Request for Proposals for the Designation of. Adult Protective Services Provider Agencies for Area 01*
|
|
- Warren Ward
- 6 years ago
- Views:
Transcription
1 Northwestern Illinois Area Agency on Aging Request for Proposals for the Designation of Adult Protective Services Provider Agencies for Area 01* (*Area 01 is comprised of Boone, Winnebago, Stephenson, Jo Daviess, Carroll, Whiteside, Lee, Ogle, and DeKalb Counties) Issued July 3, 2013 NIAAA does not discriminate in admission to programs or activities or treatment of employment in programs or activities in compliance with appropriate State and Federal Statutes. If you feel you have been discriminated against, you have a right to file a complaint with NIAAA or the Illinois Department on Aging. For information, call the Senior HelpLine: (Voice and TTY). Northwestern Illinois Area Agency on Aging (NIAAA) Request for Proposals for the Designation of Adult Protective Services Provider Agencies
2 1. Introduction The State of Illinois recently created the Adult Protective Services Program when it revised what was known as the Elder Abuse and Neglect Act (320 ILCS 20 et. seq.). The new statute is now called the Adult Protective Services Act and it governs the new Adult Protective Services Program (Program) which began on July 1, This Request for Proposals is for soliciting applications from organizations interested in being designated as provider agencies in the new Program. The purpose of the Program is protecting eligible adults living in the community who have been abused, neglected, or financially exploited by someone or themselves. Eligible adults are those who are disabled (ages 18-59) and anyone 60 and older. (Note that self-neglect cases have not been funded in the past but it is expected that they will be in the fiscal year 2014 pending an appropriation.) The Illinois Department on Aging (IDoA) is responsible for overall management of the Program. IDoA contracts with the Northwestern Illinois Area Agency on Aging (NIAAA) to administer the Program locally including designating Program service providers. With this Request for Proposal, NIAAA intends, therefore, to designate one or more service provider agencies to serve Area 01. Area 01 is comprised of Boone, Winnebago, Stephenson, Jo Daviess, Carroll, Whiteside, Lee, Ogle, and DeKalb Counties. Preference will be given to a provider agency serving all of Area 01 but NIAAA will consider a bid on a portion of a service area if there is coverage of the remaining parts of Area 01 by other applicants. There are currently four service providers in Area 01 for the Elder Abuse Program. The successful applicant(s) will be based primarily upon an evaluation of a written application submitted to NIAAA from this Request for Proposals. NIAAA reserves the right, however, to consider other factors such as an applicant s: financial resources, management structure/stability, past performance of NIAAA funded services, past performance of other grant funded services, etc. NIAAA also has the right to deny any application, to reject any informality, and to make all final decisions relative to contract award and any special contract conditions. 2. Eligible Applicant Agencies Applicant agencies must be private, not-for-profit corporations or local units of government. All successful applicants receiving provider agency designation must comply with the requirements outlined in the Adult Protective Services Act (320 ILCS 20 et.seq.) which is available at and the Illinois
3 Administrative Code (Title 89, Part ) which is available at 3. How to Apply Eligible applicant agencies must submit an electronic application with signatures to NIAAA by the deadline. All applications must be ed to Jeff Henderson at with the subject Adult Protective Services Application. Hand delivered, mailed, or facsimile (FAX) transmissions of proposals will NOT be accepted. The application form is included as an attachment with corresponding instructions. 4. Closing Date for Receipt of Applications The closing date and time for submission of applications, pursuant to this Request for Proposals, is July 29, 2013 at 4:00 p.m. It is the applicant s responsibility to ensure that NIAAA receives the application by the deadline. NIAAA is not responsible, and will make no exceptions, for unforeseen circumstances that cause an application to be submitted late. 5. Provider Agency Functions The APS Program provider agencies have the following responsibilities: Receiving reports of alleged or suspected abuse, neglect, financial exploitation, or self-neglect; Conducting face-to-face assessments for reported cases; Evaluating evidence and making a substantiation decisions; Referring substantiated cases for necessary support services; Referring criminal conduct to law enforcement when necessary; Providing case work and follow-up services for substantiated cases; and Responding immediately (24 hours a day) in situations where eligible adults are at risk of injury or death. 6. Service Delivery Process for Provider Agencies A. Intake and Assessment When a provider agency receives a report, it conducts a face-to-face assessment with the eligible adult at the adult s home to determine if further investigation is warranted. After gathering necessary evidence, the provider agency decides if the case should be substantiated. Substantiation basically means there is enough evidence of at least some indication of abuse, neglect, or financial exploitation. If the case is substantiated, the provider agency develops a service care plan for the eligible adult. B. Casework This is intensive case work activities on substantiated cases. Case work includes working with the eligible adult on a case plan for the purpose of stabilizing the abusive situation and reducing the risk of further harm. The case plan can include legal, medical, social service and/or other assistance as needed. Case work is contingent on consent from the eligible adult. C. Follow-up
4 This is a systematic method of following-up on substantiated cases to prevent recurrence. The provider agency will work with the eligible adult in detecting recurring signs of abuse before the situation becomes life-threatening. D. Early Intervention Services This is a tool used by provider agencies to address immediate needs of the eligible adult. Early intervention service funds are available for short term and/or emergency assistance where resources are not otherwise available for items such as: legal assistance (i.e. orders of protection, guardianship, etc.), housing and relocation assistance, respite care, and emergency aid (i.e., food, clothing, and medical care). Provider agencies are reimbursed by IDoA for these services. E. Multi-Disciplinary Teams A Multi-Disciplinary Team (M-Team) is a method for provider agencies to get input from experts from other fields (i.e. law enforcement, prosecutors, lawyers, clergy, mental health, medical, banking, social work, domestic violence, substance abuse, etc.) in difficult cases. G. Public Awareness/Education Provider agencies raise public awareness regarding preventing abuse, neglect, and exploitation. This is done through posters, brochures, public service announcements, and education focusing on professional groups likely to have contact with victims of abuse. 