ࡱ>  oYnq\*Mg{` ?bjbjFF p,,/ 8,FD9****!< 9999999$R;h=J;93"!33;9**P9 3X8**9 39 57* X68f9096>p>,7>7\33 33333;9;9S X33393333 $  H05-048 Policy/Procedure July 1, 2005 TO: Area Agency on Aging DirectorsFROM:Penny Black, Director, Home and Community Services DivisionSUBJECT:REVISED SENIOR INFORMATION AND ASSISTANCE STANDARDS Purpose:The purpose of this MB is to issue the final revised Senior Information and Assistance Standards, formerly the Information and Assistance/Case Management Program Standards.Background:The Senior Information and Assistance Standards are the requirements for operating services with funding from ADSA. The program standards needed to be updated to reflect changes in technology, implementation of Washington Information Network (WIN) 2-1-1, and to clarify policy on various issues that have arisen since the standards were last updated in 1995. The revised I&A Standards were issued for comment in MB H05-010. The comments received were reviewed and where necessary changes were made and items were clarified based upon that feedback.Whats new, changed, or ClarifiedThe revised standards reflect: Case Management references have been removed; The revision strives to bring the I&A system closer to Alliance of Information and Referral Systems (AIRS) Standards; Coordination with 2-1-1 and use of electronic database are incorporated; Follow up with vulnerable assistance clients is required; Ongoing training for staff and volunteers is required; An appendix for Medicaid Administrative Claiming is revised and added; Samples for Interagency Agreements and Resource Inclusion-Exclusion Policies also included in appendices.ACTION:Effective August 1, 2005, Area Agencies on Aging must implement the new standards in Senior I&A Programs. Medicaid Administrative Claiming by AAAs must comply effective with August 1, 2005 billings. Related REFERENCES:AIRS Standards:  HYPERLINK "http://airs.org/downloads/newstandardsforweb10-02.pdf" http://airs.org/downloads/newstandardsforweb10-02.pdf WIN211 website:  HYPERLINK "http://www.win211.org/" http://www.win211.org/ATTACHMENT(S):Attachment 1 Senior Information and Assistance Standards  EMBED Word.Document.8 \s  Attachment 2 Medicaid Admin Claiming (Appendix A)  EMBED Word.Document.8 \s  Attachment 3 Time Study Sheets (Appendix B)  EMBED Excel.Sheet.8  Attachment 4 Sample Timesheet  EMBED Excel.Sheet.8  Attachment 5 Sample Resource Database Inclusion-Exclusion Policy (Appendix C)  EMBED Word.Document.8 \s  Attachment 6 Sample Interagency Agreement (Appendix D)  EMBED Word.Document.8 \s  CONTACT(S):Susan Shepherd, Program Manager (360) 725-2418 shephsl@dshs.wa.gov      &234789XY^_ R ¸࡙ࡋࡴzzrrrjhUtCJaJh7CJ^J hUt;^JhUt5;\^J hUtCJhUtOJQJhUtCJ^J hUt^JhUt5B*\^JphhUthhUt5^Jhh5^JhUt5OJQJ\h5\^JhUt5\^J hUt5\jhUtCJUmHnHu'    &349X  !$If $If$a$gd$@&a$$a$/<>XY_SM$IfJkdm$$IfH0=-% o&4e4 Ha  !0$*$If $IfJkd$$IfH0=-% o&4e4 Ha   UEE & F !$IfJkdG$$IfH0=-% o&4e4 Ha  !$If $IfJkd$$IfH0=-% o&4e4 Ha   6 / f   & F$If  & F$If $IfJkd$$IfH0=-% o&4e4 Ha & F !$If  RTUV&ܶԪԟԍԪԟnfh3\CJ^J#jHh hUtCJU^Jh hUt0JCJ^J#jh hUtCJU^Jh/hUtCJ^JjhUtCJU^JhUt56\]^JhUt5;\^JhUtOJQJhUtCJ^JhUt5\^JhUt5OJQJ\hUtCJaJh7CJaJ# aUU  !$IfJkd$$IfH0=-% o&4e4 Ha $IfJkd!$$IfH0=-% o&4e4 Ha&Ewe$If $IfJkd$$IfH0=-% o&4e4 Ha&'ABCDEFPwx랏{s`Q{s{jh~h~CJU^J%jUoF h~CJOJQJUVaJh~CJ^Jjh~CJU^Jh7CJ^Jj hhMx3CJU^J%jG hMx3CJOJQJUVaJh3\CJ^JhUtCJ^Jh;7CJ^JjhhCJU^J%jG hCJOJQJUVaJhCJ^JjhCJU^J"Ccefºm^VhUtOJQJj(h~h~CJU^J%joF h~CJOJQJUVaJh?)FCJ^Jjg!h~h~CJU^J%joF h~CJOJQJUVaJh7CJ^Jh3\CJ^JhUtCJ^Jh;7CJ^Jjh~CJU^Jjh~h~CJU^J%joF h~CJOJQJUVaJh~CJ^J -./1SKI !Lkd0$$IfH0=-% o&4e4 Ha  & F$If $IfLkd/$$IfHk0=-% o&4e4 Ha-./0235689<?hHo.jhHo.UhUt5OJQJ\hUthUt5\^J 124578:;<=>? 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" # $ % & ' ( ) * + , -   !"%()*,-./25679:;<>ADEFGHIKLMNOPQRSTV  FMicrosoft Office Word Document MSWordDocWord.Document.89q@  FMicrosoft Office Word Document MSWordDocWord.Document.89q@ F!Microsoft Office Excel WorksheetObjInfo WordDocument]5SummaryInformation( DocumentSummaryInformation8,'{` bjbjFF 5,,b&V V V V V V V Jt~~~8>~~'(""΅΅΅-ɍ&(((((($h7nLV aaaLV V ΅΅aaV ΅V ΅&a& bV V ΅~ F~ b&w0` V 4hJK<LLdaaaa'''8_D'''_j $FV V V V V V  State of Washington Department of Social & Health Services  Senior Information and Assistance Program Standards Revision June 2005 Table of Contents  TOC \o "1-3" \h \z  HYPERLINK \l "_Toc107025248" I. PROGRAM DEFINITION AND PURPOSE  PAGEREF _Toc107025248 \h 3  HYPERLINK \l "_Toc107025249" Program Definition  PAGEREF _Toc107025249 \h 3  HYPERLINK \l "_Toc107025250" Target Population  PAGEREF _Toc107025250 \h 3  HYPERLINK \l "_Toc107025251" Code of Ethics  PAGEREF _Toc107025251 \h 3  HYPERLINK \l "_Toc107025252" Confidentiality  PAGEREF _Toc107025252 \h 4  HYPERLINK \l "_Toc107025253" II. ADMINISTRATIVE REQUIREMENTS  PAGEREF _Toc107025253 \h 4  HYPERLINK \l "_Toc107025254" Service Delivery Options  PAGEREF _Toc107025254 \h 4  HYPERLINK \l "_Toc107025255" Service Accessibility  PAGEREF _Toc107025255 \h 4  HYPERLINK \l "_Toc107025256" Medicaid Administrative Claiming  PAGEREF _Toc107025256 \h 5  HYPERLINK \l "_Toc107025257" Telephone Service  PAGEREF _Toc107025257 \h 5  HYPERLINK \l "_Toc107025258" Internet and e-communication  PAGEREF _Toc107025258 \h 6  HYPERLINK \l "_Toc107025259" Resource Database  PAGEREF _Toc107025259 \h 6  HYPERLINK \l "_Toc107025260" Cooperative Relations  PAGEREF _Toc107025260 \h 7  HYPERLINK \l "_Toc107025261" Insurance  PAGEREF _Toc107025261 \h 8  HYPERLINK \l "_Toc107025262" Record Maintenance  PAGEREF _Toc107025262 \h 8  HYPERLINK \l "_Toc107025263" III. INFORMATION & ASSISTANCE SERVICE DELIVERY FUNCTIONS  PAGEREF _Toc107025263 \h 8  HYPERLINK \l "_Toc107025264" Program Publicity  PAGEREF _Toc107025264 \h 8  HYPERLINK \l "_Toc107025265" Case Finding  PAGEREF _Toc107025265 \h 9  HYPERLINK \l "_Toc107025266" Information Giving  PAGEREF _Toc107025266 \h 10  HYPERLINK \l "_Toc107025267" Information &Assistance Screening  PAGEREF _Toc107025267 \h 10  HYPERLINK \l "_Toc107025268" Assistance/Referral  PAGEREF _Toc107025268 \h 11  HYPERLINK \l "_Toc107025269" Client Advocacy  PAGEREF _Toc107025269 \h 11  HYPERLINK \l "_Toc107025270" System Advocacy  PAGEREF _Toc107025270 \h 12  HYPERLINK \l "_Toc107025271" Follow-Up  PAGEREF _Toc107025271 \h 12  HYPERLINK \l "_Toc107025272" IV. STAFF REQUIREMENTS  PAGEREF _Toc107025272 \h 12  HYPERLINK \l "_Toc107025273" Staffing Plan  PAGEREF _Toc107025273 \h 12  HYPERLINK \l "_Toc107025274" Basic Staff Qualifications  PAGEREF _Toc107025274 \h 13  HYPERLINK \l "_Toc107025275" A. Information and Assistance Specialist  PAGEREF _Toc107025275 \h 13  HYPERLINK \l "_Toc107025276" Education/Experience  PAGEREF _Toc107025276 \h 13  HYPERLINK \l "_Toc107025277" Duties are:  PAGEREF _Toc107025277 \h 14  HYPERLINK \l "_Toc107025278" B. Resource Database Specialist  PAGEREF _Toc107025278 \h 14  HYPERLINK \l "_Toc107025279" Education/Experience  PAGEREF _Toc107025279 \h 14  HYPERLINK \l "_Toc107025280" Duties may include:  PAGEREF _Toc107025280 \h 14  HYPERLINK \l "_Toc107025281" C. I & A Supervisor  PAGEREF _Toc107025281 \h 15  HYPERLINK \l "_Toc107025282" Education/Experience  PAGEREF _Toc107025282 \h 15  HYPERLINK \l "_Toc107025283" Duties are:  PAGEREF _Toc107025283 \h 15  HYPERLINK \l "_Toc107025284" D. Program Director Qualifications  PAGEREF _Toc107025284 \h 15  HYPERLINK \l "_Toc107025285" Education/Experience  PAGEREF _Toc107025285 \h 15  HYPERLINK \l "_Toc107025286" Duties  PAGEREF _Toc107025286 \h 16  HYPERLINK \l "_Toc107025287" E. Orientation/Training  PAGEREF _Toc107025287 \h 16  HYPERLINK \l "_Toc107025288" APPENDICES  PAGEREF _Toc107025288 \h 18  PROGRAM DEFINITION AND PURPOSE Program Definition The Senior Information and Assistance (Senior I&A) program in Washington State is an integrated system of functions designed to assist older persons or their advocates to identify, understand, and effectively access resources available to the aging population. The goal is to provide information and the opportunity to access resources and to encourage them to solve their own problems with a sense of confidence and empowerment. Program functions include information giving, service referral, assistance, client advocacy and screening to determine whether an older person should be referred to other appropriate programs and services. Senior Information and Assistance (I&A) offices maintain a file of resources to meet community needs. Services may range from the simple provision of requested information to helping inquirers identify their needs and providing hands on assistance with paperwork if needed. Service delivery options may include: by telephone, in person at office, outstations, home visits or community presentations, e-mail, and web based options. Senior I&A offices partner with local 2-1-1 call centers to handle calls for 2-1-1 callers age 60 and over per local agreement. Target Population Senior I&A programs are funded primarily through the Older Americans Act (OAA) and the Senior Citizens Services Act (SCSA). Therefore, persons age 60 and older and those acting on their behalf are eligible for Information and Assistance (I&A) services without cost. Specific emphasis is on outreach efforts to those in greatest social and economic need with particular attention to low-income minority elderly, Native Americans, persons living alone, persons with Alzheimer's Disease and Related Disorders and their families, Limited English-speaking persons, and older persons living in rural areas. Information and Assistance programs may have other target populations based on funding and contract specifications. This may include services for persons with disabilities under 60, using local funds that are not age restricted. If however, only age-restricted funding is available, the senior I&A may refer individuals under the age of 60 to other community resources that can provide additional services. Code of Ethics Senior I&A programs must have a written Code of Ethics that establishes fundamental values and professional standards of conduct for staff in their relationships with colleagues, clients, other providers and the community. It will prohibit conflict of interests and the acceptance of gifts, gratuities and loans from clients; and defines acceptable use of agency equipment for personal use. Senior I&A Specialists will treat each client with integrity, dignity and respect. Confidentiality Senior I&A programs must have a written confidentiality policy that conforms to laws and regulations to protect and safeguard client information contained in paper files and electronic data bases. Programs will ensure that client information remains confidential in accordance with state and federal law and program requirements. The client must give the I&A Specialist explicit written or verbal consent for information