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Provider Manual: General Information for All Providers
Northwest Indiana Community Action
5240 Fountain Drive
Crown Point, Indiana
www.nwi-ca.com
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Table of Contents Introduction ............................................................................................................................................4
History .....................................................................................................................................................4
Community Action Agency .......................................................................................................................4
Area Agency on Aging ..............................................................................................................................5
Transportation .........................................................................................................................................5
2-1-1 / Information and Assistance ...........................................................................................................6
Responsibilities of the Area Agency on Aging ............................................................................................6
Responsibilities of the Community Action Agency ................................................................................... 11
NWICA’s Programs ................................................................................................................................. 17
2-1-1 Information and Assistance ........................................................................................................ 17
Aging and Disability Resource Center ................................................................................................... 18
Northwest Indiana Asset Building Campaign ....................................................................................... 19
Home and Community Based Services ................................................................................................. 20
Congregate Meal Sites ......................................................................................................................... 21
Energy Programs .................................................................................................................................. 22
Family Caregiver Program .................................................................................................................... 23
Family Development ............................................................................................................................. 24
Housing Choice Voucher Program ........................................................................................................ 25
Individual Development Accounts ........................................................................................................ 26
Long Term Care Ombudsman ............................................................................................................... 27
Outreach and Education ....................................................................................................................... 28
Pre-admission Screening ...................................................................................................................... 29
General Requirements for All Service Providers ...................................................................................... 30
Requests for Proposals and Contracting .................................................................................................. 30
Organizational Requirements ................................................................................................................. 35
Bonding and Insurance ........................................................................................................................... 35
Confidentiality and HIPAA Compliance ................................................................................................... 36
Staff, Volunteer, Student, Contract Employee Confidentiality Agreement .......................................... 39
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HIPAA Compliance ................................................................................................................................. 40
Fees ....................................................................................................................................................... 40
Consumer Complaints and Grievances .................................................................................................... 40
Non-Discrimination ................................................................................................................................ 41
Non-sectarian Activities ......................................................................................................................... 41
Political and Voter Activity ..................................................................................................................... 41
Drug Free Workplace ............................................................................................................................. 41
Provider Change of Address/Information Updates .................................................................................. 42
Emergency Operations Plan.................................................................................................................... 42
Conflict of Interest ................................................................................................................................. 50
Smoking ................................................................................................................................................ 51
Compliance ............................................................................................................................................ 51
Financial Management ........................................................................................................................... 51
Documentation of In-Kind and Cash Match ............................................................................................. 52
Human Resources Management ............................................................................................................. 59
Monitoring and Quality Assurance ......................................................................................................... 60
QIP ................................................................................................................................................... 60
Selecting Contracted Service Providers ................................................................................................ 60
Monitoring of Service Providers ........................................................................................................... 60
Information Technology ......................................................................................................................... 63
Remote Access Policy ............................................................................................................................ 63
Appendix A: Northwest Indiana Community Action Key Staff Directory .................................................. 70
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Introduction Welcome!
Northwest Indiana Community Action (NWICA) welcomes you as a service provider and community partner.
We look forward to working with you to provide valuable services for our communities.
NWICA is a unique not-for-profit organization serving the needs of elderly, disabled and low-income citizens
of Northwest Indiana through dependable and quality services. One vital element in our mutual success is
the dedication of our community partners to high performance standards and the achievement of
excellence.
This manual was developed to help familiarize you both with NWICA and with the requirements and
procedures that govern our work with our contracted service providers. We encourage Service Providers to
become familiar with the contents of the manual which contains guidelines for the implementation of
program policies. NWICA may modify any of the provisions of the manual at any time, with or without
notice, and may deviate from any provision of this handbook in its sole discretion.
We appreciate your commitment to providing services to the citizens of Northwest Indiana and expect that
together we will significantly impact the lives of the individuals and the communities we serve.
Our Mission:
To help people be independent and to advocate for those who can’t.
Our Vision:
We are the industry leader and respected voice for our constituents through demonstrated expertise and
outstanding community service in a competitive environment.
History
Community Action Agency
Northwest Indiana Community Action (NWICA) was incorporated as a Community Action Agency, a 501-C-3
private not-for-profit, in February, 1965, to serve low-income residents of Lake County, Indiana. Policies for
the agency are set by the Board of Directors composed of 1/3 each of public sector, private sector and
community consumer representatives.
As a Community Action Agency, Northwest Indiana Community Action plans and carries out a variety of
programs that serve the unique needs of low-income families and disabled communities in the Northwest
Indiana counties of Jasper, Lake, Newton and Porter. Services through the Community Action Agency
support households with incomes at or below 150% of Federal Poverty Guidelines. Services include the
following:
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Utility Assistance
Energy Conservation
Section 8 Housing
Emergency Assistance
Asset Building and Tax Preparation
Family Development Services
Weatherization and Home Rehabilitation
Area Agency on Aging
The agency was designated as the Area I Agency on Aging in May, 1974, by the Indiana Commission on Aged
and Aging to carry out a Federal and State mandate for planning, development and coordination of a
network of services that benefit older adults and persons of all ages with disabilities that are at risk of
institutionalization in the Northwest Indiana counties of: Lake, Porter, Pulaski, Jasper, Newton and Starke.
The purpose of the service network was to develop cooperative arrangements and advocate reorganizing or
reassigning functions in order to:
Secure and maintain independence and dignity in a home environment for older persons who are capable of
self-care with appropriate supportive services and,
Remove individual and social barriers to economic and personal independence for older persons.
Services through the Area Agency on Aging include the following:
Case Management
Home Delivered Meals
Home Health Services
Meals at Senior Centers
Adult Day Care
Outreach
Information/Assistance
Pre-Admission Screening
Family Caregiver Support
Transportation
Transportation services began in 1976 with the support of an Urban Mass Transportation Administration
Section 16(b)(2) grant that provided 21 vehicles to transport elderly and disabled customers. This service
was public demand response providing curb-to-curb service for those 60 years or older, people with
physical/mental disabilities, or the general public who live north of 93rd Avenue in Lake County, Indiana.
Due to limited availability of funding, transportation services were discontinued in 2009.
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2-1-1 / Information and Assistance
In February, 2006, NWICA became the 2-1-1 call center for the rural counties of Jasper, Newton, Starke and
Pulaski as an endorsed partner of Indiana 2-1-1. From any phone in those 4 counties, callers who dialed 2-1-
1 were connected to Information and Assistance Specialists at Northwest Indiana Community Action.
Through the state-wide partnership, callers can get answers to their human services needs day or night, 365
days a year.
On December 19, 2006, NWICA officially launched its 2-1-1 service in Lake and Porter counties.
Responsibilities of the Area Agency on Aging The Older Americans Act
Overview
The Older Americans Act was originally signed into law by President Lyndon B. Johnson on July 14, 1965. In
addition to creating the Administration on Aging, it authorized grants to States for community planning and
services programs, as well as for research, demonstration and training projects in the field of aging. Later
amendments to the Act added grants to Area Agencies on Aging for local needs identification, planning, and
funding of services, including but not limited to nutrition programs in the community as well as for those
who are homebound; services targeted at low-income minority elders; health promotion and disease
prevention activities; in-home services for frail elders, and those services which protect the rights of older
persons such as the long term care ombudsman program.
Older Americans Act – Title III
Title III is the section of the Older Americans Act that defines the responsibility of each state to designate
local Area Agencies on Aging. There are sixteen Area Agencies on Aging located throughout Indiana.
Each Area Agency on Aging (AAA) is responsible to:
Develop and Administrator a Local Aging Plan (also referred to as Area Plan)
Establish an Advisory Council
Provide Services
Establish Focal Points to Provide Services
Facilitate Coordination of Community Long-Term Care Services
The purposes of the legislation and of the AAA are to maximize the independence of individuals who are
elderly or disabled; to remove individual and social barriers to independence; to provide a continuum of
care; and to coordinate in-home and community based long term care services.
Mission of the Area Agency on Aging
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The Indiana Division of Aging Operations Manual Section 2017 defines the mission of the Area Agencies on
Aging (AAA) as follows:
(a) Policy.
(1) Each AAA shall proactively carry out, under the leadership and direction of the Indiana Division of
Aging, a wide range of functions related to advocacy, planning, coordination, inter-agency linkages,
information sharing, brokering, monitoring, and evaluation. It is designed to lead to the
development or enhancement of comprehensive and coordinated community-based systems in, or
serving, each community in the planning and service area (PSA). These systems shall be designed to
assist older adults in leading independent, meaningful and dignified lives in their own homes and
communities as long as possible. A comprehensive and coordinated community-based system as
described in the Code of Federal Regulations (CFR) shall do the following:
(A) Have a visible focal point of contact where anyone can go or call for help, information, or
referral on any aging issue;
(B) Provide a range of options and assure that these options are readily accessible to all older
adults: the independent, semi-dependent, and totally dependent, no matter what their income;
(C) Include a commitment of public, private, voluntary, and personal resources committed to
supporting the system;
(D) Involve collaborative decision making among public, private, voluntary, religious, and fraternal
organizations and older people in the community;
(E) provide specific objectives for providing services to older adults with the greatest economic
need and older adults with the greatest social need, include specific objectives for providing services
to low-income, minority older adults residing in rural areas;
(F) Provide effective referral from agency to agency to assure that information or assistance is
received, no matter how or where contact is made in the community;
(G) Evidence sufficient flexibility to respond with appropriate individualized assistance, especially
for the vulnerable older person;
(H) Have a unique character that is tailored to the specific nature of the community; and
(I) be directed by leaders in the community who have the respect, capacity, and authority necessary
to convene all interested persons; assess needs; design solutions; track overall success; stimulate
change; and plan community responses for the present and for the future.
(2) The resources made available to the AAA under the OAA are to be used to finance those
activities necessary to achieve elements of a community-based service system.
