacity: (for Community placement services only) We hereby agree to provide the services and/or items,at the prices quoted,pursuant to the requirements of this document and further agree that when this document is countersigned by an authorized official of the Missouri Departmentof Mental Health,a binding contrapt,:as defined herein,shall exist between the offeror and the Department of Mental Health. Contractor Name: City Of Jefferson, Missouri : Mailing Address: 320 E. McCarty Street C) c City, State Zip: Jefferson City, MO 65101 �' �" Telephone: (573L 634-6358 72r- Authorized Signature: .) Date' " R3,c rr9 n. May City Administrator Authorized Signer Printed Name and Title: The authorized signer of this document verifies that he/she is an individual or the representative of the contractor and is the duly authorized agent to execute the contract on behalf of the contractor under authority granted by action of the Board of Directors as documented in Board minutes and that this document is signed on behalf of the contractor by authority of its Board of Directors and acknowledges this act to be the free act and deed of said contractor. This proposal is accepted by the Department of Men a Health as follows: State Vendor Number: $ Contract Number: MOI) §� Contract Code: D put irecfor, � Administration, Dept. Mental Healt l Date Page: POS-7 MO650-7342 (3/91) .. ' STATE OF MISSOURI DEPARTMENT OF MENTAL HEALTH APPLICANT FILE INFORMATION • INSTRUCTIONS ARE ON THE REVERSE SIDE fl. TAX NUMBER: EMPLOYER TAX I.D.: , 41 4, _ 6 p 0, 0, 1, 9, (T) OR SOCIAL SECURITY NUMBER: 1 _ , _ , , , (S) 2. MISSOURI VENDOR NUMBER: A -1 , 144IC]3, (IF NONE CHECK HERE) 1. ❑ 3. OFFICIAL (LEGAL) NAME AND MAILING ADDRESS A. NAME: LC, I, T, Y, 1 O, FI 1 JI E F F E R S O N (LAST NAME.THEN FIRST IF USING PERSONAL NAME( , B• C. ADDRESS: ^}, �1 OI E ('� I7', �j (RESP FAC) 3 , ,. , Mp , C, A R D. CITY: I J, EI F, F, E, R, S, O, , 1 STATE: ,MIO, ZIP: 16 ,5 Ll ,0 11 I E. COUNTY: ,_C, O, L, E, , , , , , , , , CODE: (DMH USE ONLY) 4. CHIEF EXECUTIVE OFFICER A. NAME: e5IcH REZMA, N19 D,U,A,N,E, I , (LAST) ��{ 7T //'�� (FIRST) (,) B. TITLE: IM A ,Y Q IR , 1 1 1 1 1 1 C. TELEPHONE: t7 — ,6 ,3 ,0 ,4 , (PLEASE USE FACILITY NUMBER) 5. ORGANIZATION TYPE: (SEE INSTRUCTIONS—CHECK ONE BOX ONLY) ' ❑ 0 — SELF—EMPLOYED ❑ 3 — MULTIPLE FACILITY Cl 1 — SINGLE FACILITY ❑ 4 — HOLDING COMPANY AR 2 — GOVERNMENT (IF BOX 3 OR 4 IS CHECKED, PLEASE COMPLETE) CENTRAL NAME: CENTRAL MO. VENDOR NO.: 1 6. MINORITY STATUS: 1. ❑ MINORITY 2. RINON MINORITY 7. BILLING ADDRESS: (IF DIFFERENT THAN ITEM 3 ABOVE) A. NAME: T�E •F ,FERSON CITY TRANSIT 1 1 I 1 1 1 1 I I 1 1 1 1 1 1 1 1 I 1 I 1 I 1 1 1 I 1 (LAST NAME.THEN fIRST IF USING PERSONAL NAME) I B• , 1 1 I I , 1 1 I , 1 t I 1 I 1 1 1 I , , 1 1 ' C. ADDRESS: 8 2 0 , -El M I L L E R D. CITY: LJ ,E ,F ,F ,E IR IS ,O N, IC 1I,T,Y, 1 1 STATE: AO, ZIP: , 6, 5, 1, 0, 1, CERTIFY THAT THE ABOVE INFORMATION IS COMPLETE AND CORRECT TO THE BEST OF MY KNOWLEDGE. GNED DATE - 3� 9 MH USE ONLY VISION CODE FACILITY NO FACILITY 'BMITTCD BY ` 1----- �� I �� - '" l 0 �6(C)ft i t_ Cc I r .�-. 11/14/94 ART INTRODUCTION HOME AND COMMUNITY BASED MR/DD MEDICAID WAIVER DESCRIPTION OF PROGRAM 1. Medicaid Home and Community-Based Waivers permit states to offer an array of Medicaid reimbursable community-based services, both in residential and natural home settings. Services are provided to individuals with mental retardation and developmental disabilities and who are Medicaid eligible so that they may: I.I. avoid placement in an Intermediate Care Facility for the Mentally Retarded (ICF/MR); 1.2. be discharged from an ICF/MR to a less restrictive environment;or 1.3. maintain residency in an existing non-certified facility which could become certified if not for the option of the MR/DD Waiver. 2• The contractor agrees all services provided under the Medicaid Home and Community-Based MR/DD Waiver will be habilitative and will meet the individual needs of persons who would otherwise require the level of care provided in an ICF/MR. The contractor is responsible for ensuring services are designed to enable individuals with mental retardation/developmental disabilities to achieve optimal physical,emotional and intellectual functioning. Services must be intended to help individuals to live independent and productive lives,considering each individual's special needs and capabilities. 3. To the extent possible.services provided through the Medicaid Home and Community Based MR/DD Waiver by the contractor must focus on: 3.1. normalization, by affording the rights and benefits of culturally typical lifestyles, 3.2. placement in the least restrictive environment;and 3.3. community integration. 4. The contractor agrees to provide services in accordance with the specific definition of each service as described in the Medicaid Home and Community Based(MHCB)MR/DD Waiver Application.the Department's Programs and Services Catalog and in accordance with State of Missouri, Department of Mental Health,guidelines and policies, Services offered for purchase by the Department from this RFP shall consist only of those services descrbed in the RFP, Pricing/Service Data Page under service title and description(Attachment A). The Contractor shall provide, as a part of the rates noted on Attachment A in this contract,everything included in the Department's definition'of the particular service. 5/16/96 PART II SCOPE OF WORK HOME AND COMMUNITY BASED MR/DD MEDICAID WAIVER PROGRAM REQUIREMENTS Authorizations 1. The contractor understands services provided to a client prior to,receipt of an authorization given by the state agency or in excess of an authorization given by the state agency SHALL not'be reimbursed. Services SHALL be authorized and provided on an as needed, if needed,when needed basis. 2• The authorization may be adjusted or terminated during the term of this contract by the state agency for causes relating to client progress,appropriateness of the service(s)to the client or other related causes. Services SHALL be provided in accordance with a pian of care approved by the Regional Center for purposes of this.contract the plan of care may mean an individualized habilitation plan or person centered plan, 3• The contractor agrees to notify the facility of the state agency authorizing service(s)for a client in writing within seven(7)days upon receipt of a dient's authorization if unwilling,or unable to provided the service(s)as prescribed. 4. The state agency retains.the right to resolve all-controversies on all authorizations as well as automated and manual invoices, Invoices 5. The contractor SHALL follow the billing procedures and fiscal reporting system established-by the administrative office of the state agency and approved by the Department of Social Services, Division of Medical Services. Under no circumstances may the contractor bill the Medicaid agency.directly. 6. Invoices for services received twelve months or more after the date of service'provision SHALL NOT be honored by payment unless approved by the Department. 7• Services authorized in the clients plan of care which have been specifically identified as "OUTCOME BASED"SHALL be billed to the Department only as specified in an addendum to this contract or in the absence of such an agreement when the achievement of a goal has met the completion date for the service. 8. Only the time the client receives services(or is present)SHALL be billed to the DMH. In all services billed to the DMH,the client time in service is billed regardless of the number of persons providing the services. All costs SHALL be included in_a service's contracted rate. 9. Residential Habilitation contractors SHALL not be reimbursed for days the client is not present. The contractor's allowable monthly costs,as defined in this contract, SHALL be redistributed across the days the client was present to produce an adjusted payment per day,up-to the Medicaid maximum allowable per diem amount. 