to be disclosed to another agency or person. Release of information without consent is permissible only when the I&A Specialist reports suspected abuse, neglect, abandonment and/or exploitation or when the client is in imminent danger to self or others. I&A staff are mandatory reporters to Adult Protective Services (APS) (see Assistance/Referral Section 4a.) ADMINISTRATIVE REQUIREMENTS Service Delivery Options An Area Agency on Aging (AAA) may choose to contract with a service provider for the I&A service or administer it directly. Whether choosing direct or subcontracted provision, each AAA shall ensure that an I&A program unit is established and that all I&A functions are part of the locally, regionally and nationally integrated and collaborative I&A service delivery system (e.g. 211), with adequate funding, staffing, equipment, technology and administrative support to perform its mandated functions and maintain these Standards. If an AAA chooses to contract for or separately provide the I&A service, the AAA shall include in their area plan a description of how the Senior I&A service will be delivered, coordinated and monitored, and what resources the AAA will provide. If any I&A service provider provides other services, the Senior I&A program will be established as an administratively separate mechanism for service and fiscal reporting, as well as a separate program function, from the other services. In the event these I&A services are provided out of multiple offices, the administrative functions can be centralized. Service Accessibility All I&A service providers must provide a designated space where client interviews and family conferences can be conducted in private. Information and assistance will be provided free of charge to members of the target population(s). Program donations may be accepted and used in accordance with Aging and Disability Services Administration (ADSA) policy. ADSA Policy and Procedure Manual for AAA Operations states in Chapter 3, Section 4 that all contributions (donations) will be used to expand the service (I&A) which received the contribution. Program income may not be used to match federal dollars. All agencies providing I&A services must maintain the capability to assist persons who speak and/or correspond in a language other than English. Since I&A does not generally authorize direct services, family interpreters may be used if available. For those without this resource, this will be accomplished through bi-lingual staff, access to language line telephone services and/or interpreter services, or community interpreters. Similarly, all I&A providers will maintain the capability to provide services to people with vision, speech, hearing or other communication-related challenges. If a specialized Senior I&A program is available, refer callers to them when appropriate. The physical plant(s) will have prominent and appropriate signage, will be accessible by public transportation, will be accessible to people with mobility-related issues, and home visits shall be provided as necessary or appropriate. All agencies providing I&A services must be conversant with regionally relevant cultural differences and take them into account when delivering services. If a culturally distinct entity (e.g. Native American tribe) provides information and assistance, the AAA or its subcontracted Senior I&A entity will coordinate training, resource updating, etc. as may contribute to the effectiveness of both programs. All agencies providing I&A services must maintain the capabilities to assist clients seeking services via telephone, mail and email, walk-in, and home visits when necessary. The capacity to serve clients who require a home visit may be served through referral to Non-Core Case Management. I&A services may also be provided to the community in a variety of other ways. An I&A service may: Establish a presence at community facilities, such as Senior Centers or medical centers where inquirers are helped face-to-face (Out-station); Participate in local case management collaborative; Compile and distribute a directory of services in print or electronic format; Make copies of its database and software available to other organizations that provide information and/or referrals; Allow the public to visit the I&A facility to use the resource database or make its information about community resources available through community-based kiosks or other similar gateways; and Make all or a portion of its database available on a web-page on the Internet. Medicaid Administrative Claiming Many of the functions of the Information and Assistance (I&A) program are potentially eligible for Medicaid funding under Title XIX as Medicaid Administrative costs. AAAs have the opportunity to claim some match funding to increase services. Please see Appendix A for detailed policy and procedure. Telephone Service The I&A program must have adequate telephone service to perform the activities for which it is responsible, including but not limited to information-giving, service referrals, assistance, and screening to determine the need for more extensive services. This will include access to Tele-Typewriter (TTY) equipment (preferred) and/or training on how to use operator assisted TTY services (Washington Relay Service 1-800-833-6384 Voice) There must be sufficient telephone lines so that I&A staff can call out and people can call in without getting a frequent busy signal or voice mail. If queuing is utilized, there shall be periodic reviews to determine the average length of time in queue and whether additional steps need to be taken to reduce the waiting time. If the Senior I&A service cannot be reached without a charge, at least one in-state, toll-free telephone number shall be established. Collect calls from people seeking services will be routinely accepted. The telephone shall be answered with the same program title as that used in program publicity. If the Senior I&A service does not have 24-hour telephone coverage, the Senior I&A service provider must implement one of the following: Contract with an answering service, specifying the information that the service is to give, gather and maintain, including referrals to emergency services providers. Develop a formal, written agreement with another organization to handle emergency calls after Senior I&A working hours and provide training to the staff of this organization so they can effectively deal with older persons and emergencies. At a minimum, maintain answering machines/voice-mails indicating normal office hours for the service, directing the caller to a source(s) for emergencies, and having the capability for inquirers to leave messages. All messages must be responded to on the next business day. Senior I&A service providers/AAAs should be actively involved in the development and implementation of 2-1-1 in their area/region by at minimum attending planning meetings in their region. Telephone capability should developed to interface with the 2-1-1 call center, preferably allowing for hot transfers from the 2-1-1 center. Internet and e-communication The Senior I&A service provider, or sponsoring agency, should attempt to maintain a website that provides basic resource information to consumers. Hot links to sites of particular consumer interest should be included, and the availability of a searchable database should be actively considered. In communities, where there is more than one I&A/R program, providers are encouraged to collaborate on and/or share a resource database. Senior I&A programs must have reliable e-mail capability to both send and receive communications, and a website address or Senior I&A e-mail address will be included in program publicity. Resource Database The purpose of a resource database is to provide ready access to accurate, up-to-date and well-organized information about resources in the Senior I&A program service area. It is the responsibility of the Senior I&A provider to develop and maintain or obtain access to a community resource database, such as 2-1-1, which includes the following information about each resource: A unique record identification number. (Database records only) A code for identifying the organization responsible for data maintenance. Legal name, common name and/or acronym of resource (include branch office information). Program name. Street address, mailing address, telephone number (including TTY/TDD number), fax number, web site address, and email address. Hours and days of operation Geographic area served. A description of services provided Eligibility requirements. A description of languages other than English offered. Application/Intake procedures. Cost of service and/or donation policy. A description of method of payment accepted and fee structure. Known barriers to facility use (if applicable) or problems with accessibility of services (such as a waiting list). A description of the legal status of the organization. Name of contact person/intake worker and administrators. The date the information was last verified. The Senior I&A provider may choose to add additional elements. The resource file shall be updated at least once a year, and procedures shall be established for responding to interim information changes. As part of developing and maintaining a community resource file, the I&A program may choose to develop resources not otherwise available. Information about service gaps will be shared with AAA planning staff. This is valuable in AAAs overall responsibility to identify service gaps and programs to address them. The I&A provider will develop written criteria for the inclusion or exclusion of agencies and programs in the resource database. See Appendix B. Resource information shall be indexed and classified (it is recommended that the AIRS/INFO LINE Taxonomy of Human Services be utilized) to make the Resource File more easily accessible. Cooperative Relations The Senior I&A service provider will identify the primary community resources utilized by older persons. When deemed necessary and appropriate, formal working agreements with these resources may be developed. These resources may include Home and Community Services (HCS), other AAA service providers, housing authorities, mental health, home health agencies, and legal services providers. Interagency Agreement examples can be found in Appendix C. Working agreements will address at least the following: How long each party will take to respond to a request for service. Release of information procedures that meet appropriate state and federal requirements. Referral and follow-up procedures. How each party will notify the other of program changes and unavailability of service. Procedures for working out problems between the two parties. To assure clarity and