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(3) For the purpose of assuring access to information and services for older adults, the AAA shall
work with elected community officials in the PSA to designate one or more focal points on aging in
each community, as appropriate.
Local Aging Plan
As the designated AAA for Area 1 in Indiana, NWICA is required by the Older Americans Act, to develop and
submit an Area Plan to the Indiana Division of Aging. The development of the Area Plan requires that a
Needs Assessment be conducted and the results submitted to the Indiana Division of Aging. The Area Plan is
for a two, three, or four year period as determined by the Indiana Division of Aging, with adjustments made
on an annual basis.
Advisory Council
Each area agency has an advisory council that carries out advisory functions to further the area agency's
mission of developing and coordinating community-based systems of service for older adults in the agency's
PSA. The advisory council consists of older adults (including minority older adults and older adults residing
in rural areas) who are participants or who are eligible to participate in programs assisted under the Older
Americans Act, representatives of older adults, local elected officials, providers of veterans’ health care (if
appropriate), and the general public, to continuously advise the AAA on all matters relating to the
development of the area plan, the administration of the plan and operations conducted under the plan.
The council carries out advisory functions which further the AAA’s mission of developing and coordinating
community-based systems of service for all older adults in the planning and service area.
The council shall advise the AAA relative to:
developing and administering the area plan;
conducting public hearings;
representing the interest of older adults; and
reviewing and commenting on all community policies, programs, and actions which affect older
adults with the intent of assuring maximum coordination and responsiveness to older adults.
The council shall include individuals and representatives of community organizations who will help to
enhance the leadership role of the AAA in developing community-based systems of service.
The AAA submits the area plan and amendments to the advisory council for review and comment before it is
submitted to the Indiana Division of Aging.
Service Provision
NWICA works with other agencies or organizations in the area, providing health, recreational, educational,
or social services for older adults. NWICA and its service providers coordinate planning and service delivery
with other agencies and organizations within the PSA.
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Focal Points
The AAA is mandated to establish “focal points” to provide services. The Older American’s Act defines a
focal point as “a highly visible facility established to encourage the maximum co-location and coordination
of services for older individuals where anyone in a community can obtain information and access to aging
services.” Many multi-service senior centers as well as other types of centers are designated by the area
agency to serve as designated focal points.
NWICA currently has designated these focal points in our PSA.
NAME ADDRESS COUNTY SERVICES PROVIDED
NWICA 5240 Fountain Drive
Crown Point, IN 46307
Lake I & A, Outreach, Transportation,
Senior Recreation, C1 & C2 Meals,
SSBG & CHOICE Transportation,
Community Action Programs
Greater Hammond
Community Services
824 Hoffman St.
Hammond, IN 46327
Lake I & A, Outreach, Senior Recreation,
C1 Meals, Food & Clothing Pantry,
Handy Chore Services, Emergency
Assistance, Energy Assistance South Lake County
Community Services
1450 E. Joliet Suite 202
Crown Point, IN 46307
Lake I & A, Outreach, Transportation, C1
Meals, Energy Assistance
Jasper County Community
Services
967 East Leopold
Rensselaer, IN 47978
Jasper I & A, Outreach, Transportation,
Senior Recreation, C1 & C2 Meals,
Homemaker, Energy Assistance
Newton County
Community Services
106 E. State St.
Morocco, IN
Newton I & A, Outreach, Transportation,
Senior Recreation, C1 & C2 Meals,
Homemaker, Energy Assistance,
Food Pantry
Porter County Aging &
Community Services
1005 Campbell St.
Valparaiso, IN 46384
Porter I & A, Outreach, Transportation,
Senior Recreation, C1 Meals, Energy
Assistance
Pulaski County Human
Services
15 W. Pearl St.
Winamac, IN 46996
Pulaski I & A, Outreach, Transportation,
Senior Recreation , C1 & C2,
Homemaker, Energy Assistance,
Food Pantry Community Services of
Starke County
311 E. Culver Rd.
Knox, IN 46534
Starke I & A, Outreach, Transportation,
Senior Recreation, C1 & C2 Meals,
Homemaker, Handy Chore, Energy
Assistance, Food Pantry YWCA of Northwest
Indiana
150 W. 15th Ave.
Gary, IN 46407
Lake I & A, Outreach, Senior Recreation,
C1 Meals, Energy Assistance
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Coordination of Community Long Term Care Services
Title III of the Older Americans Act authorizes the distribution funds for the following categories of services:
Supportive services;
Congregate meals services;
Home delivered meals services;
In-home services;
Ombudsman services;
Special needs services;
Elder abuse services;
Preventive health services; and
Outreach services.
Funds authorized under these categories are for the purpose of assisting the area agencies to develop or
enhance comprehensive and coordinated community based systems for older persons.
Responsibilities of service providers under area plans
As a condition for receipt of funds under this part, each area agency on aging shall assure that providers of
services shall:
Provide the area agency, in a timely manner, with statistical and other information which the area
agency requires in order to meet its planning, coordination, evaluation and reporting requirements;
Specify how the provider intends to satisfy the service needs of low-income minority individuals in
the area served, including attempting to provide services to low-income minority individuals at least
in proportion to the number of low-income minority older persons in the population serviced by the
provider;
Provide recipients with an opportunity to contribute to the cost of the service as provided;
With the consent of the older person, or his or her representative, bring to the attention of
appropriate officials for follow-up, conditions or circumstances which place the older person, or the
household of the older person, in imminent danger;
Where feasible and appropriate, make arrangements for the availability of services to older persons
in weather related emergencies;
Assist participants in taking advantage of benefits under other programs; and
Assure that all services funded under this part are coordinated with other appropriate services in
the community, and that these services do not constitute an unnecessary duplication of services
provided by other sources.
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Responsibilities of the Community Action Agency Legislation Creating Community Action
Federal
In 1961 President John F. Kennedy's "New Frontier” included support for programs to prevent juvenile
delinquency. The President's Council chaired by U.S. Attorney General Robert Kennedy funded Mobilization
for Youth (MYF) with the Ford Foundation and the City of New York. MYF organized and coordinated
neighborhood councils composed of local officials, service providers, and the neighbors to develop plans to
correct conditions which led to juvenile delinquency. It also enlisted the aid of the school board and city
council members to implement these plans. This project and pilot plan was called Community Action and it
looked like an effective and inexpensive way to solve problems.
The Ford Foundation was funding other projects, including one in New Haven, Connecticut, which recruited
people from all sectors of the community to come together to plan and implement programs to help low-
income people. MYF and New Haven are often cited as the "models" for a community action agency.
After the assassination of President Kennedy in November, 1963, President Lyndon Baines Johnson
expanded the policy ideas, initiated in the Kennedy Administration. In his message to Congress on January 8,
1964, President Johnson said:
"Let us carry forward the plans and programs of John F. Kennedy, not because of our sorrow or sympathy,
but because they are right...This Administration today, here and now, declares an unconditional War on
Poverty in America...Our joint Federal-local effort must pursue poverty, pursue it wherever it exists. In City
slums, in small towns, in sharecroppers' shacks, or in migrant worker camps, on Indian reservations, among
whites as well as Negroes, among the young as well as the aged, in the boom towns and in the depressed
areas."
The "War on Poverty" was born. In February, R. Sergeant Shriver was asked to head a task force to draft
legislation. In August, the Economic Opportunity Act of 1964 was passed creating a federal Office of
Economic Opportunity. "Sarge" Shriver was named Director, serving until 1969.
Congress also passed the Civil Rights Act of 1964, guaranteeing equal opportunity for all. The Economic
Opportunity Act, designed to implement that guarantee, stated in part: "It is therefore the policy of the
United States to eliminate the paradox of poverty in the midst of plenty in this nation by opening, to
everyone, the opportunity for education and training, the opportunity to work, and the opportunity to live in
decency and dignity."
The Federal Office of Economic Opportunity led the efforts of the War on Poverty. Economic Opportunity
offices at the state level were created in order to involve governors in the effort. Funds were provided by
the Office of Economic Opportunity to allow local citizens an opportunity to create Community Action
Agencies and use the funds to meet the problems and needs of the poor in their area. These "local initiative
funds" were used in a variety of ways.
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In 1994 an ongoing task force of Federal, state, and local community action officials – the Monitoring and
Assessment Task Force (MATF) created six broad anti-poverty goals that guide the national Community
Services Network.
Goal 1: Low-income people become more self-sufficient.
Goal 2: The conditions in which low-income people live are improved.
Goal 3: Low-income people own a stake in their community.
Goal 4: Partnerships among supporters and providers of service to low- income people are achieved.
Goal 5: Agencies increase their capacity to achieve results.
Goal 6: Low-income people, especially vulnerable populations, achieve their potential by
strengthening family and other supportive systems.
To accomplish these goals, local community action agencies have been encouraged to undertake a number
of actions that focus on results-oriented management and results-oriented accountability:
Results-Oriented Management
Assess poverty needs and conditions within the community;
Define a clear agency anti-poverty mission for community action and a strategy to address
those needs, both immediate and longer term, in the context of existing resources and
opportunities in the community;
Identify specific improvements, or results, to be achieved among low-income people and
the community; and
Organize and implement programs, services, and activities, such as advocacy, within the
agency and among “partnering” organizations, to achieve anticipated results.
Results-Oriented Accountability
Develop and implement strategies to measure and record improvements in the condition of
low-income people and the communities in which they live that result from community
action intervention;
Use information about outcomes, or results, among agency tripartite boards and staff to
determine the overall effectiveness, inform annual and long-range planning, support agency
advocacy, funding, and community partnership activities.
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Indiana Code
Indiana Code describes the components of a community action program as: “designed to assist participants,
including the poor and near poor, persons with disabilities, farm workers, the elderly, and youth, to do the
following:
Secure and retain meaningful employment.
Attain an adequate education.
Make better use of available income.
Provide and maintain adequate housing and a suitable living environment.
Undertake family planning consistent with personal and family goals and religious and moral
convictions.
