Documents Requested for and On-Site Visit NOTE: Any or all of the desk review documents may be sent electronically. It is preferred that client files provided for the review are original and complete. If copies are sent in place of the original client files requested by DOEA, files must be true, accurate and complete copies of the originals and be accompanied by a signed letter from the lead agency's duly authorized representative that states: "On this day of, 20 (insert correct date), I attest that the (enter #) files transmitted with this letter are certified to be true, exact, complete, and unaltered photocopies made by me, or at my direction." If scanned or photocopied documents and files are sent, the original documents must be available during the on-site monitoring review. (Additional documentation may be requested onsite). GRANTEE OPERATIONS EFFECTIVENESS, EFFICIENCY AND APPROPRIATENESS OF SERVICE DELIVERY A ORGANIZATION GOVERNANCE, LEADERSHIP AND ADMINISTRATION A1 Board of directors' meeting minutes including committee meetings, exclude attachments (January-December 2008) A2 Advisory council meeting minutes, exclude attachments (January-December 2008) A3 A4 A5 Current corporate bylaws for the AAA's governing board and the AAA's advisory council (including any amendments), articles of incorporation (if changed in 2008) List of advisory council members and their terms of service. List of board of directors and their terms of service. A6 AAA and providers' grievance policies and procedures and complaint logs. Copies of memoranda of understanding for coordination of APS referrals between AAA, DCF and each selected A7 lead agency AAA and lead agency's service prioritization policies and procedures (APS, IM, Aging Out and 4 and 5 ranked A8 priorities) Any documentation of implementation activities for OAA targeting plan approved in area plan, and targeting achievement report for 2008 (including source documentation). A9 Documentation the AAA reviews CIRTS data for active and waitlisted clients and works with provider agencies to A10 ensure data accuracy and manage waitlists. A11 Current organizational chart with employee hire dates Current property listing (per OMB Circular A-110 and contractual requirements) and policies & procedures for A12 property management/procurement. Original and complete (or certified copies of) selected ADI, CCE and HCE client case files identified on random monitoring list for calendar years 2007, 2008 and 2009. Case file documents dated more than three years ago are A13 not required. B B1 REGULATORY/CONTRACTUAL COMPLIANCE - FEDERAL & STATE PROGRAMS CONTRACT MANAGEMENT Corrective actions taken by the AAA as a result of prior year's monitoring activities by DOEA, to include: Boardapproved changes to policies and procedures; training conducted and/or notices/clarification issued (to staff, lead agencies or providers) to address findings; CIRTS reports and FMMIS information indicating inelligible services or services not supported by worker's logs or case notes and erroneous billings were adjusted; and any other actions taken described in the AAA's corrective action plan. Documentation of communication between the AAA and providers regarding tracking and achievement of legislatively mandated outcomes. Documentation of specific efforts to utilize local human services funding prior to utilizing CCE funds (support for local match, AAA fund raising activities, etc.) (verify property items on-site) Originals are requested to be available on site.
Documents Requested for and On-Site Visit B2 B3 B4 B5 B6 B7 APS AND CLIENT FILE REVIEWS APS and Imminent Risk Referral Exception/Outcome Measure reports (with date range July 1, 2007 thru June 30, 2008). Include an explanation for each client shown as not receiving services Original and complete client case files (or certified copies) from January 2008 through current for APS clients identified on Monitoring Random List NUTRITION PROGRAM Documentation that providers are in compliance with meal temperature requirements, including monthly temperature logs for October 2008, for selected meal site checklists, and monitoring or service reports of the registered dietician (2008) for each selected nutrition service provider for congregate & home delivered meals. Current food service vendor contracts for selected meal providers Documentation of all menu substitutions for selected providers for the review period and related support documentation (i.e., nutrition analysis) for calendar year (CY) 2008 Copies of approved menus for each selected service provider for CY 2008 (please include computer analysis of menus) Note: Selected meal providers will follow in separate e-mail. Backup documentation for CIRTS APS and Imminent Risk Outcomes/Exception reports submitted to DOEA's contract mgr for current fiscal year. If individual exceptions, a sample of client files for the exceptions may be requested for onsite review Original files to be available on-site regardless of whether copies or electronic files were sent for desk review. B8 Copies of the license and/or registration of area dietitians coordinating nutrition program services for CY2008 Contract agreements (CY 2008) with registered dietitians for selected service providers, and the following: B9 All training records for provider staff, volunteers and home delivered meals drivers for selected meal providers for CY 2008. Include training documentation on safe and sanitary handling of food during preparation (where B10 applicable), storage and delivery Documentation indicating providers inform the public using appropriate media sources about nutrition services B11 available to elders in the area they serve. Documentation that nutrition education materials and presentations were developed by a Qualified Dietitian and provided at least twice a year with at least 3 months between sessions (on a monthly basis as of implementation of DOEA Programs and Services Handbook) to congregate and home delivered meal clients by a dietitian or individual of comparable expertise (e.g., health educator, home economist, etc.). B12 Documentation of availability of meals to persons under 60 who are spouses of elders age 60 and older, B13 disabled individuals living in facilities that serve meals to elders age 60 and older and caregivers. B14 Documentation of referral procedures for nutrition counseling and copies of nutrition care plans Documentation the AAA ensures that meal providers are monitored at least once a year by qualified staff and B15 corrective action is required for findings (if any). PREVENTITIVE HEALTH & WELLNESS Documentation to support the completion of outreach projects (mail, telephone logs, field work, etc.) for B16 medically underserverd, non-english speaking and other targeted groups. B17 Documentation that reflects a AAA staff member is facilitating & coordinating health promotion activities. Documentation that supports completion of one evidence-based project; chronic disease prevention or selfmanagement course, physical activity and nutrition course, medication management course, mental health B18 course and also a schedule of evidence-based courses. B19 Pre/post surveys of presentations/programs conducted.