allow for staff turnover, the I&A service provider will forward signed copies of the working agreement to the service provider and maintain an original on file. Working agreements may be reviewed as needed. Each I&A provider will be required to establish a written agreement or Interagency Agreement with local WIN 2-1-1 entities. Samples are provided in Appendix D. Record Maintenance Program and client records will be maintained to provide an information system which assures accountability to clients, the I&A program and funding agencies, and supplies data for community planning efforts. This information can be kept in paper files or electronically (preferred) for all assistance calls. The information system established will comply with ADSA, AAA and service provider policies and include, but not be limited to, the following: A face sheet containing personal and demographic information about the client and their informal support system. Pertinent correspondence relating specifically to the client. A narrative record of client contacts, including problems encountered, service referral recommendations, client permission and service plan modifications developed in response. Such other documentation as may be necessary to systematic case work and service plan continuity. Client contact documents will be retained a minimum of six full years from the date of last contact. If batching by year, retain each years documents for seven years. INFORMATION & ASSISTANCE SERVICE DELIVERY FUNCTIONS Program Publicity The purpose of program publicity is to inform older persons, their representatives, service providers and the general public about the availability of the I&A services and how it can be accessed. I&A will be publicized as an access point to community and Long-Term Care Services. Service providers shall be instructed, and community agencies shall be encouraged, to refer clients who might need long-term care services to I&A for screening. The availability of I&A services may be publicized throughout the service area using the following suggested methods: Mass Media (radio, television, local senior newspaper, internet) articles describing the program (if possible), and brochures and/or posters. The primary Senior I&A program telephone number must be listed in the yellow pages of the telephone book under the Senior Citizens heading or similar heading, and the title used shall be the same as the title used in program publicity. Publicity about the I&A program must include a title describing the population served (Elder Services, Senior I&A, etc.), the telephone number of the Senior I&A program (including the after hour emergency number if applicable), location of the I&A office, hours and days of operation, and services provided by the I&A program. If the I&A provider determines that a significant number of potential I&A consumers speak a language other than English, the I&A program shall be publicized and brochures developed in that language. The agency providing I&A services must participate in activities to increase community awareness as appropriate to setting. The I&A component must periodically contact appropriate Department of Social and Health Services (DSHS) providers and as appropriate, employers, civic groups, professional organizations etc. within its service area to inform them about the availability of I&A services. Case Finding Referrals for I&A will be accepted from any source and may include older persons seeking or already receiving another service through Home and Community Services (HCS), the Aging Network or a community agency. The person making the referral can request to remain anonymous. Once a referral is received, it is the responsibility of the I&A program to contact the individual referred within one working day. Unsuccessful attempts at contact should be documented. If requested, the I&A Specialist may provide contact confirmation with referral source as long as he/she is still in compliance with applicable federal and state laws. Each I&A program will identify and maintain periodic contact with individuals, businesses and agencies in the community who are most likely to come into contact with vulnerable older persons in its service area. The goal is to educate and/or train them on the goals of the I&A program, the services it provides, and its relationship to other programs for older persons within the area. These Gatekeepers can be instructed to play a vital role in the service delivery system by referring the names of vulnerable older persons to the I&A program. Examples of those Gatekeeper-type contacts might include: apartment, hotel, and mobile home park managers; postal carriers; gas, electric, and water meter readers; fuel oil dealers; clergy; appraisers; police and firemen; grocery store clerks (especially those who deliver groceries); pharmacists; bartenders; hospital emergency room staff; etc. Information Giving The purpose of information giving is to provide an older person or their representative with enough information to enable them to locate and obtain needed services without additional assistance from the I&A Specialist. This component is utilized when the caller can identify the seniors need and make a direct request for resource information to meet that need. If the older person is unable to self-refer and has a willing informal support system, provide necessary information and support to the older persons informal support system to enable them to make the appropriate referrals. The I&A Specialist will provide information on multiple referral options when available. The I&A Specialist will encourage inquirers to call back if the information proves to be incorrect, inappropriate or insufficient to meet their needs. Clients not meeting the criteria for target population groups shall be given contact information to access appropriate services. If the simple provision of information is not enough to enable the older person or their representative to access needed services, the I&A Specialist shall conduct a screen to determine whether the older person needs additional help from I&A or needs to be referred to another community resource. Information &Assistance Screening The purpose of screening is to determine whether an older person needs service referral, assistance and/or client advocacy from the I&A program and/or is a potential case management client who should be referred for a comprehensive assessment. Screening may be provided over the telephone or in the field by the I&A Specialist, or a community agency. As appropriate, screening shall include direct contact with the older person being screened. (Although third-party information is valuable in developing an overall impression of an individuals level of functioning, direct contact is required to confirm the need for and willingness to receive services.) The I&A provider shall develop and use a screening process which at a minimum includes the following: date of referral, referral source, date of screening, presenting problem, whether the person screened was referred for an assessment by HCS, Aging Network or other service providers. Screening for referral to community resources may include: Assessing the older persons needs. This includes exploring special needs such as disability access, transportation etc., Utilizing the resource system to identify the most appropriate resources to meet those needs, Determining the older persons potential eligibility for services, Determining the older persons ability to follow-up, Assessing possible endangerment situations. Assistance/Referral The purpose of assistance is to help an older person obtain a needed service or accomplish a necessary task. This component is also utilized when the caller requires assistance understanding the specific nature of their problem and needs. Assistance is provided only when the older person is unable to obtain the service or perform the task on their own and lacks a support system that is able and willing to act on their behalf. If an inquirer has a case manager with the Aging Network or HCS, they may be referred back to their case manager. Assistance may be provided over the telephone, in the field or in the I&A office, as appropriate and may include: Contacting resources and making referrals for the older person who is unable to advocate for themselves and lacks an informal support system. The purpose of service referral is to ensure that an older person is successfully referred to needed community resources. This function is completed by the I&A Specialist if the older person does not meet the criteria for case management target population groups served by either the Aging Network or HCS. The referral process for different types of clients shall be as follows: All I&A staff are Mandatory Reporters. Refer adults in need of Adult Protective Services (APS) directly to the APS program for APS investigation, following instructions in the ADSA Long Term Care Manual, Chapter 6. See also Partners in Protection: A Guide for Reporting Vulnerable Adult Abuse DSHS 22-810(x)(REV. 8/04). The brochure is available on-line on the ADSA internet at  HYPERLINK "http://www.aasa.dshs.wa.gov/Library/publications/brochurestext.htm#abuse_mandatory" http://www.aasa.dshs.wa.gov/Library/publications/brochurestext.htm#abuse_mandatory. Refer adults who request and appear to need ADSA-funded in-home assistance, nursing facility placement or other residential services to HCS intake for ADSA services eligibility screening within one working day after contact by the older person and/or their representative. If necessary, document reasons why the referral is not completed within this time frame, for example the need to assist with related applications, acquiring documents, or client advocacy. Refer unpaid caregivers to Family Caregiver Support Program (FCSP), if I&A is not providing those services directly. Refer to appropriate services those adults who do not meet the Non-Core Case Management target population criteria (as defined in Chapter 5 of the Long Term Care Manual) but appear to require other services. Refer to appropriate services those adults (under age 60) who do not meet the criteria for a target population group. Persons over 60 seeking services outside the AAA planning service area shall be referred to Elder Care Locator or to their closest local Senior I&A. An older person receiving assistance shall be given the Senior I&A program telephone number and encouraged to call back if further problems arise. Client Advocacy The purpose of client advocacy is to help an older person receive, retain or establish eligibility for services, by clarifying communications between inquirers and service providers. Client advocacy is provided by I&A staff only when older persons