HomeMy WebLinkAboutResolution - 2018-R0329 - Aging Direct Purchase Of Services Program Grant Agreement - 09/27/2018Resolution No. 2018-RO329
Item No. 6.20
September 27, 2018
RESOLUTION
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK:
THAT the Mayor of the City of Lubbock is hereby authorized and directed to execute for
and on behalf of the City of Lubbock, an Area Agency on Aging Direct Purchase of Services
Program Grant Agreement and related documents from the State of Texas, acting by and
through the Texas Health and Human Services and the South Plains Association of
Governments (SPAG), for funds passed through the U.S. Department of Health and Human
Services to the State of Texas. Said Grant Agreement will be used to provide an integrated
service delivery system to meet the needs of older individuals and their caregivers, and the
grant funds will be used only for the purposes for which they are intended under the grant.
Said Grant Agreement is attached hereto and incorporated in this resolution as if fully set
forth herein and shall be included in the minutes of the City Council.
Passed by the City Council on September 27, 2018
DANIEL M. POPE, MAYOR
ATTEST:
'Pd"' )c
Reb Lc
ca Garza, City Secreta
APPROVED AS TO CONTENT:
dget Faulkenberry, Director of Parks t& Recreation
APPROVED AS TO FORM:
R n rooke, Assistant City Attorney
ccdocs/RES. Grant Agreement — 2019 SPAG Aging Grant
8.31.18
The South Plains Association of Governments Area Agency on Aging %/Area Agency
SPAG� Direct Purchase of Service )Won
Fiscal Year 2019 Subrecipient Application/Renewal Update Aging
Such Fbins AssKWim
of 6ft"ORIs
Please type or clearly print application information.
City of Lubbock
Subrecipient Name/Legal Entity
DBA (if applicable)
Physical Address:
Mailing Address (complete even if same as above):
Tax Identification Number (SSN or Federal ID):
Fax Number (including area code):
Type of Provider (check one):
Governmental Agency MPrivate Non -Profit MPrivate For Profit
City Government County Government Other:
Authorizing Official:
Title:
Email Address:
Telephone:
Billing Contact Person and billing address:
Title:
Email Address:
Telephone:
Number of Years Organization has been in business:
Is Organization Bonded?
(Attach certificate of bonding insurance)
Years
1-1 Yes No
Has anyone involved in the direct provision of client services
If Yes, Explain:
been convicted of a felony (In -home Services
only)? Not Applicable
Not Applicable
Yes No
Does Organization have liability insurance?
Attach a copy of all applicable State and Federal
(Attach certificate of all insurances)
❑ Yes 1-1 No
licenses and/or certifications for your business.
Conflicts of Interest: Attach information of applicable names and relationship of any employee(s) or officers of
your organization that may have a conflict of interest with the South Plains Association of Governments
Area Agency on Aging staff person or Advisory Council member.
DPS Application
Page 1
1;
9
3.
4.
Service and Bidding Information:
A. Proposed Service:
Congregate Meals
B. Service Area:
G t"-tx�rf
C. Proposed HHS OAAA cost per unit:
$ 7.50
Whole cost per unit:
$ 8.26
A. Proposed Service:
Home Delivered Meals
B. Service Area:
N/A
C. Proposed HHS OAAA cost per unit:
I
Whole cost per unit:
Proposed Service:
B. Service Area:
G cam{ LU�� t
C. Proposed HHS OAAA cost per unit: Whole cost per unit:
$ 9.37 $ 10.41
A. Proposed Service:
N/A
B. Service Area:
N/A
Proposed HHS OAAA cost per unit:
Signature:
Whole cost per unit:
I, Daniel M. Pope , certify that the information provided in this application is true and
Printed Name
correct to the best of my knowledge.
V1_ September 27, 2018
Authorized Sig ture Date
DPS Application
Page 2
Attest: 6,�,,,, Approved as to Content: Approved as to Form:
rOA,f�
Re cca Garza Bridget Faulkenberry Brooke
Cit3Uecretary Parks and Recreation Director As eistant City Attorney
bbock
TEXAS
CERTIFICATE OF SELF-INSURANCE
The undersigned officer of the City of Lubbock, Texas, a Texas home rule
municipality, hereby certifies that the City of Lubbock has a $500,000.00 self -
insured retention for Automobile and General Liability in accordance with the laws
of the State of Texas. The City of Lubbock has a policy that covers Property/Bodily
Injury over $500,000.00 per occurrence with One Beacon America Insurance
Company under policy #791-00-02-30-0008 which expires on 10/01/18. The current
net asset balance of the self-insurance fund is $10,605,382. The existing cash asset
balance is $12,840,264 as of the date stated below.
L y Morrison
Risk Manager
Date: September 30, 2017
We will provide the FY 2018-19 Certificate of Self -Insurance after it has been finalized.
DATE
TO
FROM
SUBJECT
October 1, 2018
South Plains Association of Government
City of Lubbock — Senior Center Programs
FY 2018-19 Operating Hours and Holidays for SPAG Grant
Name of Sites
Lubbock Adult Activity Center
Rawlings Community Center
Simmons Adult Activity Center
Trejo Supercenter
Homestead Senior Program
Holidays Observed
Thanksgiving Day
Day After Thanksgiving
Christmas Eve
Christmas Day
New Year's Day
Martin Luther King, Jr. Day
Good Friday
Memorial Day
4th of July
Labor Day
Number of
Days and Hours
Serving Days
of Operation
251
M-F 8:00 am - 5:00 pm
251
M-F 8:30 am - 4:00 pm
251
M-F 8:30 am - 4:00 pm
251
M-F 8:30 am - 4:00 pm
251
M-F 10:30 am - 1:30 pm
Dates Observed
November 22, 2018
November 23, 2018
December 24, 2018
December 25, 2018
January 1, 2019
January 21, 2019
April 19, 2019
May 27, 2019
July 4, 2019
September 2, 2019
ilArea gency
SOUTH PLAINS ASSOCIATION OF GOVERNMENTS
Won ing AREA AGENCY ON AGING
SUBRECIPIENT AGREEMENT
City of Lubbock, hereinafter referred to as Subrecipient, and South Plains Association of Governments
Area Agency on Aging (AAA) do hereby agree to provide services effective beginning October 1, 2018,
in accordance with the Older Americans Act of 1965 (OAA), as amended, regulations of the Health and
Human Services (HHS), the AAA Direct Purchase of Services program and the stated Scope of Services.
The AAA Direct Purchase of Services program is designed to promote the development of a comprehensive
and coordinated service delivery system to meet the needs of older individuals (60 years of age or older)
and their caregivers. This agreement provides a mechanism for the creation of an individualized network
of community resources accessible to a program participant in compliance with the OAA and HHS AAA
Access and Assistance guidelines.
The purpose of the system of Access and Assistance is to develop cooperative working relationships with
service providers to build an integrated service delivery system that ensures broad access to and information
about community services, maximizes the use of existing resources, avoids duplication of effort, identifies
gaps in services, and facilitates the ability of people who need services to easily find the most appropriate
Subrecipient.
1. SCOPE OF SERVICES
A. The Subrecipient agrees to provide the following service(s) as identified below to program
participants authorized by the AAA staff, in accordance with the Subrecipient application, all
required assurances, licenses, certifications and rate setting documents, as applicable.
Service:
CONGREGATE MEALS
TRANSPORTATION
Service Definition:
CONGREGATE MEAL - A hot or other appropriate meal served to an eligible older individual
which meets 331/3 percent of the dietary reference intakes established by the Food and Nutrition
Board of the Institute of Medicine of the National Academy of Sciences and complies with the most
recent Dietary Guidelines for Americans, published by the Secretary of Agriculture, and which is
served in a congregate setting. The objective is to reduce food insecurity and promote socialization
of older individuals. There are two types of congregate meals:
• Standard meal - A regular meal from the standard menu that is served to the majority or all of
the participants.
• Therapeutic meal or liquid supplement - A special meal or liquid supplement that has been
prescribed by a physician and is planned specifically for the participant by a dietitian (e.g.,
diabetic diet, renal diet, pureed diet, tube feeding).
TRANSPORTATION - Taking an older individual from one location to another but does not
include any other activity. There are two types of transportation services:
• Demand/Response - transportation designed to carry older individuals from specific origin to
specific destination upon request. Older individuals request the transportation service in advance
of their need, usually twenty-four to forty-eight hours prior to the trip.
Form #: AIAAA_VA2.0
Edition Date: 9/19/11
• Fixed Route - transportation service that operates in a predetermined route that has permanent
transit stops, which are clearly marked with route numbers and departure schedules. The fixed -
route does not vary and the provider strives to reach each transit stop at the scheduled time. The
older individual does not reserve a ride as in a demand -response system; the individual simply
goes to the designated location and at the designated time to gain access to the transit system.
Unit Definition:
CONGREGATE MEALS: One Meal
TRANSPORTATION — Demand/Response: One One-way Trip
Service Area (To be filled in by provider. Please type or print neatly):
All Texas Administrative Code standards are located at the Texas Secretary of State website:
httr)://texreg.sos.state.tx.us/public/readtac$ext.viewtac.
All Older Americans Act and other required rules and regulations are located at:
https://www.acl.gov/node/75.
Targeting: AAA services are designed to identify eligible program participants, with an emphasis
on high -risk program participants and to serve older individuals with greatest economic and social
need, low-income minorities and those residing in rural areas, as required by the OAA.
B. Services & Reimbursement Methodology:
Service
Fixed Rate
(include rate)
Variable Rate
(identify range)
Cost
Reimbursement
Congregate
N/A
N/A
$7.50
Transportation — D/R
N/A
N/A
$9.37
2. TERMS OF AGREEMENT
A. The Subrecipient agrees to:
1. provide services in accordance with current or revised HHS policies and standards and the OAA.
2. submit billings with appropriate documentation as required by the AAA by the close of business
on the 2nd working day of each month following the last day of the month in which services
were provided.
a. If the 2nd working day falls on a weekend or holiday, the information shall be delivered by
the close of business on the following business day.
b. The AAA cannot guarantee payment of a reimbursement request received for more than 45
calendar days of service delivery.
c. No reimbursement for services provided will be made if Subrecipient payment invoices are
not submitted to the AAA within 45 days of service delivery.
Form#: AIAAA_VA2.0 2
Edition Date: 9/19/11
d. Reimbursement checks must be cashed or deposited within 30 days from date received.