Obtain services for the following:
o The prevention of narcotics addiction and alcoholism.
o The rehabilitation of narcotic addicts and alcoholics.
Obtain emergency assistance through loans or grants to meet immediate and urgent individual and
family needs, including the need for health services, nutritious food, housing, and employment
related assistance.
Remove obstacles and solve personal and family problems that block the achievement of self-
sufficiency.
Achieve greater participation in the affairs of the community.
Make more frequent and effective use of other programs related to the purposes of this chapter.
Indiana Code requires community action agencies to do the following:
Systematically plan for an effective community action program.
Develop information concerning the problems and causes of poverty in the community.
Determine the amount and effectiveness of the assistance being provided to deal with the problems
and causes of poverty in the community.
Establish priorities among projects, activities, and areas to ensure the best and most efficient use of
resources.
Encourage agencies engaged in activities related to the community action program to do the
following:
o Plan for, secure, and administer available assistance on a common or cooperative basis.
o Provide planning or technical assistance to those agencies.
In cooperation with community agencies and officials, undertake actions to improve existing efforts
to reduce poverty, including the following:
o Improving day-to-day communications.
o Closing service gaps.
o Focusing resources on the most needy.
Providing additional opportunities to low income individuals for any of the following:
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o Regular employment.
o Participation in the programs or activities for which those community agencies and officials
are responsible.
Initiate and sponsor projects responsive to those needs of the poor that are not otherwise being
met. The projects must emphasize the following:
o Providing central or common services that can be drawn upon by various related programs.
o Developing new approaches or new types of services that can be incorporated into other
programs.
o Filling gaps pending the expansion or modification of the programs.
Establish effective procedures to do the following:
o Enable the poor and the affected area residents to influence the character of programs
affecting the interests of the poor and the affected area.
o Provide for regular participation of the poor and the affected area residents in the
implementation of the programs.
o Provide technical and other support needed to enable the poor and neighborhood groups to
secure available assistance from public and private sources.
Join with and encourage business, labor, and other private groups and organizations to undertake,
together with public officials and agencies, activities in support of the community action program
that will result in the additional use of private resources and capabilities. These activities shall be
undertaken for the following purposes:
o Developing new employment opportunities.
o Stimulating investment that will have a measurable impact on reducing poverty among
residents of areas of concentrated poverty.
o Providing methods by which residents of the areas can work with private groups, firms, and
institutions in seeking solutions to problems of common concern.
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US DEPARTMENT OF HEALTH AND
HUMAN SERVICES
US DEPARTMENT OF ENERGY
US DEPARTMENT OF HOUSING AND
URBAN DEVELOPMENT
INDIANA FAMILY AND
SOCIAL SERVICES
ADMINISTRATION
NORTHWEST INDIANA COMMUNITY ACTION CORPORATION
ELDERLY SERVICES
(AREA AGENCY ON AGING)COMMUNITY SERVICES
(COMMUNITY ACTION AGENCY)
2-1-1
INFORMATION AND REFERRAL
Administration
on Aging
Administration for
Families and Children
In-Home Services
Nutrition Services
Legal Assistance
LO
CA
L SE
RV
ICE
PR
OV
IDE
RS
CONSUMERS
CO
NS
UM
ER
S
CO
NS
UM
ER
S
Preadmission Screening
Ombudsman
Energy Assistance Program
Weatherization Assistance
Housing Choice Voucher
Owner Occupied Rehab
Asset Building Campaign
Indiana Division
of Aging
NWICA’s Context
LO
CA
L SE
RV
ICE
PR
OV
IDE
RS
Focal Points
INTERNAL REVENUE SERVICE
OFFICE OF MANAGEMENT &
BUDGET
INDIANA HOUSING AND
COMMUNITY DEVELOPMENT
AUTHORITY
16
PRESIDENT/
CHIEF EXECUTIVE OFFICER
Executive Asst.
Home & Community Based Services
Grants
Management
Coordinator
Administrative Services
BOARD OF DIRECTORS AREA AGENCY ON AGING
ADVISORY COMMITTEE
Finance Planning and Development
Weatherization
Energy Assistance
Housing Choice
Voucher Program
Information Technology
Aging and Disability Resource Center
Access & Outreach211/ Information & Assistance
Ombudsman
Community Services Asset Building Quality
Communications
CHIEF OPERATING OFFICER
Updated July 2012 ams
Nutrition
17
2-1-1 Information and Assistance
NWICA’s Programs
18
Aging and Disability Resource Center
19
Northwest Indiana Asset Building Campaign
20
Home and Community Based Services
21
Congregate Meal Sites
22
Energy Programs
23
Family Caregiver Program
24
Family Development
25
Housing Choice Voucher Program
26
Individual Development Accounts
27
Long Term Care Ombudsman
28
Outreach and Education
29
Pre-admission Screening
30
General Requirements for All Service Providers
Requests for Proposals and Contracting NWICA enters into contracts with appropriate service providers for the provision of services to elderly,
disabled, and low-income residents of Jasper, Lake, Newton, Porter, Pulaski, and Starke counties.
Scope: The Executive Director, in conjunction with the senior management team, ensures that the RFP and
contracting process occurs every two years.
Procedure:
1. RFP packets are prepared, reviewed and approved by the senior management team.
2. Legal Notice is published in local papers.
3. Legal Advertisement will be reviewed and updated every two years. Update budget and service
information if necessary. Update RFP dates.
4. Two advertisements must be completed with the second advertisement being at least 10 days
before the RFP’s are due for review.
5. NWICA will retain proof of publications.
6. The corporate website is updated with RFP information and proposal packets.
7. Standardized tools for review of proposals are developed and approved.
8. All completed proposals are reviewed according to the following procedure
9. RFP’s will be due by 5 p.m. on the prescribed date. No RFP’s will be accepted after 5 p.m. on the
prescribed date. (RFP’s received after 5pm on the prescribed date will not be processed until the
following quarterly deadline.)
10. RFP’s will be collected and date stamped by the Administrative Services Department.
11. The Administrative Services Department will create a spreadsheet listing all RFP’s received.
12. The Administrative Services Department will review all RFP’s (with the assistance of other support
staff if needed) using the RFP checklist to determine that all necessary documentation is present.
13. Original proposals containing all necessary documentation will be forwarded to the Director of
Planning and Quality Assurance.
14. Copies of complete proposals will be forwarded with the scoring tool to the appropriate program
staff, director(s), fiscal department, and IT department as appropriate.
15. Proposals with missing documentation will be forwarded to the Director of Planning and Quality
Assurance who will communicate with the vendor regarding additional information required to
process the proposal.
16. All proposals will be reviewed and scored by the program director(s) and designated program staff,
finance, and IT, as appropriate.
17. Proposals that have been scored will be returned to Quality Assurance & Planning to be compiled.
18. Quality Assurance and Planning will complete a Due Diligence Checklist for each recommended
vendor. The Due Diligence Checklist will include, but is not limited to:
a. Verification of Active and Current status with the Indiana Secretary of State.
31
b. Verification of eligibility to participate in Federal programs through the Department of
Health and Human Services Office of the Inspector General’s Exclusions Database.
c. Verification of licensing status via the Indiana Professional Licensing Agency’s License
Express website.
d. A Better Business Bureau search, and;
e. As appropriate, a review of the Indiana State Department of Health Report Card.
19. Compiled reviews and scoring summaries will be forwarded to the Executive Director for review and
recommendation.
20. Final recommendations for contracts will be submitted to the NWICA Board of Directors at the May
Board meeting for final approval prior to the beginning of the contract period.
21. Upon final approval, an agreement is forwarded to the vendor for execution.
22. When the executed agreement is returned to NWICA, the Quality Assurance department will
establish a permanent vendor file that contains at least the fully executed agreement and the
original RFP document for each approved vendor.
23. Vendor files are monitored regularly to ensure that all required documentation is current.
Subcontracts
The service provider shall not assign the contract or enter into subcontracts to the contract with additional
parties without obtaining prior written approval of NWICA. An unsigned copy of the subcontract must be
mailed to NWICA for approval prior to implementation. Following approval a copy of the signed contract
must be sent to NWICA before service begins.
Assignees or subcontractors shall be subject to all conditions and provisions of NWICA contract. The service
provider shall be responsible for the performance of all assignees or subcontractors however, NWICA shall
retain the right to monitor and assess or otherwise determine performance.
Service providers must annually assess each subcontractor for contract compliance.
Contract Probation
When a service provider has failed to comply with the terms of a contract, NWICA may place the service
provider on probation in whole or in part. Probation will commence upon NWICA giving the service provider
written notice of probation. The notice of probation shall contain reasons for probation, any corrective
action required, the effective date, length of probation, and the right of the service provider to appeal the
decision. During the probationary period, the service provider will receive reimbursement for allowable
expenses incurred as part of the contract. If, during the probationary time frame, the service provider does
not comply with the corrective actions, suspension or termination may be initiated.
Contract Suspension
If the service provider materially fails to comply with the terms of the contract, NWICA may, upon written
notice to the service provider, suspend the contract in whole or in part.
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The notice of suspension will be issued ten (10) calendar days prior to the effective date of suspension and
will state the reasons for the suspension, any corrective action required of the service provider, the effective
date and the right of the service provider to appeal the decision. Suspensions shall remain in effect until the
service provider has taken corrective action satisfactory to NWICA or given evidence satisfactory to NWICA
that such corrective action will be taken, or until NWICA terminates the contract. Under extreme conditions
(danger to older persons or improper use of funds), immediate notice of suspension may be given.
In suspending contract operations, NWICA shall determine the anticipated length of suspension and the
extent of operations suspended.
New obligations incurred by the service provider during the suspension period will not be allowed unless
NWICA expressly authorizes them in the notice of suspension or an amendment to it. Necessary and
otherwise allowable costs which the service provider could not reasonably avoid during the suspension
period will be allowed if they result from obligations properly incurred by the service provider before the
effective date of the suspension and not in anticipation of suspension or termination.