7. RATES OF REIMBURSEMENT IDOA sets the rate of reimbursement for provider agency services. In 2013, the rates were as follows (the rates have not changed since 2007): A. Abuse, Neglect and/or Exploitation Assessments $ B. Case Work $ C. Follow-up $ 92.00/month Rates are subject to adjustment by IDoA. 8. ELDER ABUSE AND NEGLECT PROGRAM CONTRACTS Contracts awarded as a result of this Request for Proposals are between NIAAA and the applicant. Signing the contract with NIAAA is assurance by the successful applicant(s) that they meet all requirements of the contract, the application proposal, and Program requirements. Contracts awarded as a result of this Request for Proposals will be effective September 1, 2013 through June 30, The designation of the successful applicant(s) as the provider agency may be extended for up to six (6) additional fiscal years if there has been satisfactory performance. 9. CRITERIA FOR DESIGNATION SELECTION The method of procurement for Program provider agencies is competitive and based upon the total score achieved by each applicant on the contract application. Applications, however, are not the sole factor as NIAAA reserves the right to take into
5 account other factors such as an applicant s: financial stability, management structure/stability, past performance of NIAAA funded services, past performance of other grant funded services, etc. All sections of the contract application and attachments should be correctly completed. An incomplete or incorrectly completed contract application may not be processed and, therefore, no contract may be awarded no matter how high the applicant scores on the submitted contract application. The application is designed to evaluate the quality of service which will be provided to eligible adults of abuse, neglect, and exploitation. In order to secure added points, applicants should not commit themselves to specific activities outlined in the contract application which they are incapable of providing. If an applicant is awarded a contract to provide Program services, the commitments made in both the scored and the unscored portions of the agency's application become part of that contract and the applicant will be held responsible for those commitments. Tie Scores If the successful total score is achieved by two (2) or more applicants, NIAAA will use the following evaluation criteria, in the order listed, to determine the winning applicant. 1. A current provider agency who is serving a nearby service area will be selected as the designated provider agency, provided that agency has a record of satisfactory performance. 2. If the applicants are tied in overall score and neither is a current provider agency, the applicant with the highest score in Part B (Experience in Service Provision) of the contract application will be selected as the designated provider agency, if the agency has a record of satisfactory performance. 10. CONTRACT APPLICATION REVIEW & DESIGNATION PROCESS NIAAA staff will conduct review of the applications and develop staff recommendations for the final decision to be made by the NIAAA Executive Director. NIAAA will designate the successful applicant(s), execute program contracts, and will notify the unsuccessful applicants. Initial caseworker and supervisor training sessions will be held for the designated provider agency(s). 11. NEGOTIATION NIAAA reserves the right to negotiate separately with competing applicants for all or any part of the services described in this Request for Proposals. 12. REJECTION OF PROPOSALS The Executive Director of NIAAA reserves the right to reject any informality or contract applications received as a result of this Request for Proposals. 13. APPEALS TO NIAAA ON AGING DESIGNATION RECOMMENDATIONS
6 NIAAA will provide an opportunity for a hearing to any applicant (Applicant) whose application to be designated a service provider is denied. Applicants must follow the NIAAA s appeal policies and procedures as described below. Initiating an Appeal The hearing process is initiated effective with the date a written request (Request) for a hearing is received by NIAAA. The Request must be sent certified mail and must be received by NIAAA within 10 working days of the Applicant receiving notification of NIAAA's decision. The Request must be addressed to: Grant Nyhammer, Executive Director & General Counsel Northwestern Illinois Area Agency on Aging 1111 S. Alpine Road, Suite 600 Rockford, IL Content of the Request The Request for hearing must include: 1. The name of the Applicant requesting the hearing; 2. The specific issues of law, regulation or procedure which support the appeal (if any); and 3. A brief summary of facts which support the issues claimed. Hearing Schedule The president of the NIAAA Board of Directors (President) will schedule the hearing, which will be conducted within 30 days of receipt of the Request. NIAAA will notify the Applicant in writing at least ten days before the scheduled hearing of the date, time, and place. Where the hearing cannot be conducted within the required schedule, the President will set a hearing date that is convenient for the Applicant and NIAAA (collectively the Parties ). Hearing Panel / Individual The President will determine the impartial panel or individual to hear appeals. Impartial means individuals who have not participated in the action being appealed. NIAAA may terminate this hearing process at any point if the Parties negotiate a written agreement that resolves the issue(s) which led to the request for a hearing. The President may delegate procedural aspects of the hearing. Hearing Procedures Although administrative rules to conduct hearings will be adapted to the specific decision under review, the following general rules will apply to all hearings: 1. The President will designate who will be responsible for conducting the hearing. 2. Each of the Parties will have the opportunity to appear in person and/or be represented by legal counsel or other authorized representative. Action or
7 inaction of an authorized person shall be deemed to be action or inaction of that party. 3. Each of the Parties may present documentary evidence to provide a complete and accurate description of facts that are relevant and material in order to refute the basis for the decision being appealed. 4. Each of the Parties has the opportunity to review any pertinent evidence and to ask and respond to questions that arise during the hearing. 5. A verbatim transcript of the hearing will be produced. 6. The impartial hearing panel (or individual) shall report to the NIAAA Board at the next regular monthly board meeting (or the Executive Committee, acting for the board - consistent with NIAAA by-laws) the findings of the hearing and shall make a written recommendation. The written recommendation will set forth the evidence on which it is based. 7. The final written notice of decision resulting from the hearing shall be issued to the Applicant in writing by the NIAAA Board of Directors within 35 working days following the conclusion of the hearing and shall include the recommendation of the impartial hearing and the reasons upon which the final decision is based.
