MANDATED COMPLIANCE REVIEW PROCEDURES SOUTHEAST …

MANDATED COMPLIANCE REVIEW PROCEDURES

SOUTHEAST MISSOURI AREA AGENCY ON AGING CAPE GIRARDEAU, MISSOURI

FOR THE YEAR ENDED JUNE 30, 2015

SOUTHEAST MISSOURI AREA AGENCY ON AGING TABLE OF CONTENTS

Schedule

INDEPENDENT ACCOUNTANT'S REPORT ON APPLYING AGREED UPON PROCEDURES

Appendix A - Procedures and Findings

SUPPLEMENTAL SCHEDULES

Schedule of Units Provided and Persons Served 1-2 Schedule of Expenditures at Sties and Through Direct Services 3-6 Schedule of Program Income Received and Expended 7 Schedule of Expenditures Per Filed Reports 8 Schedule of Monthly Service and Expenditure Reports 9 Schedule of Contract Services and Providers 10 Schedule of Significant Contractor Monitoring Dates 11 Schedule of Compliance With DHSS Monitoring Requirements-

All Service Providers 12A Schedule of Compliance With DHSS Monitoring Requirements -

Nutrition Service Providers 12B Schedule of Compliance With DHSS Monitoring Requirements -

Transportation and In-Home Service Providers 12C

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SUITE 900 l 111 MAIN STREET KANSAS CITY'. MO 641 05 TELEPHONE (816) 221-4559 FACSIMILE: (816) 221-4563 EMAIL: ADMIN@MCBRIDELOCK COM CERTIFIED PUBLIC ACCOUNTANTS

McBRIDE, LOCK & ASSOCIATES, LLC

INDEPENDENT ACCOUNTANT'S REPORT ON APPLYING AGREED-UPON PROCEDURES

Missouri Department of Health and Senior Services Division of Senior and Disability Services Jefferson City, Missouri

and

The Board of Directors Southeast Missouri Area Agency on Aging, Inc. d/b/ a Aging Matters Cape Girardeau, Missouri

We have performed the prescribed procedures enumerated in Attachment #4 - Missouri Department of Health and Senior Services, Division of Senior and Disability Services - Mandated Compliance Review Procedures - State Fiscal Year 2015 (Attachment #4) related to Southeast Missouri Area Agency on Aging, Inc. d/b/a Aging Matters for the year ended June 30, 2015 and documented in Appendix A to this report, which were agreed to by the Missouri Department of Health and Senior Services, Division of Senior and Disability Services (DSDS) and Southeast Missouri Area Agency on Aging, Inc. (a Not-for-Profit Corporation), solely to assist the specified parties in evaluating Southeast Missouri Area Agency on Aging, Inc. 's compliance with the requirements set forth in Sections 4 through 10 of Attachment #4. Southeast Missouri Area Agency on Aging, Inc. is solely responsible for compliance with those requirements. This agreed-upon procedures engagement was conducted in accordance with attestation standards established by the American Institute of Certified Public Accountants and the standards applicable to attestation engagements contained in Government Auditing Standards issued by the Comptroller General of the United States. The sufficiency of these procedures is solely the responsibility of those parties specified in tills report. Consequently, we make no representation regarding the sufficiency of the procedures described in Attachment #4 either for the purpose for which this report has been requested or for any other purpose.

The procedures we applied and our findings are described in Appendix A to this report.

We were not engaged to, and did not conduct an examination, the objective of which would be the expression of an opinion on compliance. Accordingly, we do not express such an opinion. Had we performed additional procedures, other matters might have come to our attention that would have been reported to you.

This report is intended solely for the information and use of Missouri Department of Health and Senior Services, Division of Senior and Disability Services (DSDS) and Southeast Missouri Area Agency on Aging, Inc. and is not intended to be and should not be used by anyone other than these specified parties.

McBride, Lock & Associates, LLC April 6, 2016

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Southeast Missouri Area Agency on Aging Appendix A - Procedures and Findings

For the Year Ending June 30, 2015

Our procedures and findings are as follows:

Section 4 - Compliance Testing - Service and Expenditure Reporting Compliance Requirement: AAA's are required to submit to DSDS monthly reports for all services, by funding source.

4.2. Compliance Review Requirement: The auditor is required to review two monthly service and expenditure reports, and determine compliance with the following:

4.2.1. The reporting of service units and participants reconciles with supporting documentation service delivery records.

Finding: The total units of service and unduplicated persons reported on the February 2015 monthly service and expenditure report of 115,774 and 1,106, respectively, reconcile to supporting documentation of total units of service with no variances. The total units of service and unduplicated persons reported on the March 2015 monthly service and expenditure report of 150,664 and 1,188, respectively, reconcile to supporting documentation of total units of service with no variances. See Schedule 1 and 2.

4.2.2. The reporting of expenditures for each service and funding source reconciles to the general ledger and service reports from contract providers, as applicable.

Finding: Expenditures reported on the February 2015 monthly service and expenditure report for each service and funding source reconcile to the AAA's general ledger and service reports from contract providers with an immaterial variance of $1 in DSDS. Expenditures reported on the March 2015 monthly service and expenditure report for each service and funding source reconcile to the AAA's general ledger and service reports from contract providers with a variance of $17 4 in DSDS and $1 in In-Kind. $17 5 of DSDS -Public Education & Info expenditures per the general ledger were inadvertently not reported on the March 2015 MSER. See Schedule 3 through 6.

Section 5 - Compliance Testing - Monthly Program Income Reports Compliance Requirement: AAA's are required to submit a monthly report of AAA wide total program income activity. Data elements include fiscal year beginning balances, year to date program income collected, year to date program income expended, and balance as of the end of the reporting month.

5.1. Compliance Review Requirement: The auditor is required to review two monthly program income reports and determine compliance with the following:

5.1.1. Program income received reconciles with the AAA's general ledger, program income bank account reconciliations, and service reports from contract providers, as applicable.

Finding: Program income received per the February 2015 and March 2015 Monthly Program Income Reports reconciles with the AAA's general ledger, program income bank

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account reconciliations, and service reports from contract providers with no variances. See Schedule 7.

5.1.2. Program income expended reconciles with the AAA's general ledger and service reports from contract service providers.

Finding: Program income expended per the February 2015 and March 2015 Monthly Program Income Reports reconciles with the AAA's general ledger and service reports from contract service providers with no variances. See Schedule 7.

5.1.3. Program income beginning balances reconcile with the AAA prior year audit report, general ledger, and reports from contract service providers as applicable. Note: The program income beginning balances may differ slightly during the first few months of the fiscal year due to audit adjustments for the prior fiscal year made subsequent to the filing of the report. Beginning balances should agree with the audited financial statements for reports submitted after completion of the prior year audit report.

Finding: There was no beginning balance for program income.

Section 6 - Compliance Testing - Quarterly Line Item Expenditure Report Compliance Requirement: At the end of each calendar quarter, AAA's are required to report fiscal year to date line item expenditures for each service.

6.1. Compliance Review Requirement: At the end of each calendar quarter, AAA's are required to report fiscal year to date line item expenditures for each service.

6.1.1. Quarterly expenditure report reconciles with the AAA's general ledger and service reports from contract service providers, as applicable.

Finding: Quarterly expenditure report for the third quarter of fiscal year 2015 reconciles with the AAA's general ledger and service reports from contract service providers with an immaterial rounding variance of $1. See Schedule 8.