NWICA may reinstate the suspended contract operations if it determines conditions warrant such action.
Contract Termination
If, through any cause, the service provider shall fail to fulfill its obligation in a timely and proper manner
under the contract, or if the service provider shall violate any of the covenants, agreements, or stipulations
of the contract, NWICA shall have the right to terminate this contract in whole, or in part, at any time before
the date of expiration by giving written notice by certified United States mail to the service provider of such
termination and the effective date of termination. This will be done at least thirty (30) calendar days, prior
to the effective date of the termination. The notice from the NWICA will include reports to be completed,
the right of the service provider to appeal and the procedures to be followed for appeal. Causes may include
but not be limited to:
Lack of availability of funds,
The service provider violates conditions, under which the contract was approved,
Program performance is inadequate as documented through monitoring visits,
Other resources were unavailable,
Response to monitoring findings is inadequate for two (2) semi-annual assessments,
Suspension for more than three (3) consecutive months
Under extreme conditions (gross negligence, misappropriation of funds, etc.) immediate termination may
occur.
The service provider, for adequate cause, may terminate the contract at any time by giving written notice to
NWICA by certified United States mail at least thirty (30) calendar days, preferably 90 days, before the
effective date of such termination and specifying the effective date thereof.
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The service provider shall not be relieved of liability to NWICA for damages sustained by NWICA by virtue of
any breach of the contract by the service provider. NWICA may withhold any payments to service provider
for the purpose of setoff until such time as the exact amount of damages due NWICA from service provider
is determined.
If the contract is terminated as provided herein, the service provider shall be entitled to receive just and
equitable compensation for any satisfactory work completed. Upon termination of this contract, the service
provider shall return to NWICA, upon demand, any unencumbered funds and any equipment or personal
property purchased with funds provided under this contract. Any equipment, supplies or personal property
purchased with contract funds must be disposed of in accordance with procedures prescribed by 45 CFR
Part 74, Subpart O (74.139). Any funds realized from the sale of such equipment, supplies or personal
property must be returned to NWICA or will be an adjustment to the projected costs.
If, any cause, alteration or changes take place in the rules, regulations, laws, or policies to which NWICA is
subject, or if there is any termination or reduction in the allocation or allotment of funds provided to NWICA
for the purposes of this contract, NWICA shall have the right to terminate or reduce the amount to be paid
to service provider under this contract. Such termination or reduction in the amount to be paid shall take
effect immediately upon receipt of written notice to service provider, unless a different effective date is
specified in the notice.
When financial support of a contract terminates on completion of the approved contract period or earlier,
the service provider shall complete and submit a final project and financial report to NWICA by the date
established by NWICA pursuant to the contract.
Service Provider Appeals Procedure (Area Agency on Aging Providers Only)
Service providers may appeal a NWICA decision regarding suspension or termination of contract.
Step 1: Informal Review with NWICA
(a) The Service Provider must first discuss any questions, concerns or problems regarding an adverse action
with a representative of NWICA. The Informal Review will take place at NWICA.
(b) The NWICA representative shall prepare a written document for the Agency Review outlining the action
being disputed and the data on which the action was based. A copy of this written document shall be made
available to the service provider prior to the Agency Review.
(c) Within five days of the date of the Informal Review, the NWICA representative shall provide the service
provider a written notice of the decision reached on the issues raised at the Informal Review.
(d) The written notice shall be sent by certified mail, return receipt requested. The NWICA representative
must also inform the Service provider that an appeal of the decision made at the Informal Review may be
submitted in writing to the executive director of NWICA.
Step 2: Agency Review
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(a) The Service Provider’s request for an Agency Review of the NWICA decision must be made in writing and
submitted to NWICA, within eighteen days of the date of the decision made at the Informal Review. The
written request shall include a detailed explanation of the service provider’s grievance.
(b) The executive director or designee is to conduct the Agency Review at NWICA’s offices.
(c) NWICA shall complete the following:
(1) Schedule the Agency Review and notify the service provider of the date, time and location of the
Agency Review, within eighteen days of the receipt of the request for an Agency Review;
(2) Prepare a written document for the Agency Review outlining the action being disputed and the data on
which the action was based. A copy of this written document shall be made available to the service provider,
at least eighteen days prior to the Agency Review; and
(3) Give the service provider the opportunity to testify, present supporting materials, explain the reason for
the disagreement with the action or decision, and state what would be an acceptable alternative.
(d) Following the Agency Review, the Executive Director or Designee conducting the Agency Review will
consider the comments and written documentation provided by the service provider.
(e) Within five days from date of the Agency Review, the executive director or designee will prepare and
send a written notice of the final decision to the service provider. The written notice of the final decision will
be sent to the service provider by certified mail, return receipt requested.
(f) The final decision will include the findings of fact, the specific reason for the decision. For all providers
except Community Services Intake and Weatherization contractors, the final decision will also include
information concerning the service provider’s right to appeal the decision at the state level, if dissatisfied
with NWICA’s final decision. For Community Services Intake and Weatherization contractors, the decision
of the Executive Director will be considered final.
Step 3: Appeal Hearings at the State Level
(a) If a service provider is dissatisfied with the decision reached at the agency review, the service provider
may appeal the decision by requesting a hearing at the state level.
(b) Before seeking an appeal at the state level, the service provider must have adhered to and complied
with NWICA’s established policy and Procedures on the appeal process for:
service providers whose contract, or agreement has been terminated; and
other decisions that adversely affect a service provider.
(c) The service provider must make a written request for an appeal hearing to the Director of the FSSA DA
within eighteen days of the date of the Agency Review final decision. The FSSA DA Director shall transmit
the appeal request to the DDRS Director in a timely manner.
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(d) The request shall include a statement regarding the issues the service provider wishes to be reviewed
and must be signed and dated by the service provider. Appeal Hearing requests shall be addressed to:
Director
FSSA DIVISION OF AGING
402 W. Washington Street
P.O. Box 7083 – MS21
Indianapolis, Indiana 46207-7083
(e) Appeal hearings will be conducted by an Administrative Law Judge (ALJ), designated by the Director of
DDRS. The hearing procedures used by DDRS shall be held in accordance with Indiana Code 4-21.5.
(This section does not apply to Community Services Intake and Weatherization contractors.)
Organizational Requirements
Service providers shall have a current contract with NWICA and must meet the following conditions:
Be a formally organized business or service agency and maintain registration with the Indiana
Department of Revenue as well as the Indiana Secretary of State, as required.
Disclose all entities with a five percent or more ownership.
Have a written statement defining the purpose of the business or service agency.
Have a written statement of policies and directives, bylaws, or articles of incorporation.
Have a written table of organization that clearly identifies lines of administrative, advisory,
contractual, and supervisory authority unless the business is a sole proprietorship.
Operate the business in compliance with all applicable federal, state, and local laws, and shall have a
written statement supporting compliance with:
o Non-discrimination laws federal wage and hour laws, and workers’ compensation laws in
the recruitment and employment of individuals; and
o Non-discrimination laws in the provision of services.
Bonding and Insurance
All Service Providers are required to maintain the following insurance coverage.
Requirements for Bonding and Insurance:
Comprehensive Liability coverage for personal injury and property damage with a minimum amount
of $500,000.
Worker’s compensation and Employers Liability, as required by state law should also be noted on
the insurance certificate. State law requires a minimum of $100,000 per accident and $500,000 per
policy.
Service Providers must provide a bond and/or insurance coverage for all persons who will be
handling client's funds or property. Employee Dishonesty, which may also be referred to as Crime,
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Fidelity or Surety, must be specifically listed with a minimum coverage of $250,000 for new
providers or half of the annual funding amount for existing or continuing providers.
Sufficient vehicle insurance for all staff and vehicles utilized under the agreement.
Licensed Home Health Agencies
Health Care Providers shall carry professional liability insurance with limits equal to minimum limits
provided for the Indiana Medical Malpractice Act. (Applicable to licensed Health Care Providers
only).
Transportation Vendors
In addition to standard insurance coverage, transportation vendors must have Ambulatory coverage
in a minimum amount of $1.5 million, Wheelchair Accessible coverage in a minimum amount of $1.5
million and General Vehicle Liability in a minimum amount of $1 million. Policies must list NWICA as
an additional insured. Vendor is responsible for submitting updated Certificates of Insurance as
applicable.
Weatherization Contractors
The Certificate of Insurance must list NWICA and NIPSCO as additional insureds.
The minimum level of insurance is $1,000,000 for general liability and personal injury.
In addition, the policy must contain a rider for Manufacturer's and Contractor's Liability coverage
and completed work coverage. Contractors must maintain Workmen's Compensation Insurance and
give a copy of the Certificate of Insurance to NWICA.
Certificate of Insurance
Each Service Provider will ensure that NWICA receives a Certificate of Insurance reflecting the above
required coverages.
The Certificate of Insurance shall contain a provision that coverage afforded will not be cancelled
until at least thirty (30) days prior written notice has been given to NWICA.
NWICA shall be the Certificate Holder.
The Certificate shall be prepared on “Acord” Form 25 (2/84) or an equivalent form.
The Certificate shall indicate that NWICA is an ADDITIONAL INSURED.
The Certificate of Insurance indicates the expiration date of each policy. Service Providers are
responsible to provide NWICA with updated Certificates with each policy renewal. Certificates of
Insurance are to be submitted to NWICA Quality Assurance Department.
Confidentiality and HIPAA Compliance
Confidentiality
Service Providers must ensure that all information, including but not limited to client information, is
received and maintained in a confidential manner.
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Vendors must ensure that their staff members are informed of their legal and ethical responsibility to
preserve the confidentiality of all consumer information, including, but not limited to:
Any identifying information including name, address, telephone numbers, occupation and/or career
status;
Any health or medical information including diagnosis or condition;
Any financial information including payer source for care provided under the agreement;
Any information regarding compliance with plan of care or treatment; and,
Any information regarding the consumer’s lifestyle, living arrangements, family situation, or any
other circumstance related to the consumer.