8 14. DEMOGRAPHIC INFORMATION A. Payments by NIAAA to Elder Abuse Provider Agencies Counties DeKalb $ 88,320 $ 70,473 Lee/Whiteside/Ogle/Carroll $ 204,828 $ 172,694 Stephenson / Jo Daviess $ 65,390 $ 68,077 Winnebago / Boone $ 477,112 $ 409,500 Total $ 835,650 $ 720,744 B. Older Adults Living in Area 01 (per the 2010 Census) County Older Adults Boone 9,096 Carroll 4,432 DeKalb 14,650 JoDaviess 6,704 Lee 7,883 Ogle 11,164 Stephenson 11,886 Whiteside 13,822 Winnebago 57,345 Total 136,982 C. Number of Elder Abuse Reports The following is number of elder abuse reports in Area 01 in the past two years: Fiscal Year (July 1 June 30) Number of Reports D Number of Reported Cases for Adults with Disabilities The following is the number of reports in 2012 for adults with disabilities reports (this information was provided by the Illinois Office of Inspector General who managed the adults with disabilities program): County Reports BOONE 3 CARROLL 3 DEKALB 9 JO DAVIESS 5 LEE 2 OGLE 5 STEPHENSON 10 WHITESIDE 19 WINNEBAGO 44 Total 100
Northwestern Illinois Area Agency on Aging
Northwestern Illinois Area Agency on Aging Request for Proposals for Fiscal years 2016-2018 June 16, 2015 Older Americans Act and State of Illinois Funds Due Date: July 31, 2015 at 4:00 p.m. Northwestern
More informationpennsylvania DEPARTMENT OF AGING Know Your Rights as a Nursing Home Resident Long-Term Care Ombudsman Program
pennsylvania DEPARTMENT OF AGING Know Your Rights as a Nursing Home Resident Long-Term Care Ombudsman Program The Pennsylvania State Long-Term Care Ombudsman Program under the Pennsylvania Department of
More informationBOARD OF COOPERATIVE EDUCATIONAL SERVICES SOLE SUPERVISORY DISTRICT FRANKLIN-ESSEX-HAMILTON COUNTIES MEDICAID COMPLIANCE PROGRAM CODE OF CONDUCT
BOARD OF COOPERATIVE EDUCATIONAL SERVICES SOLE SUPERVISORY DISTRICT FRANKLIN-ESSEX-HAMILTON COUNTIES MEDICAID COMPLIANCE PROGRAM CODE OF CONDUCT Adopted April 22, 2010 BOARD OF COOPERATIVE EDUCATIONAL
More informationBOARD OF EDUCATION POLICY MANUAL TABLE OF CONTENTS SECTION 3 - GENERAL SCHOOL ADMINISTRATION. 3:30 Line and Staff Relations/Succession of Authority
BOARD OF EDUCATION POLICY MANUAL TABLE OF CONTENTS SECTION 3 - GENERAL SCHOOL ADMINISTRATION 3:10 Goals and Objectives 3:20 OPEN 3:30 Line and Staff Relations/Succession of Authority 3:40 Superintendent
More informationThank you for your request for information regarding the Plan s Appeal Process. You will find the following information to help you with your appeal:
Dear Optima Health Community Care Member: Thank you for your request for information regarding the Plan s Appeal Process. You will find the following information to help you with your appeal: Appeal Request
More informationCHAPTER 411 DIVISION 020 ADULT PROTECTIVE SERVICES GENERAL
CHAPTER 411 DIVISION 020 ADULT PROTECTIVE SERVICES GENERAL 411-020-0000 Purpose and Scope of Program (Amended 7/1/2005) (1) Responsibility: The Department of Human Services (DHS) Seniors and People with
More informationPatient Consent Form
Alexander Raskin, M.D., Q.M.E. Assistant Clinical Professor UCLA School of Medicine ORTHOPEDIC SURGERY SPORTS MEDICINE ARTHROSCOPY 16311 Ventura Blvd., Suite 1150, Encino, CA 91436 T (818) 788-ORTHO (6784)
More informationMEDICAL ASSISTANCE BULLETIN COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF PUBLIC WELFARE
MEDICAL ASSISTANCE BULLETIN COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF PUBLIC WELFARE SUBJECT BY NUMBER: ISSUE DATE: September 8, 1995 EFFECTIVE DATE: September 8, 1995 Mental Health Services Provided
More informationHIPAA PRIVACY NOTICE
HIPAA PRIVACY NOTICE PLEASE REVIEW THIS NOTICE CAREFULLY. IT DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU MAY GAIN ACCESS TO THAT INFORMATION. POLICY STATEMENT This Practice
More informationState of Adult Protective Services Baseline Assessment
State of Adult Protective Services Baseline Assessment - 2012 Response ID: 211 Data 1. State of Adult Protection Services Baseline Assessment 1. Respondent Information Name of person completing this assessment