3. encourage program participant contributions (program income) on a voluntary and confidential
basis. Such contributions will be properly safeguarded and accurately accounted for as receipts
and expenditures on Subrecipient's financial reports if contributions are not required to be
forwarded to the AAA. Client contributions (program income) will be reported fully, as
required, to the AAA. Subrecipient agrees to expend all program income to expand or enhance
the program/service under which it is earned.
4. notify the AAA Director immediately if, for any reason, the Subrecipient becomes unable to
provide the service(s).
5. maintain communication and correspondence concerning program participants' status.
6. establish a method to guarantee the confidentiality of all information relating to the program
participant in accordance with applicable federal and state laws, rules, and regulations. This
provision shall not be construed as limiting AAA or any federal or state authorized
representative's right of access to program participant case records or other information relating
to program participants served under this agreement.
7. keep financial and program supporting documents, statistical records, and any other records
pertinent to the services for which a claim for reimbursement was submitted to the AAA. The
records and documents will be kept for a minimum of five years after close of Subrecipient's
fiscal year.
8. make available at reasonable times and for required periods all fiscal and program participant
records, books, and supporting documents pertaining to services provided under this agreement,
for purposes of inspection, monitoring, auditing, or evaluations by AAA staff, the Comptroller
General of the United States and the State of Texas, through any authorized representative(s).
9. if applicable, comply with the HHS process for Centers for Medicare and Medicaid Services
(CMS) screening for excluded individuals and entities involved with the delivery of the Legal
Assistance and Legal Awareness services.
B. The Subrecipient further agrees:
1. The agreement may be terminated for cause or without cause upon the giving of 30 days
advance written notice.
2. The agreement does not guarantee a total level of reimbursement other than for individual
units/services authorized; contingent upon receipt of funds.
3. Subrecipient is an independent provider, NOT an agent of the AAA. Thus, the Subrecipient
indemnifies, saves and holds harmless the South Plains Association of Governments AAA
against expense or liability of any kind arising out of service delivery performed by the
Subrecipient. Subrecipient must immediately notify the AAA if the Subrecipient becomes
involved in or is threatened with litigation related to program participants receiving services
funded by the AAA.
4. Employees of the Subrecipient will not solicit or accept gifts or favors of monetary value by or
on behalf of program participants as a gift, reward or payment.
C. Through the Direct Purchase of Services program, the South Plains Association of Governments
AAA agrees to:
Form #: AIAAA_VA2.0
Edition Date: 9/19/11
1. review program participant intake and assessment forms completed by the Subrecipient, as
applicable, to determine program participant eligibility. Service authorization is based on
program participant need and the availability of funds.
2. provide timely written notification to Subrecipient of program participant's eligibility and
authorization to receive services.
3. maintain communication and correspondence concerning the program participants' status.
4. provide timely technical assistance to Subrecipient as requested and as available.
5. conduct quality -assurance procedures, which may include on -site visits, to ensure quality
services are being provided and if applicable, CMS exclusion reviews are conducted.
6. provide written policies, procedures, and standard documents concerning program participant
authorization to release information (both a general and medical/health related release), client
rights and responsibilities, contributions, and complaints/grievances and appeals to all program
participants.
7. contingent upon the AAA's receipt of funds authorized for this purpose from HHS, reimburse
the Subrecipient based on the agreed reimbursement methodology, approved rate(s), service(s)
authorized, and in accordance with subsection (A)(2) of this document, within 45 days of the
AAA's receipt of Subrecipient's invoice.
3. ASSURANCES
The Subrecipient shall comply with:
A. Title VI of the Civil Rights Act of 1964 (42 U.S.C. §2000d et.seq.)
B. Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. §794)
C. Americans with Disabilities Act of 1990 (42 U.S.C. § 12101 et seq.)
D. Age Discrimination in Employment Act of 1975 (42 U.S.C. §§6101-6107)
E. Title IX of the Education Amendments of 1972 (20 U.S.C. §§1681-1688)
F. Food Stamp Act of 1977 (7 U.S.C. §200 et seq.)
G. Drug Free Workplace Act of 1988
H. Texas Senate Bill 1 - 1991, as applicable
I. HHS administrative rules, as set forth in the Texas Administrative Code, to the extent applicable to
this Agreement
J. Certification Regarding Debarment - 45CFR §92.35 Subawards to debarred and suspended
parties; this document is required annually as long as this agreement is in effect
K. Centers for Medicare and Medicaid Services (CMS) State Medicaid Director Letter SMDL #09-
001 regarding Individuals or Entities Excluded from Participation in Federal Health Care
Programs
L. HHS Information Letter 11-07 — Obligation to Identify Individuals or Entities Excluded from
Participation in Federal Health Care Programs
4. ATTACHMENTS
A. Description of Assurance A — H listed in section 3 of this document.
B. List of Focal Points in the AAA planning and service area.
Form #: A[AAA_V A2.0 4
Edition Date: 9/19/11
5. SIGNATURES
For the faithful performance of the terms of this agreement, the parties affix their signatures and bind
themselves effective October 1, 2018.
(,,W13
Authorized Subrecipient Signa ure
Daniel M. Pope
Print Name
Mayor
Title
September 27, 2018
Date
Form#: AIAAA_VA2.0
Edition Date: 9/19/11
Authorized Signature
South Plains Association of Governments
(Agency)
P.O. Box 3730 — Freedom Station
(Address)
Lubbock Texas 79452
(City, State, Zip)
September 28, 2018
(Date)
Attest:
R ecca Garza
Ci Secretary
Bridget Faulkenberry
Parks and Recreation Director
Approved as to Form
R an rooke
Assi ant City Attorney
ASSURANCES ATTACHMENT
A. Title VI of the Civil Rights Act of 1964 (42 U.S.C. §2000d et.sea.), which prohibits any
person from being excluded from participation in, denied the benefits of, or subjected to
discrimination under any program or activity receiving Federal financial assistance.
B. Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. §794), which states that employers
may not refuse to hire or promote handicapped persons solely because of their disability.
C. Americans with Disabilities Act of 1990 (42 U.S.C. §12101 et sea.), which prohibits a
covered entity from discriminating against a qualified individual on the basis of disability in
regard to job application procedures, the hiring, advancement, or discharge of employees,
employee compensation, job training, and other terms, conditions, and privileges of
employment.
D. Age Discrimination in Employment Act of 1975 (42 U.S.C. §6101-6107), prohibits
discrimination on the basis of age in programs and activities receiving federal financial
assistance.
E. Food Stamp Act of 1977 (7 U.S.C. §200 et sea.), whose purpose is to strengthen the
agricultural economy; to help to achieve a fuller and more effective use of food abundances;
to provide for improved levels of nutrition among low-income households through a
cooperative Federal -State program of food assistance to be operated through normal
channels of trade; and for other purposes.
F. Drug Free Workplace Act of 1988, which requires that all organizations receiving federal
grants, regardless of amount granted, maintain a drug -free workplace.
G. Texas Senate Bill 1 - 1991, as applicable, which refers to proper reporting of contributions
as addressed in OAA §315 and TAC, Title 40, §85.201.
FOCAL POINTS FOR
THE SOUTH PLAINS ASSOCIATION OF GOVERNMENTS REGION
FY 2019
CENTER:
Bailey County Commissioners Court (A-020)
DIRECTOR:
Judy Coffman
BOOKKEEPER:
Judy Coffman
ADDRESS:
300 South First Street Room 110
CITY:
Muleshoe, Texas 79347
PHONE:
(806) 272-3647 E-mail: jcoffman@co.bailey.tx.us
DAYS & HRS. OPEN:
Mon. - Fri. 8:30-12:00, 1:00-5:00 Fax: (806) 272-4656
SERVICES:
TRANS.
COUNTY:
Bailey
CENTER:
Bailey County Senior Citizens Assoc., Inc. (A-007)
DIRECTOR:
Geraldine Redwine
ASSISTANT:
Geraldine Redwine
ADDRESS:
319 S. Main St / PO Box 292
CITY:
Muleshoe, Texas 79347
PHONE:
(806) 272-4969E-mail: muleshoesenior@outlook.com
DAYS &, HRS. OPEN:
Mon. — Fri. 8:00 — 4:00 Fax: (806) 272-4460
SERVICES:
CONG.
COUNTY:
Bailey Miles 156.72
CENTER:
Cochran Co. Senior Citizens Assoc., Inc. (A-045)
DIRECTOR:
Reynalda Alvarado
BOOKKEEPER:
Reynalda Alvarado
ADDRESS:
120 W. Wilson
CITY:
Morton, Texas 79346
PHONE:
(806) 266-5121 E-mail: ccsci@windstream.net
DAYS & HRS. OPEN:
Mon. — Fri. 8-3 Fax #: 266-9027
SERVICES:
CONG., TRANS.
COUNTY:
Cochran Miles 119.62
1 Updated 07/26/2018
CENTER:
Crosby Co. Senior Citizens Assoc., Inc. (A-050)
DIRECTOR:
Lenette Fowler
BOOKKEEPER:
Lenette Fowler
ADDRESS:
119 North Berkshire
CITY:
Crosbyton, Texas 79322
PHONE:
(806) 675-2107
Director Cell phone
(806) 928-1586
E-mail: CrosbyCountySeniors@windstream.net
DAYS & HRS. OPEN:
Mon. —Fri. 8-3
SERVICES:
CONG., H.D.
COUNTY:
Crosby Miles 84
CENTER:
Garza County Trailblazers, Inc. (A-070)
DIRECTOR:
JoAnn Rathbun
BOOKKEEPER:
LaGayluah McReynolds
ADDRESS:
205 E. 10th
CITY:
Post, Texas 79356
PHONE:
(806) 495-2998 E-mail:garzatrailblazers@vahoo.com
DAYS & HRS. OPEN:
Mon. — Fri. 8-1
SERVICES:
CONG., H.D.
COUNTY:
Garza miles 76.32
CENTER:
Hale Center Senior Citizens Assoc., Inc. (A-075)
DIRECTOR:
Karen Boyce
BOOKKEEPER:
Karen Boyce
ADDRESS:
P.O. Box 205 (416 West 2nd St.)
CITY:
Hale Center, Texas 79041
PHONE:
(806) 839-2428 E-mail: hcsrcenter@sbcalobal.net
DAYS & HRS. OPEN:
Mon. — Fri. 8-3
SERVICES:
CONG., H.D., TRANS.
COUNTY:
Hale Miles 75.36
CENTER:
Hockley County Senior Citizens Assoc., Inc. (A-085)
DIRECTOR:
Ashley Scifres
BOOKKEEPER:
Olga Gonzales
ADDRESS:
1202 Houston
CITY:
Levelland, Texas 79336
PHONE:
(806) 894-2228 E-mail: hcsca@aol.com
DAYS & HRS. OPEN:
Mon. — Fri. 8-4:30
SERVICES:
CONG., H.D., TRANS.