Disclosure of consumer information shall be limited to individuals directly involved in the care of the
consumer.
Consumer files and records should be maintained in a secure location such as a locked file cabinet or locked
room.
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Best Practice All staff will be made aware of the Confidentiality Policy at staff orientation and an “Employee-Client
Confidentiality Agreement” (sample attached) signed at that time.
Staff, volunteers and any student interns will have access to consumer information only as it pertains to
consumer care, or to satisfy his/her program requirements.
Any request for additional information concerning a consumer must be accompanied by a copy of a signed
release by the consumer or his/her legal guardian.
Any and all correspondence with regards to information about a consumer will be considered confidential.
Any such information generated by the program must also have a signed release by the consumer or his/her
legal guardian.
Any violation of a consumer’s right to confidentiality by a staff person, volunteer, or student will be cause
for immediate disciplinary action, up to and including termination.
Violations of confidentiality include:
Obtaining or seeking to obtain information that the staff person, volunteer or student does not require to
provide consumer care or to otherwise satisfy his/her program requirements.
Communicating confidential information to any individual, including the staff person’s family, friends, etc.,
who have no right to access such information.
Discussing consumer information in public areas, i.e., waiting rooms, hallways, and areas where other
individuals can overhear.
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Staff, Volunteer, Student, Contract Employee Confidentiality Agreement
As a staff member/volunteer/student/contract employee of _________________________, I understand
that I must abide by the following policies which assist in maintaining the consumer’s right to privacy and
confidentiality in all matters related to his/her personal life, medical care and client services.
I will not:
Obtain information which I do not need in order to carry out the duties and responsibilities of my
position.
Communicate information to any person who does not need it to carry out the duties and
responsibilities of their position.
Assist others in obtaining confidential information
Discuss the consumer’s affairs in public areas such as hallways or away from
____________________.
Seek out and/or disclose irrelevant or embarrassing facts about any consumer.
I understand:
These policies, which include, but are not limited to the specific examples above, apply to all
consumers and all employees; that any action which violates the spirit of the consumer
confidentiality policy will be dealt with in the same manner.
Breaches of confidentiality are matters of serious consequences that may harm consumer care,
slander a consumer and his/her family, or lead consumer’s physicians, or others, to not choose
__________________________ for the services they need.
That violation of any of these policies may result in my termination from employment, volunteering
or student placement, and disciplinary action may be taken without previous warning.
Also, as a staff member/volunteer/student of __________________________, I understand that I must
abide by these confidentiality policies and that I may be subject to state and federal criminal penalties
related to slander or breach of confidentiality.
Name (printed) ___________________________________________________________
Signature _______________________________________________________________
Witness _________________________________________________________________
Date ___________________________________________________________________
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HIPAA Compliance
In the language of HIPAA, “Covered Entities” and their “Business Partners” must adhere to the Act. A
Covered Entity is any person or organization that creates, uses, transmits, stores or otherwise handles
information pertinent to the health of an individual and includes health care providers who handle any
health information in electronic form in connection with a transaction. Business Partners are companies that
provide products and/or services to Covered Entities and, in the process, get private health information
(patient data or medical records) from Covered Entities. A covered entity must keep records and be able to
submit reports evidencing that the covered entity is in compliance with HIPAA.
With few exceptions, an individual’s health care information must be used by health care providers
(“covered entities”) only for legitimate health purposes like treatment and payment.
Covered entities must protect consumers’ health care information against deliberate or inadvertent misuse
or disclosure. To do this, these organizations must create and implement clear policies and procedures to
protect private health information.
It is the responsibility of each Service Provider to determine the applicability of HIPAA legislation to their
organization and to develop a compliance plan accordingly.
Fees
Service providers may not impose, solicit or collect any fees from recipients of services funded by NWICA.
Consumer Complaints and Grievances
Complaints - Each service provider must have a written procedure in place to address complaints from
individual recipients of services under the contract, which provides for protection from retaliation against
the complainant.
Appeals - Each program must also have a written appeals procedure for use by recipients with unresolved
complaints, individuals determined to be ineligible for services or by recipients who have services
terminated. Persons denied service and recipients of service who have services terminated, or who have
unresolved complaints, must be notified of their right to appeal such decisions and the procedure to be
followed for appealing such decisions.
The procedure should include the following:
The method of informing consumers of the procedure for expressing complaints
The individual responsible for investigating and responding to consumer complaints
The time frame for resolving complaints
The provision for informing a consumer that, if a consumer is not satisfied with the Service
Provider’s resolution of the complaint, the consumer may contact their NWICA Case Manager, and if
the consumer remains unsatisfied with the resolution, he/she may contact the Family and Social
Services Administration.
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Documentation of consumer complaints and documentation of any investigation and/or resolution must be
kept on file at the Service Provider’s offices.
Each program must provide written notification to each client, at the time service is initiated, of her/his right
to comment about service provision and to appeal termination of services.
Non-Discrimination
Service Providers must maintain policies regarding non-discrimination for both employees and consumers.
Service Providers will not discriminate on the basis of national origin, race, color, sex, age, marital status,
sexual orientation, religious affiliation, political beliefs, or disability during any phase of employment,
recruitment, hiring, training or promoting.
Service Providers must provide services without regard to national origin, race, color, sex, age, marital
status, sexual orientation, religious affiliation, political beliefs, or disability.
Any publicity released or other public reference, including media releases, informational pamphlets, etc.
regarding the services provided under the Agreement, shall contain the statement that all services are
provided without regard to national origin, race, color, sex, age, marital status, sexual orientation, religious
affiliation, political beliefs, or disability.
Non-sectarian Activities Activities conducted with funding obtained through the Agreement are non-sectarian in nature and religious
activities are not included in any activity conducted under the agreement.
Political and Voter Activity Vendor does not use funds provided by NWICA through the Agreement to further any type of political or
voter activity.
Drug Free Workplace
Service Providers must maintain a written Drug-Free Workplace policy, which includes the following:
A written statement provided to all employees notifying employees that the unlawful manufacture,
distribution, dispensing, possession, or use of a controlled substance is prohibited in Vendor’s workplace
and specifying the actions that will be taken against employees for violations of such prohibition. Statement
notifies employees that as a condition of employment the employee will (1) abide by the terms of the
statement; and (2) notify the employer of any criminal drug statute conviction for a violation occurring in
the workplace no later than (5) days after such conviction.
A drug-free awareness program to inform employees of (1) the dangers of drug abuse in the workplace; (2)
Vendor’s policy of maintaining a drug-free workplace; (3) any available drug counseling, rehabilitation, and
employee assistance programs, and (4) the penalties that may be imposed upon an employee for drug abuse
violations occurring in the workplace.
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Procedures that state that within (30) days after receiving notice of any criminal drug statute conviction for
a violation occurring in the workplace, vendor will impose the following sanctions or remedial measures: (1)
take appropriate personnel action against the employee, up to and including termination; or (2) require such
employee to satisfactorily participate in a drug abuse assistance or rehabilitation program approved for such
purpose by a federal, state, or local health, law enforcement, or other appropriate agency.
Provider Change of Address/Information Updates
In order to change their payment address with NWICA’s business offices, a service provider should submit a
new W-9 form reflecting the new address. A blank W-9 form can be downloaded from
http://www.irs.gov/pub/irs-pdf/fw9.pdf. All other information changes should be submitted in writing to
the Quality Assurance Department.
Emergency Operations Plan Consumers are dependent on services for their health care and personal care. How quickly your company
can get back to business after a terrorist attack, a tornado, a fire, or a flood depends on emergency planning
done today. Each service provider must have an established, written Emergency Operations Plan (EOP).
Though each situation is unique, any organization can be better prepared if it plans carefully, puts
emergency procedures in place, and practices for emergencies of all kinds. To meet this requirement, an
EOP must contain at least the following elements.
1. An employee communication plan
2. A consumer communication plan
3. A Business Continuity Plan describing how business operations will continue in the event of an
emergency, including an event that disables the site of the provider’s offices
There is a Sample Business Emergency Plan from www.ready.gov included on the next several pages. Visit
www.ready.gov for more information regarding Business Continuity Planning.
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Conflict of Interest
Service Providers must maintain a written Conflict of Interest policy which assures that no employee, agent,
representative, or subcontractor of vendor who may be in a position to participate in the decision-making
process of the vendor or its subcontractors may derive an inappropriate personal or financial interest or
benefit from any activity funded through this agreement, either for him/herself or for those with whom
he/she has family or business ties.
Best Practice
Implement an annual Conflict of Interest Disclosure procedure in which employees, agents, representatives
and/or subcontractors complete a form certifying that no Conflict of Interest exists or, identifying any
potential conflict in order for the organization to make an informed decision regarding how best to handle
the potential conflict.
SAMPLE CONFLICT OF INTEREST STATEMENT
Conflict of Interest Statement
I have read and am familiar with the ABC board policy concerning conflict of interests, and I have initialed
the line opposite the appropriate paragraph below.
_____During the past year, neither I, nor to the best of my knowledge, any member of my family has had an
interest or taken any action which would contravene the policy of this board.
_____During the past year, neither I, nor to the best of my knowledge, any member of my family has had an
interest or taken any action which would contravene the policy of this board, except such interest or action
fully disclosed below:
_______________________________________________________________________________________
_______________________________________________________________________________________
Board member signature ___________________________________________________________________
Date___________________________________________________________________________________
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Smoking
Smoking cannot be permitted in any portion of any indoor facility owned, leased, or contracted for by
Vendor and which a used routinely or regularly for the provision of health, day care, education, or library
services to children under the age of eighteen (18) years if the services are funded by federal programs
either directly or through states or local governments by federal grant, contract, loan, or loan guarantee.
This provision shall not apply to children's services provided in private residences, facilities funded solely by
Medicare or Medicaid funds, and portions of facilities used for inpatient drug or alcohol treatment.