More informationALABAMA MEDICAID AGENCY ADMINISTRATIVE CODE CHAPTER 560-X-45 MATERNITY CARE PROGRAM TABLE OF CONTENTS
ALABAMA MEDICAID AGENCY ADMINISTRATIVE CODE CHAPTER 560-X-45 MATERNITY CARE PROGRAM TABLE OF CONTENTS 560-X-45-.01 560-X-45-.02 560-X-45-.03 560-X-45-.04 560-X-45-.05 560-X-45-.06 560-X-45-.07 560-X-45-.08
More information5. Name: Last First MI. Street Number and Name or P.O Box. City State ZIPCODE. City State ZIPCODE
508 - ILLINOIS CERTIFIED DOMESTIC VIOLENCE PROFESSIONAL CERTIFICATION EXAMINATION APPLICATION PLEASE PRINT IN INK 1. Exam Date Applying For: 2. Exam Location 3. Fee: $175.00 February Chicago Area Certified
More informationAdult Protective Services Program Regional Inter-Agency Fatality Review Teams Manual
State of Illinois Illinois Department on Aging Adult Protective Services Program Regional Inter-Agency Fatality Review Teams Manual Rev. 09/16 Table of Contents I. Acknowledgement... 4 II. Introduction...
More informationNavigating Work Life Health. Affiliate Clinical Forms
Navigating Work Life Health Affiliate Clinical Forms Introduction Lytle EAP Partners is an independent consulting and service organization that provides development, implementation, and administration
More informationAdult Protective Services Referrals Operations Manual
Adult Protective Services Referrals Operations Manual Developed by the Department of Elder Affairs and The Department of Children and Families and The Area Agencies on Aging November 2012 Table of Contents
More informationINTAKE REGISTRATION FORM
INTAKE REGISTRATION FORM Therapist: of Appt: File Created Practice Fusion: Discovering new choices together File Created Kareo: Today s : PCP: CLIENT INFORMATION Last Name First M.I. D.O.B Marital Status
More informationDescribe the City s requirements and desired outcomes within a written specification;
1.0 REQUEST FOR PROPOSAL (RFP) The purpose of this policy is to provide a uniform process for the issuance, evaluation, and selection of competitive proposals for services and/or customized goods. 1.1
More informationAdult Protective Services Referrals Operations Manual. Developed by the Department of Elder Affairs And The Department of Children and Families
Adult Protective Services Referrals Operations Manual Developed by the Department of Elder Affairs And The Department of Children and Families December 11, 2007 Table of Contents Appropriate Referrals...
More informationSUMMARY OF THE CIRCUMSTANCES AND PURPOSES FOR WHICH YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED
374 Hudlow Road, Post Office Box 336 Forest City, NC 28043 Phone: (828) 245-0095 FAX: (828) 248-1035 Toll Free: 1-800-218-CARE (2273) HOSPICE OF RUTHERFORD COUNTY PRIVACY PRACTICES THIS NOTICE DESCRIBES
More informationSUMMARY OF NOTICE OF PRIVACY PRACTICES
LAKE REGIONAL MEDICAL GROUP 54 HOSPITAL DRIVE OSAGE BEACH, MO 65065 SUMMARY OF NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU
More informationSTANDARDS OF CONDUCT A MESSAGE FROM THE CHANCELLOR INTRODUCTION COMPLIANCE WITH THE LAW RESEARCH AND SCIENTIFIC INTEGRITY CONFLICTS OF INTEREST
STANDARDS OF CONDUCT A MESSAGE FROM THE CHANCELLOR Dear Faculty and Staff: At Vanderbilt University, patients, students, parents and society at-large have placed their faith and trust in the faculty and
More informationState of Adult Protective Services Baseline Assessment
State of Adult Protective Services Baseline Assessment - 2012 Response ID: 153 Data 1. State of Adult Protection Services Baseline Assessment 1. Respondent Information Name of person completing this assessment
More informationNOTICE OF PRIVACY PRACTICES
535 East 70th Street New York, NY 10021 (212) 606-1000 Specialists in Mobility NOTICE OF PRIVACY PRACTICES Effective Date: April 14, 2003 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE
More informationPediatric Dental Specialists
Pediatric Dental Specialists Notice of Privacy Practices This Notice describes how your health information may be used and disclosed and how you can get access to this information. Please review it carefully.