5/16/96 Medicaid Provider Enrollment 10. All contractors of waivered services SHALL be properly enrolled as a Medicaid Home and Community Based Waiver provider with the Department of Social Services, Division of Medical Services, prior to receiving authorization for delivery of waivered services. The contractor SHALL NOT receive reimbursement if the agreement with the single State Medicaid agency is not in place. 11. The contractor SHALL have all current licenses/accreditation's/certifications required by the waiver. In the event the contractor fails to be relicensed, reaccredited, recertified or ceases to be a Medicaid Waiver contractor,the state agency may,without penalty,terminate all prior authorizations. Subcontracting 12. Per the terms and conditions specified in Part III,General,Contractual Requirements,the contractor SHALL obtain written approval from the Department to subcontract services. The department's written approval for subcontracting SHALL pDly be granted to the contractor in the Home and Community Based Medicaid Waiver Program for requests which are incompliance with 42 CFR 447.10. Service Records 13. The contractor SHALL maintain and submit upon request,client and service specific daily attendance records which specify the service type,the date(s)of service provision,the number of units.and the signature and title of the program supervisor/provider and any other information deemed necessary by the state agency.Residential Habilftation Contractor's SHALL maintain and submit upon request time records on all personnel providing habituation services. As a minimum these records SHALL specify:staff name,date worked,start& end time, and client name or location where habilitation services were provided. 14. Residential Habilitation Contractor's SHALL maintain and submit upon request employee files which document:staff name,date hired,current hourly pay rate or salary, highest level of education completed or passage of the General Education Requirements(GED),completion dates of training courses,and criminal history background check results. 15. All staff providing residential habilitation services SHALL have a high school diploma or have - passed the GED and have received training in Cardiopulmonary resuscitation and first aid. Further, all staff providing residential.habilftation services,within three(3) months of employment, SHALL have received training in behavior support. If a client's individual habilitation/support plan.includes receiving medication,staff administering medication SHALL have successfully completed medication administration training before administering medication. 15.1. The contractor SHALL have at least one(1)staff person on duty during each shift and at each residentiallservice location,who has successfully completed a Department sanctioned medication administration training course. 15.2 The contractor may allow the resident or client self-administer'medication if pre-approved on the clients services/.support plan. The contractor SHALL ensure that the resident or client understands the purpose and side effects of their medication The contractor SHALL monitor the resident's or client's self-administration of medication so as to ensure their safety and,health. Contractor personnel working-with residents or clients who self- administer medication do not require training in medication administration but SHALL be 5/16/96 knowledgeable about the resident's or client's medication regime and their possible side effects. 16. The contractor SHALL maintain and submit upon request,client and service specific progress notes which specify the service type,the time period being assessed, an assessment of client progress on specific service goals and objectives as contained in their habilitation/support plan, the signature and title of the program supervisor/provider and any other information deemed necessary t y the state agency. The contractor SHALL participate in their client's service reviews as requested by the authorizing state agency. 17. The contractor SHALL write progress notes on at least on a monthly basis unless requested more frequently by the state agency. Miscellaneous Requ;mments 18. The contractor SHALL assist in the formulation,implementation and evaluation of-their client's annual haW tafQG&% =plans upon the request of the state agency. 19. The contractor SHALL cooperate with the state agency in arranging or providing transportation. and in removing a client when the contractor or state agency has provided proper notification that a client is to vacate its premises. The contractor may be reimbursed for travel*mileage at the current department rate when preauthorized by the state agency. 20. The offeror SHALL complete a Pricing/Service Data Page(Attachment A)for each specific type of specific service being proposed. 21• The contractor SHALL assist and cooperate with the state agency during monthly visits by the state agency with the clients participating in the waiver Author's tion for Service 22. Services provided for a particular client SHALL not be reimbursed unless the form authorizing the service(s) is executed and subsequently approved by the appropriate Department division director,or designee,prior to the delivery of the service(s). Prior approval for the provision or the obtainment of emergency medical care is not required. Any follow-up medical services relating to the emergency SHALL require prior approval of the authorizing Department facility. 23. An authorization for ancillary services may be adjusted or terminated as follows: 23.1 All client specific services where there is no contractor expense incurred,such as taxi services or client specific medical services,,may be adjusted or terminated as of the day of the Department's notification to the contractor. Adjustment or termination of such a service SHALL be based on individual client need or other related causes which SHALL be specified to the contractor. Termination of payment for ancillary services SHALL be effective on the date the service is discontinued. 23.2 Services that are provided for the Department clients in a contractor facility where the contractor is either purchasing treatment related services or directly funding a specialized service component SHALL be reviewed by the Department for continuation,adjustment or termination on at least an annual basis. 24• Nothing in this contract SHALL be construed to require the Department to place its clients with the contractor or to continue to use the contractor for placement of its clients. 5/16/96 Services cif thQContractor 25. The contractor SHALL, without additional reimbursement, provide basic personal supplies and first aid supplies for Department clients as deemed appropriate by the Department. Client personal spending allowances may be utilized to purchase additional items or services if all requirements set forth in 9 CSR 25-5.010 are met. Prescribed non-legend medications may be a reimbursable cost by the Department if prior approval is obtained from the Department. Legend prescriptions SHALL be a reimbursable cost by the Department when: 25.1 The client is a Medicaid recipient and has been prescribed medication not obtainable on -the Title XIX Drug Formulary for the treatment of mental illness;a mentally retarded/developmentally disabled;and/or an alcohol or drug abuse related diagnosis; 25.2 The client is not a Medicaid recipient or eligible for other third-party payment, and is not financially able to pay for the medication,as determined by application of the _ Department's standard means test. Reimbursement to pharmacies SHALL not exceed the Tale XIX rate where possible. _ 26. If medication is to be totally or partially paid for by the Department, the contractor SHALL request that physicians prescribe or allow the substitution of generic drugs whenever available and appropriate. 