Compliance
The vendor implements business practices to prevent and control fraud, waste, and abuse by:
Using procedures that articulate standards of conduct to ensure the organization’s compliance with
applicable laws and regulations; and
Designating one or more individuals in leadership positions to address compliance issues
Financial Management Service providers must maintain books, records, documents and other evidence and follow generally
accepted accounting procedures and practices which sufficiently and properly reflect all transactions
attributable to each service provided pursuant to the Agreement.
Service providers shall implement financial management practices that ensure accurate accounting and
billing to NWICA. Vendors must maintain financial and accounting records, which support transactions
attributable to each service code specified on "Attachment A."
Financial records shall be accurate, complete, current, and reflect cash or accrual based accounting
practices.
The service provider shall maintain accounts that link equipment, items or services to the client and manage
revenues and expenses on an ongoing basis, as they relate to client services, including the following:
Reconciling charges to clients for equipment, supplies, and services with invoices, receipts, and deposits;
Planning to meet the needs of clients and maintain business operations by having an operating budget, as
appropriate to the business’s size and scope of services; and
Having a mechanism to track actual revenues and expenses
If Vendor has a financial and/or compliance audit conducted by an independent public or certified public
accountant, a copy of the Audit must be submitted to NWICA within sixty (60) days of the acceptance of the
audit.
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Prompt compliance with a request by the State or NWICA to submit program and financial documentation is
critical. Failure to comply with any such request could result in immediate suspension of payments or
termination of the agreement by NWICA.
The State, the United States Government or NWICA shall have the right to enter the premises of Vendor or
any subcontractor of Vendor and inspect or audit any records and property maintained by Vendor or its
subcontractors in connection with this agreement. Vendor and its subcontractors shall make all books,
records, and documents that relate to their activities under this agreement available for inspection, review,
and audit when requested by authorized representatives of the State of Indiana, the United States
Government or NWICA.
Financial records, supporting documents, statistical records, and other records pertinent to the agreement
shall be retained for a period of three years from the date of submission of the final claims and/or reports or
until such time as any pending litigation or audit findings have been resolved and final action is taken.
Not-for profit service providers must adhere to OMB circular A-122 “Cost Principles for Nonprofit
Organizations”.
Organizations that expend $500,000 or more in a year in Federal funds must adhere to OMB circular A-133
“Audits of States, local governments, and non-profit organizations” and submit a copy of the audited
financial statements to the NWICA within 60 days of the acceptance of the audit.
Documentation of In-Kind and Cash Match
In-Kind contributions must meet the following criteria to be acceptable as match.
The contribution must be necessary to accomplish the scope of work as described in the contract.
The contribution must meet all the requirements of allowable costs per OMB Circular A-122.
The contribution must be adequately documented. Documentation should include:
A description of the goods or services contributed.
The purpose of the goods or services as related to contract performance.
The basis for determining value and supporting calculations and documentation.
Time sheets for volunteer personnel services.
Any additional documentation necessary to authenticate the transaction.
The value of In-Kind contributions must be recorded in the contractor's general ledger under a unique set of
accounts (i.e. - a separate and distinct cost center.)
In- Kind contributions will be subjected to the same financial review procedures as cash expenditures and
must be supported with appropriate documentation. To the extent feasible, documentation for In-Kind
contributions should be supported by the same methods used by the agency to support all other costs.
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In valuing In Kind contributions, the amount claimed will be considered reasonable to the extent that it is
consistent with the value placed on similar work or services performed within the agency. In cases where
the type of service provided is not found within the agency, the amount claimed will be considered
reasonable to the extent that it is comparable to that paid for similar services in the labor market in which
the agency competes for the service involved. The service must typically be provided at a cost to the public
and/or be a requirement under the provisions of the grant award. For example, ordinarily there is no cost
associated with public service announcements, newspaper articles, and talk shows; therefore, there is no
cost basis for claiming an In-kind contribution. Surveys providing verifiable data representative of the
services involved will be an acceptable basis for evaluating reasonableness of costs claimed as In-Kind
contributions.
Listed below are general guidelines for backup documentation to support the most common types of In-Kind
contributions. Each agency must determine the backup documentation required for other types of In-Kind
contributions based on the minimum documentation requirements listed above.
Speakers/Professional Services
To adequately document the contribution of a speaker or other professional’s time, a document should be
used that is very similar to an invoice (i.e., -a pro-forma invoice) on which, at minimum, the following
information is provided.
Name, address, phone number, and occupation of the person.
The date and actual time (i.e., 7:00 to 9:00 p.m. –not just number of hours) that the services were
provided.
The location name (i.e., John F. Kennedy High School) and address of the site where the service was
provided.
The specific type of service provided (i.e., Delivered speech on A Specific Topic of Speech).
The rate of pay for the service. (Note -The rate of pay should be based on the service provided -not
the individual’s rate of pay in his/her profession.)
A signature and date line for the speaker or professional attesting to the validity and accuracy of the
invoice.
In addition to the above, documentation should be on file to justify the basis of the rate of pay (i.e., -how
the fair market value for the service was established) being charged to the contract for the speaker or other
professional services.
Note- Title this form In-Kind Services, Volunteer Services, or some other descriptive phrase that will ensure
that this pro-forma invoice can never be confused for an actual vendor invoice.
Volunteer Workers
A time sheet should be used to adequately document the volunteer’s time contributed to contract related
activities. At minimum, the time sheet should provide the following information.
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Name, address, and phone number of the person.
The date and actual time (i.e., 7:00 to 9:00 P.M. -not just number of hours) that the volunteer
worked.
The job site at which the volunteer worked.
The specific type of service provided (i.e., -secretarial services, set up tables and chairs for
workshop, etc.) or job description on file.
The rate of pay for the service. (Note -The rate of pay should be based on the service provided -not
the individual's rate of pay at his/her regular job.)
A signature and date line for the volunteer attesting to the validity and accuracy of the time sheet.
A signature and date line for the supervisor of the volunteer attesting to the validity and accuracy of
the time sheet.
In addition to the above, documentation should be on file to justify the basis of the volunteer's rate of pay
(i.e., surveys providing pay rates for similar work in the competing labor market) and a job description
identifying responsibilities/essential functions of the volunteer position.
Note -Volunteers who work multiple times during the month can record all of the time donated on one time
sheet rather than filling out a separate time sheet for each occasion worked, but each occasion worked must
be a separate line item on the time sheet.
Note -Title this form In-Kind Time Sheet, Volunteer Time Sheet, or some other descriptive phrase that will
ensure that this pro-forma time sheet can never be confused for a time sheet used for payroll purposes.
Mileage Reimbursement for Volunteer Services
A mileage log should be used to adequately document the contribution of mileage incurred by the volunteer
to provide donated goods or services on which, at minimum, the following information is provided.
Name, address, and phone number of the person.
The date that the mileage was contributed.
Description of origination/destination points. Example:
From: Home To: JFK High School
Address Actual Address
The number of miles driven.
The specific purpose of the trip
The Mileage Reimbursement Rate
A signature and date line for the person attesting to the validity and accuracy of the mileage log.
In addition to the above, documentation should be on file to justify the basis of the mileage reimbursement
rate that is being charged to the contract for the volunteer's mileage.
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Note -Title this form In-Kind Mileage, Volunteer Mileage, or some other descriptive phrase that will ensure
that this pro-forma mileage log can never be confused for an actual mileage log that could be submitted for
cash reimbursement.
Donation of Goods, Equipment or Furniture
To adequately document the contribution of goods, furniture, or equipment (i.e., -The actual donation of
furniture or equipment where the title to the property changes hands as opposed to the use of furniture or
equipment), a document should be used that is very similar to an invoice on which, at minimum, the
following information is provided.
Name, address, and phone number of the person or entity (i.e., -XYZ Office Supply, Public Library,
etc.) that is making the contribution.
The date of the contribution.
A detailed description of the contribution. Describe each type of item being contributed (Office Max
Copy Paper, Parker F-6000 Ball Point Pens, etc.) and list as a separate line item on the invoice with
the number of units, the price per unit and the extended price for the item. Likewise, donations of
equipment should describe the make, model, serial number, etc. for each piece of equipment with
the price per unit and extended price for the equipment.
The Price per Unit for donations of equipment, furniture, etc. should be the Fair Market Value (FMV)
of the item on the date of the contribution. Therefore, if the item was not new when donated, the
item's age, condition, useful life, etc. are contributing factors in determining the FMV of the item
and must be documented.
The best backup documentation to substantiate the Price per Unit for the donations of goods (i.e.,
supplies, stamps, etc.) would be the invoice or cash register receipt that was given to the person or
entity making the donation when they originally purchased the goods, less any depreciation. If this is
not available, then other sources (i.e., an Office Depot catalog) could be used as the basis for valuing
the donated goods.
A signature and date line for (1) the person making the contribution or (2) the representative of the
entity making the contribution attesting to the validity and accuracy of the contributed items.
Note -These must be third party donations. A contractor (or its subcontractor) cannot donate goods,
equipment, or furniture to itself.
The contribution of goods (i.e., supplies, stamps, etc.) by a contractor would be a Cash contribution, not an
In- Kind contribution.
In addition to the above, documentation should be on file to justify the cost basis of each item (how the fair
market value for the item was established) that is being charged to the contract. For example, when
determining the value of the contributed item, consideration should be given to such factors as prior
depreciation of the donated item, whether the item is new, used, or damaged, and the overall condition of
the item.
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Note -Title this form In-Kind Goods and/or Equipment, Donated Goods and/or Equipment, or some other
descriptive phrase that will ensure that this pro-forma invoice can never be confused for an actual vendor
invoice.
In-Kind Contribution for The Use Of A Building and/or Office Space
(In-Kind Lease/Rent)
To adequately document the contribution for the use of an entire building or partial space within a building,
a document should be used that is very similar to a lease agreement (a pro-forma lease) on which, at
minimum, the following information is provided.