More informationNOTICE OF PRIVACY PRACTICES
BUTTE COUNTY DEPARTMENT OF BEHAVIORAL HEALTH NOTICE OF PRIVACY PRACTICES Effective Date: 4/14/2003 THIS NOTICE DESCRIBES NOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS
More informationCHAPTER 411 DIVISION 20 ADULT PROTECTIVE SERVICES -- GENERAL
CHAPTER 411 DIVISION 20 ADULT PROTECTIVE SERVICES -- GENERAL 411-020-0000 Purpose and Scope of Program (Amended 11/15/1994) (1) The Seniors and People with Disabilities Division (SDSD) has responsibility
More informationCAPITAL SURGEONS GROUP, PLLC
CAPITAL SURGEONS GROUP, PLLC NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW
More informationMARENGO HIGH SCHOOL DISTRICT POLICY MANUAL TABLE OF CONTENTS GENERAL SCHOOL ADMINISTRATION
MARENGO HIGH SCHOOL DISTRICT POLICY MANUAL TABLE OF CONTENTS GENERAL SCHOOL ADMINISTRATION 3:10 Goals and Objectives 3:20 OPEN 3:30 Line and Staff Relations 3:30-APAdministrative Procedure Organizational
More informationSERVICE GUIDELINES TITLE III-E Respite Assessments
Service Guidelines: III-E Respite Assessments 1 December 2015 SERVICE GUIDELINES TITLE III-E Respite Assessments DEFINITION Case Management: A service that assists caregivers in obtaining access to the
More informationRequest for Proposal # SIM LPHA Stigma Reduction Messaging For Tri-County Health Department
Request for Proposal #2016-01-08 SIM LPHA Stigma Reduction Messaging For Tri-County Health Department Physical Address (mailing address): Tri-County Health Department 6162 South Willow Drive, Suite 100
More informationAdvanced Oral & Maxillofacial Surgery, Ltd. NOTICE OF PRIVACY PRACTICES
Advanced Oral & Maxillofacial Surgery, Ltd. NOTICE OF PRIVACY PRACTICES This notice describes how health information about you may be used and disclosed and how you can get access to this information.
More informationIndiana Victim Assistance Basic Academy
Indiana Victim Assistance Basic Academy The Indiana Coalition Against Domestic Violence, the Indiana Coalition to End Sexual Assault and the Domestic Violence Network have partnered to create the Indiana
More informationS.E. Wisconsin Hearing Center Inc.
NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. Effective Date:
More informationPatient Registration Form Pediatrics
Patient Registration Form Pediatrics For Office Use Only: Visit Date: Initials: PATIENT INFORMATION Preferred Language: English Spanish Other: Patient s Last Name First Middle Initial Date of Birth Sex
More informationCDDO HANDBOOK MISSION STATEMENT
Adopted 6-19-09 Revised 11-1-10 Revised 4-30-13 Revised 2-27-17 CDDO HANDBOOK MISSION STATEMENT Arrowhead West, Inc. is the Community Developmental Disabilities Organization (CDDO) for initial contact
More informationHIPAA Notice of Privacy Practices
HIPAA Notice of Privacy Practices Georgia Mountains Hospice understands that your health information is highly personal and we are committed to safeguarding your privacy. Please read this Notice of Privacy
More informationARTICLE V DISCIPLINE
ARTICLE V DISCIPLINE I. Policy A. The Office of Professional Review ( OPR ) will conduct criminal and administrative investigations into allegations of violations of State and Federal Law, of violations
More informationREQUEST FOR APPLICATIONS
REQUEST FOR APPLICATIONS Mississippi Community Oriented Policing Services in Schools (MCOPS) Grant Mississippi Department of Education Office of Safe and Orderly Schools Contact: Robert Laird, Phone: 601-359-1028
More informationWELCOME. Payment will be expected at the time of service. Please remember our 24 hour cancellation notice.
WELCOME Those of us at Crossroads Counseling want to thank you for choosing to work with us and we want to make your time with us as productive as possible. In order to expedite the intake process, please
More informationDisclosure Statement
Disclosure Statement The state of Colorado requires that I, as a licensed psychotherapist, provide the following items of information to you as a client: Business Address and Phone: Mooney and Associates,
More informationPROPOSED REGULATION OF THE PEACE OFFICERS STANDARDS AND TRAINING COMMISSION. LCB File No. R September 7, 2007
PROPOSED REGULATION OF THE PEACE OFFICERS STANDARDS AND TRAINING COMMISSION LCB File No. R003-07 September 7, 2007 EXPLANATION Matter in italics is new; matter in brackets [omitted material] is material
More informationPATIENT BILL OF RIGHTS & NOTICE OF PRIVACY PRACTICES
Helping People Perform Their Best PRIVACY, RIGHTS AND RESPONSIBILITIES NOTICE PATIENT BILL OF RIGHTS & NOTICE OF PRIVACY PRACTICES Request Additional Information or to Report a Problem If you have questions
More informationEarly Education and Care Voucher Services Agreement Summer Camps 2018
Early Education and Care Voucher Services Agreement Summer Camps 2018 This Agreement is between, the Child Care Resource and Referral Agency (CCRR), and (Program) for purposes of providing summer camp