PREVENTITIVE HEALTH & WELLNESS (continued) Documents Requested for and On-Site Visit B20 Work plans and quarterly reports. B21 Record of volunteer activities including logs containing total number of hours and affiliated organizations B22 Volunteer recruitment materials for professionals and the general public MOUs, MOAs or any other type of agreements to demonstrate the AAA partners with agencies such as B23 Department of Health, Dept. of Children and Families, etc. to conduct Wellness activities. Resources/data used in program planning (needs assessment) and any tracking or other methodology B24 demonstrating needs assessed are being addresesed. EHEAEP Original and complete client files or certified copies (random sample list to be provided) including applications and supporting documents B25 Copies of Weatherization Assistance Program (WAP) and Low-income Home Energy Assistance Program B26 (LIHEAP) Memorandums of Understanding (MOU s) Documentation of outreach activities and tracking information demonstrating the AAA is targeting low-income and senior population centers for outreach activities (if bulky, outreach documentation may be retained and B27 viewed on site). B28 Monitoring reports and corrective action follow up (if findings indicated). ELDER ABUSE AND NEGLECT PREVENTION B29 Annual work plan Public service announcements, written and/or evidence of radio or television announcements (one per B30 quarter) B31 Documentation of training for professionals (sign-in sheets and evaluations) Sample of working agreements with organizations such as Triads, SALT Councils, SHINE, LTCOP and other organizations. B32 B33 B34 INFORMATION AND REFERRAL ELDER HELPLINE; ELDER SERVICES DIRECTORY Original files to be available on-site regardless of whether copies or electronic files were sent for desk review. Selected payment records to be available on site to verify only minimum amount to resolve the crisis was paid Information regarding partnerships, collaborations with entities providing similar services, and project reports Documentation of Public education and outreach (evidence of outreach events) Documentation of technical assistance to programs providing services to elder abuse victims Contracts and Memoranda of Understanding between AAA and subcontractors of I & R services (including 2-1- B35 1 agencies) if all or part of these duties are contracted out All written Information and Referral/Elder Helpline policies and procedures, including referrals and follow-ups, B36 protocols for formal crisis intervention services, resource directory updates and inclusion/exclusion criteria B37 I & R staff training files Documentation of timely follow-ups on referrals made by Elder Helpline, to include individual referral type, May be reviewed on site if bulky. B38 dates, etc B39 Documentation of Elder Helpline public awareness initatives throughout the PSA B40 Sample of information and Referral consumer satisfaction surveys conducted Respite for Elders Living in Everyday Families (RELIEF) B41 Area Plan information regarding volunteer resources B42 Most recent monitoring report(s) for provider agencies including corrective action follow-up
B43 SERVING HEALTH INSURANCE NEEDS OF ELDERS Documents Requested for and On-Site Visit Work plan(s)/quarterly Reports (evidence of achieving target outputs/outcomes including National Performance Reports) Training schedules and supporting documentation of training volunteers (evidence of volunteer training, e.g., B44 training meetings; and evidence that Elder Helpline SHINE clients referrals are directed to trained volunteers) Documentation of outreach activities (documented outreach in every county consistent with plan evidence of B45 targeting and services to underserved populations) B46 List of SHINE volunteers. B47 Evidence of recruitment efforts shared between liaison and volunteer leadership to ensure volunteer diversity Evidence of partnerships with community resources to establish collaborative services and working B48 relationships Documentation of volunteer retention strategies and of volunteer recognition events conducted at least semiannually. B49 C C1 FINANCIAL MANAGEMENT, INTERNAL CONTROLS AND SUBRECEIPIENT MONITORING Summarized service cost reports, cost or price analysis used to evaluate the reasonableness of contracted rate for services (can be reviewed on site if too voluminous) Contractor and Subcontractor payment requests and general ledger detail reflecting adminstrative expenses and expenditure reports for OAA and CCE for December 2008 including CIRTS reports and spreadsheets that support the units paid. Supporting documentation for cost analysis may be reviewed on site C2 C3 Debarment certifications for subrecipients and auditors; most recent bid file. C4 Fiscal or operational policies and procedures for the following: a. Check writing and reconciliation duties b. Procedures regarding identification of cash and revenues received c. Procurement, congruent with 45 CFR, Subtitle A, Part 92.36; OMB Circular A-110 and Chapter 287, Florida Statutes. Include formal bid thresholds and Conflict of Interest policy d. Subrecipient versus vendor determination procedure e. Tracking of due dates for financial reports, audits, payroll functions and taxes ` f. Travel, congruent with Section 112,061, F.S. g. Approval of corrective actions as a result of monitoring h. Current monitoring instrument Documentation of match/in-kind