Name, address, and phone number of the person or entity that is making the contribution.
The specific period that the lease will cover
The price for the full term of the lease and/or the hourly, weekly, or monthly rate being charged for
the use of the building or office space.
A detailed description of the building or office space contributed. The detailed description should
include, at minimum, the following:
The square footage of the building or office space provided.
The time when the building or space is being used. In other words, is the space available for your
exclusive use 24 hours a day 7 day a week or do you have access to it only on Friday nights from 7:00
to 9:00 P.M.
Any other pertinent information that would have a bearing on establishing the fair market price of
the building or office space.
A signature and date line for the person (if an individual) or authorized representative (if an entity)
making the donation of the In-Kind attesting to the validity and accuracy of the contribution.
Note -These must be third party donations. A contractor (or its subcontractors) cannot charge In-Kind rent on
a building or office space that it owns.
In addition to the above, documentation should be on file to justify the monetary basis of the pro-forma
lease agreement (how the fair market value for the rent of the building or space was established).
Justification of the monetary basis should be something that can be objectively documented such as, but not
limited to, the following:
A copy of a recent lease for the same building or space that is being donated.
Quotes from Realtors for buildings or space in the same area and in relatively the same condition as
the building or space that is being donated.
An independent Realtor's assessment or report as to the market value of the building or space being
donated.
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Note -Title this form In-Kind Building or Office Space Rent, or Donated Building or Office Space Rent, or some
other descriptive phrase that will ensure that this pro-forma lease can never be confused for an actual lease
requiring payment.
In-Kind Contribution For The Use Of Office Furniture Or Equipment (In-Kind Rental Agreement)
To adequately document the contribution of the use (rent) of furniture or equipment, a document should be
used that is very similar to a rental agreement (a pro-forma rental agreement) on which, at minimum, the
following information is provided.
Name, address, and phone number of the person or entity that is making the contribution.
A description of each specific piece of furniture or equipment including its date of purchase (if
available), purchase price (if available), age, condition, make, model, serial number, etc.
The rental rate for each piece of furniture or equipment.
A signature and date line for (1) the person donating the furniture or equipment or (2) the
representative of the entity donating the furniture or equipment.
The specific period that the rental agreement will cover.
Note -These must be third party donations. A contractor (or its subcontractor) cannot charge In-Kind rent on
furniture or equipment that it owns.
In addition to the above, documentation should be on file to justify the monetary basis of the pro-forma
rental agreement (how the fair market value for the furniture and equipment was established). Justification
of the monetary basis (rental rate) should be something that can be objectively documented such as, but
not limited to, the following:
A copy of a recent rental agreement that details the established rental rate for the furniture or
equipment being donated.
Quotes from Rental stores for the monthly rental rates of furniture or equipment of the same type
and condition.
Rental rate quote(s) from independent companies (i.e., Xerox, 3M, Pitney Bowes, etc.) that are in
the business of renting and/or leasing office furniture or equipment.
Note -Title this form In-Kind Rent/Use of Furniture or Equipment, Donated Rent/Use of Furniture or
Equipment, or some other descriptive phrase that will ensure that this pro-forma rental agreement can never
be confused for an actual rental agreement requiring payment.
Project Income/Cash Match
Program Income: Program incomes means gross income received by the grantee or sub grantee directly
generated by a grant supported activity, or earned only as a result of the grant agreement during the grant
period.
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Voluntary contributions in the nutrition service programs are the most frequent form of program income in
AOA programs. The Older American’s Act limits its use. Cash contributions, however, may not necessarily be
program income.
Cash contributions means the grantee’s cash outlay, including the outlay of money contributed to the
grantee or sub grantee by other public agencies and institutions, and private organizations and individuals.
Program Income/Voluntary Participant Donations:
For the purpose of the contract with NWICA and reporting clarifications, NWICA will classify voluntary
contributions from participants as program income.
Program income in the form of voluntary contributions will not be allowable to meet the match
requirements of the contract.
At the end of the program year, each provider is to provide NWICA with a close-out profit and loss
statement for each federal funding source. Program Income/Voluntary Participant Donations are required to
be spent in the following manner:
To be spent in the program for which the donations are received to defray program costs and/or
expand or enhance program services being delivered.
Project Income/Voluntary Participant Donations must be fully expended within the program year.
As a result of project income/voluntary participant donations, the provider may not end the grant year with
revenues over expenses. Project income must be utilized before federal funds are claimed. NWICA will allow
each provider to reconcile this at the end of the grant year. If the grant year ends with revenue over
expenses, the final claim for the federal funding will be reduced by that amount.
Cash Match: For the purpose of the contract with NWICA and reporting clarifications, NWICA will classify
other cash contributions not from participants as cash match. The cash match contributions will be
allowable to meet the match requirement of the contract.
Cash match claimed will be accepted as part of the vendor’s cost sharing or matching when they meet all of
the following criteria.
Are verifiable from the vendor’s records.
Are not included as match for any other federally-assisted project or program.
Are necessary and reasonable for proper and efficient accomplishment of project or program
objectives.
Are allowable under the applicable cost principles.
Are not paid by the Federal Government under another award, except where authorized by Federal
statute to be used for cost sharing or matching.
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Sample General Ledger
Example of Cash Match/Project Income Documentation:
330004 TIIIC1 Congregate Meals
Revenues
10000 Federal 1,000.00$
10300 Cash Match 200.00$
10400 Project Income 150.00$
10900 In-Kind 750.00$
10910 Contra In-Kind (750.00)$
1,350.00$
Expenses
20000 Salaries & Wages 650.00$
20500 Fringe Benefits 175.00$
23900 Postage 50.00$
24320 Supplies/Office 200.00$
24500 Training 250.00$
24600 Travel 25.00$
1,350.00$
Monitoring
When NWICA conducts on-site monitoring visits with your organization, the required documentation as
outlined in this brief will be reviewed.
Human Resources Management Service providers shall employ competent and qualified personnel sufficient to provide services pursuant to
the contractual agreement.
Each service provider shall have a written policy for conducting reference checks and criminal background
checks for all employees and volunteers that interact with clients in the home. Supporting documentation
for reference and background checks must be available in the personnel file of each employee and
volunteer.
Staff shall receive a written job description, orientation, training and at least a yearly written performance
evaluation.
Service providers must implement policies to specify personnel qualifications, training, experience, and
continuing education requirements consistent with the equipment, items, and services it provides to clients.
Records identifying dates of training, attendance, and topics covered are to be maintained in employee
personnel files.
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Monitoring and Quality Assurance
NWICA is mandated to monitor the services provided by vendors. The focus of these quality assurance
activities is primarily to ensure that the health, safety and rights of consumers are protected; and
secondarily, to minimize the risk of disallowed costs in an audit from our funders. NWICA employs a variety
of methods to accomplish these goals.
QIP
QIP stands for Quality Improvement Program and is a module of the state’s designated software for area
agencies on aging. This module consists of survey questions related to the quality of services that
consumers receive.
Case managers conduct QIP surveys with a minimum of 10% of the clients assigned to them on a quarterly
basis. When problems or concerns regarding a service provider are identified, the Quality Assurance and
Planning department communicates with the provider and requests documentation of corrective action.
The total number of documented problems and concerns regarding a service provider is taken into
consideration during the risk assessment process.
Selecting Contracted Service Providers
A formal Request for Proposals is issued every two years. Notice of the RFP is placed in local newspapers.
Contract proposals are accepted and reviewed during a specified time period. Agency staff uses a
standardized scoring tool to review and compare each proposal and to determine which providers best meet
the needs of consumers and the Agency. Agency staff then presents their recommendations to the Advisory
Council and the Advisory Council makes recommendation to the Board of Directors. At the discretion of
Board of Directors, the proposal is accepted, rejected, or placed on hold pending further investigation.
Once a proposal is accepted, a Memorandum of Understanding between the Agency and the service
provider is executed and the Agency provides any training or technical assistance that may be required for
the provider to perform as expected under the agreement.
Interested parties may submit proposals between formal RFP periods. The same procedure is followed for
proposals received in the interim.
Monitoring of Service Providers
NWICA utilizes a Risk-Based Monitoring approach to appropriately determine the intensity and frequency of
vendor monitoring.
On-site Program Reviews
Programmatic Reviews will be conducted on all community service providers as needed but at least once
every contract period. (NEED is defined as the AAA’s knowledge or perception that a problem exists with a
community service provider which has the potential to disrupt service, be an audit exception, and/or violate
state or federal policy, laws, etc. Need is determined through the area agency’s annual risk assessment
process.) The initial review during a contract period will include at least the following:
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a review of compliance with the agreement including:
vendor policies and procedures
personnel practices and personnel files
organizational requirements
bonding and insurance
service specific requirements per each service definition
Vendors will be notified in writing in advance of the site visit and the standard review tools to be utilized will
be provided with the notification. The tools contain weighted and alert standards. The standards that are
defined as weighted and/or alert are those that are specific to the health, safety or rights of consumers and
those that would result in disallowed costs in a monitoring by any of our funding sources.
Following the initial review during a contract period, additional on-site reviews may be conducted.
Circumstances that may initiate additional program reviews include, but are not limited to, the following:
If non-compliance findings are identified and not corrected by the service provider within the time
frames specified in their Corrective Action Plan.
If NWICA determines that an additional assessment(s) is/are warranted.
If requested by the community service provider.
If the current contract period is the first period for which NWICA has a contract with the provider.
If a service provider is closing out its contract, and will no longer be providing contracted services in
the subsequent year within the PSA.
Unit Verification (Review of Billing)
Unit verifications are performed as needed but at least once during each contract period for each program
or funding source under which a vendor provides services. NWICA staff selects at least a 10% random client
sample. If the unit verification is completed at the vendor’s offices, the client sample is provided to the
service provider on the day of the monitoring. Documentation of services provided is compared to the
number of units invoiced to NWICA.