cannot advocate for themselves and have no one in their support system able and willing to advocate on their behalf. In all cases involving advocacy, the specialist must obtain the informed consent of the inquirer before proceeding. As appropriate, I&A staff should seek to involve the older person and/or their representative in advocacy efforts. Client advocacy will usually be provided over the telephone, but may be provided in the field or I&A office as appropriate. System Advocacy System Advocacy may be undertaken to effect changes in public policy relating to the needs of older people. Actions may be taken by the I&A entity to seek changes in state and/or community conditions, structures or institutions when modifications in the service delivery system are required to ensure the adequate availability of essential community services. Such advocacy may include the collection, analysis, and dissemination of data on human service needs. For the purposes of these standards, system advocacy does not include legislative advocacy (lobbying). All advocacy efforts shall be consistent with written policies established by the governing body of the I&A entity. Follow-Up Follow-up is important to determining client satisfaction and identifying service gaps or systemic issues, client outcomes, and additional needs the client may have. The I&A service must offer follow-up with all inquirers/representatives who need further assistance accessing services due to capacity or disability issues, or had endangerment issues. The timeframe will be ten business days, unless the referral type provided would need a longer timeframe to be determined successful or not. The I&A service must also follow up with a random 5 percent sample of other assistance contacts to determine if information given by I&A was successfully utilized. During the initial contact(s), the specialist should obtain permission to contact the inquirer/representative for follow-up. If permission is denied, it should be duly noted in the case record. On follow-up, should the original referrals prove unsuccessful, I&A staff will identify substitute resources and referrals if they are available and make another follow-up contact within ten working days. Follow-up results will be documented in the client record. Include a brief description of the reason referrals were unsuccessful. STAFF REQUIREMENTS Staffing Plan A record will be kept on each I&A staff person and volunteer according to standard human resources best practices, including a criminal background check when hired or grandfathered. Each service provider shall develop a written staffing plan which: Defines the qualifications and skills for and duties of each staff position for I&A Specialist, Resource Database Specialist, and others. Indicates whether each position is full or part-time. Indicates which positions are filled by paid employees and which are filled by volunteers. Includes an organizational chart showing lines of reporting. Provides a sufficient number of I&A Specialists and other staff to support the service area and call volume. Basic Staff Qualifications Responsibilities of I&A staff may vary depending on the size of the I&A program. Areas of specialization may include I&A Specialist, Resource Database Specialist, and others. In large programs, one or more staff members may be assigned to each task. In smaller programs each staff member may have a variety of I&A responsibilities or even other program responsibilities such as Title 19 Case Management, Respite, and Family Caregiver Support. All staff must have demonstrated proficiency in interpersonal communication, both oral and written. All staff must have demonstrated skills and knowledge commensurate with their job responsibilities at the time of employment or have the potential of achieving the required skills and knowledge through training. All staff who provide I&A services must have a general knowledge of: The aging process and disabilities; The Aging Network service delivery system; Services funded by ADSA and other service delivery systems in the community; The purpose of the I&A program and the services it provides; Responsibilities of I&A, Case Management, and HCS staff. All I&A staff, including volunteers, who have unsupervised access to vulnerable adults must have a Washington State Patrol Criminal History Background Check on file. Staff or volunteers with disqualifying crimes as defined in  HYPERLINK "http://www.leg.wa.gov/RCW/index.cfm?section=43.43.830&fuseaction=section" RCW 43.43.830 and  HYPERLINK "http://www.leg.wa.gov/RCW/index.cfm?section=43.43.842&fuseaction=section" 43.43.842 cannot be given unsupervised access to vulnerable adults. The information is used to determine the staff persons character, suitability and competence to perform in the position. A. Information and Assistance Specialist I&A Specialist staff, or others performing the full range of these duties may be volunteers, but must meet the same qualifications as paid employees. Special project volunteers may or may not meet these qualifications. Education/Experience B.A. in relevant field (social science) and two years of experience providing direct human services. OR two years of relevant college level courses and four years of experience providing direct human services. If no qualified applicants, contact ADSA Program Manager for possible waiver to this requirement. Experience may be paid or volunteer. Experience providing services to older people and people with disabilities is preferred. AIRS Certified Information & Referral Specialist in Aging (CIRS-A) credentialing is encouraged. Duties are: Provide information individually as requested or in group settings Refer for services Screen and assess callers to determine if assistance is needed Provide appropriate assistance over the telephone or in person Arrangement of services Screen callers to determine whether a referral for Non-Core Case Management services, HCS, or other services is appropriate Provide supportive counseling Advocate Follow up to see if services were put in place Record maintenance B. Resource Database Specialist The use of this position will vary by size of agency and usage of technology. Education/Experience High School diploma or G.E.D. plus a minimum of two years of post-secondary education in a computer technology related field. Four-year degree preferred. OR one year of relevant college level courses and two years of relevant experience. Proficiency in applicable software, which might include information and referral/assistance software. Technical mastery sufficient to write queries, forms, reports and macros. Experience involving services to older people and people with disabilities is preferred. AIRS Certified Resource Specialist (CRS) credentialing is encouraged. Duties may include: Develop and maintain database of resources available for older adults and their caregivers for use by I&A staff in service provision. Coordinate the updating of Information and Assistance resource files by: Developing and monitoring annual plan for update of resources. Contacting providers to update resource information. Noting any changes in the service delivery system and purging old information. Categorizing resource information in accordance to the AIRS Taxonomy. Promptly updating the computerized database and hardcopy consumer documents. Research and assist with the development and maintenance of a website. Maintain, troubleshoot and repair databases. Assist with the production and management of Agency databases. Develop appropriate written consumer materials. Assign and coordinate writing tasks for consumer directories. Maintain and develop database forms and reports as requested by I&A Specialists. Coordinate the distribution of updated material to designated staff. C. I & A Supervisor All I&A staff shall have an assigned supervisor. Supervisors shall be paid employees. The term supervisor as used in these standards does not necessarily refer to a person who has hiring and firing authority, monitors attendance, etc. Although this person may also perform the job duties listed below, this is not required. The person performing the listed job duties might be called a Lead I&A Specialist, but the AAA must ensure that they meet the education/experience requirements listed below. The supervisor shall be knowledgeable about the community resources, screening tools and process, and physical and mental health issues in the client population. Education/Experience BA in relevant field (social science) plus two years of experience providing direct human services or two years of supervisory experience. Experience must be paid. Experience providing services to older people is preferred. AIRS Certified Information & Referral Specialist in Aging (CIRS-A) credentialing is encouraged. Duties are: Maintain regular contact with staff. Review case records with staff to determine effectiveness of actions taken. Provide and arrange for formal staff training. Provide consultation to staff as needed. Arrange for appropriate case consultation by other professionals, as needed. Monitor and report follow-up activities. Review a sample of two assistance records for accuracy and completeness at least once every 90 days for each I&A Specialist. Conduct a formal evaluation of each staff person at least once a year. D. Program Director Qualifications Each I&A program, or each component if the program is divided among more than one service provider, shall have a program director. The program director shall be a paid employee. Education/Experience A. B.A. in relevant field and two years of administrative experience (one year of supervisory experience may be substituted for one year of administrative experience). Duties Develop and implement program policies, goals and objectives utilizing follow-up information to identify possible gaps in the service delivery system. Advocate and plan for system improvement. Cooperate and advocate with AAA planning unit to determine where gaps in services exist for the target population Hire and supervise appropriate staff. Arrange for volunteer and student assistance and supervision as appropriate. Manage or delegate day-to-day program operation. Develop program operating procedures, personnel policies, job descriptions and record maintenance system. Submit required reports in a timely fashion. Develop and maintain linkages with community agencies and organizations that could give support to the program or individual older persons. Educate community agencies and groups and the general public on the goals of the I&A program, the target population and services provided. Develop program publicity. Establish systems for evaluating program effectiveness. Ensure that a case finding system is developed