6.1.2. Quarterly expenditure report reconciles with the sum of the corresponding monthly expenditure reports by funding source.

Finding: Quarterly expenditure report for the third quarter of fiscal year 2015 reconciles with the sum of the corresponding monthly expenditure reports by funding source with the exception of the March 2015 monthly expenditure report. The difference of $3,654 is due to a revision made to the Third Quarter reported expenditures which was not made to the March 2015 monthly report. See Schedule 9.

Section 7 - Compliance Testing - Salaries Paid to Highly Compensated Personnel Compliance Requirement: AAA' s are required to identify budgeted salaries by position title with their Area Plan.

7.1. Compliance Review Requirement: With respect to salaries paid to AAA staff, the auditor is responsible for performing the following review:

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7.1.1. For positions paid $75,000 or more during the fiscal year, the auditor must review actual salary for compliance with budgeted salary amounts within the final approved Area Plan, and report any instance of salaries paid in excess of the approved budget.

Finding: We reviewed one position paid $75,000 or more during the year. The actual amount paid did not exceed the budgeted salary amount within the approved Area Plan.

7.1.2. For positions filled or vacated during the year, the auditor must review actual salary paid to positions with annualized salary rates of $75,000 for compliance with the budgeted salary within the final approved Area Plan, and report to DSDS any instance of salaries paid in excess of the approved budget.

Finding: There was one position filled or vacated with annualized rates of $75,000 or more during the year. The actual amount paid did not exceed budgeted salary amount within the approved Area Plan for this position.

7.1.3. The auditor must inquire to determine any "other compensation" afforded any individual and compare to "other compensation" disclosed in the final Area Plan. Other Compensation is defined as the fair market value of any benefit, service, item or use of an item, awarded to an employee, including board members, for their personal use that is not awarded to all other employees in the same degree. Other compensation in excess of the amounts in the Area Plan must be reported to DSDS.

Finding: No other compensation was reported in the AAA's general ledger or disclosed in the approved Area Plan.

Section 8 - Compliance Testing - Cost Allocations and Cost Allocation Plan Compliance Requirement: Expenditures incurred must be in accordance with Office of Management and Budget Cost Principles set forth within Circular A-87 or A-122, as applicable.

8.1 Compliance Review Requirements: The auditor must review AAA expenditures for allowability and allocability with applicable cost principles and determine such expenditures are consistent with the following:

8.1.1. Line item classification of the expenditures within the accounting records is consistent with the nature of the expenditures (e.g. personnel, supplies, contractual services, etc.)

Finding: A sample of 62 disbursements (payroll and non-payroll) was selected and the line item classification of expenditures within the accounting record was consistent with the nature of the expenditures for all items tested.

8.1.2. Financial statement reporting of expenditures 1s consistent with the nature of the expenditure.

Finding: Expenditures reported in the financial statements were consistent with the nature of the expenditure and the recording of transactions in the AAA's trial balance.

8.1.3. Costs are allocated to programs and service in accordance with the AAA's cost allocation plan filed in the final approved Area Plan document.

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Finding: A sample of 62 disbursements (payroll and non-payroll) was selected and all costs were allocated to programs and services in accordance with the AAA's cost allocation plan filed in the final approved Area Plan.

Section 9 - Compliance Testing - Federal Reversionary Interest in Senior Centers Compliance Requirement: The Federal Government retains a reversionary interest in Multipurpose Senior Center (MSC) facilities acquired or constructed in whole or in part with Federal funds, and is entitled to recover funds if, within the time frames outlined in Section 312 of the Older Americans Act (OAA), if the owner ceases to be a public or non-profit agency or organization or if the facility ceases to be used to provide services to senior citizens. The amount of recovery is the percentage of the current market value of the facility equal to the percentage of federal funds contributed to the original cost of the facility. This precept is set forth at OAA Section 312.

9.1 Compliance Review Requirements: With respect to AAA records of MSC facilities in existence between July 1, 2014 and June 30, 2015, the auditor is responsible for determining whether or not AAA records include documentation of all of the following information for all facilities acquired or constructed with OAA and related resources:

9.1.1. The owner of the MSC and organizational structure of the owner of the MSC (public or non-profit agency or organization).

9.1.2. The location of the MSC.

9.1.3. The date of acquisition or completion of construction.

9.1.4. The total acquisition or construction cost.

9.1.5. The amount of the acquisition or construction cost funded from OAA and related funding.

9.1.6. The date the MSC ceased to be owned by a public or non-profit private agency or organization, where applicable.

9 .1. 7. The total fair market value on the date the MSC ceased to be owned by a public or nonprofit private agency or organization, if subject to OAA Section 312 recapture requirements.

9.1.8. The date the facility ceased to be used as a MSC, where applicable.

9.1.9. The total fair market value on the date the facility ceased to be used as a MSC, if subject to OAA Section 312 recapture requirements.

Finding: No Multipurpose Senior Center facilities acquired or constructed with OAA resources were in existence between July 1, 2014 and June 30, 2015.

9 .2. Compliance Review Requirements: With respect to MSC facilities in existence between July 1, 2014 and June 30, 2015 acquired or constructed in whole or in part with AAA resources received from DHSS, the auditor is responsible for determining:

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9.2.1. Whether or not each facility was used as a MSC, and where applicable, the date any facility ceased to be used as a MSC.

9.2.2. Whether or not the owner of each facility was either a public or non-profit agency or organization.

9.2.3. Whether or not the owner of any facility ceased to be a public or non-profit agency or organization between July 1, 2014 and June 30, 2015.

9.2.4. Whether or not any AAA resources received from DHSS for acquisition or construction of MSC facilities were subject to Older Americans Act (OAA) Section 312 recapture requirements during the period July 1, 2014 through June 30, 2015.

Finding: No Multipurpose Senior Center facilities acquired or constructed with OAA resources were in existence between July 1, 2014 and June 30, 2015.

9.3 Compliance Review Requirements: With respect to funds subject to OAA Section 312 recapture requirements, auditor is responsible for determining:

9.3.1. The date and amount refunded to DHSS by payment or adjustment through the monthly service and expenditure report, credit and/or

9.3.2. A written waiver of the recapture of the OAA Section 312 recapture requirement has been granted by the U.S. Commissioner on Aging.

Finding: There were no funds subject to OAA Section 312 recapture requirements.

9.4 Compliance Review Requirements: OAA Section 312 Recordkeeping. The auditor is responsible for determining AAA complfance with record keeping required by Section 312 of the Older American's Act, and providing one of the following assurances:

9.4.1 The AAA's records include all Multipurpose Senior Center information referenced in the Missouri Division of Senior Disability Services Mandated Compliance Review Procedures for all centers in existence at any time during the period July 1, 2014 through June 30, 2015, or,

9.4.2 The AAA's records do not include all Multipurpose Senior Center Information referenced in the Missouri Division of Senior and Disability Services Mandated Compliance Review Procedures for all Centers in existence at any time during the period July 1, 2014 through June 30, 2015 (in such instances the report document must include a written listing of all instances of noncompliance), or,

9.4.3 There were no MSC's in existence between July 1, 2014 and June 30, 2015, which were acquired or constructed with AAA resources received from DSDS.

Finding: There were no MSC's in existence between July 1, 2014 and June 30, 2015, which were acquired or constructed with AAA resources received from DSDS.