COUNTY:
Hockley 78.00
2 Updated 07/26/2018
CENTER:
Lorenzo Senior Citizens Assoc., Inc. (A-095)
DIRECTOR:
Denice Sellers
BOOKKEEPER:
Denice Sellers
ADDRESS:
P.O. Box 571 (606 611 St.)
CITY:
Lorenzo, Texas 79343
PHONE:
(806) 634-5957 E-mail: lorenzosca@windstream.net
DAYS & HRS. OPEN:
Mon. —Fri. 8-2
SERVICES:
CONG., H.D.
COUNTY:
Crosby 49.94
CENTER:
Lubbock - City of Lubbock (A-100)
DIRECTOR:
Johnny McLellan, Supervisor: 775-2678
Nancy Neill, 775-2685
ADDRESS:
P.O. Box 2000 (1611 10 St.)
CITY:
Lubbock, Texas 79457
PHONE:
(806) 775-2678
E-mail: jmclellan@mail.ci.lubbock.tx.us
nneill@mvlubbock.us &
pibrown@mail.ci.lubbock.tx.us
nancv.m.neill@gmail.com
DAYS & HRS. OPEN: Mon. —Fri. 8-5 Fax: 775-2686
SERVICES: CONG., TRANS.
COUNTY: Lubbock
Mae Simmons — 767-2708, Shameca Wilson (2004 Oak Avenue 79404),
Copper Rawlings — 767-2704, Herminia Martinez (213 4011 Street 79404), (401h & Ave. B),
Maggie Treio — 767-2705, Cecilia Gonzalez (3200 Amherst 79415),
Homestead - 687-7898, Nancy Dubose (5401 56`1 Street 79414);
Lubbock Senior Center — 767-2710, Paula Brown (2001 1911 Street, 79401) FAX 765-0820
Gloria Gutierrez Transportation Director
CENTER:
Lynn County Pioneers (A-110)
DIRECTOR:
Sandra Norwood
BOOKKEEPER:
Sandra Norwood
ADDRESS:
P.O. Box 223 (1600 S. 3rd St.)
CITY:
Tahoka, Texas 79373
PHONE:
(806) 561-5264 E-mail: lynncopioneers@2mail.com
DAYS & HRS. OPEN:
Mon. —Fri. 9-3 Fax: 561-5571
SERVICES:
CONG., H.D. (No Cong. in O'Donnell)
COUNTY:
Lynn Miles 54.52
3 Updated 07/26/2018
CENTER:
Senior Citizens Assoc. of S. Dickens County (A-130)
DIRECTOR:
Linda Alexander
BOOKKEEPER:
Jean Hoover
ADDRESS:
210 Burlington
CITY:
Spur, Texas 79370
PHONE:
(806) 271-4472 E-mail: sscaosdc@caprock-spur.com
DAYS & HRS. OPEN:
Mon. —Fri. 8-3
SERVICES:
CONG., H.D.
COUNTY:
Dickens 154.00
CENTER:
Slaton Senior Citizens Assoc., Inc. (A-135)
DIRECTOR:
Charlotte O'Connell
BOOKKEEPER:
Charlotte O'Connell
ADDRESS:
230 West Lynn
CITY:
Slaton, Texas 79364
PHONE:
(806) 828-3784 E-mail: coconnell@door.net
DAYS & HRS. OPEN:
Mon. —Fri. 8-4 slatonseniors@door.net
SERVICES:
CONG., H.D.
COUNTY:
Lubbock 28.52
CENTER:
Yoakum County Senior Citizens Assoc., Inc. (A-150)
DIRECTOR:
Becky Riley
ASSISTANT DIRECTOR:
Amber Cline
BOOKKEEPER:
Shelia Hinson
ADDRESS:
709 W. Broadway (Box 519)
CITY:
Denver City, Texas 79323
PHONE:
(806) 592-8000 E-mail: _ycsc60@windstream.net
Fax:
(806) 592-2835
DAYS & HRS. OPEN:
Mon. —Fri. 9-2
SERVICES:
LONG., H.D.
COUNTY:
Yoakum 159.94
LEGEND
CONG. — Congregate Meals (on -site)
H.D. - Home Delivered Meals
TRAN. - Transportation Service
4 Updated 07/26/2018
Certification Regarding Debarment
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY
AND VOLUNTARY EXCLUSION FOR COVERED CONTRACTS AND GRANTS
Federal Executive Order 12549 requires the Texas Health and Human Services (HHS) to
screen each covered potential subrecipient/grantee to determine whether each has a right to
obtain a contract/grant in accordance with federal regulations on debarment, suspension,
ineligibility, and voluntary exclusion. Each covered subrecipient/grantee must also screen
each of its covered sub-subrecipients/providers.
In this certification "subrecipient/grantee" refers to both subrecipient/grantee and sub-
subrecipient/sub-grantee: "contract/grant" refers to both contract/grant and subcontract/sub-
grant.
By signing and submitting this certification the potential subrecipient/grantee accepts
the following terms:
1. The certification herein below is a material representation of fact upon which reliance
was placed when this contract/grant was entered into. If it is later determined that the
potential subrecipient/grantee knowingly rendered an erroneous certification, in
addition to other remedies available to the federal government, the Department of
Health and Human Services, United States Department of Agriculture or other federal
department or agency, or the Texas Health and Human Services may pursue available
remedies, including suspension and/or debarment.
2. The potential subrecipient/grantee shall provide immediate written notice to the
person to whom this certification is submitted if at any time the potential
subrecipient/grantee learns that the certification was erroneous when submitted or has
become erroneous by reason of changed circumstances.
3. The words "covered contract", "debarred", "suspended", "ineligible", "participant',
"person", "principal", "proposal" and "voluntarily excluded", as used in this
certification have meanings based upon materials in the Definitions and Coverage
sections of federal rules implementing Executive Order 12549. Usage is as defined in
the attachment.
4. The potential subrecipient/grantee agrees by submitting this certification that, should
the proposed covered contract/grant be entered into, it shall not knowingly enter into
any subcontract with a person who is debarred, suspended, declared ineligible, or
voluntarily excluded from participation in this covered transaction, unless authorized
by the Department of Health and Human Services, United States Department of
CERTIFICATION REGARDING DEBARMENT
Page 2
Agriculture or other federal department or agency, and/or the Texas Health and
Human Services, as applicable.
Do you have or do you anticipate having sub-subrecipients/sub-grantees under
this proposed contract?_ YES NO
5. The potential subrecipient/grantee further agrees by submitting this certification that it
will include this certification titled "Certification Regarding Debarment, Suspension,
Ineligibility, and Voluntary Exclusion for Covered Contracts and Grants" without
modification, in all covered subcontracts and in solicitations for all covered
subcontracts.
6. A subrecipient/grantee may rely upon a certification of a potential sub-
subrecipient/sub-grantee that is not debarred, suspended, ineligible, or voluntarily
excluded from the covered contract/grant, unless the subrecipient/grantee knows that
the certification is erroneous. A subrecipient/grantee must, at a minimum, obtain
certifications from its covered sub-subrecipients/sub-grantees upon each
subcontract's/sub-grant's initiation and upon each renewal.
7. Nothing contained in all the foregoing shall be construed to require establishment of a
system of records in order to render in good faith the certification required by this
certification document. The knowledge and information of a subrecipient/grantee is
not required to exceed that which is normally possessed by a prudent person in the
ordinary course of business dealings.
8. Except for contracts/grants authorized under paragraph 4 of these terms, if a
subrecipient/grantee in a covered contract/grant knowingly enters into a covered
subcontract/subgrant with a person who is suspended, debarred, ineligible, or
voluntarily excluded from participation in the transaction, in addition to other
remedies available to the federal government, Department of Health and Human
Services, United States Department of Agriculture, or other federal department or
agency, as applicable, or the Texas Health and Human Services may pursue available
remedies, including suspension and/or debarment.
CERTIFICATION REGARDING DEBARMENT
Page 3
Indicate which statement applies to the covered potential subrecipient/grantee:
The potential subrecipient/grantee certifies by submission of this certification that
neither it nor its principals are presently debarred, suspended, proposed for
debarment, declared ineligible, or voluntarily excluded from participation in this
contract/grant by any federal department or agency or by the State of Texas.
The potential subrecipient/grantee is unable to certify one or more of the terms in this
certification. In this instance, the potential subrecipient/grantee must attach an
explanation for each of the above terms to which he/she is unable to make
certification. Attach the explanation(s) to this certification.
NAME OF POTENTIAL SUBRECIPIENT/GRANTEE:
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Signa e o uthorized Representative
Printed/Typed Na e of Authorized Representative
gz
Tit e of Authorized Repres ntative Date
This certification is for FFY 2019 period beginning October 1, 2018 and ending
September 30, 2019.
CERTIFICATION REGARDING DEBARMENT
Page 4
DEFINITIONS
Covered Contract/Grant and Subcontracts/Sub-grants.
(1) Any non -procurement transaction which involves federal funds (regardless of
amount and including such arrangements as sub -grants) and is between the
Texas Health and Human Services or its agents/grantees and another entity.
(2) Any procurement contract for goods or services between a participant and a
person, regardless of type, expected to equal or exceed the federal
procurement small purchase threshold fixed at 10 U.S.C. 2304(g) and 41
U.S.C. 253(g) (currently $100,000) under a grant or sub -grant.
(3) Any procurement contract for goods or services between a participant and a
person under a covered grant, sub -grant, contract or subcontract, regardless of
amount, under which that person will have a critical influence on or
substantive control over that covered transaction including:
a. Principal investigators.
b. Providers of audit services required by the Texas Health and Human
Services or federal funding source.
C. Researchers.
DEBARMENT
An action taken by a debarring official in accordance with 45 CFR Part 76 (or
comparable federal regulations) to exclude a person from participating in covered
contracts/grants. A person so excluded is "debarred."
GRANT
An award of financial assistance, including cooperative agreements, in the form of
money, or property in lieu of money, by the federal government to an eligible grantee.
INELIGIBLE
Excluded from participation in federal non -procurement programs pursuant to a
determination of ineligibility under statutory, executive order, or regulatory authority,
other an Executive Order 12549 and its agency implementing regulations: for
example, excluded pursuant to the Davis -Bacon Act and its implementing regulations,
the equal employment opportunity acts and executive orders, or the environmental
protection acts and executive orders. A person is ineligible where the determination
of ineligibility affects such person's eligibility to participate in more than one covered
transaction.