and maintained by the I&A. E. Orientation/Training The agency providing I&A services must make orientation and training available to paid and volunteer staff. Each service provider will have a process for identifying the training needs of staff, both at the initial point of employment and during the course of employment. The I&A program will develop a written training plan and standardize orientation for new staff members and continuing training. The plan will encourage staff professional development including pursuing the nationally approved Alliance of Information & Referral Systems (AIRS) Certification program as a suggested standard for excellence. Initial training should cover skills that are essential to good telephone contact and should be completed prior to a new staff member assuming his/her duties assisting callers. Types of training appropriate for I&A staff include, but are not limited to: Introduction to the Aging Network; Philosophy of the I&A program, target population, and program functions; Agency policies and procedures; Interviewing techniques and listening skills; Screening and assessment skills; Information-giving and referral procedures, including protocol for working with other agencies; Techniques for handling emergency situations; Setting up and maintaining resource files; Appropriate data collection and documentation of I&A activities; How to work as part of a team; Use of technology in provision of services. Six hours of continuing training shall be offered annually, with topics to be determined as staff needs/interests are identified. In-service training can be held as a part of regularly scheduled meetings in which staff has an opportunity to discuss problems and successes and receive peer feedback regarding call handling techniques. In addition, there should also be regularly scheduled training sessions which focus on more specialized topics to refine and up-date staff skills and increase understanding of emerging issues. Training programs should also be designed to meet the continuing education needs of I&A program directors and supervisors. The ABCs of I&R Training Manual published by AIRS ( HYPERLINK "http://www.airs.org" www.airs.org) is a valuable training resource. A staff person who answers the telephone but does not meet the qualifications for an I&A Program Specialist, at a minimum, shall be trained to: Know what types of information he/she can give; Take the callers name and telephone number and inform him/her when an I&A Program Specialist or case manager will be in contact; Know how to handle an emergency by providing the name and phone number of community resources that provide emergency services. Follow a protocol for dealing with difficult callers. 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Normal_directsvs`6 FTE Worksheet\A<\B<\C<\D<\E<!!!!\F< \G<\H<\I<\J<####\K<%%%%\L<\M< \N<\O<\P<\Q<''''\R<////\S<\T< \V<))))\W<\X<++++\Y<---- A;q;! AAAASUM;.! AASAEXP;- B;q;"NAME:BUDGET PERIOD:Account Number BA Sub 555Sub ElObject DescriptionTOTALSalaries & WagesPersonnel BenefitsSuppliesOther Services & ChargesCapital OutlaysTotal Direct ExpendituresNumber of FTEs *"Detail of Staff Wages and Benefits]* Include all FTE's providing services that qualify under Title XIX Administrative Claiming G and who will be regularly participating in the required time studiesJuly 1, 2005 - June 30, 2006 ~l2 cc.   dMbP?_*+%&R&12EXHIBIT C PAGE 1 OF 2&R&FM\\dshspsoly2001c\COMMUNITY_SER4C odXXLetter DINU"43 "dXX??U} I }  } I } $}  I } I} $ } m } I }  8} I h,;,,J ,@,,@ ; , , , , ,,,,,,,,,,,; ,,,,,,,      :!!!!!!!!!!"!!!" #$%&;!!!!!!!!!!"!!!" ' ( )* <+,&=~ -&@ . %D &= +.%&= +. % &~ >  +.%&= +~ .$@ % &~ ? +.%&?+~ .4@ % &~ ?+.%&?+~ .>@ % &~ ?+.%&?+~ .D@ % &~ ?+.%&?+~ .N@ % &~ ?/.01@23&A 4 556#B % о7  CDDDDDDDD>l  ,!,",#,$,%,&,',(,),*,+,,,-,.,/,0,1,2,3,4,5,6,7,8,9,:,;,<,=,>,?, 8!8"8#999998$999998%999998&999998'999998(999998)999998*999998+8,8-8.8/808182838485868788898:8;8<8=8>8?8D<l@,A,B,C,D,E,F,G,H,I,J,K,L,M,N,O,P,Q,R,S,T,U,V,W,X,Y,Z,[,\,],^,_,@8A8B8C8D8E8F8G8H8I8J8K8L8M8N8O8P8Q8R8S8T8U8V8W8X8Y8Z8[8\8]8^8_8D<l`,a,b,c,d,e,f,g,`8a8b8c8d8e8f8g8 >@ 7 DocumentSummaryInformation8WordDocument>SummaryInformation(DocumentSummaryInformation8 DSHS\ADSAG FTE Worksheet  WorksheetsOh+'0  8 D P \hpx TITLE XIXENGELSSNormal 1STGX270{` :bjbjFF >,,1%2222222F***8&+d+FAVZ,(,",,,-n-$.@UBUBUBUBUBUBU$Wh1ZZfU2%.--%.%.fU22,,{U:333%.p2,2,@U3%.@U33bL 22S,N, ݘ*.lR<@UUAVR8ZA/$ZxSZ2S`%.%.3%.%.%.%.%.fUfUe3d%.%.%.AV%.%.%.%.FFFdDFFFFFF222222  Senior Information & Assistance Standards Appendix A Title XIX/MEDICAID Administrative Claiming Procedures June 2005 Medicaid Administrative Claiming Claiming Federal Financial Participation (FFP) for case services which assist Medicaid recipients in gaining access to needed medical, social, educational and other Medicaid covered services. Claimable activities must be necessary for the proper and efficient administration of the Washington State Medicaid Plan. Activities must also be furnished to Medicaid applicants or recipients, and in some way be connected with determining eligibility or administering services covered under the State Plan. Medicaid Administrative Claiming activities cannot be duplicative of costs paid for by Medicaid through other mechanisms. Therefore, it is not available for the cost of the actual Medicaid services to which an individual is referred or for services already provided by TXIX Case Management. Administrative Claiming cannot be used for activities that may be beneficial to the recipient, but are unrelated to Medicaid (e.g. assistance in locating suitable housing, food stamps, energy assistance, social services, wellness programs, etc.) The following describes activities that may be reimbursable under Title XIX Medicaid Administrative Activities. Target Population: Current Medicaid recipients not already served by Aging &Disability Services Administration (ADSA) Title XIX Case Management Programs; Low income/asset individuals who are potentially eligible and in need of Medicaid services. All eligible activities claimed must serve members of the target population. When determining whether an activity is eligible for federal match as a Medicaid Administrative Cost, two basic rules apply: 1. Does the activity assist an individual to access a Medicaid service (of any kind)? 2. Is federal match already being received for this same activity (e.g., AAA case management, Medicaid brokered Transportation and Interpreter services)? Potentially Matchable Activities: Type I Time spent on Type I activities will be adjusted by the percentage of your target population determined to be Medicaid eligible and not already served by AAA case management. If a client contact begins with a Type I Activity, but moves quickly to a Type II Activity, the entire contact can be claimed as a Type II Activity. A. Pre-screening - functions that evaluate an individual's appropriateness for participation in a given Medicaid program. 1. Necessary paperwork and staff travel time supporting this activity. B. Outreach - Functions of staff that inform individuals about programs financed by Medicaid and how to access these programs. 1. Informing individuals, agencies, potential providers, practitioners and community groups about specific Medicaid programs. 2. Informing individuals and their representatives served by the agency about their potential eligibility for Medicaid programs, including their rights and responsibilities. Designing and carrying out strategies to inform high-risk population groups of Medicaid programs that will benefit them. Necessary paperwork and staff travel time supporting this activity. Potentially Matchable Activities: Type II Time spent on Type II activities may be claimed at 100% because these activities will only be provided to Medicaid eligible persons not already served by AAA case management. C. Facilitating Medicaid Application - Activities that directly assist clients who have been screened and appear potentially eligible to apply for Medicaid services. 1. Collecting information that is needed for eligibility determination, such as verification of resources, SSN, etc. 2. Assisting individuals in filling out and processing eligibility forms for Medicaid programs. Gathering pertinent information to determine the nature and extent of the individual's need for additional Medicaid services. Necessary paperwork and staff travel time supporting this activity. D. Assisting Clients to Utilize Medicaid Services 1. Arranging for scheduling or coordinating the delivery of Medicaid services. 2. Providing follow-up contact to ensure that the individual received the Medicaid service identified in the case plan. 3. Developing referral resources of Medicaid providers for the individual to use. Informing or arranging for Medicaid brokered transportation or interpreter services that assist a client to access Medicaid services. Necessary paperwork and staff travel time supporting this activity. E. Interagency Coordination - This function is performed by staff when collaborating with Medicaid providers to: 1. Improve the cost effectiveness of the Medicaid service delivery system. Identify, promote and develop needed Medicaid services. Necessary paperwork and staff travel time supporting this activity. F. Administration of Claimed Activities - Can be related to any of the above functions. In-service training for Medicaid programs; Tabulation of daily time study data during time study periods (limited to 15 minutes per day); Other allocable administrative costs for Medicaid programs; 4. Necessary paperwork and staff travel time supporting this activity. Administrative Claiming Procedures In order to claim federal matching funds, two things are necessary: Document the extent of staff time spent on Type I and Type II activities eligible for Medicaid administrative match. This requires the participation of all appropriate staff in a periodic time study to determine what proportion of staff time is actually spent on activities defined as Medicaid administration. Direct tracking of Type I and Type II activities on daily time slips used for payroll is also an acceptable methodology in place of a time study. Determine the percent of clients served who are Medicaid eligible. Time Study For statistical reliability, all claiming staff are required to do time studies. Time studies must be performed daily, quarterly or bi-annually. The program manager will use the following criteria to determine the frequency a program is required to complete time studies. Daily Time Study Programs that are new to administrative claiming must complete six months of daily time study. Quarterly Time Studies Quarterly Time Study covers a two-week period every 3 months as approved by the ADSA program manager. Programs