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9.5 Compliance Review Requirements: With respect to OAA Section 312 recapture of funds, the auditor is responsible for providing one of the following assurances:

9.5.1 All AAA resources received from DSDS and subject to OAA Section 312 recapture requirements between July 1, 2014 and June 30, 2015 have either been refunded to DSDS or reported to DSDS as a credit adjustment consistent with OAA Section 312 recapture requirements, or a written waiver of the OAA Section 312 recapture requirement has been granted by the U.S. Commissioner on Aging, or

9.5.2 All AAA resources received from DSDS and subject to OAA Section 312 recapture requirements between July 1, 2014 and June 30, 2015 have not been refunded to DSDS or reported to DSDS as an adjusting credit consistent with OAA Section 312 recapture requirements, nor has a written waiver of the OAA Section 312 recapture requirement been granted by the U.S. Commissioner on Aging, (in such instances the practitioner is responsible for providing within the report document a written listing of all instances of noncompliance), or,

9.5.3 No MSC, acquired or constructed with AAA resources received from DSDS, ceased operations as a MSC or ceased to be owned by a public or non-profit agency or organization between July 1, 2014 and June 30, 2015.

Finding: No MSC, acquired or constructed with AAA resources received from DSDS, ceased operations as a MSC or ceased to be owned by a public or non-profit agency or organization between July 1, 2014 and June 30, 2015.

Section 10 - Monitoring Direct Services and Subrecipients Compliance Requirement: AAA' s are required to provide adequate oversight of service delivery and perform annual assessments of each contractor and direct service location.

10.1 Compliance Review Requirements. The audit firm is responsible for:

10.1.1. Reviewing the AAA's monitoring system for the criteria below.

10.1.2. Reviewing supporting documentation of AAA monitoring efforts representing at least 20% of the AAA service providers for compliance with criteria listed below, with the sample representing files from at least 20% of each of the following contract and direct service locations: congregate and home delivered nutrition, legal services, transportation, and inhome services.

Finding: Schedule 10 identifies the providers selected for testing to satisfy the 20% sample requirement.

10.2. Determine if procedures are in place and annual on-site monitoring were performed for each contract and direct service, which includes:

10.2.1. Control listing is maintained showing the status of the AAA's monitoring efforts.

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Finding: A control listing is maintained that identifies the status of the AAA's monitoring efforts. See Schedule 11 for a listing of important monitoring dates for the 20% of contract service providers that were tested.

10.2.2. Control listing includes all contract and direct services, and providers.

Finding: The AAA's control listing includes all contract and direct service providers.

10.2.3. Review of AAA documentation for at least 20% of the contract and direct service providers, to ensure:

10.2.3.1. The monitoring process includes written documentation to support a review, on a test basis, of each of the following components for each direct and contract service:

A. Billings and service reports are supported by, and in agreement with, service delivery records (signature sheets, route sheets, service logs, etc.).

B. Service participants meet eligibility criteria.

C. Service participants are reassessed, where applicable.

D. Service participant data is in NapisPak, as applicable.

E. Participant Contributions:

1. Participants afforded opportunity to contribute. 2. Contribution system is voluntary and confidential. 3. Recorded on date of receipt. 4. Counted by 2 persons, (preferable volunteers) 5. Deposited timely (daily, or as per waiver). 6. Cash count record agrees with deposit slip, and bank statement.

F. Safeguards are in place to ensure client confidentiality.

G. Employee background screenings are completed, where applicable.

H. Service providers have a written grievance procedure for participants.

I. Service providers are infonned on recognizing and reporting abuse and neglect of program participants.

Finding: Monitoring process of all transportation, in-home and legal service providers includes written documentation to support review, on a test basis, of all of the above components. Monitoring process of nutrition service providers includes written documentation to support a review, on a test basis, of all of the above components except for employee background screenings for the Fredericktown, Park Hills, Qulin, and Williamsville Senior Centers which were marked as "unknown" or left blank on the fiscal monitoring assessment. See Schedule 12A.

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Agency Response: The fiscal officer position was in transition during the time frame fiscal assessments were completed. The agency will develop a quality review process to ensure all monitoring steps have been performed and documented.

10.2.4. The AAA has a system to ensure compliance with the Americans with Disabilities Act, as set forth in the assurance section of the agency's currently approved Area Plan.

Finding: The AAA has a system implemented to ensure compliance with the Americans with Disabilities Act. The AAA requires each service provider to identify access barriers and remove any easily correctable barriers. A written corrective action plan must be updated on an annual basis to address any instances where facilities are not barrier free. The AAA must obtain a waiver from DSDS for any service providers that are not barrier free.

10.2.5. The AAA has a system to ensure OMB Circular A-133 audits are performed for subrecipients, or the AAA has some form of positive assurance that the sub-recipient is not required to have an A-133 audit.

Finding: The AAA has a system implemented to ensure OMB Circular A-133 audits are performed for sub-recipients or has positive assurance that the sub-recipients are not required to have an A-133 audit.

10.2.6. The AAA has a system to ensure OMB Circular A-133 or other audits are submitted to the AAA for review and follow up on findings or questioned costs related to an AAA funded service.

Finding: The AAA has a system implemented to ensure OMB Circular A-133 or other audits are submitted to the AAA for review and follow up on findings or questioned costs related to an AAA funded service.

10.2.7. A written report, with findings, recommendations, and required corrective action, is issued to each service provider or direct service manager.

Finding: The AAA issues a written report, with findings, recommendations and required corrective action to each service provider or direct service manager tested. See Schedule 11.

10.2.8. The written report is issued in a timely manner (generally within 45-60 days).

Finding: The AAA issued written reports in a timely manner to all transportation, in-home and legal service providers. The AAA issued two written reports for each nutrition service provider tested. The two reports address separate areas of the compliance supplement. The nutrition monitoring reports tested were issued to each service provider within 45-60 days. The fiscal monitoring reports tested all exceeded the 45-60 day requirement. See Schedule 11.

Agency Response: The fiscal officer position was in transition during the time frame the written reports were being completed. The agency will develop a quality review process to ensure all monitoring reports are issued timely.

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10.3. Additional Compliance Review Requirements - Nutrition: The audit firm is responsible for reviewing the AAA's monitoring systems and files to determine AAA monitoring includes a review of the following criteria with respect to nutrition service providers:

10.3.1. Annual sanitation inspection conducted within the last year.

Finding: AAA examined each service provider selected to ensure an annual sanitation inspection was conducted within the last year.

10.3.2. Sanitation inspection deficiencies corrected within the last year.

Finding: AAA examined each service provider selected to ensure sanitation inspection deficiencies were corrected within the last year.

10.3.3. Annual fire inspection conducted within the last year.

Finding: AAA examined each service provider selected to ensure an annual fire inspection was conducted within the last year.

10.3.4. Fire inspection deficiencies corrected and documented.

Finding: AAA examined each service provider selected to ensure fire inspection deficiencies were corrected and documented within the last year.

10.3.5. Compliance with all state or local fire safety laws including review of:

A. Adequate number of smoke detectors and/ or fire extinguishers.

B. Written safety and evacuation plans.

Finding: AAA examined each service provider selected to ensure compliance with all state and local fire safety laws including number of smoke detectors and fire extinguishers and written safety and evacuation plans.

10.3.6. Records showing specific personnel designated and trained for emergencies during all hours of operation that have completed training courses in:

A. Basic first aid;

B. Cardiopulmonary resuscitation (CPR); and

C. Heimlich maneuver

Finding: AAA examined records for each service provider selected to ensure personnel have completed training courses in basic first aid, cardiopulmonary resuscitation (CPR) and Heimlich maneuver.