CERTIFICATION REGARDING DEBARMENT
Page 5
PARTICIPANT
Any person who submits a proposal for, enters into, or reasonably may be expected to
enter into a covered contract. This term also includes any person who acts on behalf
of or is authorized to commit a participant in a covered contract/grant as an agent or
representative of another participant.
PERSON
Any individual, corporation, partnership, association, unit of government, or legal
entity, however organized, except: foreign governments or foreign governmental
entities, public international organizations, foreign government owned (in whole or
part) or controlled entities, and entities consisting wholly or partially of foreign
governments or foreign governmental entities.
PRINCIPAL
Officer, director, owner, partner, key employee, or other person within a participant
with primary management or supervisory responsibilities: or a person who has a
critical influence on or substantive control over a covered contract/grant whether or
not the person is employed by the participant. Persons who have a critical influence
on or substantive control over a covered transaction are:
(1) Principal investigators.
(2) Providers of audit services required by the Texas Health and Human Services
or federal funding source.
(3) Researchers.
PROPOSAL
A solicited or unsolicited bid, application, request, invitation to consider or similar
communication by or on behalf of a person seeking to receive a covered
contract/grant.
SUSPENSION
An action taken by a suspending official in accordance with 45 CFR part 76 (or
comparable federal regulations) that immediately excludes a person from participating
in covered contracts/grants for a temporary period, pending completion of an
investigation and such legal, debarment, or Program Fraud Civil Remedies Act
proceedings as may ensue. A person so excluded is "suspended."
VOLUNTARY EXCLUSION OR VOLUNTARILY EXCLUDED
A status of nonparticipation or limited participation in covered transactions assumed
by a person pursuant to the terms of a settlement.
DATA USE AGREEMENT
BETWEEN THE
SOUTH PLAINS ASSOCIATION OF GOVERNMENTS
AND
CITY OF LUBBOCK ("SUBRECIPIENT")
This Data Use Agreement ("DUA"), effective as of the Subrecipient agreement ("Effective Date"),
is entered into by and between the SOUTH PLAINS ASSOCIATION OF GOVERNMENTS (SPAG) and
CITY OF LUBBOCK ("SUBRECIPIENT"), and incorporated into the terms of the following Subrecipient
agreement, in Lubbock County, Texas:
83124-19-A100 — Direct Purchase of Nutrition and Transportation Services Agreement
ARTICLE 1. PURPOSE; APPLICABILITY; ORDER OF PRECEDENCE
The purpose of this DUA is to facilitate creation, receipt, maintenance, use, disclosure or access to
Confidential Information with SUBRECIPIENT, and describe SUBRECIPIENT's rights and obligations
with respect to the Confidential Information and the limited purposes for which this SUBRECIPIENT may
create, receive, maintain, use, disclose or have access to CONFIDENTAIL INFORMATION. 45 CFR
164.504(e)(1)-(3) This DUA also describes SPAG's remedies in the event of SUBRECIPIENT's
noncompliance with its obligations under this DUA. This DUA applies to both Business Associates and
subrecipients who are not Business Associates who create, receive, maintain, use, disclose or have access
to Confidential Information on behalf of SPAG, its programs or clients as described in the Subrecipient
agreement.
As of the Effective Date of this DUA, if any provision of the Subrecipient agreement, including
any General Provisions or Uniform Terms and Conditions, conflicts with this DUA, this DUA controls.
This DUA is intended to apply only to Confidential Information that SUBRECIPIENT handles in
performing services provided under the Subrecipient agreement.
ARTICLE 2. DEFINITIONS
For the purposes of this DUA, capitalized, underlined terms have the meanings set forth in the
following: Health Insurance Portability and Accountability Act of 1996, Public Law 104-191 (42 U.S.C.
§ 1320d, et seq.) and regulations thereunder in 45 CFR Parts 160 and 164, including all amendments,
regulations and guidance issued thereafter; The Social Security Act, including Section 1137 (42 U.S.C. §§
1320b-7), Title XVI of the Act; The Privacy Act of 1974, as amended by the Computer Matching and
Privacy Protection Act of 1988, 5 U.S.C. § 552a and regulations and guidance thereunder; Internal Revenue
Code, Title 26 of the United States Code and regulations and publications adopted under that code,
including IRS Publication 1075; OMB Memorandum 07-18; Texas Business and Commerce Code Ch. 521;
Texas Government Code, Ch. 552,and Texas Government Code § 2054.1125. In addition, the following
terms in this DUA are defined as follows:
"Authorized Purpose" means the specific purpose or purposes described in the Scope of Work of
the Subrecipient agreement for SUBRECIPIENT to fulfill its obligations under the Subrecipient agreement,
or any other purpose expressly authorized by SPAG in writing in advance.
SPAG Data Use Agreement V.1 HIPPA Omnibus Compliant April 2017
GOVERNMENTAL ENTITY VERSION - CITY OF LUBBOCK
SPAG Agreement No. 83124-19-A100
"Authorized User" means a Person:
(1) Who is authorized to create, receive, maintain, have access to, process, view, handle,
examine, interpret, or analyze Confidential Information pursuant to this DUA;
(2) For whom SUBRECIPIENT warrants and represents has a demonstrable need to create,
receive, maintain, sue disclose or have access to the Confidential Information; and
(3) Who has agreed in writing to be bound by the disclosure and use limitations pertaining to
the Confidential Information as required by this DUA.
"Confidential Information" means any communication or record (whether oral, written,
electronically stored or transmitted, or in any other form) provided to or made available to SUBRECIPIENT
or that SUBRECIPIENT may create, receive, maintain, use, disclose or have access to on behalf of SPAG
that consists of or includes any or all of the following:
(1) Client Information;
(2) Protected Health Information (PHI) in any form including without limitation, Electronic
Protected Health Information or Unsecured Protected Health Information;
(3) Sensitive Personal Information defined by Texas Business and Commerce Code Ch. 521;
(4) Federal Tax Information;
(5) Personally Identifiable Information;
(6) Social Security Administration Data, including, without limitation, Medicaid information;
(7) All privileged work product;
(8) All information designated as confidential under the constitution and law dog the State of
Texas and of the United States, including the Texas Health & Safety Code and the Texas Public Information
Act, Texas Government Code, Chapter 552.
"Locally Authorized Representative" of the Individual, as defined by Texas Law, including as
provided in 45 CFR 435.923 (Medicaid); 45 CFR 164.502(g)(1) (HIPAA); Tex. Occ. Code § 151.002(6);
Tex. H. & S. Code § 166.164; Estates Code Ch. 752 and Texas Prob. Code §3.
ARTICLE 3. SUBRECIPIENT'S DUTIES REGARDING CONFIDENTIAL INFORMATION
Section 3.01 Obligations of SUBRECIPIENT
SUBRECIPIENT agrees that:
(A) SUBRECIPIENT will exercise reasonable care and no less than the same degree of care
SUBRECIPIENT uses to protect its own confidential, proprietary and trade secret information to prevent
any portion of the Confidential Information from being used in a manner that is not expressly an Authorized
Purpose under this DUA or as Required by Law. 45 CFR 164.502(b)(1); 45 CFR 164.514(d)
(B) SUBRECIPIENT will not, without SPAG's prior written consent, disclose or allow access
to any portion of the Confidential Information to any Person or any other entity, other than Authorized
User's Workforce or Subcontractors of SUBRECIPIENT who have completed training in confidentiality,
privacy, security and the importance of promptly reporting any Event or Breach to SUBRECIPIENT'S
management, to carry out the Authorized Purpose or as Required by Law.
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SPAG Agreement No. 83124-19-A100
SPAG, at its election, may assist SUBRECIPIENT in training and education on specific or unique
SPAG processes, systems and/or requirements. SUBRECIPIENT will produce evidence of completed
training to SPAG upon request. 45 C.F.R. 164.3O8(a)(5)(1); Texas Health Safety Code §181.01
(C) SUBRECIPIENT will establish, implement and maintain appropriate sanctions against any
member of its Workforce or Subcontractor who fails to comply with this DUA, the Subrecipient agreement
or applicable law. SUBRECIPIENT will maintain evidence of sanctions and produce it to SPAG upon
request. 45 C.F.R. 164.308(a)(1)(ii)(C); 164.530(e); 164.410(b);164.530(b)(1)
(D) SUBRECIPIENT will not, except as otherwise permitted by this DUA, disclose or provide
access to any Confidential Information on the basis that such act is Required by Law without notifying
either SPAG or SUBRECIPIENT's own legal counsel to determine whether SUBRECIPIENT should
object to the disclosure or access and seek appropriate relief. SUBRECIPIENT will maintain an accounting
of all such requests for disclosure and responses and provide such accounting to SPAG within 48 hours of
SPAG's request. 45 CFR 164.504(e)(2)(ii)(A)
(E) SUBRECIPIENT will not attempt to re -identify or further identify Confidential
Information
or De -identified Information, or attempt to contact any individuals whose records are contained in the
Confidential Information, except for an Authorized Purpose, without express written authorization from
SPAG or as expressly permitted by this Subrecipient agreement. 45 CFR 164.502(d)(2)(i) and (ii)
SUBRECIPIENT will not engage in prohibited marketing or sale of Confidential Information. 45 CFR
164.501, 164.5O8(a)(3) and (4); Texas Health & Safety Code Ch. 181.002
(F) SUBRECIPIENT will not permit, or enter into any agreement with a Subcontractor to,
create, receive, maintain, use , disclose, have access to or transmit Confidential Information, on behalf of
SUBRECIPIENT without requiring that Subcontractor first execute the Form Subcontractor Agreement,
Attachment I, which ensures that the Subcontractor will comply with the identical terms, conditions,
safeguards and restrictions as contained in this DUA for PHI and any other relevant Confidential
Information and which permits more strict limitations; 45 CFR 164.5O2(e)(1)(1)(ii); 164.504(e)(1)(i) and
(2)
(G) SUBRECIPIENT is directly responsible for compliance with and enforcement of, all
conditions for creation, maintenance, use, disclosure, transmission and Destruction of Confidential
Information and the acts or omissions of Subcontractors as may be reasonably necessary to prevent
authorized use. 45 CFR 164.504(e)(5); 42 CFR 431.300, et seq.
