Disability Memorandum

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Disability Memorandum Powered By Docstoc
					           Pierce County Aging and Disability Resource Center
                  2007 Memorandum of Understanding

This Memorandum of Understanding is made by and between Pierce County Aging and
Long Term Care, Area Agency on Aging and administering the Pierce County pilot
Aging and Disability Resource Center (ADRC) and ____________________.

Project Description
The Pierce County ADRC is a walk-in/call center and enhanced interactive web site
whose mission is to improve access to information and linkages to long-term supports
and services for aging persons and for persons with disabilities. This pilot project is
funded by a federal grant awarded by the Centers for Medicare & Medicaid Services
(CMS) and the Administration on Aging. It is administered by Aging and Disabilities
Services Administration (ADSA) and is implemented by Pierce County Aging and Long
Term Care. The missions of these two agencies are closely aligned:

      Mission - ADSA
      The Aging and Disability Services Administration (ADSA) assists adults with
      disabling conditions due to aging, disease or accident and children and adults
      with developmental disabilities to gain access the high quality, cost effective
      supports they need.

      Mission – ALTC
      The mission of Aging and Long Term Care is to ensure that Pierce County
      residents have available a range of community-based services that promote
      dignity and maximize individual choice.

Goal - ADRC
The goal of the ADRC pilot project is to:
 Create a “One Stop Shop” where consumers can access long-term living and related
 Develop a seamless system that will include eligibility screening, counseling, a
   single application, quicker functional and financial eligibility determinations, and
   personalized referrals;
 Making available comprehensive and consumer friendly information on long-term
   living services and benefits so that consumers can make informed decisions;
 Identifying and intervening with individuals at risk of entering an institution with the
   goal of providing them with information and counseling that will allow them to make
   informed choices about the long term supports they receive;
 Linkage of consumers who are not eligible for Home and Community Based
   Services with other community resources (including private-pay individuals); and
 Integration of other governmental programs relevant to the Pierce County ADRC
To this end, a collaborative approach from all our local participating agencies is
essential for the ADRC to be a success.

ADRC Services
The services provided by the Pierce County ADRC are screening, information and
referral, benefit and options counseling, application assistance, follow up, and
streamlining of the functional and financial eligibility determination process. These
services are provided for all consumers needing long-term care services and support
regardless of their age, disability, or ability to pay.

The resource center is located at Pierce County Human Services, 3580 Pacific Avenue,
Tacoma, WA 98418. This center serves the population of all of Pierce County.

Consumer Eligibility
All consumers, their families, and those who provide consumers with service and
support will be assisted in finding, applying to, and/or utilizing the services that they
need, regardless of age, disability, or ability to pay. Those who would like help in long-
term living planning will be offered an opportunity for the center to assist them.

Collaborative Partners
The parties will work together to accelerate the eligibility process and avoid duplicative
paperwork and administrative overhead through the integration of staff and services
necessary to determine eligibility for public services.

Mutual Agreements
Pierce County Aging and Long Term Care and _________________ agree to abide by
the Health Insurance Privacy Portability and Accountability Act (HIPAA) and any
applicable Federal and State privacy laws.

Each party will assign a liaison(s) to serve as the single point of contact for purposes of
this understanding.

Each party will be responsible for participating in local stakeholder and cross training

Each party will participate in initial, and as needed, cross training activities.

Each party will participate and assist in outreach activities in an effort to inform and
educate the public about the Aging and Disability Resource Center and ____________.

Each party will assign appropriate and adequate staff and resources, as mutually
agreed by the parties, to carry out responsibilities outlined in this memorandum.

The parties will meet together, at least quarterly, to discuss issues related to eligibility
determination, enrollment, staff capacity, coordination, communication and operations.

The ADRC will provide adequate space and facilities for Participating Agency staff that
may be physically collocated at the designated facility.

Terms of the Memorandum
This Memorandum of Understanding is effective for the 2007 calendar year. The
Memorandum has no expiration date. However, the signing parties will review this
Memorandum of Understanding annually. Amendments will be made as deemed
necessary and agreed to by the signing parties. In the event that the Collaborative
Partner violates any of the terms or conditions of this Memorandum of Understanding,
the Pierce County ADRC reserves the right to immediately terminate this agreement. In
the event of termination of this Memorandum of Understanding for any other reason, the
party terminating the agreement shall give notice of such termination in writing to the
other party. Termination shall be effective sixty (60) days after the date of receipt of

As the representative of ____________________, I have read, fully understand, and
agree to the terms and guidelines set forth in this Memorandum of Understanding and
also the User Confidentiality Agreement (Attachment 1).

Pierce County Aging & Long Term Care           (Agency Name)
Department of Human Services                   (Address)
3580 Pacific Avenue                            (City), WA (Zip)
Tacoma, WA 98418-7915

Printed Name                                   Printed Name

Signature                                      Signature / Representative

Date                                           Date

The Pierce County Aging and Disability Resource Center (ADRC)
Confidentiality Agreement (Attachment 1)

I. Client Confidentiality

The Pierce County Aging and Disability Resource Center seeks to establish a network of organizations committed to
improving service access and the development of services to address the needs of residents living in Pierce County.
As a representative of an ADRC partner organization, I understand I have access to confidential information, some
of which is personal and is, by law, considered confidential. I will at all times treat this information as confidential,
and will disclose this information only to explicitly authorized individuals and/or organizations for the purpose of
service delivery as required by the Health Insurance Privacy Portability and Accountability Act (HIPPA) and other
federal or state laws that govern protection of client confidentiality. I will not access or share confidential
information for any reason other than to perform my job duties.
                                                                                      Initial: _____
I understand that client confidentiality is of utmost importance; therefore, I agree to take the necessary measures to
ensure that all client information is handled in strict confidence.
                                                                                       Initial: _____

  II. Data Base System Access

I acknowledge that I may be assigned a user ID and password that is to be used ONLY by myself to access the
ADRC system data base. I understand that I will be held accountable for all actions and activities produced by my
user ID. I will not share my ID and/or password with anyone, and I will not use the ID and/or password assigned to
someone else/
                                                                                     Initial: _____
I will not enter any unauthorized data or change or alter existing data in a manner inconsistent with my job duties.
Under no circumstances will I enter knowingly false data that may compromise the integrity of the system.
                                                                                      Initial: _____
I agree not to attempt to intentionally cause the system to malfunction or knowingly alter data without authorization
in an effort to compromise the computer security system. I further agree to report any suspected misuse or lapse in
the security system.
                                                                                      Initial: _____

  III. Statement of Understanding

By signing this agreement I acknowledge that I understand the purpose and intent of the ADRC system data base,
and understand the relationship of the ADRC and the organization with which I am employed. I understand that
maintaining client confidentiality is my first duty and largest responsibility as a user of the system. I acknowledge
that I have read, understand, and voluntarily agree to follow the guidelines set forth above. I further understand that
failure to follow these guidelines may result in possible termination of the ADRC data base privileges and that I may
be subject to applicable penalties under the laws that govern the confidentiality of client information.


_________________________________                   ___________________
Signature                                           Date

_________________________________                   ___________________
Executive Director’s Signature                      Date


Description: Disability Memorandum document sample