27. The contractor SHALL be responsible for implementing those _portions of the individualized habititation/support plan and/or individualized supported living residential budget plan which are approved and authorized by the Department for payment to the contractor and provide care and oversight. The contractor and appropriate direct contact staff SHALL attend an annual individual habilitation/support plan conference as required by the authorizing Department facility.. All Providers SHALL document provision of authorized services and client progress. 28. When the contractor delivers less than the hours and/or cost approved on an individualized supported living budget, the contractor SHALL report the reduction to the Regional Centel within thirty (30) days of the service. The Regional Center SHALL either adjust the individualized supported living budget or approve the variance in writing. Variances of five (5) percent or more SHALL require the District Deputy Director or designee's approval. 29. Contractors providing residential services SHALL serve the needs and conditions of their clients with opportunities for leisure activities and recreational programming. 30. Contractor's having a licensed, certified or accredited residential capacity of ten (10) or more clients SHALL appoint a client rights committee whose function SHALL be to review existing and planned programs, ensuring that legal rights of clients are upheld. These rights.include: The right to habilitation, education, and/or treatment, the right to communication, the right to protection from harm and abuse, the right to adequate programming for individual needs, the right to advance notification in a manner which they understand when limitations of any right are under consideration, the right to an impartial review of any proposed limitations, the right to appeal any decision reached through the impartial review and the right to have an advocate, friend, family member.and/or counsel assist them in understanding any limitations of their rights and/or to assist them in representing their views.. This committee SHALL consist of no fewer than five(5) adult individuals. The contractor may have a client rights committee which does not conform with this section with the prior written approval of the Department. - 5/16/96 31. The contractor,SHALL obtain an annual physical examination for all Department clients receiving residential services from the contractor withinlime lines set forth•by the authorizing Department facility. Additional physical examinations may be authorized at the discretion of the Department. A record of the examinations SHALL -be included in the client's chart maintained by the contractor. If any Department client is not a Medicaid recipient, and the physical examinations ' are not provided by the.authorizing Department facility, the cost for the physical examinations cost of these services SHALL have prior Department approval. and other physician services SHALL be an approved reimbursable_ancillary service; however, the 32. The contractor. SHALL administer or obtain immediate emergency medical care whenever the withholding of such care may result in bodily injury or jeopardize the life of a client. 33. The contractor SHALL exercise diligence to protect a Department client's rights in accordance with Federal/State statutes and regulations and the Department's rules and regulations. 34. The contractor SHALL provide, as a part of the rates noted on the p6cing/service data page (Attachment A) in this contract, everything incIdded in the definition of the particular service as defined in the Department'scurrent service catalog. Admission Criteria Treatment Habilitation/Rehabilitation 35. All contractor facilities which are not 'licensed by the Department SHALL comply with Departmental policy and procedure regarding the following: Admission Criteria, tment Planning, Seclusion, Restraint and Time-out. All guidelines SHALL be issued/implemented to coincide with the contract period. No revisions SHALL be made-during the contract period. Notifcatfon 36. - The contractor SHALL not transfer a client to another place of residence without the prior written consent of the Department. 37. The Department may remove any or all of its clients, withdraw financial support for any or all of its clients-and may terminate this contract without notice when, in the, Department's •sole judgment, the heafth and welfare of its clients are threatened by their continued presence in the contractor's facility. 38. If the contractor is unable to continue to provide the required residential, ancillary services, as separately authorized by•the Department on the services .authorization form, to a particular Department client, the contractor SHALL notify the placing Department facility ire writing at least fifteen (15) days prior to the date proposed for curtailment of existing ancillary services to that •client. 39. The contractor may decline to provide services to a Department client for any reason within the first ten (10) days after service authorization by the Department. written notice to the supervising Department facility, unless an earlier return 40. The residential contractor SHALL not ,return a Department client without thirty (30) days prior agreed to,except as noted in paragraphs 39 or 41. date is mutually 41. When•it becomes apparent to the contractor that the health or welfare of the client is jeopardized by continued services with the contractor, the contractor SHALL(1) if a medical emergency, seek immediate emergency medical care/treatment for the client followed by immediate notification to the authorizing Department facility, or (2) if riot a medical emergency. notify 1h.- a,iti,,,,;��,,, fni,;1;t..4— _- - 5/16/96 .' 42. The contractor SHALL notify the authorizing Department facility of the Department whenever there is a significant unanticipated deterioration in a Department client's physical or mental condition. Notification SHALL be.made on the day of occurrence or-during business hours of the first Department working day after the day of occurrence, followed by written notification mailed within 48 hours. 43. The contractor SHALL notify the authorizing Department facility whenever there is a change in the contractors name, address,telephone number, administration or controlling ownership. Written notification SHALL.be made-within five(5)working days of the change. Change of ownership SHALL necessitate execution of a new contract with the Department. A change of ownership SHALL be considered to have occurred as set out by 9 CSR 40-1.055 (9) (C). 44. The contractor SHALL immediately notify the authorizing facility of the Department w0never there is a medical emergency involving a Department client. Notification SHALL be followed with written notification mailed within 48 hours. 45. The contractor SHALL immediately- notify the authorizing facility of the Department whenever there is a death of a Department client. Notification SHALL be followed with written notification by certified mail sent within 48 hours. 46. The contractor SHALL immediately notify the authorizing facility of the Department whenever' there is an unexplained absence of a Department client. Notification SHALL be followed with written notification by certified mailed within 48 hours. 