(H) If SUBRECIPIENT maintains PHI in a Designated Record Set, SUBRECIPIENT will
make PHI available to SPAG in a Designated Record Set or, as directed by SPAG, provide PHI to the
Individual, or Legally Authorized Representative of the Individual who is requesting PHI in compliance
with the requirements of the HIPAA Privacy Regulations. SUBRECIP ENT will make other Confidential
Information in SUBRECIPIENT's possession available pursuant to the requirements of HIPAA or other
applicable law upon a determination of a Breach of Unsecured PHI as defined in HIPAA. 45 CFR 164.524
and 164.504(e)(2)(ii)(E)
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SPAG Agreement No. 83124-19-A100
(I) SUBRECIPIENT will make PHI as required by HIPAA available for amendment and
incorporate any amendments to this information that SPAG directs or agrees to pursuant to the HIPAA.
45 CFR 164.504(e)(2)(ii)(E) and (F)
Q) SUBRECIPIENT will document and make available to SPAG the PHI required to provide
access, an accounting of disclosures or amendment in compliance with the requirements of the HIPAA
Privacy Regulations. 45 CFR 164.504(e)(2)(ii)(G) and 164.528
(K) If SUBRECIPIENT receives a request for access, amendment or accounting of PHI from
an individual with a right of access to information subject to this DUA, it will respond to such request in
compliance with HIPAA Privacy Regulations. SUBRECIPIENT will maintain an accounting of all
responses to request for access to or amendment of PHI and provide it to SPAG within 48 hours of SPAG's
request. 45 CFR 164.504(e)(2)
(L) SUBRECIPIENT will provide, and will cause its Subcontractors and agents to provide, to
SPAG periodic written certifications of compliance with controls and provisions relating to information
privacy, security and breach notification, including without limitation information related to data transfers
and the handling and disposal of Confidential Information. 45 CFR 164.308; 164.530(c); I TAC 202
(M) Except as otherwise limited by this DUA, the Subrecipient agreement, or law applicable to
the Confidential Information, SUBRECIPIENT may use or disclose PHI for the proper management and
administration of SUBRECIPIENT or to carry out SUBRECIPIENT's legal responsibilities if. 45 CFR
164.504(e)(ii)(1)(A)
(1) Disclosure is Required by Law, provided that SUBRECIPIENT complies with Section
3.01(D);
(2) SUBRECIPIENT obtains reasonable assurances from the Person to whom the information
is disclosed that the Person will:
(a) Maintain the confidentiality of the Confidential Information in accordance with this DUA;
(b) Use or further disclose the information only as Required by Law or for the Authorized Purpose
for which it was disclosed to the Person; and
(c) Notify SUBRECIPIENT in accordance with Section 4.01 of any Event or Breach of
Confidential Information of which the Person discovers or should have discovered with the exercise of
reasonable diligence. 45 CFR 164.504(e)(4)(ii)(B)
(N) Except as otherwise limited by this DUA, SUBRECIPIENT will, if requested by SPAG,
use PHI to provide data aggregation services to SPAG, as that term is defined in the HIPAA. 45 C.F.R. §
164.501 and permitted by HIPAA. 45 CFR 164.504(e)(2)(i)(B)
(0) SUBRECIPIENT will, on the termination or expiration of this DUA or the Subrecipient
agreement, at its expense, return to SPAG or Destroy, at SPAG's election, and to the extent reasonably
feasible and permissible by law, all Confidential Information received from SPAG or created or maintained
by SUBRECIPIENT or any of SUBRECIPIENT's agents or Subcontractors on SPAG's behalf if that data
contains Confidential Information. SUBRECIPIENT will certify in writing to SPAG that all the
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SPAG Agreement No. 83124-19-A100
Confidential Information that has been created, received, maintained, used by or disclosed to
SUBRECIPIENT, has been Destroy or returned to SPAG, and that SUBRECIPIENT and its agents and
Subcontractors have retained no copies thereof. Notwithstanding the foregoing, SUBRECIPIENT
acknowledges and agrees that it may not Destroy any Confidential Information if federal or state law, or
SPAG record retention policy or a litigation hold notice prohibits such Destruction. If such return or
Destruction is not reasonably feasible, or is impermissible by law, SUBRECIPIENT will immediately
notify SPAG of the reasons such return or Destruction is not feasible, and agree to extend indefinitely the
protections of this DUA to the Confidential Information and limit its further uses and disclosures to the
purposes that make the return of the Confidential Information not feasible for as long as SUBRECIPIENT
maintains such Confidential Information. 45 CFR 164.504(e)(2)(ii)(J)
(P) SUBRECIPIENT will create, maintain, use, disclose, transmit or Destroy Confidential
Information in a secure fashion that protects against any reasonably anticipated threats or hazards to the
security or integrity of such information uses. 45 CFR 164.306; 164.530(c)
(Q) If SUBRECIPIENT accesses, transmits, stores, and/or maintains Confidential Information,
SUBRECIPIENT will complete and return to SPAG at aaareports@spag org the HHS information security
and privacy initial inquiry (SPI) at Attachment 2. The SPI identifies basic privacy and security controls
with which SUBRECIPIENT must comply to protect SPAG Confidential Information. SUBRECIPIENT,
will comply with periodic security controls compliance assessment and monitoring by SPAG as required
by state and federal law, based on the type of Confidential Information SUBRECIPIENT creates, receives
maintains, uses, discloses or has access to and the Authorized Purpose and level of risk. SUBRECIPIENT's
security controls will be based on the National Institute of Standards and Technology (NIST) Special
Publication 800-53. SUBRECIPIENT will update its security controls assessment whenever there are
significant changes in security controls for SPAG Confidential Information and will provide the updated
document to SPAG. SPAG also reserves the right to request updates as needed to satisfy state and federal
monitoring requirements. 45 CFR 164.306
(R) SUBRECIPIENT will establish, implement and maintain any and all appropriate
procedural, administrative, physical and technical safeguards to preserve and maintain the confidentiality,
integrity and availability of the Confidential Information, and with respect to PHI, as described in the
HIPAA Privacy and Security Regulations, or other applicable laws or regulations relating to Confidential
Information, to prevent any unauthorized use or disclosure of Confidential Information as long as
SUBRECIPIENT has such Confidential Information in its actual or constructive possession. 45 CFR
164.308 (administrative safeguards); 164.310 (physical safeguards); 164.312 (technical safeguards);
164.530 (c) (privacy safeguards)
(S) SUBRECIPIENT will designate and identify, subject to SPAG approval, a Person or
Persons, as Privacy Official 45 CFR 164.530 (a)(1) and Information Security Official, each of whom is
authorized to act on behalf of SUBRECIPIENT and is responsible for the development and implementation
of the privacy and security requirements in this DUA. SUBRECIPIENT will provide name and current
address, phone number and e-mail address for such designated officials to SPAG upon execution of this
DUA and prior to any change. 45 CFR 164.308(a)(2)
(T) SUBRECIPIENT represents and warrants that its Authorized Users each have a
demonstrated need to know and have access to Confidential Information solely to the minimum extent
SPAG Data Use Agreement V.1 HIPPA Omnibus Compliant April 2017
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SPAG Agreement No. 83124-19-A100
necessary to accomplish the Authorized Purpose pursuant to this DUA and the Subrecipient agreement, and
further that each has agreed in writing to be bound by the disclosure and use limitations pertaining to the
Confidential Information contained in this DUA. 45 CFR 264.502; 264.514(d)
(U) SUBRECIPIENT and its Subcontractors will maintain an updated, complete, accurate and
numbered list of Authorized Users, their signatures, titles and the date they agreed to be bound by the terms
of this DUA, at all times and supply it to SPAG, as directed, upon request.
(V) SUBRECIPIENT will implement, update as necessary, and document reasonable and
appropriate policies and procedures for privacy, security and Breach of Confidential Information and an
incident response plan for an Event or Breach, to comply with the privacy, security and breach notice
requirements of this DUA prior to conducting work under the DUA. 45 CFR 164.308; 164.316; 164.514(d);
164.530(i)(1)
(W) SUBRECIPIENT will produce copies of its information security and privacy policies and
procedures and records relating to the use or disclosure of Confidential Information received from, created
by, or received, used or disclosed by SUBRECIPIENT on behalf of SPAG for SPAG's review and approval
within 30 days of execution of this DUA and upon request by SPAG the following business day or other
agreed upon time frame. 45 CFR 164.308; 164.514(d)
(X) SUBRECIPIENT will make available to SPAG any information SPAG requires to fulfill
SPAG's obligations to provide access to, or copies of, PHI in accordance with HIPAA and other applicable
laws and regulations relating to Confidential Information. SUBRECIPIENT will provide such information
in a time and manner reasonably agreed upon or as designated by HHS, or other federal or state law. 45
CFR 164.504(e)(2)(i)(1)
(Y) SUBRECIPIENT will only conduct secure transmissions of Confidential Information
whether in paper, oral or electronic form A secure transmission of electronic Confidential Information in
motion includes secure File Transfer Protocol (SFTP) or Encryption at an appropriate level or otherwise
protected as required by rule, regulation or law. Confidential Information at rest requires Encryption unless
there is adequate administrative, technical, and physical security, or as otherwise protected as required by
rule, regulation or law. All electronic data transfer and communications of Confidential Information will
be through secure systems. Proof of system, media or device security and/or Encryption must be produced
to SPAG no later than 48 hours after SPAG's written request in response to a compliance investigation,
audit or the Discovery of an Event or Breach. Otherwise, requested production of such proof will be made
as agreed upon by the parties. De -identification of Confidential Information is a means of security. With
respect to de -identification of PHI "secure" means de -identified according to HIPAA Privacy standards and
regulatory guidance. 45 CFR 164.312; 164.530(d)
(Z) SUBRECIPIENT will comply with the following laws and standards if applicable to the
type of Confidential Information and Subrecipient's Authorized Purpose:
• Title 1, Part 10, Chapter 202, Subchapter B, Texas Administrative Code;
• The Privacy Act of 1974;
• OMB Memorandum 07-16;
• The Federal Information Security Management Act of 2002 (FISMA);
SPAG Data Use Agreement V.1 HIPPA Omnibus Compliant April 2017
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SPAG Agreement No. 83124-19-A100
• The Health Insurance Portability and Accountability Act of 1996 H( IPAA) as defined in the
DUA;
• Internal Revenue Publication 1075 — Tax Information Security Guidelines for Federal, State
and Local Agencies;
• National Institute of Standards and Technology (NIST) Special Publication 800-66 Revision 1
— An Introductory Resource Guide for Implementing the Health Insurance Portability and
Accountability Act (HIPAA) Security Rule;
• NIST Special Publications 800-53 and 800-53A — Recommended Security Controls for Federal
Information Systems and Organizations, as currently revised;
• NIST Special Publication 800-47 — Security Guide for Interconnecting Information
Technology Systems;
• NIST Special Publication 800-88, Guidelines for Media Sanitization;
• NIST Special Publication 800-111, Guide to Storage of Encryption Technologies for End User
Devices containing PHI; and
• Any other State or Federal law, regulation, or administrative rule relating to the specific SPAG
program area that SUBRECIPIENT supports on behalf of SPAG.