contribution information from the general ledger and suporting documentation C5 for both Supporting documentation for co-payments assessed and Memoranda or any other communications between the AAA and providers evidencing ADI and CCE co-pay collected C6 collections and co-pay tracking instrument for 2007-08 General Revenue closeout and at December 2008 C7 Copies of contracts for selected subrecipients, including contracted unit rates. Original contracts for selected recipients Financial and compliance audits for selected subrecipients, including documentation of AAA's review of the C8 audit for (specify providers) C9 Fiscal and program monitoring reports for any of the above that are subrecipients, and program monitoring for subcontractors (if any) for RELIEF, SHINE, Elder Abuse Prevention, Information and Referral and Health & Wellness programs, including corrective action follow-up Contracts for Selected subrecipients
Documents Requested for and On-Site Visit FINANCIAL MANAGEMENT, INTERNAL CONTROLS AND SUBRECEIPIENT MONITORING (continued) Evidence of follow-up for any findings, deficiencies or concerns as a result of monitoring or the review of the C10 independent auditors reports Originals of this documentation C11 Internal Control Questionnaire (if available from AAA's independent auditor) Expense documentation for specific checks (check numbers to follow under separate cover), include actual original invoices, check copy (stub or other documentation indicating check number for paid expenses), payment date, supporting documents (CIRTS report, packing slip, receiving report, etc.), general ledger detail for the posted expense and bank statements and reconciliations indicating the date checks cleared the bank Originals of this documentation C12 C13 D D1 D2 D3 D4 D5 D6 D7 D8 D9 MEDICAID WAIVER Five original and complete direct service provider files or certified copies (select providers at least one of the clients on the Monitoring List) Five original and complete ALE provider files or certified copies (select providers serving at least one of the clients on the Monitoring List) List of current service providers for each county categorized by Medicaid waiver service and evidence of provider maintenance and recruitment efforts, if necessary AAA's Medicaid Waiver related policies and procedures Medicaid Waiver Specialist case management agency provider monitoring schedule Three months of menus for two HDM providers (one hot meal and one frozen meal provider) Lead agency and service provider referral agreements. If referral agreements are standardized, only one agreement from each provider type is required Number of ALE clients assigned to each case managers in each case management agency ALE provider monitoring schedule Assessment and care plan training documentation (schedule, agendas, attendance, attendee scores and training evaluations). May be retained on-site if documentation is voluminous D10 D11 Quality Assurance/Quality Improvement initiatives developed by the AAA D12 Technical assistance files (retain at the AAA for onsite review if files are voluminous) D13 Consumer complaints tracking documentation (database copy or methodology or system used) Case management agency provider qualifications documentation for the ALE and ADA Waivers (new D14 agencies only) D15 Documentation that AAA ensures service providers meet minimum waiver provider standards ADA and ALE monitoring files and reports (retain for onsite review if files are voluminous) D16 Form 941's & UCT-6's for calendar year 2008 and supporting documentation for 4th quarter 2008 payroll. Technical assistance files and monitoring reports, if not sent in advance
D17 Documents Requested for and On-Site Visit MEDICAID WAIVER (continued) Documentation that the care plan review protocol team has reviewed and approved or disapproved requests for above threshold care plans in accordance with DOEA's Notice of Instruction D18 D19 Original and complete (or certified copies of) ADA and ALE selected client case files for calendar years 2007, 2008 and 2009 Case file documents dated more than three years ago are not required D20 E AGING RESOURCE CENTERS/AGING AND DISABILITY RESOURCE CENTERS E1 ARC/ADRC operational policies and procedures. E2 Position descriptions for Medicaid administrative claiming staff. ARC/ADRC training plan, including training for ARC/ADRC staff, partners, providers, access points, and other community stakeholders. E3 E4 E5 E6 E7 E8 Tools used to track the time it takes to determine eligibility. Minutes of Local Coalition Workgroup meetings, with identification of participating members. ARC/ADRC quality assurance policies and procedures. Monitoring reports for functions performed directly, by outsourced entities or by access points. Original files to be available on-site regardless of whether copies or electronic files were sent for desk review. A waiver program monitor and a Medicaid Waiver Specialist or supervisor will select two ADA and two ALE waiver clients from the monitoring list provided by DOEA for client visits Documentation of MWS qualifications for the position, including job descriptions and personnel files Training documentation (e.g., training agendas, training materials including handouts and copies of presentations, attendance rosters, evaluation sheets, etc. Back-up documentation for items on the Medicaid administrative claiming reports not accompanied by a CIRTS report.