that have completed six months of daily time study and have a stable base line set (less than 15% variance). Programs experiencing significant change (such as changing from contracted to in-house) or a Quarterly Time Study showing that the time spent on claimable activities varies by more than fifteen percent from the rolling average for the previous time studies must revert to a daily time study for a period determined by the ADSA program manager. Bi-Annual Time Studies Time study covering a two-week period occurring once every six months. Sample period is determined by the ADSA program manager. Programs with a three-year history of performing time studies and the rolling average for the time spent on claimable activities varies fifteen percent or less. Programs experiencing significant change or a Bi-Annual time study showing that the time spent on claimable activities varies by more than fifteen percent from the rolling average for the previous time studies must revert to a Daily or Quarterly time study for a period determined by the ADSA program manager. Procedures Each time study participant must document all Type I and Type II activities performed during the time study period. Total paid time off (breaks, sick leave, holidays/vacation) should also be tracked and subtracted from Total Paid Time (i.e. 40 hours/week, 32 hours/week). The Agency may choose to develop and use their own time sheets with approval from Aging & Disability Services Administration. Daily, weekly or monthly formats may be used. Time must be tracked in fifteen-minute increments. Sample sheets are available. Staff members will be responsible for classifying their activities and coding them appropriately (see previous definitions and attached sample pages for coding instructions). It is very important to assure that all staff applies the activity definitions consistently. Prior to conducting a time study, training of staff should occur to assure that definitions and activities are uniformly understood. To complete the Time Study Sheet each employee must: Track time in quarter-hour increments using decimals (.25 for 15 minutes, etc) For each matchable activity, record the date, a brief description of the eligible activity, including client name or identifier, enter it in the appropriate Type I or Type II section, and record the duration (ie. 1.25 hours, .5 hours). Paid time off (break time, paid holidays, vacation, and sick leave) should be tracked. Paid time off may be deducted from the total paid time to count actual working hours. Unpaid lunch-time or any other non-paid time will not be coded or counted. Tally the totals for each category (Type I, Type II, Paid Time off, and Total Paid Hours) and report data to the local program manager for compilation. The agency must compile the results of all the Individual Summaries onto an Agency Time Study Summary (see attached for sample) for each period indicated in their contract. The ADSA Program Manager can provide electronic Individual Time Study Sheets as well as an Agency Summary Time Study Sheet via e-mail if desired. The Agency Time Study Summary is used to determine the actual proportion of claimable staff time spent on activities eligible for Medicaid match. The Total Time per Activity is multiplied by the percentage of Medicaid Eligible*to determine the Total Hours Claimable under the Admin Claiming. When the time study is complete, the percent of time spent on claimable activities will be determined by dividing the total claimable hours by the total working hours in the time study period. *The percentage of Medicaid Eligible is the percent of the resident population determined financially eligible for Medicaid Services who are not receiving case management services through the AAA, AAA subcontractors or HCS. This percentage would be used for the Type I activities. This percentage can be applied to the wage, benefit, and other costs appropriately allocated to support the relevant staff associated with the time study participants as reported on the  EMBED Excel.Sheet.8 HYPERLINK "Y:\\HCSMB2005\\AdminClaimingFTEWorksheet 7 1 05.xls"FTE Worksheet. The FTE Worksheet must show annualized costs for all employees participating in the Time Study and will be submitted with the Budget (Exhibit B) during contract negotiations. Federal matching dollars can be billed at a rate of fifty percent for claimable percentage of time spent on eligible activities. Agency must provide local/state funding to match the Federal dollars. The most current Agency Time Study Summary must be submitted with the monthly invoice. The Individual Time Study Sheets must be kept on file by the agency for audit purposes. Medicaid Eligibility Each agency must identify the percentage of clients in their target population, who receive or are potentially eligible to receive Medicaid and are not already receiving Title XIX case management services through Aging & Disability Services Administration (ADSA) or one of its subcontractors. This percentage of clients will be used in the calculation to determine the amount of Medicaid match claimed for reimbursement for Type I activities (Prescreening and Outreach). Agencies can use a variety of sources to determine their population profile. Examples include sample surveys or other statistically sound means of gathering data, income and asset information on file or other sources of income information about this population being served, or individual verification of Medicaid eligibility. Census data may be used during the two years following a Census. The method must be approved by the ADSA Program Manager. The accepted threshold for Categorical Medicaid Eligibility is the Federal Benefit Rate (SSI Standard) and assets under $2000. Higher income thresholds (such as those used under COPES) cannot be used. If a more detailed survey or other methodology can capture a combination of Medicare Eligibility, and Federal Poverty Level with assets <$4000, then the FPL (QMB level) can be used as approved by ADSA. Furthermore, if an even more detailed survey or other methodology captures Categorically Needy criteria, then the methodology can be used as approved by ADSA. The determination of Medicaid target population percentage as described above must occur at least every two years.     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B *urn:schemas-microsoft-com:office:smarttagscountry-regioni*urn:schemas-microsoft-com:office:smarttagsStreet/http://www.5iantlavalampft-com:office:smarttagsh*urn:schemas-microsoft-com:office:smarttagsCity0http://www.5iamas-microsoft-com:office:smarttagsn*urn:schemas-microsoft-com:office:smarttags PostalCode0http://www.5iamas-microsoft-com:office:smarttagsk*urn:schemas-microsoft-com:office:smarttagsaddress0http://www.5iamas-microsoft-com:office:smarttagsV *urn:schemas-microsoft-com:office:smarttagsplacehttp://www.5iantlavalamp.com/i*urn:schemas-microsoft-com:office:smarttagsState0http://www.5iamas-microsoft-com:office:smarttagsZ *urn:schemas-microsoft-com:office:smarttags PlaceNamehttp://www.5iantlavalamp.com/= *urn:schemas-microsoft-com:office:smarttags PlaceType   ks! =u a f J O FQ! 3333333333sq r  ! ks!  .+ $̆;p$ 2B=:̆6W=DQtU`P#*^`.^`.p^p`.@ ^@ `.^`.^`.^`.^`.^`.^`.p^p`.@ ^@ `.^`.^`.^`.^`. hh^h`OJQJo(@h8^8`.^`o(.^`.pLp^p`L.@ @ ^@ `.^`.L^`L.^`.^`.PLP^P`L.@h8^8`.^`o(.^`.pLp^p`L.@ @ ^@ `.^`.L^`L.^`.^`.PLP^P`L.^`o(.h^`.pLp^p`L.@ @ ^@ `.^`.L^`L.^`.^`.PLP^P`L. :(;l;.+tU`;p$ 6W=$=:: @h ^`OJQJo( 0                            /QNjm! @Dx @UnknownGz Times New Roman5Symbol3& z Arial?5 z Courier New5& zaTahoma"1h' ' T:T:!4  2QHX?m2HThe mission of Senior Services is to support the independence of seniorsSenior ServicesBenneD0         {` (bjbjFF *<,, $$$$$49,$$$$$$$$9999999$:h$=59h*$$h*h*59$$J9z+z+z+h*:$$9z+h*9z+z+6{8$$ ~$*=89 `909[8>0+4>08>8$$%z+8&l&$$$5959d+$$$9h*h*h*h*   Senior Information & Assistance Appendix C Sample Resource Data Base Inclusion-Exclusion Policies  The mission of Senior Services is to support the independence of seniors. We do this by offering programs and services for older persons and their caregivers. The purposes of the Senior Information and Assistance (I&A) resource file are to catalog community services, maintain accuracy of community information, provide information to older people, those who care for them and the public at large, and link people with needed service The following guidelines will be used in determining whether an agency or organization may be considered eligible to be listed in the I&A Resource File. Agencies/Programs Eligible for Inclusion Nonprofit agencies which provide community services. Governmental (public) agencies which provide social, education, or health services. Self-help support groups . Community and civic advocacy organizations. Professional organizations in the health or human services field. Elected government officials at the federal, state, and local levels representing the residents of service area. Hospitals, health clinics and long term care facilities Toll-free telephone services or web sites if they offer a social, health, or community service to residents of the service area. For-profit, proprietary human service agencies which are providing services not adequately provided by the nonprofit sector For-profit organizations, offering services parallel to a nonprofit service, to which clients are referred and fees paid by a government agency (i.e. proprietary agencies offering homemaking services to qualified clients.) For-profit, proprietary businesses offering a unique or specialized service of interest to the target population but not provided by the non-profit sector (i.e., in-home hair care or specialty clothing for adults with disabilities.) Agencies/Programs NOT Eligible for Inclusion in the I&A Resource Database: Private, for-profit service providers unless they meet one or more of the specific inclusion criteria listed above. Services which are available only to members of a certain group or affiliation (i.e. counseling available to a church's parishioners only). Churches that offer no special community-based service components Any organization which promotes or delivers illegal services. Agencies or organizations who have been in existence less than six months Senior Information and Assistance reserves the right to make the final determination as to what organizations are included in the database and may remove or exclude any organization for fraud, misrepresentation, discrimination, service non-delivery or any other reason. Agencies or organizations that want to appeal a decision by Senior I&A regarding the inclusion or exclusion decision should follow these guidelines: Talk to the I&A Resource Data Manager to clarify program services in relation to this policy. If concerns are not resolved