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10.3.7. Training requirements met by staff:

A. Administrator (16 hours)

B. Cook (8 hours)

C. Assistant Cook ( 4 hours)

Finding: AAA examined each service provider selected to ensure training requirements have been met.

10.3.8. Perpetual and physical inventory records for all foods.

Finding: AAA examined each service provider selected to ensure perpetual and physical inventory records for all foods are kept.

10.3.9. Process to ensure menus meet 1/3 RDA and U.S. Dietary Guidelines and are certified by an R.D. or Nutritionist.

Finding: AAA examined each service provider selected to ensure menus meet 1/3 RDA and U.S. Dietary Guidelines and are certified by an R.D. or Nutritionist.

10.3.10. Records showing temperature logs maintained for:

A. Hot food items at or above 140° F.

B. Cold food items at or below 41° F.

C. Refrigerator at or below 41° F.

D. Freezers at or below 0° F.

Finding: AAA examined each service provider selected to ensure hot food items are at or above 140° F, cold items are at or below 41° F, refrigerators are at or below 41° F and freezers are at or below 0° F.

10.3.11. Review of home delivered meal route records to ensure meals are delivered within 4 hours.

Finding: AAA examined each service provider selected to ensure home delivered meals are delivered within 4 hours.

10.3.12. Appropriate food samples taken.

Finding: AAA examined each service provider selected to ensure appropriate food samples are taken.

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10.3.13. Cleaning schedule in place.

Finding: AAA examined each service provider selected to ensure cleaning schedules are in place.

10.3.14. Insulated carriers used to transport home delivered meals.

Finding: AAA examined each service provider selected to ensure insulated carriers are used to transport home delivered meals.

10.3.15. The service provider has a method for documenting domestic food purchases equal to the NSIP funding received.

Finding: AAA examined service providers selected to ensure service providers selected have a method for documenting domestic food purchases equal to the NSIP funding received.

10.4. Additional Compliance Review Requirements - Transportation: The audit firm is responsible for reviewing the AAAs monitoring systems and files to determine AAA monitoring includes a review of the following criteria with respect to transportation service providers:

10.4.1. No further review of service standards are required for services provided through public mass-transit systems. Reliance is placed on authorities regulating the provision of mass transit services.

Finding: Not applicable.

10.4.2. Public non-profit transit providers and Private for-hire providers:

A. Valid local taxi cab vehicle license, where applicable.

B. Vehicle is licensed (state).

C. Vehicle is insured within state and local minimums.

D. Driver has a current CDL or Class E license (vans).

E. Annual driver's license check.

F. Criminal background screening at time of employment.

Note: If any of the above requirements are covered by local taxi licensing ordinance, reliance may be placed upon the taxi license.

Finding: AAA examined service providers selected to ensure providers have valid local taxicab vehicle licenses, vehicles are licensed, vehicles are insured within state and local minimums, drivers have current CDL or Class E license, an annual driver's license check is conducted and criminal background screenings are conducted at time of employment.

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10.4.3. P1ivate Volunteer individual providers:

A. Vehicle is licensed.

B. Vehicle is insured within state and local minimums.

C. Current Class Operators license.

D. Annual driver's license check.

E. Criminal background screening at time of enrollment.

F. Enrolled with Family Care Safety registry.


10.4.4. Consumer Directed Transportation

A. Client uses a provider who is enrolled with the AAA, or

B. AAA obtains a signed waiver from the client, that they have been encouraged to have their provider enrolled with the AAA, but have chosen to use a provider who has not been screened by the AAA.


10.5. Additional Compliance Review Requirements - In Home Services: The audit firm is responsible for reviewing the AAAs monitoring systems and files to determine AAA monitoring includes a review of the following criteria with respect to in-home services and service providers:

10.5.1. Employees display adequate identification for the program participant to view.

Finding: AAA examined service providers selected to ensure provider's employees display adequate identification for program participant to view.

10.5.2. In-home service workers/aides are prohibited from providing service to an immediate family member.

Finding: AAA examined service providers selected to ensure provider's employees are prohibited from providing service to an immediate family member.

10.5.3. A written copy of the client's rights is reviewed with the client.

Finding: AAA examined service providers selected to ensure providers review a written copy of the client's rights with the clients.

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10.5.4. Review of Workers records for each of the following:

A. Application, signed by the employee, with proof of meeting the following criteria:

1. 18 years of age; 2. Ability to read, write, and follow instructions; 3. 6 months paid experience as an agency homemaker, nurse aide, maid, or household

worker; or I -year experience, paid or unpaid, in caring for children, sick or aged individuals, or successfully completed formal training in nursing arts, nurse aid, or in-home aid.

4. Registered with the Family Care Safety Registry. RSMo 210.900 through RSMo 210.936

B. At least two creditable references.

C. Training records, which indicate the following requirements have been met:

1. 20 hours of orientation, or 2 hours orientation to the provider agency, including protocol for handling emergencies, within 3 0 days of employment, or 8 hours of classroom training prior to the first day of client contact, or Training on Alzheimer's disease, and other related dementia, and methods of communicating with persons with dementia, pursuant to the requirements of RSMo 660.050(22)8.

2. 10 hours annual in-service training after the first 12 months of employment.

D. Annual performance evaluation, which includes an on-site review of the worker in the performance of their duties.

E. Statement signed by the worker, indicating they have received and reviewed the following information:

1. Client's rights; 2. Code of ethics; 3. Provider's policy regarding confidentiality of client information.

F. Position Description

G. Documentation of Employee Disqualification List, and criminal background screenings, and the individual has not been disqualified as a result of the screening.

Finding: AAA examined worker's records of service providers selected to ensure records included an appropriate application, two credible references, training records, annual performance evaluations, position descriptions, criminal background screenings and statements signed by workers indicating they have received and reviewed the client's rights, code of ethics and client confidentiality agreement.