47. The authorizing Department facility SHALL immediately notify the contractor whenever the Department takes any action relating to a Department client's psychiatric medications, admission to any hospital,or any action that would require any.follow-up performance by the contractor. 48. The contractor SHALL immediately notify the head of the authorizing Department facility of any allegations of physical abuse, sexual abuse,verbal abuse or neglect of a Department client. The person in charge SHALL immediately take appropriate action to protect the safety and welfare of the client and investigate and resolve the complaint, and cooperate fully with the Department's investigation of the allegation. Management of Client Properties 49. Money belonging to Department clients SHALL be held in trust for the client(s) and SHALL not be commingled with any contractor funds. Money authorized and funded in the individualized supported living residential budget plan for room and board costs SHALL belong to the Department's clients. 50. Any client personal allowance amount authorized by the Department on the services = authorization form SHALL not be considered to be a portion of the contract rate paid to the contractor by the Department. 51. The contractor SHALL maintain records,on a cash basis,of receipts and disbursements by or on behalf of'individual Department clients. For each individualized supported living resident, a record SHALL be maintained for personal spending moneys and a separate record for all other moneys (rent, utilities, and any other funding). Money of one client SHALL not be'used to defray the expenses of the contractor or another client. 52. The contractor SHALL report quarterly, or more frequently if required by authorizing agency, the 5116196 52. The contractor SHALL report quarterly, or more frequently if required by authorizing agency, the account balance of each Department client. 53. The contractor SHALL notify the Department after any discrepancy is discovered or reasonably should have been discovered, upon the receipt of.moneys for a Department client that does not conform to the amounts designated on the services authorization form. 54. Within thirty(30) days after-.the death or transfer of a Department client, the contractor SHALL return to the Department all moneys and-personal properties of the client, unless otherwise directed by the Department,the client or the client's conservator. 55. The contractor SHALL not purchase property from a Department clients moneys which will not meaningfully benefit the client. Any client property purchase of$100.00 or more SHALL not be made without' the written permission of the authorizing Department facility: Any property purchased for a Department client should be kept in the client's immediate living area if-practical. If it is not practical to keep a Department client's property in the client's immediate living area,the Department client's property SHALL be kept in,an area easily accessible to the Department client, and SHALL not be used by anyone else without the permission of the client. Unless otherwise agreed to in writing by the client or other responsible person, all property purchased from a Department client's moneys or purchased for the client SHALL clearly carry such client's personal identification. In any case,a record of each such purchase SHALL be maintained on an Individual Client's Personal Property Listing in the client's file. 56: The contractor SHALL not charge for the maintenance of a client's personal account. However, the contractor may charge client personal accounts'for bank check-writing charges. These bank - charges SHALL not include charges-for check overdrafts. Bank charges may be allocated to client-personal accounts based on the number of personal accounts comprising the bank balance 57. The contractor understands that the Department SHALL not assume responsibility for deficit spending of client accounts. 58. The contractor SHALL. not charge the client's personal funds for any expenses which the contractor is obligated to provide by this contract or for items or services not clearly set out in 9 CSR 25-5.010. Payments 59. The date on which,services begin SHALL be reimbursable . The date of discharge, transfer, death, or other departure SHALL not be considered as a reimbursable day for computation of payments. 60. Allowable monthly costs for congregate residential habilitation contractors SHALL consist of the contractor's per diem rate times the total days in a month,less any days prior to admission or subsequent to discharge. Allowable monthly costs for Individualized Supported Living (ISL) contractors SHALL consist of the monthly reimbursable amount specified on the supported living budget, approved by the regional center for the month of service. 61. The Department SHALL not be billed for unapproved absences;however, at the option of the contractor,the client, the spouse,parents,conservator or others may be billed for such- -absences. , 5/16/96 62. All amounts paid to the contractor on behalf of a Department client by the Department of Social Services, Social Security Administration, Department of Housing and Urban Development, the client, the client's conservator and other sources SHALL reduce the amount payable on a dollar for dollar basis by the Department for any client's care and treatment. 63. The contractor understands that it SHALL make a reasonable effort' to collect from the responsible person the amounts designated on the services authorization form. The contractor agrees and understands that failure to coiled any amounts due from clients or their financially responsible person SHALL be. losses incurred by the contractor, except when the contractor notifies the authorizing Department facility, in writing, within thirty (30) days after default of a payment or installment, and can demonstrate that a reasonable effort has been made to collect. Such notice should be. made within ninety (90) days-of the payment or installment due date. Upon receipt, of notification, of failure to pay, the Department SHALL assume responsibility for the payment. The contractor understands that the Department may exercise its option to discharge the client for failure to pay under the provisions of.Section 630.210, RSMo. 64. Money received from the Department under this contract SHALL not be used to supplant other sources of reimbursement for which the client is eligible. 65. The contractor SHALL not charge, increase or decrease charges to a Department client or to his relatives or to his conservator without the written consent of the Department. If the contractor reduces charges to a client or to his relatives or conservator without the written consent of the Department, such decrease SHALL be at the expense of the contractor. 66. If. the Department gives a retroactive base rate increase to the contractor for its authorized client(s) and the contractor provides like services to any non-Department client(s),the contractor is not required to increase base rate charges up to the new Department base rate retroactively and should provide up to 60 days notice of a rate increase to any non-Department client(s). Identification of the Landlord 67. The person or entity'that owns the property and premises used by the contractor is whose address is 68. . In the event that the owner of the property or premises is not the contractor,the contractor SHALL provide to the Department a written statement(Form DMH 7805)signed by the contractor and the Owner of the Property to the effect that the owner of the property-SHALL notify the contractor sixty(60)days before evicting or otherwise requiring the contractor to quit the premises. A copy of a lease or other agreement whic provides for the above notice provisions to be given contractor by the owner of the property may be provided in lieu of the statement. If the contractor receives notice from the owner of the property to quit the premises,then it SHALL notify the Department within 24 hours of the receipt of such notice. Resident and Client Rights 69. The contractor SHALL not limit the rights of a resident or client as defined in RSMo.630.115. 