More informationMEMORANDUM OF AGREEMENT BETWEEN THE FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION AND THE UNITED STATES ENVIRONMENTAL PROTECTION AGENCY
***DRAFT DELIBERATIVE. DO NOT RELEASE UNDER FOIA. NOTHING CONTAINED HEREIN SHALL BE CONSTRUED AS CREATING ANY RIGHTS OR BINDING EITHER PARTY*** MEMORANDUM OF AGREEMENT BETWEEN THE FLORIDA DEPARTMENT OF
More informationEarly Education and Care Voucher Services Agreement Summer Camps 2017
Early Education and Care Voucher Services Agreement Summer Camps 2017 This Agreement is between, the Child Care Resource and Referral Agency (CCRR), and (Program) for purposes of providing summer camp
More informationAnaheim Police Department Anaheim PD Policy Manual
Policy 326 Anaheim Police Department 326.1 PURPOSE AND SCOPE The purpose of this policy is to provide guidelines for the investigation and reporting of suspected abuse of certain adults who may be more
More informationNotice of Privacy Practices
2269 CHERRY VALLEY ROAD, NEWARK, OH 43055 (740) 788-1400 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW
More informationState of Adult Protective Services Baseline Assessment
State of Adult Protective Services Baseline Assessment - 2012 Response ID: 217 Data 1. State of Adult Protection Services Baseline Assessment 1. Respondent Information Name of person completing this assessment
More informationSandra V Heinsz, Ph.D. Informed Consent Services Agreement
Welcome to my practice. This document (the Agreement) contains important information about my professional services and business policies. It also contains summary information about the Health Insurance
More informationConnecticut Office of the Arts Grant Overview Guidelines
CONNECTICUT OFFICE of the ARTS (COA) Department of Economic and Community Development ABOUT THE CONNECTICUT OFFICE OF THE ARTS The Department of Economic and Community Development s (DECD) Office of the
More informationA.A.C. T. 6, Ch. 5, Art. 50, Refs & Annos A.A.C. R R Definitions
A.A.C. T. 6, Ch. 5, Art. 50, Refs & Annos A.A.C. R6-5-5001 R6-5-5001. Definitions The following definitions apply in this Article. 1. ADE means the Arizona Department of Education, which administers the
More informationPerson to Contact in Case of Emergency. THE COUNSELING PLACE YOUTH INTAKE FORM Yearly Family Income:
Person to Contact in Case of Emergency Name Relationship Best Contact Number Alt. Number Office Use Only Intake Date Reason for referral Counselor Who Can Pick Up Client (if Minor) THE COUNSELING PLACE
More informationChapter 15. Medicare Advantage Compliance
Chapter 15. Medicare Advantage Compliance 15.1 Introduction 3 15.2 Medical Record Documentation Requirements 8 15.2.1 Overview... 8 15.2.2 Documentation Requirements... 8 15.2.3 CMS Signature and Credentials
More informationVISITING SCIENTIST AGREEMENT. Between NORTH CAROLINA STATE UNIVERSITY. And
VISITING SCIENTIST AGREEMENT Between NORTH CAROLINA STATE UNIVERSITY And Rev. 5/15 THIS AGREEMENT made this day of 20, by and on behalf of North Carolina State University ( NC State ) located in Raleigh,
More informationPain Specialists of Greater Chicago Notice of Privacy Practices
1 Pain Specialists of Greater Chicago Notice of Privacy Practices This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please
More informationDepartment of the Army Volume 2014 Defense Civilian Intelligence Personnel System Employee Grievance Procedures March 25, 2012 Incorporating Change
Department of the Army Volume 2014 Defense Civilian Intelligence Personnel System Employee Grievance Procedures March 25, 2012 Incorporating Change 2, November 16, 2017 SUMMARY of CHANGE Army Policy-Volume
More informationBias Incident Response Protocol. I. Definitions
Bias Incident Response Protocol I. Definitions A. Bias Incident- A Bias Incident is defined an act either verbal, written, physical, or psychological that threatens or harms a person or group on the basis
More informationNotice of HIPAA Privacy Practices Updates
Notice of HIPAA Privacy Practices Updates The following is a summary of the updates to the privacy notice for Meridian Hospitals Corporation, Meridian Home Care Services, Inc., Meridian Nursing & Rehabilitation,
More informationCHAPTER 35. MEDICAL ASSISTANCE FOR ADULTS AND CHILDREN-ELIGIBILITY SUBCHAPTER 15. PERSONAL CARE SERVICES
CHAPTER 35. MEDICAL ASSISTANCE FOR ADULTS AND CHILDREN-ELIGIBILITY SUBCHAPTER 15. PERSONAL CARE SERVICES 317:35-15-8.1. Agency Personal Care services; billing, and issue resolution (4-1-2009) The ADvantage
More informationRequest for Qualifications Construction Manager
Midland Community Unit School District #7 Request for Qualifications Construction Manager April 6, 2016 MIDLAND ELEMENTARY SCHOOL LACON, ILLINOIS Page 1 of 11 Construction Management Statement of Qualifications