by step one, a written request providing rationale for the appeal or concerns must be sent to the Director of the Senior Information and Assistance Project. The Director, in consultation with the CEO of Senior Services, will make a final determination. No endorsement or lack of endorsement of any agency/program shall be construed from its inclusion in or omission from the I&A Resource Database. END SAMPLE Community Information Line of Snohomish and Skagit Counties Volunteers of America Western Washington INCLUSION / EXCLUSION CRITERIA Included in our database are privately supported and public organizations. It is designed to serve the public, agencies, and organizations of Snohomish and Skagit counties, Washington. Our funding and ability to manage the amount of data constricts the size of our database and our publications. Our directories, Where to Turn in Snohomish County and Where to Turn in Skagit County, are limited to a portion of our total database determined by those referrals most given by our staff in serving callers in the previous year. INCLUSION Local, regional, state, and national hotlines on specific human service subjects. Puget Sound area crisis lines and community information lines. Government and not-for-profit agencies and programs that provide assistance to the general public. Agencies or organizations which are tax-exempt, and/or offer services that are of interest to Snohomish County or Skagit County residents at no fee or sliding fee. For-profit, commercial, or private organizations may be considered on an individual basis. Inclusion is based on: Uniqueness of service; Lack of comparable services from not-for-profit; Degree of need for the services. Professional organizations that do specialized referral to private persons. EXCLUSION The Community Information Line reserves the right to exclude any agency or organization at the discretion of the Program Director. In general, private practitioners or group practices of mental health providers, medical doctors, legal/paralegal providers or dentists, except as may be necessary under inclusion criteria, are excluded. Exception is made for licensed private mental health providers whom purchase a listing through the Where To Turn directories. Any agency or organization that knowingly or unknowingly discriminates or denies services based on age, gender, race, religion, disability, or sexual orientation. Agencies or organizations that violate municipal, state, or federal laws or regulations. Agencies or organizations that consistently fail to provide the services that they claim to provide, or which misrepresent their services in any way. Programs that are very infrequently needed by our callers and staff. The Community Information Line will refrain from duplicating other agencies or organizations specialized databases, using the agency or organization as the referral point, rather than the agencies or organizations they include in their database, except where the specialized database excludes specific resources that we include (i.e., Parent Support Groups and Classes through VOAs Parent Provider Resource Line, or Volunteer Opportunities through Snohomish County United Way Volunteer Center). DISCLAIMER Inclusion of an agency or organization does not imply endorsement or assumption of liability by Volunteers of America Western Washington. Exclusion of an agency or organization by Volunteers of America Western Washington does not imply lack of endorsement nor does it imply that there is an anomaly with the agency. END SAMPLE SENIOR INFORMATION AND ASSISTANCE RESOURCE DIRECTORY INCLUSION POLICY Guidelines for inclusion to the Resource Directory: Non-profit agencies providing a community service, Government agencies which provide community services, Support and advocacy groups, Professional organizations, For-profit agencies which provide services for free, under a sliding fee scale, accept third party payment, or are under government contract to provide services to the target population. Private for-profit organizations that provide a unique long term care service that is not adequately available in the non-profit sector, (e.g., Case Management Services, Overnight Respite Care, etc.) Private for-profit organizations that provide fee for service and are licensed by federal or state government. Some guidelines for exclusion from the resource file could be: Services that are only available to members of a group, club or religious organization, Individuals in a private professional practice (e.g., Therapists, Financial Managers, Attorneys, etc.) Services that do not meet recognized standards of practice (e.g. licensing standards). New agencies or organizations that have been in existence less than six months. In the event that any agency or individual disputes their exclusion from the I&A Resource Directory, the Information and Assistance Advisory Committee will review this decision and make a recommendation to the Information and Assistance Program Director. Appeals should be made in writing to: Program Director Senior Information and Assistance 8221 44th Ave West, Suite E Mukilteo, WA 98275 1;<=VWstB C    = > \  ;  lU\grsh7h/Q5^Jh7h/Q5 h/Q5>*h/Q5B* ph h/Q5jh/QUhh/QCJ0aJ0hmCJ0aJ0h/QCJ0aJ0hh/Q5CJ4aJ4hm5CJ4aJ4h/Q5CJ4aJ4h/Q8     1<=tuvwxyz{|$a$(|}~. / B  >  & F$a$  L Y()ghYsfg & F @& & F & Fgrs  h  7hcP? & F & F & F $ & F5W[y c>!!!!""(( h/QCJ h/Q5h7h/Q5 h/Q6^J h/Q6h/Q h/QCJ h/Q^J?z { !!!!!!!!!!""P"Q"""""#v$$$ & F$a$ & F & F$'%(%%%>&&&''''((((( & F (/ =!"#$% SummaryInformation(/1DocumentSummaryInformation8_11817415734 F"1TableUOh+'0(< LX x  LThe mission of Senior Services is to support the independence of seniorsSenior Services Normal.dotBenneD2Microsoft Office Word@@BL~@BL~T՜.+,00 hp|   : G IThe mission of Senior Services is to support the independence of seniors Title     Ke !"#$%&'()*+,-./0123456789:;<=>?@ABDEFGHIJMNOPQRSUVWXYZ[\]^_`abcdfijklmnopqrstuvwxyz{|}~>@> Normal7$8$_HmH sH tH DAD Default Paragraph FontRiR  Table Normal4 l4a (k(No List <Z< Plain Text OJQJ^JHH  Balloon TextCJOJQJ^JaJRYR  Document Map-D M OJQJ^J2 V 1<=Z[\]^_`abcdefghijklmnopqrstuvwxyzbc\]378   R 6Xl56 NHACIJHIFG)*+KL 9 : ~!"'#(#/%0%b%c%&&''H(I(w*x*A+B+++++;-<-l.m...?/@///////R0S0g0h000011111192A2B2C22222000000000000000000000100=0=0=0=0=0=0=0=0=0=0=0=0=0=0=0=0=0=0=0=0=0=0=0=0=0=0=0=0=0=0=0=00z0z0z0z0z0z0z0z00]0]# 0]# 0]# 0]# 0]# 0]0]0]0]0]0000000$ 0$ 0$ 0$ 0$ 000000 0 0 0 0 00000 0000 00% 0% 0% 0% 0% 0% 0000 00 00' 0' 0' 0' 0' 0' 0' 0( 0( 0000 000000 00 00 00 000 00 0000( 0( 0( 0( 0000 00 00 00 00 0000 00000000! 000000@/0@/0@/0@/0@/0@/0@/" 0@/0C/0C/0C/0C/0C/0C/0C/0C/0C/0C/0C/0C/0C/0C/0C/0C/0C/0C/>d::%*a6:(39:!"#$&'(): l,b$Y OAۮ<9@0(  B S  ?2=CDOPY222=Y  R [ K#M#%%**..2333333333331:;=Z2=C2'&+vI yFQ( +"ONoH ^~6 ̇  Rl'V. 6BJ!h"r+O&`&e(j^(H~Œ G2H~Œ[5BJ!xb7FXs >z׆C[?ZAL"5B.SJBJ!\ELY]nUFX7W zW=xYT+K{bZboF ~cζ^\cz׆CYeFXueFX9oL0gpr(RsxOuimiv:*C<{&Q`;vH}̇`%{*@h&h^h`56>*CJOJQJ\]^JaJo(. @h&^`56>*CJOJQJ\]^JaJo(. @h&h^h`56>*CJOJQJ\]^JaJo(. @h&h^h`56>*CJOJQJ\]^JaJo(. @h&^`56>*CJOJQJ\]^JaJo(. h^`OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh  ^ `OJQJo(hHh\ \ ^\ `OJQJ^Jo(hHoh,,^,`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hH@h&h^h`56>*CJOJQJ\]^JaJo(. @h&H^H`56>*CJOJQJ\]^JaJo(. @h&^`56>*CJOJQJ\]^JaJo(. @h&^`56>*CJOJQJ\]^JaJo(. @h&h^h`56>*CJOJQJ\]^JaJo(. h88^8`OJQJo(hHh^`OJQJ^Jo(hHoh  ^ `OJQJo(hHh  ^ `OJQJo(hHhxx^x`OJQJ^Jo(hHohHH^H`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hH@h&X^X`56>*CJOJQJ\]^JaJo(. @h&h^h`56>*CJOJQJ\]^JaJo(. @h&8^8`56>*CJOJQJ\]^JaJo(. @h&^`56>*CJOJQJ\]^JaJo(. @h&h^h`56>*CJOJQJ\]^JaJo(. @h&^`56>*CJOJQJ\]^JaJo(. @h&^`56>*CJOJQJ\]^JaJo(. @h&^`56>*CJOJQJ\]^JaJo(. @h&h^h`56>*CJOJQJ\]^JaJo(. @h&^`56>*CJOJQJ\]^JaJo(. @h&h^h`56>*CJOJQJ\]^JaJo(. @h&+^+`56>*CJOJQJ\]^JaJo(. @h&h^h`56>*CJOJQJ\]^JaJo(. 88^8`OJQJo(hH^`OJQJ^Jo(hHo  ^ `OJQJo(hH  ^ `OJQJo(hHxx^x`OJQJ^Jo(hHoHH^H`OJQJo(hH^`OJQJo(hH^`OJQJ^Jo(hHo^`OJQJo(hH88^8`OJQJo(hHh ^`o(hH)  ^ `OJQJo(hH  ^ `OJQJo(hHxx^x`OJQJ^Jo(hHoHH^H`OJQJo(hH^`OJQJo(hH^`OJQJ^Jo(hHo^`OJQJo(hH@h&^`56>*CJOJQJ\]^JaJo(. @h&X^X`56>*CJOJQJ\]^JaJo(. @h&^`56>*CJOJQJ\]^JaJo(. @h&+^+`56>*CJOJQJ\]^JaJo(. @h&H^H`56>*CJOJQJ\]^JaJo(. @h&+^+`56>*CJOJQJ\]^JaJo(. h^`OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh  ^ `OJQJo(hHh\ \ ^\ `OJQJ^Jo(hHoh,,^,`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hH@h&+^+`56>*CJOJQJ\]^JaJo(. @h&:^:`56>*CJOJQJ\]^JaJo(. @h&h^h`56>*CJOJQJ\]^JaJo(. 88^8`OJQJo(hHh ^`o(hH.  ^ `OJQJo(hH  ^ `OJQJo(hHxx^x`OJQJ^Jo(hHoHH^H`OJQJo(hH^`OJQJo(hH^`OJQJ^Jo(hHo^`OJQJo(hH((C<{zW9o(Rsmiv[?]nUSJgp'Vxb7 G2vH} 6 6 )s > xY&+7W\ELue[5h""5BQ( Ye^(~6 y\cNoH +O&Ou F ~c`K{be(( @h&^`56>*CJOJQJ\]^JaJo() @h&^`56>*CJOJQJ\]^JaJo(. ''                                             mj:tk@\\dshspsoly2001c\HCS_PROGRAMS-FOR BIG JOBSNe01:winspoolHP LaserJet 4100 PCL 6\\dshspsoly2001c\HCS_PROGRAMS- odXXLetter.HP LaserJet 4100 PCL 62exeM+Da6Xx\ql,,PJ)3).Y K vXyy9?_hm 2) ?$}khR 8e@}Ȭ-H/3AH?4~=&2{.d9YaqacAᆃGn Q= @u,~ qETFP0PE%U1!.%UF%U~F$u!] ] ] PP_!] ] ] P] ] ] ] D~~~~~~  Senior Information & Assistance Appendix D Sample Interagency Agreement INTERAGENCY AGREEMENT Aging and Disability Services Case Management Program and Senior Information and Assistance The purpose of this Agreement is to increase the coordination between the Case Management Program (CMP) and the Senior Information and Assistance Program (Senior I&A) in order to improve the quality and effectiveness of services to persons 60 years of age and older residing in King County who are at risk of institutionalization or require case management level service. The common goal shared by both agencies is to increase and/or to maintain the maximum independence possible for older persons by providing the most appropriate and the least restrictive alternative(s) and/or service(s) for vulnerable older persons. The Senior Information and Assistance Program The purpose of Senior Information and Assistance is to enhance the capacity of elderly persons to receive all present rights, benefits, entitlements and resources under federal, state and local laws by providing access to community services. The types of services offered by Senior Information and Assistance include: Provide current information about services available to older persons. Provide assistance by making referrals to services on behalf of individuals who cannot directly access services. Monitor clients to determine if services being provided are meeting the clients needs. Provide advocacy/grievance resolution when the rights of a client are not being upheld. Serve as the primary entry point for discretionary Case Management, Respite, African American Elders Project, Minor Home Repairs, and other programs. Make referrals to HCS for CORE service programs, which are Medicaid Personal Care, COPES and Chore programs. Senior Information