70. Client rights as specified in RSMo. 630.110 may be limited by the contractor only if exercising these rights would be inconsistent with the person's therapeutic care, treatment, habilitation or rehabilitation. The contractor SHALL make this determination of inconsistency only when the resident or client is a clear danger to themselves, others or community property and the Department's authorizing facility concurs. 5/16/96 71. The contractor SHALL comply with RSMo. 630.120 and SHALL not presume that residents and clients are incompetent or limit their rights, responsibilities or obligations of citizenship as•a consequence of receiving evaluation, care, treatment, habilitation for mental retardation or other developmental disabilities. 72. Any contractor employee who has reasonable cause to believe that a resident or client of a Community residential facility or day program has been subjected to physical abuse, sexual abuse, Class I neglect , Class II neglect or verbal abuse while under the care of a community residential facility or day program SHALL immediately make a verbal or written complaint. Failure to report SHALL be in violation of the contrdct and/or cause for criminal prosecution. 73. No person found to have committed physical abuse, sexual abuse or Class I neglect SHALL be employed by the contractor. 74. No person who has committed verbal abuse or Class II neglect three (3) or more times in a twelve(12)-month period SHALL be employed by the contractor. — 75. No person convicted of a felony against persons SHALL be employed in a direct care capacity in facilities or programs contracted with by the department. 11/20/98 PART III GENERAL CONTRACTUAL REQUIREMENTS GENERAL 1. Authorization for the Department of Mental Health (Department) to purchase services is granted each fiscal year by the Office of Administration. Authorization to purchase services for additional contract periods requires annual renewal of the authorization. 2. The contract between the Department and the contractor SHALL consist of (1) the Request for Proposal (RFP), any amendments, attachments and/or I exhibits thereto and (2) the proposal submitted by the contractor in response to the RFP and approved by the Department . If there is a conflict in language between the two documents, the requirements set forth and/or referenced in the Request for Proposal SHALL govern. The Department reserves the right to clarify any contractual relationship in writing with the concurrence of the contractor. Such written clarification SHALL-govern in case of conflict with requirements of the RFP or the contractor's proposal. The contractor's proposal, when accepted by the Department, is binding on the contractor without further clarification. 3. This contract SHALL be interpreted according to the laws of the state of Missouri and SHALL govern the terms and conditions of services to clients of the Department by the contractor.pursuant to Chapter 630 RSMo., as amended. The contractor SHALL comply with all local, state and federal laws, rules and regulations related to the performance of the contract to the extent that these may be applicable. The contractor SHALL have all licenses and/or certifications current which are required by law, rule or regulation. 4. This contract SHALL constitute an assignment by the contractor to the state of Missouri of all rights to, title to and interest in all causes of action that the contractor may have under the antitrust laws of the United States or the state of Missouri for which causes of action have accrued or will accrue as the result of or in relation to the particular goods or services purchased or procured by the contractor in the fulfillment of the contract. 5. Unless otherwise specified, the contractor SHALL be responsible for furnishing all material, labor, facilities, equipment and supplies necessary to perform the services required. The contractor SHALL comply with the Fair Labor Standard Act, Equal Opportunity Employment Act, and any other federal and state laws, rules, regulations and executive orders to the extent that these may be applicable and further agrees to insert the foregoing provision in all subcontracts awarded. 6. The contractor SHALL assume all legal and financial responsibility for taxes, FICA and employee benefits. The contractor SHALL authorize and direct all custodians of records of their taxes,.FICA and other employee benefits to release information to the Department upon request. 7. This contract is predicated, in part, on the utilization of the specific resources, individual(s) and/or personnel qualifications as identified and /or described in the contractor's Department approved proposal and, when applicable, Department approved Uniform Budget packet (schedules A, B & C) or any other financial reporting tool prescribed by the Department. No personnel and/or individuals will be utilized in the.performance of this contract who fail to meet specific provider qualifications as set out in the Department's service catalog. No substitution of provider qualifications SHALL be made without written notification to the Department and the Department's approval. The contractor agrees that substitutions made pursuant to this paragraph SHALL be equal to or better than originally proposed. 11/20/9 8. Department approved staffing ratios and/or patterns are essential for providing the services identified. The contractor SHALL maintain all Department approved staff ratios, hours of services and/or patterns or request a written waiver from the Department. The contractor SHALL maintain time, salary or hourly pay rate data and personnel records as specified by the Department. Downward deviation of staff/resources upon which the unit price is based may require a downward adjustment of unit price(s). Recovery of fees paid on which there has been a downward deviation in staff/resources for the contract year per (a) Department approved Uniform Budget Form (DMH- 8836) and its Expense Categories (b) Department approved staffing ratios, or (c) any other financial reporting tool prescribed and approved by the Department SHALL be required and may be retroactive to the date of occurrence. Recovery of payments for services provided which are contrary to the provisions of this contract SHALL be pursuant to §630.460, RSMo and other applicable statutory provisions, rules and regulations. 9. The contract will be read and enforced as though every provision of law and clause required by law to be inserted herein were included. If any such provision is not inserted, then upon the rtatification of"either party the contract will be amended to make such correction. 10. The contractor agrees to consolidate all or portions of related service contracts into a single contract at the request of the Department. SUBCONTRACTING 1'1. The contractor SHALL not assign interest in the contract and SHALL not transfer interest in the contract without the prior written consent of the Department. 