More informationCenter for Medicaid, CHIP, and Survey & Certification/Survey & Certification Group
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop 02 02 38 Baltimore, Maryland 21244 1850 Center for Medicaid, CHIP, and Survey & Certification/Survey
More informationNOTICE OF PRIVACY PRACTICES
NOTICE OF PRIVACY PRACTICES Effective Date: July 12, 2017 THIS NOTICE OF PRIVACY PRACTICES ( NOTICE ) DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO
More informationSCARF. Serving Children and Reaching Families, LLC. Client Handbook
SCARF Serving Children and Reaching Families, LLC Client Handbook Table of Content Who We Serve..... 3 Our Services..... 3 Our Service Philosophy........... 4 Our Mission Statement....... 4 Our Client
More information79th OREGON LEGISLATIVE ASSEMBLY Regular Session. Enrolled. Senate Bill 58
79th OREGON LEGISLATIVE ASSEMBLY--2017 Regular Session Enrolled Senate Bill 58 Printed pursuant to Senate Interim Rule 213.28 by order of the President of the Senate in conformance with presession filing
More informationSample Notice of Privacy Practices 2 of 6 cda.org/practicesupport
Sample Notice of Privacy Practices 2 of 6 cda.org/practicesupport RUSSELL L. CURETON D.D.S. Notice of Privacy Practices This Notice describes how your health information may be used and disclosed and how
More informationNotice of Privacy Practices
Notice of Privacy Practices, pg. 1 of 5 Notice of Privacy Practices CATHOLIC CHARITIES OF THE ROMAN CATHOLIC DIOCESE OF SYRACUSE, NY This notice describes the privacy practices of Catholic Charities of
More informationA GUIDE TO HOSPICE SERVICES
A GUIDE TO HOSPICE SERVICES PURPOSE: Minnesota Rules 4664.0140, subpart 1 states: "Every individual applicant for a license, and every person who provides direct care, supervision of direct care, or management
More informationCHIEF NATIONAL GUARD BUREAU INSTRUCTION
CHIEF NATIONAL GUARD BUREAU INSTRUCTION NGB-EO CNGBI 9601.01 DISTRIBUTION: A NATIONAL GUARD DISCRIMINATION COMPLAINT PROGRAM References: See Enclosure B. 1. Purpose. This instruction establishes policy
More informationNuSpine Chiropractic NOTICE OF PRIVACY PRACTICES. This notice takes effect on March1, 2007 and remain in effect until we replace it.
NuSpine Chiropractic NOTICE OF PRIVACY PRACTICES PURPOSE: THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW
More informationCity and County of San Francisco Nonprofit Contractor Corrective Action Policy
CITY AND COUNTY OF SAN FRANCISCO OFFICE OF THE CONTROLLER Ben Rosenfield Controller I. Introduction City and County of San Francisco Nonprofit Contractor Corrective Action Policy The City and County of
More informationCapital Area Council of Governments Criminal Justice Advisory Committee (CJAC) PY 2019 Policy Statement
Capital Area Council of Governments Criminal Justice Advisory Committee (CJAC) PY 2019 Policy Statement The following policies and procedures are established for the purpose of defining the rules and regulations
More informationNotice of Privacy Practices for Protected Health Information (PHI)
Notice of Privacy Practices for Protected Health Information (PHI) 301 Sicomac Avenue, Wyckoff, New Jersey 07481 (201) 848-5200 l www.chccnj.org CHRISTIAN HEALTH CARE CENTER LONG-TERM CARE DIVISION HERITAGE
More informationNOTICE OF PRIVACY PRACTICES
NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. WHY ARE YOU GETTING
More informationAPPLICATION. For An Opportunity Grant From the American Bar Endowment
APPLICATION For An Opportunity Grant From the American Bar Endowment An Application must include complete and accurate responses to all of the following questions and be signed by an authorized officer
More informationNotice of Health Information Privacy Practices Acknowledgement
I understand that as part of my healthcare, Sonoma Valley Hospital and its medical staff creates, receives and maintains health records describing my health history, symptoms, examination and test results,
More informationThis notice describes Florida Hospital DeLand s practices and that of: All departments and units of Florida Hospital DeLand.
MRN: FIN: FLORIDA HOSPITAL DELAND HIPAA NOTICE OF PRIVACY PRACTICES Effective Date: September 23, 2013 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN
More informationRE: Request for Proposal Number GCHP081517
RE: Request for Proposal Number GCHP081517 Gold Coast Health Plan (GCHP) is interested in establishing multiple agreements with temporary labor service providers. Qualified Contractors will be placed on
More informationREQUEST FOR PROPOSAL AUDITING SERVICES. Chicago Infrastructure Trust
REQUEST FOR PROPOSAL AUDITING SERVICES Chicago Infrastructure Trust 10 August 2016 Table of Contents Background Information... 3 Objective and Scope of Services... 3 RFP Process and Submission Requirements...