ARTICLE 4. BREACH NOTICE, REPORTING AND CORRECTION REQUIREMENTS
Section 4.01. Breach or Event Notification to SPAG. 45 CFR 164.400-414
(A) SUBRECIPIENT will cooperate fully with SPAG in investigating, mitigating to the extent
practical and issuing notifications directed by SPAG, for any Event or Breach of Confidential Information
to the extent and in the manner determined by SPAG.
(B) SUBRECIPIENT' S obligation begins at the Discovery of an Event or Breach and continues
as long as related activity continues, until all effects of the Event are mitigated to SPAG's satisfaction (the
"incident response period"). 45 CFR 164.404
(C) Breach Notice:
Initial Notice.
a. For federal information, including without limitation, Federal Tax Information, Social Security
Administration Data, and Medicaid Client Information, within the first, consecutive clock hour of
Discovery, and for all other types of Confidential Information not more than 24 hours after Discovery or
in a timeframe otherwise approved by SPAG in writing, initially report to SPAG Administration via email
at: aaareports ftag.org; and IRS Publication 1075; Privacy Act of 1974, as amended by the Computer
Matching and Privacy Protection Act of 1988, 5 U.S.C. § 552a; OMB Memorandum 07-16 as cited in
HHSC-CMS Contracts for information exchange.
b. Report all information reasonably available to SUBRECIPIENT about the Event or Breach of
the privacy or security of Confidential Information. 45 CFR 264.410
c. Name, and provide contact information to SPAG for, SUBRECIPIENT's single point of contact
who will communicate with SPAG both on and off business hours during the incident response period.
2. 48-Hour Formal Notice. No later than 48 consecutive clock hours after Discovery, or a
time within which Discovery reasonably should have been made by SUBRECIPIENT of an Event or Breach
SPAG Data Use Agreement V.1 HIPPA Omnibus Compliant April 2017
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SPAG Agreement No. 83124-19-A100
of Confidential Information, provide formal notification to the SPAG, including all reasonably available
information about the Event or Breach, and SUBRECIPIENT's investigation, including without limitation
and to the extent available: For (a) — (m) below: 45 CFR 164.400-414
a. The date the Event or Breach occurred;
b. The date of SUBRECIPIENT's and, if applicable, Subcontractor's Discovery;
c. A brief description of the Event or Breach; including how it occurred and who is responsible (or
hypotheses, if not yet determined);
d. A brief description of SUBRECIPIENT's investigation and the status of the investigation;
e. A description of the types and amount of Confidential Information involved;
f. Identification of and number of all Individuals reasonably believed to be affected, including first
and last name of the individual and if applicable the, Legally authorized representative, last known address,
age, telephone number, and email address if it is a preferred contact method, to the extent known or can be
reasonably determined by SUBRECIPIENT at that time;
g. SUBRECIPIENT's initial risk assessment of the Event or Breach demonstrating whether
individual or other notices are required by applicable law or this DUA for SPAG approval, including an
analysis of whether there is a low probability of compromise of the Confidential Information or whether
any legal exceptions to notification apply;
h. SUBRECIPIENT's recommendation for SPAG's approval as to the steps Individuals and/or
SUBRECIPIENT on behalf of individuals, should take to protect the Individuals from potential harm,
including without limitation SUBRECIPIENT's provision of notifications, credit protection, claims
monitoring, and any specific protections for a Legally Authorized Representative to take on behalf of an
Individual with special capacity or circumstances;
i. The steps SUBRECIPIENT has taken to mitigate the harm or potential harm caused (including
without limitation the provision of sufficient resources to mitigate);
j. The step SUBRECIPIENT has taken, or will take, to prevent or reduce the likelihood of
recurrence of a similar Event or Breach;
k. Identify, describe or estimate of the Persons, Workforce, Subcontractor, or Individuals and any
law enforcement that may be involved in the Event or Breach;
1. A reasonable schedule for SUBRECIPIENT to provide regular updates to the foregoing in the
future for response to the Event or Breach, but no less than every three (3) business days or as otherwise
directed by SPAG, including information about risk estimations, reporting, notification, if any, mitigation,
corrective action, root cause analysis and when such activities are expected to be completed; and
in. Any reasonably available, pertinent information, documents or reports related to an Event or
Breach that SPAG requests following Discovery.
Section 4.02 Investigation, Response and Mitigation. For A-F below: 45 CFR 164.308, 310 and 312;
164.530
(A) SUBRECIPIENT will immediately conduct a full and complete investigation, respond to
the Event or Breach, commit necessary and appropriate staff and resources to expeditiously respond and
SPAG Data Use Agreement V.1 HIPPA Omnibus Compliant April 2017
Page 8 of 12
SPAG Agreement No. 83124-19-A100
report as required to and by SPAG for incident response purposes and for purposes of SPAG's compliance
with report and notification requirements, to the satisfaction of SPAG.
(B) SUBRECIPIENT will complete or participate in a risk assessment as directed by SPAG
following an Event or Breach, and provide the final assessment, corrective actions and mitigations to SPAG
for review and approval.
(C) SUBRECIPIENT will fully cooperate with SPAG to respond to inquiries and/or
proceedings by state and federal authorities, Persons and/or Individuals about the Event or Breach.
(D) SUBRECIPIENT will fully cooperate with SPAG's efforts to seek appropriate injunctive
relief or otherwise prevent or curtail such Event or Breach, or to recover or protect any Confidential
Information, including complying with reasonable corrective action or measures, as specified by SPAG in
a Corrective Action Plan if directed by SPAG under the Subrecipient agreement.
Section 4.03 Breach Notification to Individuals and Reporting to Authorities, Tex. Bus. & Comm.
Code §521.053; 45 CFR 164.404 (Individuals), 164.406 (Media); 164.408 (Authorities)
(A) SPAG may direct SUBRECIPIENT to provide Breach notification to Individuals,
regulators or third -parties, as specified by SPAG following a Breach.
(B) SUBRECIPIENT must obtain SPAG's prior written approval of the time, manner and
content of any notification to Individuals, regulators or third -parties, or any notice required by other state
or federal authorities. Notice letters will be in SUBRECIPIENT's name and on SUBRECIPIENT's
letterhead, unless otherwise directed by SPAG, and will contain contact information, including the name
and title of SUBRECIPIENT's representative, an email address and a toll -free telephone number, for the
Individual to obtain additional information.
(C) SUBRECIPIENT will provide SPAG with copies of distributed and approved
communications.
(D) SUBRECIPIENT will have the burden of demonstrating to the satisfaction of SPAG that
any notification required by SPAG was timely made. If there are delays outside of SUBRECIPIENT's
control, SUBRECIPIENT will provide written documentation of the reasons for the delay.
(E) If SPAG delegates notice requirements to SUBRECIPIENT, SPAG shall, in the time and
manner reasonably requested by SUBRECIPIENT, cooperate and assist with SUBRECIPIENT's
information requests in order to make such notifications and reports.
ARTICLE 5. SCOPE OF WORK
Scope of Work means the services and deliverables to be performed or provided by
SUBRECIPIENT, or on behalf of SUBRECIPIENT by its Subcontractors or agents for SPAG that are
described in detail in the Subrecipient agreement. The Scope of Work, including any future amendments
thereto, is incorporated by reference in this DUA as if set out word-for-word herein.
ARTICLE 6. GENERAL PROVISIONS
Section 6.01 Ownership of Confidential Information
SUBRECIPIENT acknowledges and agrees that the Confidential Information is and will remain
the property of SPAG. SUBRECIPIENT agrees it acquires no title or rights to the Confidential Information.
SPAG Data Use Agreement V.1 HIPPA Omnibus Compliant April 2017
Page 9 of 12
SPAG Agreement No. 83124-19-A100
Section 6.02 SPAG Commitment and Obligations
SPAG will not request SUBRECIPIENT to create, maintain, transmit, use or disclose PHI in any
manner that would not be permissible under applicable law if done by SPAG.
Section 6.03 SPAG Right to Inspection
At any time upon reasonable notice to SUBRECIPIENT, or if SPAG determines that
SUBRECIPIENT has violated this DUA, SPAG, directly or through its agent, will have the right to inspect
the facilities, systems, books and records of SUBRECIPIENT to monitor compliance with this DUA.
Section 6.04 Term; Termination of DUA; Survival
This DUA will be effective on the date on which SUBRECIPIENT executes the DUA, and will
terminate upon termination of the Subrecipient agreement and as set forth herein. If the Subrecipient
agreement is extended or amended, this DUA is updated automatically concurrent with such extension or
amendment.
(A) SPAG may immediately terminate this DUA and Subrecipient agreement upon a material
violation of this DUA.
(B) Termination or Expiration of this DUA will not relieve SUBRECIPIENT of its obligation
to return or Destroy the Confidential Information as set forth in this DUA and to continue to safeguard the
Confidential Information until such time as determined by SPAG.
(C) If SPAG determines that SUBRECIPIENT has violated a material term of this DUA; SPAG
may in its sole discretion:
I. Exercise any of its rights including but not limited to reports, access and inspection under
this DUA and/or the Subrecipient agreement; or
2. Require SUBRECIPIENT to submit to a corrective action plan, including a plan for
monitoring and plan for reporting, as SPAG may determine necessary to maintain
compliance with this DUA; or
3. Provide SUBRECIPIENT with a reasonable period to cure the violation as determined by
SPAG; or
4. Terminate the DUA and Subrecipient agreement immediately, and seek relief in a court of
competent jurisdiction in Lubbock County, Texas.
Before exercising any of these options, SPAG will provide written notice to
SUBRECIPIENT describing the violation and the action it intends to take.
(D) If neither termination nor cure is feasible, SPAG shall report the violation to HHS.
(E) The duties of SUBRECIPIENT or its Subcontractor under this DUA survive the expiration
or termination of this DUA until all the Confidential Information is Destroyed or returned to SPAG, as
required by this DUA.