12. Upon written approval by the Department the contractor may subcontract for services described herein provided that any subcontracts include appropriate provisions and contractual obligations to ensure the successful fulfillment of all contractual obligations agreed to by the contractor and the Department and to ensure that the Department.is indemnified, saved and, held harmless from and against any and all claims of damage, loss, and cost (including attomey fees) of any kind related to a subcontract in those matters described in the contract between the Department and the contractor. The contractor SHALL expressly understand and agree that he SHALL assume and be solely responsible for all legal and financial responsibilities related to the execution of a subcontract. The contractor SHALL agree and understand that utilization of a sub-contractor to provide any of the services in the contract SHALL in no way relieve the contractor of the responsibility for providing the services as described and set forth herein. 13. In accordance with Executive Order 94-03, state agencies SHALL have a goal of awarding at least five percent (5%) of all contracts to businesses that qualify as minority business enterprises (MBE), as defined in RSMo. 33.750. MBE means an individual, partnership, corporation or joint venture that is owned and controlled by one or more persons who are members of the following racial minority groups: African Americans, Native Americans, Hispanic Americans, Asian Americans, or other similar racial groups. The contractor SHALL therefore make a good faith effort to obtain five percent (5%) minority participation in any subcontracting activities. CONFLICT OF INTEREST 14. In accordance with the Revised 'Statutes of.the State of Missouri, no official or employee of the Department or public official of the State of Missouri who exercises any functions or responsibilities in the review or approval of the Scope of Work covered by the contract SHALL acquire any personal interest, directly or indirectly, in the contract or proposed contract. 11/20/98 15. In accordance with state and federal laws and regulations, state executive order or regulations and policies of the Department, the contractor agrees that it presently has no interest and SHALL not acquire any interest, directly or indirectly, which would conflict in any manner or degree with the performance of the services. The contractor agrees that no person having such interest SHALL be e employed or conveyed an interest, directly or indirectly, in the contract. 15.1 It is agreed that no Missouri state employee SHALL help the contractor obtain this contract or participate in the performance of this contract if such involvement will constitute a conflict of interest. Before any state employee may be involved in the performance of this contract written approval SHALL be obtained from the director of the Department. 15.2 A state employee SHALL not be compensated under this contract for duties performed in the course of his/her state employment. A state employee SHALL not use state facilities or materials for personal gain relating to the performance of this contract. 16: Thi contractor represents itself to be an independent contractor offering such services to the general public:and SHALL not represent itself or its employees as employees of the State of Missouri. 17. If the contractor is a not-for-profit agency, board members must abstain from voting on any funding proposal in which they have administrative control or a monetary interest with the proposed grantee. Board members who have such an interest and participate in discussion prior to a vote must disclose such interest in a meeting of the board prior to such discussion. FINANCIAL REQUIREMENTS 18. The availability of funding for this contract SHALL be determined solely by the Department and such determination SHALL be final and without recourse by the contractor. The Department does not give any assurances under the terms of this contract that the maximum calculated reimbursement for service(s)specified herein will be purchased. 19. Moneys received from the Department under this contract SHALL not be used to supplant local funds or subsidize services provided to other agencies, organizations, or individuals. 20. Payment due under the terms of the contract SHALL be made by the Department upon receipt of a properly itemized invoice. The contractor SHALL utilize the fiscal reimbursement system required by the Department. The contractor SHALL not invoice federal or state tax. The State of Missouri's tax- exempt certificate number is 43-750026K- 21. The contractor SHALL invoice for services provided at the contracted unit price. Unit prices charged the Department SHALL be no greater than those charged to the general public for the same service. 21.1 The-Department reserves the right to audit all invoices and to reject any invoice for good cause. 21.2 The Department reserves the right to deduct from an invoice any overpayment made by the Department. 21.3 All overpayments SHALL be collected in accordance with §630.460, RSMo. 21.4 The Department SHALL deduct from the contractors invoice, if not deducted by the contractor, all amounts to be collected by the-contractor from the client or othee payment sources. 11/20/98 21.5 The Department reserves the right to make invoice corrections and/or changes with appropriate notification to the contractor. REPORTING REQUIREMENTS 22. The contractor SHALL coordinate its contractual activities with those of the Department. 23. The contractor SHALL retain all records pertaining to the contract for seven years after the close of the contract year unless audit questions have arisen within the seven year limitation and have not been resolved. All records SHALL be retained until all audit questions have been resolved. 24. The contractor SHALL notify the Department, in accordance with guidelines established by the Divisions,when any of the following occur: - 24,11 The death of a client. 24.2 A change of licensure or certification/accreditation status. 24.3 Any change in the contractors official name, address, telephone number, ownership administration, board or directors or stockholders. 24.4 Allegations of physical abuse, sexual abuse,verbal abuse or neglect of a client . 25. The contractor SHALL maintain auditable records for *all activities performed under this contract. Financial records SHALL conform to Generally Accepted Accounting Principles (GAAP). Such records SHALL reflect, at a minimum, the specific number and type of service units provided, the number and type of clients served, client progress and other relevant records. The contractor SHALL submit itemized reports, records and information at the request of the Department. 26. The contractor SHALL allow the Department or its authorized representative to inspect and examine the contractor's premises and/or records which relate to the performance of the contract at any time during the period of the contract and within the period specified for Retention of Records. 27. The Department SHALL have access to its clients and client records without limitation. If access is denied or limited, the Department SHALL terminate payment from the day access is denied or limited. 28. Upon filing for bankruptcy or an insolvency proceeding by or against the contractor or upon the appointment of a receiver, trustee, or assignee for the benefit of creditors,.the contractor SHALL immediately notify the Department. Upon notification of bankruptcy or insolvency, the Department reserves the right at its sole discretion either to cancel the contract or re-affirm the contract and to hold the contractor responsible for damages. 29. If the contractor receives notice of a Class I license violation from the Department of Health and Human Services or the Division of Aging or a notice under certification that a condition of jeopardy exists, the contractor SHALL immediately notify the authorizing Department facility. Verbal notification SHALL be followed by written notification mailed within 48 hours. The contractor SHALL send a copy of any plan of corrections for Class I deficiencies which has been approved by the Division of Aging, the Department, Health Care Financing Administration or other license certification or accreditation authority to the head of the Department facility who has authorized services to be delivered by the contractor. 