More informationWAKE FOREST BAPTIST HEALTH NOTICE OF PRIVACY PRACTICES
WAKE FOREST BAPTIST HEALTH NOTICE OF PRIVACY PRACTICES Effective April 14, 2003 Revised February 17, 2010 Revised September 23, 2013 Revised July 1, 2016 This Notice of Privacy Practices applies to the
More informationSECTION 3 GUIDEBOOK: POLICIES AND PROCEDURES
SECTION 3 GUIDEBOOK: POLICIES AND PROCEDURES 1 TABLE OF CONTENTS WHAT IS SECTION 3?... 5 WHY IS SECTION 3 IMPORTANT TO THE CITY?... 5 THE CITY S POLICIES REGARDING SECTION 3... 5 Section 3 Plan... 6 What
More informationSERVICE STANDARDS. TITLE: Title III Ombudsman Updated 2/06. I. Definition
TITLE: Title III Ombudsman Updated 2/06 I. Definition SERVICE STANDARDS Ombudsman or Representative of the Office means any person employed by the Department to fulfill the requirements of the Office or
More informationHOUSTON HOUSING AUTHORITY Public Housing Grievance Policy
2640 Fountain View Drive Houston, Texas 77057 713.260.0500 P 713.260.0547 TTY www.housingforhouston.com HOUSTON HOUSING AUTHORITY Public Housing Grievance Policy 1. DEFINITIONS A. Tenant: The adult person
More informationNOTICE OF PRIVACY PRACTICES
NOTICE OF PRIVACY PRACTICES Effective Date: May 31, 2013 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW
More informationRFP REQUEST FOR PROPOSALS FOR EMPLOYABILITY SKILLS CURRICULUM PLANNING AND DEVELOPMENT. Proposals Due by: January 22, 2018
ADMINISTRATIVE OFFICE Area Community Services Employment & Training Council 1550 Leonard NE Grand Rapids, MI 49505 (616) 336-4100 SERVICE CENTERS Allegan County 3255 122nd Ave Allegan, MI 49010 (269) 686-5079
More informationPrivacy Practices Home Visit Doctor, LLC July 2017
Privacy Practices Home Visit Doctor, LLC July 2017 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
More informationCredentialing and. Recredentialing. Plan
Credentialing and Recredentialing Plan This Credentialing and Recredentialing Plan may be distributed to applying or participating Licensed Independent Practitioners, Hospitals and Ancillary Providers
More informationHome Care Ombudsman Expansion. Lyle VanDeventer, Deputy State Home Care Ombudsman (v)
Home Care Ombudsman Expansion Lyle VanDeventer, Deputy State Home Care Ombudsman 217.557.1532 (v) lyle.vandeventer@illinois.gov Service Integration February 22, 2013, the Centers for Medicare and Medicaid
More informationBELGRADE SCHOOL DISTRICT NO. 44
BELGRADE SCHOOL DISTRICT NO. 44 Request for Proposals Mobile Devices May 29, 2015 Page 1 of 8 Table of Contents Request for Proposals Section Page 1. Introduction... 3 2. General Information... 4-6 3.
More informationARTICLE N SPECIALIZED TRAINING
ARTICLE N SPECIALIZED TRAINING I. Policy A. The Sheriff s Department is committed to meet the training needs of the agency and to improve and develop employee job skills, knowledge and abilities by providing
More informationMEMBER WELCOME GUIDE
2015 Dear Patient; MEMBER WELCOME GUIDE The staff of Scripps Health Plan and its affiliate Plan Medical Groups (PMG), Scripps Clinic Medical Group, Scripps Coastal Medical Center, Mercy Physician Medical
More informationCountyCare Critical Incident Reporting Form
A. *Tell us about you (the person or entity reporting the incident): Name: Organization: Email Address: Relationship to Member: Telephone Number: Other Contact Number: B. Tell us about the CountyCare member
More informationDISA INSTRUCTION March 2006 Last Certified: 11 April 2008 ORGANIZATION. Inspector General of the Defense Information Systems Agency
DEFENSE INFORMATION SYSTEMS AGENCY P. O. Box 4502 ARLINGTON, VIRGINIA 22204-4502 DISA INSTRUCTION 100-45-1 17 March 2006 Last Certified: 11 April 2008 ORGANIZATION Inspector General of the Defense Information
More informationSTENOGRAPHER REQUEST FOR QUALIFICATIONS (RFQ)
STENOGRAPHER REQUEST FOR QUALIFICATIONS (RFQ) Los Angeles County Children and Families First Proposition 10 Commission (aka First 5 LA) RELEASE DATE: FEBRUARY 11, 2014 TABLE OF CONTENTS I. TIMELINE FOR
More informationTHE COUNSELING PLACE ADULT INTAKE FORM Yearly Family Income:
Person to Contact in Case of Emergency Name Relationship Best Contact Number Alternative Contact Number Office Use Only Intake Date Reason for referral Counselor THE COUNSELING PLACE ADULT INTAKE FORM
More informationFrequently Asked Questions
450 Simmons Way #700, Kaysville, UT 84037 (801) 547-9947 unar@davistech.edu www.utahcna.com Frequently Asked Questions UNAR stands for the Utah Nursing Assistant Registry, the agency in charge of the registry
More informationNOTICE OF PRIVACY PRACTICES
THIS NOTICE OF PRIVACY PRACTICES ( NOTICE ) DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. Respect for
More informationAugust 2015 Approved January :260. School Board
August 2015 Approved January 2016 2:260 Uniform Grievance Procedure School Board A student, parent/guardian, employee, or community member should notify any District Complaint Manager if he or she believes
More informationLOUISIANA MEDICAID PROGRAM ISSUED: 10/18/13 REPLACED: CHAPTER 9: ADULT DAY HEALTH CARE WAIVER SECTION 9.10: SUPPORT COORDINATION PAGE(S) 13
SUPPORT COORDINATION Support coordination, also referred to as case management, is an organized system by which a support coordinator assists a recipient to prioritize and define his/her personal outcomes
More informationPEDIATRIC HEALTH ASSOCIATES HIPAA NOTICE OF PRIVACY PRACTICES
Policy effective date: 4-14-2003 Revised January 2014 PEDIATRIC HEALTH ASSOCIATES HIPAA NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND
More informationPOLICY ON INCIDENT REPORTING AND INCIDENT MANAGEMENT
POLICY ON INCIDENT REPORTING AND INCIDENT MANAGEMENT It is the policy of ACHIEVA to establish procedures for the prevention and management of incidents in accordance with ODP Incident Management Bulletin
More information