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Schedule 1

SEAAA SEAAA

February 2015 Supporting February 2015 Supporting

Program MSER Documents Difference MSER Documents Difference

ADMINISTRATION

Admin - - - - - -

SUPPORT SERVICES

Transportation 6,778 6,778 - 169 169 -

Info & Assistance 2,180 2,180 - - - -

Homemaker 555 555 - 1 1 -

Legal 60 60 - 7 7 -

Case Management 36 36 - 27 27 -

Personal Care 137 137 - - - -

Public Education & Info - - - - - -

RSVP 1,954 1,954 - - - -

Counseling - - - - - -

Care Transition Services 62 62 - 11 11 - -

OMBUDSMAN

Ombudsman - - - - - - -

NUTRITION

Congregate 22,256 22,256 - 606 606 -

Home Delivered 80,693 80,693 - 238 238 - -

DISEASE PREVENTION AND

HEALTH PROMOTION

Evidence Based Med Mgmt 89 89 - 7 7 - -

FAMILY CAREGIVERS

Respite 252 252 - 1 1 -

Day Care 632 632 - - - -

Case Mgmt 65 65 - 17 17 -

Info & Assistance 4 4 - 1 1 -

Sup. Services - Nutritional Supplies 5 5 - 5 5 -

Sup. Services - Personal Supplies 16 16 - 16 16 - -

SPECIAL

MIPPA - - - - - -

CDSMP - - - - - -

TOTAL 115,774 115,774 - 1,106 1,106 -

UNITS PROVIDED UNDUPLICATED PERSONS SERVED

For the Year Ended June 30, 2015

SCHEDULE OF UNITS PROVIDED AND PERSONS SERVED

Southeast Missouri Area Agency on Aging

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Schedule 2

SEAAA SEAAA

March 2015 Supporting March 2015 Supporting

Program MSER Documents Difference MSER Documents Difference

ADMINISTRATION

Admin - - - - - -

SUPPORT SERVICES

Transportation 8,066 8,066 - 162 162 -

Info & Assistance 551 551 - - - -

Homemaker 615 615 - 1 1 -

Legal 83 83 - 10 10 -

Case Management 45 45 - 17 17 -

Personal Care 148 148 - - - -

Public Education & Info - - - - - -

RSVP 14,850 14,850 - - - -

Counseling - - - - - -

Care Transition Services 39 39 - 2 2 - -

OMBUDSMAN

Ombudsman - - - - - - -

NUTRITION

Congregate 28,720 28,720 - 609 609 -

Home Delivered 96,498 96,498 - 333 333 - -


HEALTH PROMOTION

Evidence Based Med Mgmt 132 132 - 6 6 - -

FAMILY CAREGIVERS

Respite 254 254 - 2 2 -

Day Care 520 520 - - - -

Case Mgmt 114 114 - 24 24 -

Info & Assistance 5 5 - - - -

Sup. Services - Nutritional Supplies 3 3 - 2 2 -

Sup. Services - Personal Supplies 21 21 - 20 20 - -

SPECIAL

MIPPA - - - - - -

CDSMP - - - - - -

TOTAL 150,664 150,664 - 1,188 1,188 -


SCHEDULE OF UNITS PROVIDED AND PERSONS SERVED


UNITS PROVIDED UNDUPLICATED PERSONS SERVED

17

General Ledger General Ledger General Ledger

February 2015 via February 2015 via February 2015 via

MSER Financial Statements Difference MSER Financial Statements Difference MSER Financial Statements Difference

ADMINISTRATION

Admin 18,532$ 18,532$ -$ 1,650$ 1,650$ -$ -$ -$ -$

TOTAL 18,532$ 18,532$ -$ 1,650$ 1,650$ -$ -$ -$ -$

SUPPORT SERVICES

Transportation (20,559)$ (20,559)$ -$ 54,600$ 54,600$ -$ -$ -$ -$

Info & Assistance (3,669) (3,669) - - - - - - -

Homemaker 13,421 13,421 - - - - - - -

Legal 1,110 1,110 - - - - - - -

Case Management 5,519 5,519 - - - - - - -

Personal Care 3,019 3,019 - - - - - - -

Public Education & Info - - - - - - - - -

RSVP - - - - - - - - -

Counseling - - - - - - - - -

Care Transition Services - - - - - - - - -

TOTAL (1,159)$ (1,159)$ -$ 54,600$ 54,600$ -$ -$ -$ -$

OMBUDSMAN

Ombudsman 8,719$ 8,719$ -$ -$ -$ -$ -$ -$ -$

TOTAL 8,719$ 8,719$ -$ -$ -$ -$ -$ -$ -$

NUTRITION

Congregate 59,633$ 59,633$ -$ -$ -$ -$ -$ -$ -$

Home Delivered 150,384 150,384 - - - - 223,148 223,148 -

TOTAL 210,017$ 210,017$ -$ -$ -$ -$ 223,148$ 223,148$ -$


HEALTH PROMOTION

Evidence Based Med Mgmt 2,235$ 2,235$ -$ -$ -$ -$ -$ -$ -$

TOTAL 2,235$ 2,235$ -$ -$ -$ -$ -$ -$ -$

FAMILY CAREGIVERS

Respite 3,944$ 3,944$ -$ -$ -$ -$ -$ -$ -$

Day Care 1,084 1,083 1 - - - - - -

Case Mgmt 11,234 11,234 - - - - - - -

Info & Assistance - - - - - - - - -

Sup. Services - Nutritional Supplies 980 980 - - - - - - -

Sup. Services - Personal Supplies 3,109 3,109 - - - - - - -

TOTAL 20,351$ 20,350$ 1$ -$ -$ -$ -$ -$ -$

SPECIAL

MIPPA -$ -$ -$ -$ -$ -$ -$ -$ -$

CDSMP 551 551 - - - - - - -

TOTAL 551$ 551$ -$ -$ -$ -$ -$ -$ -$

TOTALS ALL PROGRAMS 259,246$ 259,245$ 1$ 56,250$ 56,250$ -$ 223,148$ 223,148$ -$

DSDS, MTP, MCD 538,644$

PI, OCM,IK 344,532

February 2015 Total 883,176$


Schedule 3

DSDS MEHTAP MEDICAID


SCHEDULE OF EXPENDITURES AT SITES AND THROUGH DIRECT SERVICES, FEBRUARY 2015

18

General Ledger General Ledger General Ledger

March 2015 via March 2015 via March 2015 via

MSER Financial Statements Difference MSER Financial Statements Difference MSER Financial Statements Difference

ADMINISTRATION

Admin 20,088$ 20,088$ -$ -$ -$ -$ -$ -$ -$

TOTAL 20,088$ 20,088$ -$ -$ -$ -$ -$ -$ -$

SUPPORT SERVICES

Transportation 34,320$ 34,320$ -$ -$ -$ -$ -$ -$ -$

Info & Assistance 21,158 21,158 - - - - - - -

Homemaker 9,978 9,978 - - - - - - -

Legal 1,142 1,142 - - - - - - -

Case Management 14,324 14,324 - - - - - - -

Personal Care 2,807 2,807 - - - - - - -

Public Education & Info - 175 (175) - - - - - -

RSVP 16,415 16,415 - - - - - - -

Counseling - - - - - - - - -

Care Transition Services - - - - - - - - -

TOTAL 100,144$ 100,319$ (175)$ -$ -$ -$ -$ -$ -$

OMBUDSMAN

Ombudsman 10,320$ 10,320$ -$ -$ -$ -$ -$ -$ -$

TOTAL 10,320$ 10,320$ -$ -$ -$ -$ -$ -$ -$

NUTRITION

Congregate 59,357$ 59,357$ -$ -$ -$ -$ -$ -$ -$

Home Delivered 150,800 150,800 - - - - 258,061 258,061 -

TOTAL 210,157$ 210,157$ -$ -$ -$ -$ 258,061$ 258,061$ -$


HEALTH PROMOTION

Evidence Based Med Mgmt 3,315$ 3,315$ -$ -$ -$ -$ -$ -$ -$

TOTAL 3,315$ 3,315$ -$ -$ -$ -$ -$ -$ -$

FAMILY CAREGIVERS

Respite 4,009$ 4,009$ -$ -$ -$ -$ -$ -$ -$

Day Care 1,083 1,083 - - - - - - -

Case Mgmt 15,111 15,111 - - - - - - -

Info & Assistance - - - - - - - - -

Sup. Services - Nutritional Supplies 772 771 1 - - - - - -

Sup. Services - Personal Supplies 4,826 4,826 - - - - - - -

TOTAL 25,801$ 25,800$ 1$ -$ -$ -$ -$ -$ -$

SPECIAL

MIPPA -$ -$ -$ -$ -$ -$ -$ -$ -$

CDSMP - - - - - - - - -

TOTAL -$ -$ -$ -$ -$ -$ -$ -$ -$

TOTALS ALL PROGRAMS 369,825$ 369,999$ (174)$ -$ -$ -$ 258,061$ 258,061$ -$

DSHS, MTP, MCD 627,886$

PI, OCM,IK 479,114

March 2015 Total 1,107,000$

DSDS MEHTAP MEDICAID

Schedule 4


SCHEDULE OF EXPENDITURES AT SITES AND THROUGH DIRECT SERVICES, MARCH 2015


19

General Ledger General Ledger General Ledger General Ledger

February 2015 via February 2015 via February 2015 via February 2015 via

MSER Financial Statements Difference MSER Financial Statements Difference MSER Financial Statements Difference MSER Financial Statements Difference