11/20/98 CLIENT BASED INFORMATION REQUIREMENTS 30. If required, the contractor SHALL submit client data and invoicing information via its computer network with the Department's on-line computerized client based information system. 31. The Department has sole authority in determining the compatibility of the contractor's computer, system. 32. At the sole option of the Department, termination of this contract may result if the contractor fails to maintain accurate and complete information or misuses the Department's computer network. GENERAL AUDIT GUIDELINES 33. If during the contractor's fiscal year the contractor expends $300,000 or more in federal grant funds received from the Department, the contractor SHALL have an annual audit conducted in accordance - 'With United States Office of Management and Budget (OMB) Circular A-133. The audit SHALL be conducted by an individual of firm licensed by the Missouri State Board of Accountancy. The due date for filing the audit with the Department SHALL be the same as the due date for filing the audit with the federal clearinghouse specified in OMB Circular A-133. The items to be filed with the Department SHALL consist of the reporting package specified in OMB A-133. Failure to comply with these requirements may result in reduction of available allocation of funds, reduction or suspension of payments to the contractor or cancellation of this contract between the Department and the contractor. STANDARD MEANS TEST 34. For all clients whose services are paid by the Department.' the contractor SHALT. apply the Department's Standard Means Test (9 CSR 10-1.016) when not applied by the Department. Nothing in this contract SHALL deny the right of a client or his responsible person to appeal to the Department for re-determination of the amounts payable by them to the contractor under 9. CSR 10- 31.011. 35. The contractor SHALL charge and become responsible for the collection of client payments as determined by the Standard Means Test (SMT). Amounts charged to clients, whether or not collected, SHALL be shown as a credit on the invoice. 36. The contractor SHALL not impose or increase fees for service for Department clients without the written consent of the Department except as permitted by the SMT. 37. Nothing in this contract SHALL impair the statutory rights of the Department to charge a Department client, a client's estate or the person(s) obligated to pay for services rendered to the client for expenditures made by the Department for the client. AMENDMENT TERMINATION AND RENEWAL 38. Funds expended for the purposes of the contract SHALL be appropriated by the General Assembly of the State of Missouri. The contract SHALL automatically terminate without penalty or termination costs if such funds are not appropriated or available. If funds are not appropriated or available for the contract, the contractor SHALL not prohibit or limit the Department's right to pursue alternate contracts as necessary for the conduct of state governmental affairs. The requirements stated in this paragraph SHALL apply to any amendment or the execution of any option to extend the contract. 39. Any change in the contract SHALL be accomplished by a contract amendment signed by the authorized representative of the contractor and the Department. 11/20/98 40. The Department may terminate the contract for breach of contract by providing the contractor with a written notice of termination. The termination SHALL become effective on the date specified in the notice. Payments for services SHALL not be made beyond the date of termination. 41. This contract may be terminated by either party, by giving sixty (60) days advance written notice to the other party at its principal address. The termination SHALL be effective sixty (60) days from the date of notice or the date specified in the notice; however, the Department may withdraw any or all of its clients before the end of the sixty (60) day period. 42. Any written notice to the contractor SHALL be deemed sufficient when deposited in the United States mail, postage prepaid, and addressed to the contractor at the address on the signature page of the contract or at an address the contractor may have requested in writing. . 43. In the event of termination all documents, data, reports, supplies, equipment and accompffshments prepared, furnished or completed by the contractor pursuant to the terms of this contract SHALL, at the opinion of the Department, become the property of the Department. 44. This contract SHALL not bind, nor purport to bind, the State of Missouri for any commitment in excess of the original contract period. The Department SHALL have the right, at its sole option, to renew the contract. If the Department exercises its options, all terms, conditions and provisions of the original contract and any amendments SHALL remain the same and apply during the renewal period. HUMAN RIGHTS 45. The contractor SHALL establish a system satisfactory to the Department through which recipients of services under this contract may present grievances. The contractor SHALL maintain at the facility a file of all Department client grievances of an alleged violation of rights and how the grievance has been or is proposed to be resolved. The person in charge SHALL cooperate fully with any subsequent Department investigation of the grievance. 46. In compliance with Governor's Executive Order #87-6 (Art. XIII); Executive Order 11246 as amended; Section 503 of the Rehabilitation Act as amended; Vietnam-Era Veterans Readjustment Assistance Act as amended 38 U.S.C.4212 (formerly 2012); and the Americans with Disabilities Act of 1990; contractors that employ fifty (50) or more persons SHALL comply with the above state and federal regulations which require non-discrimination in employment and delivery of services. 46.1 In addition to the above,the contractor SHALL make the following human rights assurances: a. Not to discriminate against recipients of services on the basis of race, color, religion, national origin,sex, physical ability or age. b. Not to discriminate against any employee or applicant for employment on the basis of race, color, religion, national origin, sex or otherwise qualified status of physical ability. c. Not to-discriminate against any applicant for employment or employee on the basis of age, where such applicant or employee is between the ages of forty (40) and seventy (70) and where such contractor employs at least twenty(20) persons. d. Not to discriminate against any applicant for employment or employee on the basis of that person's status as a disabled or Vietnam-era veteran, if the compensation payable to the contractor or subcontractor is at least$10,000 within a fiscal year. 11/20/98 e. To develop, implement and maintain an affirmative action program if at least fifty (50) persons in the aggregate are employed. For the purpose of this contract, an "affirmative action program" means positive action to influence all employment practices (including, but not limited to, recruiting, hiring, promoting and training) in providing equal employmerit opportunity regardless of race, color, sex, origin, religion, age, physical ability and Vietnam-era veteran status. Such an Affirmative Action Program SHALL include: 1. A written policy statement committing the total organization to affirmative action and assigning management responsibilities and procedures for evaluation and dissemination; 2. The identification of a person designated to handle affirmative action; 3. The establishment of non-discriminatory selection standards, objective measures to analyze re_cruitment, an upward mobility system, a wage and salary structure and standards applicable to layoff, recall, discharge, demotion and discipline; 4. The exclusion df discrimination from all collective bargaining agreements; and 5. Performance of an internal audit of the reporting system to monitor execution and to provide for future planning. f. If the contractor uses any funds of this contract in a subcontract, then the contractor SHALL require such a subcontractor to comply with the applicable human rights clauses above. 