Section 6.05 Governing Law, Venue and Litigation
SPAG Data Use Agreement V.1 HIPPA Omnibus Compliant April 2017
Page 10 of 12
SPAG Agreement No. 83124-19-A100
(A) The validity, construction and performance of this DUA and the legal relations among the
Parties to this DUA will be governed by and construed in accordance with the laws of the State of Texas.
(B) The Parties agree that the courts of Lubbock County, Texas, will be the exclusive venue
for any litigation, special proceeding or other proceeding as between the parties that may be brought, or
arise out of, or in connection with, or by reason of this DUA.
Section 6.06 Injunctive Relief
(A) SUBRECIPIENT acknowledges and agrees that SPAG may suffer irreparable injury if
SUBRECIPIENT or its Subcontractor fail to comply with any of the terms of this DUA with respect to the
Confidential Information or a provision of HIPAA or other laws or regulations applicable to Confidential
Information.
(B) SUBRECIPIENT further agrees that monetary damages may be inadequate to compensate
SPAG for SUBRECIPIENT's or its Subcontractor's failure to comply. Accordingly, SUBRECIPIENT
agrees that SPAG will, in addition to any other remedies available to it by law or in equity, be entitled to
seek injunctive relief without posting a bond and without the necessity of demonstrating actual damages,
to enforce the terms of this DUA.
Section 6.07 Insurance
(A) SUBRECIPIENT represents and warrants that it maintains either self-insurance or
commercial insurance with policy limits sufficient to cover any liability arising from any acts or omissions
by SUBRECIPIENT or its employees, directors, officers, Subcontractors, or agents or other members of its
Workforce under this DUA. SUBRECIPIENT warrants that SPAG will be a loss payee and beneficiary for
any such claims.
(B) SUBRECIPIENT will provide SPAG with written proof that required insurance coverage
is in effect, at the request of SPAG.
Section 6.08 Fees and Costs
Except as otherwise specified in this DUA or the Subrecipient agreement, including but not limited
to requirements to insure and/or indemnify SPAG, if any legal action or other proceeding is brought for the
enforcement of this DUA, or because of an alleged dispute, contract violation, Event, Breach, default,
misrepresentation, or injunctive action, in connection with any of the provisions of this DUA, each party
will bear their own legal expenses and the other cost incurred in that action or proceeding.
Section 6.09 Entirety of the Contract
This Data Use Agreement is incorporated by reference into the Subrecipient agreement and, together with
the Subrecipient agreement, constitutes the entire agreement between the parties. No change, waiver, or
discharge of obligations arising under those documents will be valid unless in writing and executed by the
party against whom such change, waiver, or discharge is sought to be enforced.
Section 6.10 Automatic Amendment and Interpretation
Upon the effective date of any amendment or issuance of additional regulations to HIPAA, or any
other law applicable to Confidential Information, this DUA will automatically be amended so that the
obligations imposed on SPAG and/or SUBRECIPIENT remain in compliance with such requirements. Any
ambiguity in this DUA will be resolved in favor of a meaning that permits SPAG and SUBRECIPIENT to
comply with HIPAA or any other law applicable to Confidential Information.
SPAG Data Use Agreement V.1 HIPPA Omnibus Compliant April 2017
Page 11 of 12
SPAG Agreement No. 83124-19-A100
ARTICLE 7. AUTHORITY TO EXECUTE
The Parties have executed this DUA in their capacities as stated below with authority to bind their
organizations on the dates set forth by their signatures.
IN WITNESS HEREOF, SPAG and SUBRECIPIENT have each caused his DUA to be signed and
delivered by its daily authorized representative.
SOUTH PLAINS ASSOCIATION OF GOVERNMENTS
AREA NC7WAR GING
BY:
NAME: Tim C. Pierce
TITLE: Executive Director
DATE: 1) S LAd Z ! k
SUBRECIPIENT
BY:
NAME: Daniel M. Pope
TITLE: Mayor
DATE: September 27, 2018
SPAG Data Use Agreement V.1 HIPPA Omnibus Compliant April 2017
Page 12 of 12
Garza
Abbroved as to Content:
T3ridget Faulkenberry
Parks and Recreation
Approved as to Form:
RyA B oke
Assis t City Attorney
7/30/201810:43 AM Submission #1 771
Texas Health and Human Services
Uniform Rate Negotiation Workbook/Budget
Federal Contract Period: 10-01-18 / 09-30-19
AAA Provider Only
Nutrition Providers Legal Business Name: City of Lubbock
Street Address: 1626 13th Street, Lubbock, TX 79401
Mailing Address: PO Box 2000
City: Lubbock
Zip Code: 79457
Phone Number: 806-775-2685
E-mail Address: nneill@mylubbock.us
Contact Name: Nancy Neill
Nutrition Providers website address: www.playlubbock.com
this Nutrition provider complete a rate setting workbook last year?
as, what was the provider name listed on the workbook?
Is the Provider a AAA Provider?
Yes
Yes
City of Lubbock
0
If Yes, select the AAA Name: Area Agency on Aging of South Plains
If Yes, contact name at AAA: Liz Castro
If Yes, is it a contract or subrecipient? Subrecipient
Is the Provider a HHS Contracted Community Services Provider? No
If Yes, Contract Manager name at HHS Contracted Community Services:
If Yes, select the HHS Region Number:
If Yes, enter the HHS contract number:
s Delivery Information
Delivered Meals
Does this Nutrition provider serve home delivered meals paid for by HHS or the AAA?
Does this Nutrition provider have an approved Home Delivered Nutrition Waiver for 2018?
Is this Nutrition provider requesting a Home Delivered Nutrition Waiver for 2019?
Total number of home delivered meal routes for this provider: _
Total number of meal preparation sites used by this provider: _
Congregate Meals
Does this Nutrition provider serve congregate meals paid for by the AAA?
Does this Nutrition provider have an approved Congregate Nutrition Waiver for 2018?
Is this Nutrition provider requesting a Congregate Waiver for 2019?
Total number of meal preparation sites used by this provider:
Total number of meal sites used by this provider:
No
No
No
Yes
No
No
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7/30/2018 10:44 AM
Provider Name: City of Lubbock
AAA Name: Area Agency on Aging of South Plains
Region Number: 0
Type of Provider: AAA Provider Only
Provider Service Area
This section is used to identify the nutrition provider's service area for IFFY 2019. This will assist HHS
in defining unserved areas of the state.
Please specify the provider's service area by geographical location (county, city, zip code, etc.) If the
provider serves an entire county, record the name of the county. City, zip code, and other
designations can be used when the provider agency is not serving an entire county.
Examples: 1) City of El Paso; 2) Harris County; 3) Two mile radius of the city limits of Rockdale and
Cameron; 4) City of Cedar Park, Leander Zip Codes 78745 and 78746.
Congregate Meals Service Area:
City of Lubbock
Home Delivered Meals - AAA Service Area:
n/a
Home -Delivered Meals - CSS Service Area:
7/30/2018 10:44 AM
Provider Name: City of Lubbock
AAA Name: Area Agency on Aging of South Plains
Region Number:
Section 1
This section is used to compare the amounts budgeted/allocated to each program by cost area.
Example: What percent of the agencies personnel cost is budgeted/allocated to home delivered meals
versus congregate meals and other agency programs? The information should be used as a review tool to
gain an understanding of the agencies overall budget and operations.
Percentage of the Total Cost Area
Budgeted to:
Cost Area
Home
Delivered
Meals I
Congregate
Meals
Other
Programs
Total Personnel
0.00%1
18.50%
81.50%
Total Professional Development
0.00%
0.00%
0.00%
Total Raw Food
0.00%
0.00%
100.00%
Total Purchased Meals
0.00%
90.91%
9.09%
Total Freight
0.00%
0.00%
0.00%
Total Storage Cost
0.00%
0.00%
0.00%
Total Consumables
0.00%
15.16%
84.84%
Total Other Meal/Food
0.00%1
0.00%
0.00%
Total Meals/Food
0.00%
84.79%
15.21 %
Total Equipment
0.00%
0.00%
0.00%
Total Occupancy/Building
0.00%
8.03%
91.97%
Total Transportation/Travel
0.00%
0.00%
100.00%
Total Administrative & General
0.00%
24.62%
75.38%
Total of all Cost Areas
0.00%
32.73%
67.27%
Example of how to use this information:
Compare the percentage of total personnel budgeted to the meal programs and other programs. Based on
the percentages of total cost does the percentages appear reasonable and equitably distributed between
programs? If the percentages are not easily identified as equitable a further review of the salaries may be
necessary. There are many reasons for variances in percentage for example the agency may use volunteers
for some of the programs this may cause the overall percentages appear out of line.
REMEMBER: There are no right or wrong percentages. The reviewer through analysis of the budget and
discussions with the provider must determine if the allocation is acceptable.
The reviewers notes detailing budget review, discussions with the provider, and decisions made should be
included in the work file.
7/30/2018 10:44 AM
Provider Name: City of Lubbock
AAA Name: Area Agency on Aging of South Plains
Region Number:
Section 2
This section is a summary of information to use to analyze the cost and how they are allocated between Congregate and Home Delivered
Meals. The information is presented in three different ways:
• Total Cost: Amount budgeted by cost area
• Percentage of total cost: Percentage of the total of cost area for the two meal programs applied to each program
• Cost per unit: How much of the unit cost is used to pay for each cost area. $X.XX of the cost of each meal is for XX cost area.
Below the cost area summary information is additional information showing:
• Percentage of the total budgeted meal cost applied to the home delivered and congregate meal programs
• Percentage of the total budgeted meals (home Delivered & congregate) applied to the home delivered and congregate programs.
• Whole Unit rate for each meal program
• Calculated meal rate based on information entered on the home delivered and congregate meal budget worksheets.
Cost Area
Total Cost
Home
Delivered
Meals
Congregate
Meals
Total Personnel
83,554.41
Total Professional Development
-
Total Raw Food
-
Purchased Meals
Hot Prepared Meals Purchased from a
Supplier or Central Kitchen
146,320.00
Frozen Meals
-
Chilled Meals
Shelf Stable Meals
Total Consumables
1,850.00
Total Other Meat(Food
-
Total Meals/Food
148,170.00
Total Equipment
Total Occupancy/Building
7,119.94
Total Transportation/Travel
Total Administrative & General
4,827.94
Subtotal
243,672.29
Nutrition Education
Total
243,672.29
Percentage of Total Cost
Home
Delivered
Meals
Congregate
Meals
0.00%
100.00%
0.00%
0.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
160.00%
0.00%
0.00%
0.00%
100.00%
0.00%
0.00%
0.00%
1 100.00%
0.00%
1 100.00%
Total Bud eted Cost 1 0.001 243,672.29 243,672.29
Percentage of Total Budgeted Meal Cost 0.00% 100.00% 100.00%
Total -Budgeted Meals 1 01 29,500 29,500
Percenta a of Total Budgeted Meals 1 0.00%1 100.00% 1 100.00%
Whole Unit Rate Full Cost per Meal #DIV/0! 1 8.28
Calculated Rate I - 1 7.50
Cost er unit
Home
Delivered
Meals
Congregate
Meals
2.83
4.96
0.06
5.02
-
0.24
0.16
8.26
-
8.26
7/30/2018 10:44 AM
Provider Name: City of Lubbock
AAA Name: Area Agency on Aging of South Plains
Region Number:
Example of how to use this information:
Review each of the cost areas based on the three different ways the information is presented. Determine if the dollar amount is reasonable
for each of the cost areas. Is the percentage of the cost allocation between congregate and home delivered comparable to the percentage of
total budgeted meals for each program?