ADMINISTRATION

Admin -$ -$ -$ 20$ 20$ -$ -$ -$ -$ 9,029$ 9,029$ -$

TOTAL -$ -$ -$ 20$ 20$ -$ -$ -$ -$ 9,029$ 9,029$ -$

SUPPORT SERVICES

Transportation 8,629$ 8,629$ -$ -$ -$ -$ -$ -$ -$ 3,255$ 3,255$ -$

Info & Assistance - - - 22,511 22,511 - - - - 976 976 -

Homemaker 16 16 - - - - - - - - - -

Legal 57 57 - - - - - - - 4,768 4,768 -

Case Management 70 70 - 4,650 4,650 - - - - 15 15 -

Personal Care 4 4 - - - - - - - - - -

Public Education & Info - - - - - - - - - - - -

RSVP - - - - - - 10,267 10,267 - 2,673 2,673 -

Counseling - - - - - - - - - - - -

Care Transition Services - - - - - - - - - - - -

TOTAL 8,776$ 8,776$ -$ 27,161$ 27,161$ -$ 10,267$ 10,267$ -$ 11,687$ 11,687$ -$

OMBUDSMAN

Ombudsman -$ -$ -$ 1,500$ 1,500$ -$ -$ -$ -$ 4,395$ 4,395$ -$

TOTAL -$ -$ -$ 1,500$ 1,500$ -$ -$ -$ -$ 4,395$ 4,395$ -$

NUTRITION

Congregate 57,600$ 57,600$ -$ 57,235$ 57,235$ -$ -$ -$ -$ 36,397$ 36,397$ -$

Home Delivered 33,793 33,793 - 40,318 40,318 - - - - 25,660 25,660 -

TOTAL 91,393$ 91,393$ -$ 97,553$ 97,553$ -$ -$ -$ -$ 62,057$ 62,057$ -$


HEALTH PROMOTION

Evidence Based Med Mgmt 435$ 435$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$

TOTAL 435$ 435$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$

FAMILY CAREGIVERS

Respite 50$ 50$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$

Day Care - - - - - - - - - 20,209 20,209 -

Case Mgmt - - - - - - - - - - - -

Sup. Services - Nutritional Supplies - - - - - - - - - - - -

Sup. Services - Personal Supplies - - - - - - - - - - - -

TOTAL 50$ 50$ -$ -$ -$ -$ -$ -$ -$ 20,209$ 20,209$ -$

SPECIAL

MIPPA -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$

CDSMP - - - - - - - - - - - -

TOTAL -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$

TOTALS ALL PROGRAMS 100,654$ 100,654$ -$ 126,234$ 126,234$ -$ 10,267$ 10,267$ -$ 107,377$ 107,377$ -$

Total PI, OCM, IK+ 344,532$

IN-KIND

Schedule 5

PROGRAM INCOME OTHER CASH MATCH-DA OTHER CASH MATCH-NON DA


SCHEDULE OF EXPENDITURES AT SITES AND THROUGH DIRECT SERVICES, FEBRUARY 2015


20

General Ledger General Ledger General Ledger General Ledger

March 2015 via March 2015 via March 2015 via March 2015 via

MSER Financial Statements Difference MSER Financial Statements Difference MSER Financial Statements Difference MSER Financial Statements Difference

ADMINISTRATION

Admin -$ -$ -$ -$ -$ -$ -$ -$ -$ 7,416$ 7,416$ -$

TOTAL -$ -$ -$ -$ -$ -$ -$ -$ -$ 7,416$ 7,416$ -$

SUPPORT SERVICES

Transportation 10,776$ 10,776$ -$ -$ -$ -$ -$ -$ -$ 3,777$ 3,777$ -$

Info & Assistance - - - 2,669 2,669 - - - - 1,472 1,472 -

Homemaker 482 482 - - - - - - - - - -

Legal 25 25 - - - - - - - 6,648 6,648 -

Case Management - - - 6,225 6,225 - - - - 30 30 -

Personal Care 118 118 - - - - - - - - - -

Public Education & Info - - - - - - - - - - - -

RSVP - - - - - - 100 100 - 3,809 3,808 1

Counseling - - - - - - - - - - - -

Care Transition Services - - - - - - - - - - - -

TOTAL 11,401$ 11,401$ -$ 8,894$ 8,894$ -$ 100$ 100$ -$ 15,736$ 15,735$ 1$

OMBUDSMAN

Ombudsman -$ -$ -$ 2,550$ 2,550$ -$ -$ -$ -$ 6,945$ 6,945$ -$

TOTAL -$ -$ -$ 2,550$ 2,550$ -$ -$ -$ -$ 6,945$ 6,945$ -$

NUTRITION

Congregate 74,373$ 74,373$ -$ 125,308$ 125,308$ -$ -$ -$ -$ 44,535$ 44,535$ -$

Home Delivered 42,694 42,694 - 87,788 87,788 - - - - 30,543 30,543 -

TOTAL 117,067$ 117,067$ -$ 213,096$ 213,096$ -$ -$ -$ -$ 75,078$ 75,078$ -$


HEALTH PROMOTION

Evidence Based Med Mgmt 645$ 645$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$

TOTAL 645$ 645$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$

FAMILY CAREGIVERS

Respite 50$ 50$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$

Day Care - - - - - - - - - 20,136 20,136 -

Case Mgmt - - - - - - - - - - -

Sup. Services - Nutritional Supplies - - - - - - - - - - - -

Sup. Services - Personal Supplies - - - - - - - - - - - -

TOTAL 50$ 50$ -$ -$ -$ -$ -$ -$ -$ 20,136$ 20,136$ -$

SPECIAL

MIPPA -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$

CDSMP - - - - - - - - - - - -

TOTAL -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$

TOTALS ALL PROGRAMS 129,163$ 129,163$ -$ 224,540$ 224,540$ -$ 100$ 100$ -$ 125,311$ 125,310$ 1$

Total PI, OCM, IK+ 479,114$

IN-KIND

Schedule 6

PROGRAM INCOME OTHER CASH MATCH-DA OTHER CASH MATCH-NON DA


SCHEDULE OF EXPENDITURES AT SITES AND THROUGH DIRECT SERVICES, MARCH 2015


21

February General Ledger February General Ledger March General Ledger March General Ledger

2015 via 2015 via 2015 via 2015 via

MPIR Trial Balance Difference MPIR Trial Balance Difference MPIR Trial Balance Difference MPIR Trial Balance Difference

ADMINISTRATION

TOTAL -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$

SUPPORT SERVICES

TOTAL 86,328$ # 86,328$ # -$ 86,328$ # 86,328$ # -$ 97,729$ # 97,729$ # -$ 97,729$ # 97,729$ # -$

OMBUDSMAN

TOTAL -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$

NUTRITION

Congregate 600,328$ 600,328$ -$ 600,328$ 600,328$ -$ 674,701$ 674,701$ -$ 674,701$ 674,701$ -$