46.2 The Department SHALL have the right to enforce all applicable clauses by appropriate procedures, including but not limited to, requests, reports, site visits and inspection of relevant documentation of the contractor. 47. The contractor SHALL comply with the applicable titles of the Americans with Disabilities Act (Public Law 101-336), which prohibits discrimination against people with disabilities in employment, services, transportation, public accommodations, communications and activities of state and local government. Where applicable, The State of Missouri SHALL contract with only those individuals or agencies which comply with this act. The contractor's failure to comply with this act SHALL result in termination of the contract. The contractor SHALL notify the Department immediately of any allegations, claims, disputes, or challenges made against the contractor concerning this act. INSURANCE_ 48. The contractor SHALL maintain adequate liability insurance to protect the State of Missouri, its agencies, its clients, employees and the general public against any loss, damage and/or expense related to the performance of this contract. The insurance coverage SHALL include, but not be limited to, general liability, errors and omissions, professional liability, etc. 49. The contractor SHALL be responsible for all injury or damage which occurs as a result of services rendered under the terms and conditions of the contract including liability based upon personal injury, bodily injury (including death) or property .damage suffered as a result of the contractor's performance under the contract 50. Automobile liability coverage for the operations of any motor vehicle SHALL be maintained if the terms of the contract require any form of transportation services. 1 1/2-0/98 51. If the contract requires the performance of medical services of any type, the contractor SHALL maintain adequate liability insurance to cover all medical services rendered. 52. Proof of the insurance coverage SHALL include, but not be limited to, effective dates of coverage, limits of liability, insurers' names, policy numbers, company, etc. Proof of self-insurance coverage or another alternative risk financing mechanism may be utilized provided that such coverage is verifiable and irrevocably reliable. Proof of insurance coverage SHALL be submitted upon request. MISCELLANEOUS 53. The Department may require the attendance of the contractor's personnel at training activities and may require the cooperation of the contractor's personnel where the Department provides technical assistance. .54.- By_signing this contract the contractor enters into an affiliation agreement with the Department to coordinate a delivery system of accessible services. The contractor agrees to integrate community- based programs into the Department system and to avoid duplication of state provided or supported services. 55. Disclosure by any party of information concerning a client for any purpose not directly related to the performance of this contract is prohibited except as specified by applicable state and federal laws and regulations. 56. Under circumstances, as referenced in Section 632.300 RSMo., in which a client's conduct is jeopardizing the safety of the client himself or others in the community, the contractor SHALL immediately notify first the mental health coordinator and secondly the authorizing Department facility. If an immediate response is needed to insure the health and/or safety of the client or residents,the local taw enforcement officials SHALL also be notified. 57. The Department may place a monitor with the contractor, given any situation as described in Section 630.763 RSMo. or when the Department determines that the health, safety or welfare of the clients cannot be adequately assured. 58. The Department enters into this contract by the authority of its director. The contractor enters into this contract individually or, if incorporated, pursuant to and by authority of its board of directors. 59. The contractor SHALL fully cooperate with all investigations conducted by the Department, or its agents, which relate, directly or indirectly,with the performance of this contract. APPEALS 60. The offeror or provider may appeal an action or decision made by the Department regarding the Request for Proposal (RFP) process, the award of a contract or other related issues by submitting a written appeal in accordance with the procedures and regulations contained in 9 CSR 25-2.505. � STATE OF MISSOURI DEPARTMENT OF MENTAL HEALTH ATTACHMENT AIPRICING PAGE =4m• JFFERORS SHALL COMPLETE, SIGN AND RETURN ATTACHMENT A/PRICING PAGE WITH THEIR PROPOSAL "HE OFFEROR SHALL COMPLETE ATTACHMENT AIPRICING PAGE WITH FIRM, FIXED PRICES FOR PROVIDING SERV;CES IN ICCORDANCE WITH THE SERVICE DEFINITION(S),REQUIREMENTS AND ALL OTHER TERMS AND CONDITIONS SPECIFIED IN THIS 1EQUEST FOR PROPOSAL :EFORE COMPLETING THIS PAGE, THE OFFEROR IS CAUTIONED TO REVIEW THE TERMS AND CONDITIONS OF THIS RE OR PROPOSAL INCLUDING PROVISIONS FOR INVOICING AND PAYMENT. QUEST HE OFFEROR SHALL ATTACH ALL ELIGIBLE PROVIDER INFORMATION(E.G.RESUME'S, LICENSES AND/OR CERTIFICATIONS)AS EQUIRED BY THE SERVICE DEFINITION(S), REQUIREMENTS AND ALL OTHER TERMS AND CONDITIONS SPECIFIED IN THIS EQUEST FOR PROPOSAL. SERVICE TITLE' UNIT as contained in the division's catalog DESIGNATION NUMBER OF (e.g. 1/4 hr., day) UNITS PRICE/UNIT r- 1 R s POr T-71--M D 13 ��£ sc It�D ULzr 1711+C lid 0 'RICING INFORMATION PROVIDED IN ATTACHMENT AIPRICING PAGE IS IN ACCORDANCE WITH THE SERVICE DEFINITIONS, 11REMENTS AND ALL OTHER TERMS AND CONDITIONS OFTHIS REQUEST FOR PROPOSAL )R'S AU71iOIIZED SIGNATt�FE A /1- 1 RATE SCHEDULE JEFFERSON CITY TRANSIT HANDIWHEELS SYSTEM The City of Jefferson Transit Handiwheels System provides.transportation for Medicaid-eligible clients. The rate schedule is $9.64 per trip. This fee is determined annually based on the cost of services. TRANSPORTATION GENERAL WAIVER - LOPEZ WAIVER Transportation is a reimbursable service when necessary for an individual to travel to and from day programs, medical appointments, and resources. PROVIDER REQUIREMENTS: Providers must satisfy all State of Missouri licensure requirements and applicable State of Missouri statutes for both drivers and vehicles under RSMo., Chapter 302. Providers must have a DMH Home and Community Based Medicaid Waiver contract for the provision of transportation services. UNIT OF SERVICE • Medicaid procedure code: Y9135 • 'DMH procedure code(s): Y91359_Transportation Y94109 Trans Ambl Small Grp Y-24169 Trans Ambl Large Grp Y94209 Trans AM Att Sm Grp Y94269 Trans AM Att Lg Grp Y94309 Trans Non Am Sm Grp Y94369 Trans Non Am Lg Grp Y94469 Trans ISL Ind • Unit of Service: one month of transportation • Maximum units: 1/month. 'All DMH transportation codes convert to a single Medicaid code. DOCUMENTATION To document service delivery, a transportation provider must maintain: • Individual trip records for each individual transported; • Mileage or zone records of miles or zones provided,and • Accurate records of trarisportation costs.