Review examples:
e Occupancy/Building cost is expected to be higher for congregate than home delivered because the home delivered program should only
be charged a share of the cost for the kitchen and delivery preparation area for the time those areas are used to prepare and disburse
meals. The congregate program would be charged a share of the cost for the kitchen area for the time those areas are used to prepare
meals and include the cost associated with the area used to consume meals.
e How are Personnel costs allocated between the two meal programs? Is the allocation based on the percentage of meals, percentage of
total cost, or actual time spent between the two programs?
e Review the cost per unit of raw food. Is the amount the same for both programs? If not, why are they different?
e Review the total cost per unit rates, are the rates for the programs similar? Because the program requirements are different, small
variances are expected. If the variances cannot be explained by program differences, you need to explain in your review papers why they
are different.
No Text
AAA Name: Area Agency on Aging of South Plains
Most Recent Completed Budget 2017
Year
Budget
miris" I Percentage I Peroentage
Printing
0
Copying
300.00
300.00
0
Office Supplies
0
Contractual Agreements
0
Postage
0
Telecommunications
1,237.45
1,237.45
0
Liability Insurance
431.94
431.94
0
Legal Fees
0
Accounting Fees
0
CormAirg Fees
0
Other Fees (Explain)
Asia
0
0
VwWwo (Provider Total Budgeted Congregate wde - I I
Review of Most Recent Completed Year Approved Budget to Actual Year End Expertse and Current Proposed
Proposed Budget
Percentage Variance
- Prior Year Actual to
Percentage of Unit
P B
Cost
1,980.00
0.00%
-
0.00%
300.00
0.00%
0.00%
0.00%
0.00%
1,325.03
7.08%
597.91
38.42%
0.00%
•
0.00%
0.00%
0.00%
o.00%
625.00
0.00%
4,827.94
5.54%
1.9td%
243,67229 1 -3,61% 100.00%
Explanation of variances
1. An explanation of variance must be provided for each coat area where the exPemm Per
General Ledger varies from the approved budget for the most recent completed Yew by 10%
or more; and
2. An explenetbn of variance must be provided for each cost area where the proposed budget
amount exceeds the Prior year actual amount by more than the two year combined inflation
2.70. Scheluded charges have increased for the coming Year.
7/25/18 4:54 PM
Provider Name: City of Lubbock
AAA Name: Area Agency on Aging of South Plains
Congregate Meals
BUDGET WORKSHEET CALCULATION OF THE PER MEAL UNIT RATE
1. Total Budgeted Expenses for Contract Year
2. Total Number of Anticipated Meals to be Provided by Funding Source
Other Funds
HHS OAAA 14,750 Eligible Meals 10,706 Other Sources 5 0
Other Funds -
Non -Eligible
Program Income 4,044 Meals 0 Other Sources 6 0
3. Whole Unit Rate (Line 1 divided by Line 2)
Reimbursement Calculation
HHS OAAA
4. Projected NSIP per Meal Value 0.69
5. Rate Less NSIP per Meal Value $ 7.57
6. Mandatory Local Match of 10% $ 0.76
** If Applicable, Match Reduction
From the In -kind Match
Certification form
Required Cash Match
$ 0.76
7. Proposed Meal Rate (Line 3 minus Line 6) $ 7.50
** If any portion of the required match is in -kind, you must complete an In -Kind Match Certification form.
By signing below, the provider acknowledges that all related records are subject to audit in accordance with
contract requirements and all applicable federal and state laws.
City of Lubbock
Legal Name of Contract P vider
��—J
Signature
Area Agency on Aging of South Plains
Name of Area Agency on Aging
Tim C. ierce
PritecNypedfyameo Signe
Signature
®8/pa // 2
Date
Daniel A Pope
Printed/Typed Name of Signer
September 27, 2018
Date
1. $ 243,672.29
2. 29,500
3. $ 8.26
Attest:
e ecca Garza
Cit -Secretary
Approved as to Content:
I b �h AA A I
ridget Faulkenberry
Parks and Recreation Direct r
Approved as to Fo
n ro ce
Assistant City Attorney
7/25/18 4:54 PM
Provider Name: City of Lubbock
AAA Name: Area Agency on Aging of South Plains
Congregate Meals
BUDGET WORKSHEET CERTIFICATION
AS SIGNER OF THIS BUDGET WORKSHEET, I HEREBY CERTIFY THAT:
• I have read the note below and the instructions applicable to this budget worksheet.
• I have reviewed this budget worksheet after its preparation.
• To the best of my knowledge and belief, this budget worksheet is true, correct and
complete, and was prepared in accordance with the instructions applicable to this
budget worksheet.
• This budget worksheet was prepared from the books and records of the contracted
provider.
• I acknowledge that all books and records related to this rate setting process are
subject to audit in accordance with contract requirements and all applicable federal
and state laws.
Note: The person legally responsible for the conduct of the contracted provider must
sign this Budget Worksheet Certification. If a sole proprietor, the owner
must sign the Budget Worksheet Certification. If a partnership, a partner must
sign the Budget Worksheet Certification. If a corporation, the person authorized by the
Board of Directors Resolution must sign the Budget Worksheet Certification.
Misrepresentation of information contained in the budget worksheet may result in
adverse action, up to and including contract termination. Furthermore, falsification of
information in the budget worksheet may result in a referral for prosecution.
City of Lubbock Daniel M. Pope
Name of Contracted Provider Printedfryped Name of Signer
September 27, 2018
Date Signature
Signer Authority: ❑ Sole Proprietor ❑ Association Officer
(check one) ❑ Partner ❑ Board Member
❑ Corporate Officer 14 Governmental Official
Attest:
kRe� ecca Garza arzaCity Secretary
A o Cont t:
Bridget Faulkenberry
Parks and Recreation Director
Approved as to Form:
Ry n roo e
Assistant City Attorney
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7/25/18 4:54 PM
Provider Name: City of Lubbock
AAA Name: Area Agency on Aging of South Plains
Transportation
BUDGET WORKSHEET CALCULATION OF THE UNIT RATE
1.Total Budgeted Expenses for Contract Year
2.Total Number of Anticipated Units to be Provided
HHS OAAA - 10 % Match
Program
Required 3,500
Income
HHS OAAA - 25 % Match
Local Funds -
Required 0
Eligible Trips
Other Funds -
Non -Eligible
HHS OAAA - Full Unit Rate 0
Trips
3. Cost per unit (Line 1 divided by Line 2) - Full Unit Rate
86 Other Sources 6 0
3,414 Other Sources 7
Other Sources 8
Reimbursement Calculation for Contracts Requiring Unit Rate Match Reduction
1. $ 72,836.67
2. 7,000
3. $ 10.41
4. Mandatory Local Match of 10% $ 1.04
** If Applicable, Match Reduction From the In -kind Match Certification form $
Required Match 4. $ 1.04
5.Full Unit Rate Less Required Match (Line 3 minus Line 4: 5. $ 9.37
4. Mandatory Local Match of 25% $ 2.60
** If Applicable, Match Reduction From the In -kind Match Certification form $
Required Match 4. $ 2.60
5.Full Unit Rate Less Required Match (Line 3 minus Line 4; 5. $ 7.81
**If any portion of the required match is in -kind, you must complete an In -Kind Match Certification form.
Contract Reimbursed at Full Cost Per Unit Rate. Match Requirements Will Be Met Through Provision of Additional Units
$ 10.41
Contractor Initial AAA Initial
Citv of Lubbock
Legal Name of Contrac ovider
Signature
Daniel M. Pope
Printed/Typed Name of Signer
September 27, 2018
Date
Area Agency on AgingAgLng of South Plains
ame o Are gen on Aging
Signature
Tim C. Pierce
Printed/Typed Name of Signer
Date
Attest:
f ) t6t,�
Re ecca Garza
City Secretary
Approved as to Content:
Bridget Faulkenberry
Parks and Recreation Directo
Approved as to Form:
roof e
Ass'stant City Attorney
7/25/18 4:54 PM
Provider Name: City of Lubbock
AAA Name: Area Agency on Aging of South Plains
Transportation
BUDGET WORKS EET CERTII+ICATION
AS SIGNER OF THIS BUDGET WORKSHEET, I HEREBY CERTIFY THAT:
® I have read the note below and the instructions applicable to this budget worksheet.
e I have reviewed this budget worksheet after its preparation.
® To the best of my knowledge and belief, this budget worksheet is true, correct and
complete, and was prepared in accordance with the instructions applicable to this
budget worksheet.
® This budget worksheet was prepared from the books and records of the contracted
provider.
® I acknowledge that all books and records related to this rate setting process are
subject to audit in accordance with contract requirements and all applicable federal
and state laws.
Note: The person legally responsible for the conduct of the contracted provider must
sign this Budget Worksheet Certification. If a sole proprietor, the owner
must sign the Budget Worksheet Certification. If a partnership, a partner must
sign the Budget Worksheet Certification. If a corporation, the person authorized by the
Board of Directors Resolution must sign the Budget Worksheet Certification.
Misrepresentation of information contained in the budget worksheet may result in
adverse action, up to and including contract termination. Furthermore, falsification of
information in the budget worksheet may result in a referral for prosecution.
City of Lubbock
Name of Contracted Provider
September 27, 2018
Date
Signer Authority: Sole Proprietor
(check one) El Partner
E] Corporate Officer
Daniel M. Pope
Printed/Typed Name of Signer
Signature
Association Officer
Board Member
Governmental Official
Attest: onte
eb cca Garza BridMFd6lk—en—berry
City ecretary Parks and Recreation Director
Approved as to Fo
y Bro e
Assistant City Attorney