Home Delivered 339,462 339,462 - 339,462 339,462 - 382,157 382,157 - 382,157 382,157 -

TOTAL 939,790$ 939,790$ -$ 939,790$ 939,790$ -$ 1,056,858$ 1,056,858$ -$ 1,056,858$ 1,056,858$ -$


HEALTH PROMOTION

TOTAL 5,055$ # 5,055$ # -$ 5,055$ # 5,055$ # -$ 5,700$ # 5,700$ # -$ 5,700$ # 5,700$ # -$

FAMILY CAREGIVERS

TOTAL 200$ # 200$ # -$ 200$ # 200$ # -$ 250$ # 250$ # -$ 250$ # 250$ # -$

SPECIAL

TOTAL -$ -$ # -$ -$ # -$ # -$ -$ # -$ # -$ -$ # -$ # -$

TOTALS ALL PROGRAMS 1,031,373$ 1,031,373$ -$ 1,031,373$ 1,031,373$ -$ 1,160,537$ 1,160,537$ -$ 1,160,537$ 1,160,537$ -$

February 2015 March 2015

Beginning Program Income -$ Beginning Program Income -$

Program Income Received 1,031,373 Program Income Received 1,160,537

Program Income Expended 1,031,373 Program Income Expended 1,160,537

Month End Balance -$ Month End Balance -$

PROGRAM INCOME RECEIVED PROGRAM INCOME EXPENDED PROGRAM INCOME RECEIVED PROGRAM INCOME EXPENDED

Schedule 7


SCHEDULE OF PROGRAM INCOME RECEIVED AND EXPENDED


22

Schedule 8

Third Quarter General Ledger

Report to via

DSDS Trial Balance Difference

ADMINISTRATION

Admin 291,397 291,398 (1)

TOTAL 291,397$ 291,398$ (1)$

SUPPORT SERVICES

Transportation 439,134 439,134 -

Info & Assistance 180,643 180,643 -

Homemaker 117,359 117,359 -

Legal 64,108 64,108 -

Case Management 130,226 130,226 -

Personal Care 27,203 27,203 -

Care Transition Services 1,120 1,120 -

Public Education & Info 9,208 9,208 -

RSVP 155,422 155,421 1

Counseling - - -

TOTAL 1,124,423$ 1,124,422$ 1$

OMBUDSMAN

Ombudsman 158,953 158,953 -

TOTAL 158,953$ 158,953$ -$

NUTRITION

Congregate 2,368,669 2,368,669 -

Home Delivered 4,952,921 4,952,921 -

TOTAL 7,321,590$ 7,321,590$ -$


HEALTH PROMOTION

Evidence Based Med Mgmt 34,950 34,950 -

TOTAL 34,950$ 34,950$ -$

FAMILY CAREGIVERS

Respite 38,933 38,932 1

Day Care 191,768 191,768 -

Case Mgmt 136,111 136,111 -

Info & Assistance - - -

Sup. Services - Nutritional Supplies 4,109 4,109 -

Sup. Services - Personal Supplies 30,731 30,731 -

TOTAL 401,652$ 401,651$ 1$

SPECIAL

MIPPA 19,198 19,198 -

CDSMP 2,542 2,542 -

TOTAL 21,740$ 21,740$ -$

TOTALS ALL PROGRAMS 9,354,705$ 9,354,704$ 1$

THIRD QUARTER 2014-2015


SCHEDULE OF EXPENDITURES PER FILED REPORTS


23

Schedule 9

Cash Match In-Kind

DSS Program for DSS Other for DSS

Total Resources MEHTAP Medicaid Income Resources Cash Resources

July 2014 1,079,534$ 369,436$ 1,875$ 263,545$ 138,298$ 183,237$ 6,094$ 117,049$

August 2014 1,020,248 374,068 - 254,417 135,018 130,115 3,783 122,847

September 2014 1,010,806 349,841 (1,875) 253,846 140,886 120,682 10,680 136,746

October 2014 1,171,241 463,912 - 273,559 144,500 154,156 466 134,648

November 2015 1,035,778 424,282 - 246,860 117,121 133,323 1,928 112,264

December 2015 1,004,518 335,517 56,250 265,786 125,606 103,674 3,194 114,491

January 2015 1,038,750 381,555 - 267,615 129,321 138,706 2,012 119,541

February 2015 883,176 259,246 56,250 223,148 100,654 126,234 10,267 107,377

March 2015 1,107,000 369,825 - 258,061 129,163 224,540 100 125,311

Totals for SFY 2015 9,351,051$ 3,327,682$ 112,500$ 2,306,837$ 1,160,567$ 1,314,667$ 38,524$ 1,090,274$

Third Quarter 2014-15 Quarterly Expenditure Report 9,354,705$ A Difference due to a revision of Third Quarter reported expenditures, however

the March 2015 monthly report was not revised to reflect changes.

Difference (3,654)$ A

SOURCE:

Missouri Division of Senior and Disability Services

"SFY 2015 Monthly Service and Expenditure Report" (MSER)


SCHEDULE OF MONTHLY SERVICE AND EXPENDITURE REPORTS


24

Nutrition In-Home Legal

Sites Transportation Services Services

Number of service contractors 32 6 5 1

20% of service contractors (rounded up) 7 2 1 1

Nutrition Sites

Bonne Terre Senior Center �

East Prairie Senior Center �

Farmington Senior Center �

Fredericktown Senior Center �

Park Hills Senior Center �

Qulin Senior Center �

Williamsville Senior Center �

Transportation

Cape Co. Transit Authority �

SEMO Transit System (SMTS) �

In-Home Services

Tri County Group XV, Inc. �

Legal Services

Legal Service of Southeast Missouri �

Total Sites Monitored 7 2 1 1

� Service provider selected for testing in accordance with Section 10.1.2 of Attachment #4


Schedule of Contract Services and Providers


Schedule 10

25

Site Date of Written

Monitoring Report to Monitoring

Contractor Date Contractor Complete

Bonne Terre Senior Center

Nutrition Monitoring 9/11/2014 9/15/2014 11/7/2014

Fiscal Monitoring 4/23/2015 9/4/2015* 9/14/2015

East Prairie Senior Center



Farmington Senior Center



Fredericktown Senior Center



Park Hills Senior Center



Qulin Senior Center



Williamsville Senior Center



Cape Co. Transit Authority 5/28/2015 6/25/2015 8/11/2015

SEMO Transit System (SMTS) 6/11/2015 7/20/2015 7/20/2015

Tri-County Group XV, Inc. 4/8/2015 6/11/2015 6/11/2015

Legal Services of Southeast Missouri 6/9/2015 6/9/2015 6/9/2015

* Written report not issued in a timely manner (45-60 days)

Schedule 11


Schedule of Significant Contractor Monitoring Dates


26

Bonne Terre East Prairie Farmington Fredericktown Park Hills Qulin Williamsville Cape Co. SEMO Tri-County Legal Service

Compliance Requirement Senior Center Senior Center Senior Center Senior Center Senior Center Senior Center Senior Center Transit Transit Group XV, Inc. of Southern MO

All Service and Service Providers

��

A A A A A A A

�� Agency did not monitor the contractor's compliance with this requirement

A Fiscal monitoring was not completed in a timely manner

B. Service participants meet eligibility criteria.

C. Service participants are reassessed, where applicable.

Schedule 12A

A. Billings and service reports are supported by, and in agreement with, service

delivery records (signature sheets, route sheets, service logs, etc).