and Assistance may have the capacity to provide bilingual service depending on current staff. The Case Management Program The Case Management Program is a countywide program that specializes in coordinating, and managing in-home services for older persons who are living on limited incomes, lacking family and informal supports, have multiple physical/emotional/social needs, and who are experiencing difficulty maintaining their independent living situation. In addition, the Program provides reassessment and reauthorization for older and disabled CORE service clients using the CARE assessment, service planning and authorization tool. The Primary functions of the Case Management Program include: conducting in-home comprehensive assessments which address physical/mental health, functional abilities, economic information, and eligibility for discretionary case management and in-home CORE in-home services clients. develop, implement, coordinate, and monitor discretionary case management and CORE client service plans. As part of service plan development, case managers may provide assistance to clients in hiring independent or agency providers. assist clients in obtaining other needed services such as home health, counseling, skilled nursing, durable medical equipment, housing, legal, and other community supports. promoting benefits and services that support clients ability to remain independent. When independence is no longer possible, assist client/family in finding placement into residential care facilities. providing client advocacy by helping older and disabled persons ability to remain independent. The Case Management Program has the capacity to provide bilingual service coordination for several languages depending on current staff. In addition, the program uses interpreters for a wide range of client language needs. This Agreement will cover, at a minimum, 5 major areas for mutual cooperation and coordination: Referral Criteria and Procedures; Case Consultation and Back-up; Resource and Information Sharing; Joint Meetings; and Grievance Procedures I REFERRAL CRITERIA AND PROCEDURES Referral criteria to Case Management Program Senior I&A will refer to the CMP when the client requires an in-home assessment and/or the client level of need/dysfunction falls in the case management target population. The client is then assigned a case manager to perform a comprehensive assessment, develop a written service summary and assist in the implementation of the service summary. The discretionary Case Management level of client is considered to be an individual who is 60 years of age or over who resides in the community, is assessed as able to remain in a non-institutional setting and who: is not eligible for or refuses a State in-home CORE Service OR is referred by Adult Protective Services or GRAT for Case Management, OR requires multiple services and/or activities performed on their behalf, AND is unable to obtain the required services and/or perform the required activities for themselves; AND does not have family or friends who are both able and willing to provide adequate assistance; AND agrees to home visit by case manager Clients who are screened and thought to be eligible for CORE services will be referred to Home and Community Services for assessment and development of the service summary. These clients are transferred to Aging and Disability Services by HCS for ongoing case management when appropriate. The procedures for Senior I & A are to perform the Case Management screening by phone directly with the client, whenever possible, prior to a referral to the CMP. Senior I&A will provide written referrals to the CMP for clients needing case management services. Whenever possible, Senior I&A will include the following information: Name, age, address, phone number, social security number and current location. Original referral source and telephone number Contact person and phone number. Clear presenting problem outlining the reasons a home visit is needed (medical condition, physical limitations, mental/emotional status, communication barriers, etc.) Formal/Informal supports. Any simultaneous referrals. Financial data. Violence/weapons present. If client is a smoker. 4. I&A will FAX referrals to the CMP team offices by 12 noon each day. Referrals to the CMP team offices will be made only in writing unless the clients situation is serious enough to warrant an immediate telephone referral and request for urgent status. A written referral will be sent within one working day of intake. Urgent Clients: Sudden and definite change in a persons behavior. Persons who are refusing and/or who cannot comply with the recommended medical care, and there is a definite physical and/or behavioral change which is detrimental to the individual. If a persons condition requires immediate/emergency medical, mental health or other emergency care, other more appropriate emergency providers should be contacted. A form will accompany each days intake sheets which will list the names of the clients, the advocate and a space to list the name of the Case Management staff assigned to the case. The completed form will be faxed to Senior I&A the following day by the Case Management Program, Monday Thursdays only. It is understood that simultaneous referrals can be made to GRAT and the CMP when both programs services appear needed. It is understood that the CMP case manager has the primary (lead) responsibility for coordinating client services, and GRAT is one of several specialized community resources to be used by the CMP. GRAT may refer directly to the CMP when the client clearly meets case management population standards of multiple service needs and lacks adequate support system. Senior I&A will ask the referring agency if they have made simultaneous referrals to other services (e.g. HCS Intake Unit, APS, GRAT or other.) Senior I&A will provide pre-screening for the African American Elders Project and the Amy Wong Fund and send referrals to the CMP as outlined above Referral Criteria to Senior I&A In keeping with the information and assistance single entry system, the CMP staff will refer requests for case management services directly to Senior I&A for intake phone screening, information, and assistance. The only exceptions are: Clients who appear unable to contact Senior I&A on their own behalf. For these clients, CMP staff will call Senior I&A with the name and telephone number of the client. The client is a former discretionary case management client who has been closed three months or less and needs to be re-opened for additional services. The clients situation requires immediate response (i.e., walk-in client, field referral). In these cases, the case manager will respond to client need, and make subsequent referral to Senior I&A, unless the client is a revolving door individual unwilling to follow through on services. A Respite client who requires Case Management or a Case Management client needing respite will be transferred internally by ADS staff. 2. CMP referrals to Senior I&A can be made for client follow-up contacts when the client has been stabilized but has no other support system available to monitor his/her condition. These requests for follow-up will be mailed or faxed to Senior I&A, and will include the original referral sheet or client face sheet and a copy of the termination summary which will contain a brief description of the clients need and a specific list of services provided and the frequency, duration and purpose of the client follow-up. Case Management Program Response to Case Referral Upon receipt of the referral, the CMP will assign the case within 24 working hours, and will notify Senior I&A as soon as possible (usually within 24 hours) of the name of the case manager assigned to each case referred. CMP will fax the list of clients and the case managers assigned to the case. Unless urgency is noted on the referral form, the case manager will contact the client within 3 working days of the case intake to schedule an in-home client assessment visit. For urgent cases, the CMP will contact the client within 24 working hours to schedule an in-home client assessment. An in-home assessment will be initiated by the CMP case manager within 10 working days of the case intake by ADS on all referrals from Senior I&A. A follow-up call will be made to Senior I&A to briefly summarize the clients needs, and the tentative service plan. The follow-up call will be made within 15 working days of the intake date. A subsequent call may be needed if the in-home visit occurs after the 10 day response time. The follow-up call will include a brief description of the clients needs, the case managers initial plan for services, any major barriers to service implementation that are anticipated, and any needs mentioned on the referral that were not found during the assessment. Senior I&A advocates will notify the CMP staff of any additional client information received following the initial referral, and will refer subsequent callers to the case manager assigned to the case. The CMP clerical staff will provide Senior I&A with a monthly list of terminated clients that were initially referred by Senior I&A. II CASE CONSULTATION AND BACK-UP When appropriate, Senior I&A staff will contact Case Management designated staff to seek case support or advice of information on community-based services and informal/volunteer support systems. Likewise, the Case Management Program will contact Senior I&A staff to seek advice on available resources or information on client cases. Such case consultations can be conducted either by phone or in person, depending upon the nature and complexity of the case. On occasions when both agencies are providing service to elderly clients, it is expected that both staffs will work in a cooperative manner for the best interest of the clients. RESOURCE, TRAINING AND INFORMATION SHARING Each agency will inform the other in writing of major changes in referral criteria and/or procedures. Other program changes will be discussed at periodic meetings. ADS will fax or email a list of all new CORE clients to Senior I&A monthly. IV REGULAR MEETINGS Staff persons from both agencies will meet regularly to clarify referral criteria and procedures and to share community resource information and program changes as needed. GRIEVANCE PROCEDURE Both programs agree to follow the grievance procedures established by Aging and Disabilities Services Contracts Unit. This Agreement covers the period from January 1, 2004 to December 31, 2005. The Agreement can be revised at any time. All major revisions will be made in writing. ________________________________ ______________________________ Margaret P. 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