Schedule of Compliance With DHSS Monitoring Requirements - All Service Providers


10.2. Determine if procedures are in place and annual on-site monitoring were performed for each

contract and direct service, which includes:

10.2.1. Control listing is maintained showing the status of the AAA's monitoring efforts.

10.2.2. Control listing includes all contract and direct services, and providers.

10.2.3. Review of AAA documentation for at least 20% of the contract and direct service

providers, to ensure:

10.2.3.1. The monitoring process includes written documentation to support a review,

on a test basis, of each of the following components for each direct and contact service:

D. Service participant data is in NapisPak, as applicable.

E. Participant Contributions:

1. Participants afforded opportunity to contribute.

6. Cash count record agrees with deposit slip, and bank statement.

F. Safeguards are in place to ensure client confidentiality.

2. Contribution system is voluntary and confidential.

3. Recorded on date of receipt.

4. Counted by 2 persons (preferably volunteers).

5. Deposited timely (daily, or as per waiver).

G. Employee background screenings are completed, where applicable.

10.2.7. A written report, with findings, recommendations, and required corrective action, is

issued to each service provider or direct service manager.

10.2.8. The written report is issued in a timely manner (generally within 45-60 days).

H. Service providers have a written grievance procedure.

I. Service providers are informed on recognizing and reporting abuse and neglect

of program participants.

10.2.4. The AAA has a system to ensure compliance with the Americans with Disabilities

Act, as set forth in the assurance section of the agency's currently approved Area Plan.

10.2.5. The AAA has a system to ensure OMB Circular A-133 audits are performed for

subrecipients, or the AAA has some form of positive assurance that the subrecipient in not

required to have an A-133 audit.

10.2.6. The AAA has a system to ensure OMB Circular A-133 or other audits are submitted

to the AAA for review and follow-up on findings or questioned costs related to an AAA

funded service.

27

Compliance Requirement Bonne Terre East Prairie Farmington Fredericktown Park Hills Qulin Williamsville

Nutrition Services and Service Providers


10.3.14. Insulated carriers used to transport home delivered meals.

10.3. Additional Compliance Review Requirements - Nutrition: The audit firm is responsible for reviewing

the AAAs monitoring systems and files to determine AAA monitoring includes a review of the following

criteria with respect to nutrition providers:

10.3.15. The service provider has a method for documenting domestic food purchases equal to the

NSIP funding received.

B. Cardiopulmonary resuscitation (CPR); and

C. Heimlich maneuver.

D. Freezer at or below 0° F.

A. Administrator (16 hours).

B. Cook (8 hours).

C. Assistant cook (4 hours).

10.3.8. Perpetual and physical inventory records for all foods.

10.3.9. Process to ensure menus meet 1/3 RDA and U.S. Dietary Guidelines and are certified by an

R.D. or Nutritionist.

A. Menus are kept on file for one year.

B. Menu changes or substitution policy followed.

10.3.10. Records show temperature logs maintained for:

10.3.6. Records showing specific personnel designated and trained for emergencies during all hours of

operation that have completed training courses in:

A. Basic first aid.

10.3.12. Appropriate foods samples taken.

10.3.13. Cleaning schedule in place.

A. Hot food items at or above 140° F.

B. Cold food items at or below 41° F.

C. Refrigerator at or below 41 ° F.

10.3.11. Review of home delivered meal route records to ensure meals are delivered within 4 hours.

Schedule 12B


Schedule of Compliance With DHSS Monitoring Requirements - Nutrition Service Providers


10.3.7. Training requirements met by staff:

10.3.1. Annual sanitation inspection conducted within the last year.

10.3.2. Sanitation inspection deficiencies corrected within the last year.

10.3.3. Annual fire inspection conducted within the last year.

10.3.4. Fire inspection deficiencies corrected and documented.

10.3.5. Compliance with all state or local fire safety laws including review of:

Senior Centers

A. Adequate number of smoke detectors and/or fire extinguishers.

B. Written safety and evacuation plans.

28

Cape Co. SEMO Tri-County

Compliance Requirement Transit Transit Group XV, Inc.

Transportation Services and Service Providers

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

In-Home Services and Providers

n/a n/a

n/a n/a

n/a n/a

n/a n/a

n/a n/a

n/a n/a

n/a n/a

n/a n/a

n/a n/a

n/a n/a


G. Documentation of Employee Disqualification List, and criminal background screenings, and the individual has not been disqualified as a result of the

screen.

D. Annual performance evaluation, which includes an on-site review of the worker in the performance of their duties.

E. Statement signed by the worker, indicating they have received and reviewed the following information:

1. Client's rights;

2. Code of ethics;

3. Providers policy regarding confidentiality of client information.

F. Position Description

10.5.1. Employee display adequate identification for the program participant to view.

E. Criminal background screening at time of enrollment.

F. Enrolled with Family Care Safety registry.

10.5. Additional Audit Review Requirements - In-Home Services: The audit firm is responsible for reviewing the AAAs monitoring systems and files to determine

AAA monitoring includes a review of the following criteria with respect to in-home services and in-home service providers:

2. 20 hours annual in-service training after the first 12 months of employment.

10.5.2. In-home service workers/aides are prohibited from providing services to an immediate family member.

10.5.3. A written copy of the client's rights is reviewed with the client.

10.5.4. Review of Workers records for each of the following:

A. Application, signed by the employee, with proof of meeting the following criteria:

1. 18 years of age;

2. Ability to read, write and follow instructions;

3. 6 months paid experience as an agency homemaker, nurse aide, maid, or household worker; or 1 year experience, paid or unpaid, in caring for

children, sick or aged individual, or successfully completed formal training in nursing arts, nurse aid, or in-home aid.

4. Registered with the Family Care Safety Registry. RSMo 210.900 through RSMo 210.936.

B. Al least 2 creditable references.

C. Training records, which indicate the following requirements have been met:

1. 20 hours of orientation, or 2 hours of orientation to the provider agency, including protocol for handling emergencies, within 30 days of

employment, or 8 hours of classroom training prior to the first day of client contact, or Training on Alzheimer's disease, and other related dementia, and

methods of communicating with persons with dementia, pursuant to the requirements of RSMo 660.050 (22) 8.

Schedule 12C


Schedule of Compliance With DHSS Monitoring Requirements - Transportation and In-Home Service Providers


10.4.1. No further review of service standards are required for services provided through mass-transit systems. Reliance is placed on the authorities regulating

the provision of mass transit services.

10.4.3. Private Volunteer individual providers:

A. Vehicle is licensed.

B. Vehicle is insured within state and local minimums.

C. Current Class Operators license.

D. Annual driver's license check.

E. Annual driver's license check.

F. Criminal background screening at time of employment

Note: If any of the above requirements are covered by local taxi licensing ordinance, reliance may be placed upon the taxi license.

D. Driver has a current CDL or Class E license (vans).

10.4. Additional Audit Review Requirements - Transportation: The audit firm is responsible for reviewing the AAAs monitoring systems and files to determine AAA

monitoring includes a review of the following criteria with respect to transportation service providers:

10.4.2. Public non-profit transit providers and Private for-hire providers:

A. Valid local taxi cab vehicle license, where applicable.

B. Vehicle is licensed (state).

C. Vehicle is insured within state and local minimums.

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