If deemed appropriate by the AAA or if 10% of the total units reviewed {not client records} in the Base
Sample are found to be ineligible, the sample is expanded to include new names and months for which the
provider has received reimbursement. The number of units sampled per client is left to the discretion of the
Director of Elderly Services.
Follow Up and Corrective Action
Following each monitoring activity, NWICA issues a written report to the vendor. Service providers with
areas of non-compliance are asked to submit a corrective action plan within 30 days of receipt of the
findings. Corrective action plans are reviewed for completeness and appropriateness and a letter is issued
indicating the acceptance of the corrective action plan or the need for additional corrective actions. Upon
acceptance of the corrective action plans, NWICA will close out the monitoring.
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Upon completing a vendor review, a risk assessment is completed. This assessment looks at all aspects of a
vendor’s performance under our agreement, including: management and administration of program funds,
timeliness and accuracy of reporting and billing, the results of any surveys or inspections conducted by other
entities, customer satisfaction issues that have been entered into the INsite software program, policies and
procedures, and compliance with program requirements based on the service definition.
Providers who are determined to be “Low Risk” may be released from further on-site monitoring during the
contract period at the discretion of NWICA. If the provider’s circumstances change (i.e. a change in
administrative staff or an increase in consumer concerns) NWICA may determine that further on site
monitoring is required.
For providers who are determined to be “Moderate Risk,” NWICA will determine an appropriate course of
technical assistance, ongoing communication and monitoring to help move the vendor to the “Low Risk”
category.
For providers who are determined to be “High Risk,” NWICA will develop a more intense course of technical
assistance, ongoing communication and monitoring to help move the vendor to a lower category of risk.
For service providers found to be non-compliant after the corrective action plan or who remain “high risk”
for multiple consecutive monitoring periods, NWICA will bring the findings and termination
recommendation to the board of directors. Service providers have the right to follow the service provider
appeal process if there is a disagreement with the findings.
Technical Assistance
In addition to the regular vendor monitoring activities, NWICA provides technical assistance opportunities
including meetings with individual providers as warranted and the distribution of Technical Assistance Briefs
regarding issues that affect multiple providers.
Vendor File Compliance
NWICA utilizes a database to maintain current documents in each provider’s file as required per the
agreement. Appropriate reports are printed monthly to determine which providers need to submit updated
insurance, licensing, and other documents.
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Information Technology
Remote Access Policy
1.0 Purpose
The purpose of this policy is to define standards for connecting to NWICA's network from any host. These
standards are designed to minimize the potential exposure to NWICA from damages which may result from
unauthorized use of NWICA resources. Damages include the loss of sensitive or company confidential data,
intellectual property, damage to public image, damage to critical NWICA internal systems, etc.
2.0 Scope
This policy applies to all NWICA contractors, vendors and agents with a NWICA-owned or personally-owned
computer or workstation used to connect to the NWICA network. This policy applies to remote access
connections used to do work on behalf of NWICA, including reading or sending email and viewing intranet
web resources.
Remote access implementations that are covered by this policy include, but are not limited to, dial-in
modems, frame relay, ISDN, DSL, VPN, SSH, and cable modems, etc.
2.1 Definitions
Third parties are defined, as any individual, NWICA partner, group contractor, vendor or agent not wholly
owned by the NWICA. Third party Access is defined as all local or remote access to the corporate network or
devices attached to the NWICA network for any purpose.
3.0 Access Requests
Requests to allow access to the NWICA network or attached devices must meet the following criteria:
An initial request for third party access must be formally authorized by the appropriate NWICA Director.
The Director will complete the Third Party Access Authorization Form and submit to the Director of
Information Technology.
Access to the NWICA network facilities by third parties will not be provided until the appropriate measures
have been implemented and a contract signed defining the terms for the connection.
Third party access must be permitted only to the facilities, services and data, which are required to perform
the specified tasks, as outlined by the Director in the original request for access.
3.1 General
It is the responsibility of NWICA employees, contractors, vendors and agents with remote access privileges
to NWICA's corporate network to ensure that their remote access connection is given the same
consideration as an on-site connection to NWICA.
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3.2 Requirements
In order to ensure individual accountability on network devices and applications, all third parties granted
access must be given a unique user id and password. The third party will at all times be held responsible for
any activities which occur on the NWICA networks and applications using this unique user id. The Third Party
is solely responsible for ensuring that any username and password that they are granted remains
confidential and is not used by unauthorized individuals. At no time should any contractor, vendor or agent
provide their login or password to anyone.
NWICA contractors with remote access privileges must ensure that their NWICA-owned or personal
computer or workstation, which is remotely connected to NWICA's corporate network, is not connected to
any other network at the same time, with the exception of personal networks that are under the complete
control of the user.
When a Third Party is logged into the NWICAs network they should not leave the host they are logged onto
unattended. Workstations/laptops that are used to display data should be located in such a way that
confidential information is not displayed to unauthorized persons or the general public.
Up-to-date Virus checking software & Anti-spyware/Malware software must be installed on any relevant
devices that are being used to access the NWICA network or attached devices and these devices must be up
to date with relevant operating system patches.
Personal equipment that is used to connect to NWICA's networks must meet the minimum requirements for
remote access.
3.3 Confidentiality
Where an individual has direct or indirect access to data or information owned by NWICA, this information
must not be divulged or distributed to anyone. Documents which contain personal information including but
not limited to names, addresses or telephone numbers, medical records, financial records must be carefully
controlled and must not be released or disclosed to any unauthorized individuals or sources.
NWICA reserves the right to monitor activity and revoke access.
On completion of the contract the third Party must return or destroy all data belonging to the NWICA.
4.0 Enforcement
Any contractor or vendor found to have violated this policy may be subject to probation, suspension or
termination of the agreement.
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Minimum requirements for workstations are:
Component Minimum Requirements
Processor Type and Processor Speed (example: Pentium IV/2.0 GHz)
Pentium IV/2.0 GHz
RAM (example: 512mb RAM)
512mb RAM
Operating System (example: Windows XP)
Windows XP Professional or Windows Vista
Browser (example: Internet Explorer 8.0)
Internet Explorer 8.0
Available hard drive space (example: 500mb available hard drive space)
500mb available hard drive space
Printer HP LaserJet compatible printer
Antivirus Software (example: Trend Micro, Symantec)
Antivirus Software (Symantec, MacAfee, Trend
Micro)
Citrix Software Citrix Xenapp Client Software v11.2
Internet Connection (example: DSL)
DSL Internet Connection
Current Windows Service Pack Updates/ Hot Fixes
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Forms
Third Party NWICA Network Access Agreement
67
Vendor Name
Introduction
The purpose of this contract is to agree conditions for third party access by
________________________________________________________________ to the NWICA data
network.
Third party access is defined as all remote access to the NWICA Data Network or devices attached to the
NWICA Network for any purpose.
Access Request
Access to the NWICA’s network has
been requested by
Access Details
Access is granted to Specify Name and Contact
details of Company/Individual
Access is granted to the following
device(s)/data
Access is granted to the
following device(s)/data
Remote access method granted will
be
Specify access details (e.g.
vpn/dial-up)
2.4 Security Conditions
Access to NWICA systems and data is granted for approved purposes only. The use of this access for any
other purpose is strictly prohibited.
Access to the NWICA network facilities will not be provided until a signed copy of this contract has been
returned to NWICA.
NWICA network access is limited to the facilities, services and data and connection types as defined in
section 1.3
The third party is permitted only to use access methods meeting appropriate protocols as described in
section 1.4
The third Party is required to maintain a list of all individuals authorized to use the access and make this
available to NWICA on request.
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The third Party will inform NWICA in writing of appropriate staff changes. This includes the rotation and
resignation of employees so that the NWICA can disable user ids and remove / change passwords in
order to secure its resources.
The third Party must comply with all relevant government legislation including but not limited to HIPAA.
The NWICA reserves the right to monitor activity and revoke access.
The NWICA reserves the right to audit contractual responsibilities.
Where the third Party has direct or indirect access to data or information owned by the NWICA, this
information must not be copied, divulged or distributed to any other party.
On the completion of this contract the third Party must return or destroy all data belonging to NWICA.
Any suspected security breaches or other incidents must be reported in a timely manner to the NWICA
IT Service Desk.
The third Party will at all times be held responsible for any activities which occur on NWICA network and
applications using any unique user ids granted.
The third Party is solely responsible for ensuring that any username(s) and password(s) that they are
granted remain confidential and are not used by unauthorized individuals.
When a third Party is connected to the NWICA network they should not leave the machine/device
unattended.
Workstations/laptops that are used to display NWICA data should be located in such a way that
confidential information is not displayed to unauthorized persons or the general public.
NWICA reserves the right to increase security thresholds if future security risks are identified.
All hosts connecting to the NWICA networks must:
1. Use the most up-to-date anti-virus/anti-spyware/anti-malware software.
2. Be protected by a Corporate or private Firewall.
3. Be up to date with operating system patches.
4. Not be made available for use to unauthorized third parties.
5. Be available for inspection by the Director of Information Technology or his/her designee if requested.
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Signed for on behalf of 3rd PARTY
By:
Name:
Title:
Date:
Signed for on behalf of NWICA
By:
Name:
Title:
Date:
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Appendix A: Northwest Indiana Community Action Key Staff Directory Main Office : (219) 794-1829 FAX: 219-794-1860
TOLL FREE: 800 826-7871 TTY: 888 814-7597
NAME EXT E-MAIL TITLE
Bohacek, Melissa 2311 [email protected] Executive Assistant/Communications
Manager
Brown, Jessica 2203 [email protected] Access & Outreach Manager
Fagan, Dennis [email protected] Ombudsman
Freel, Robyn 2320 [email protected] Director of Finance
Freeland, Carolyn 2312 [email protected] Director of Administrative Services
Gomez, Gina 2410 [email protected] Community Services Manager
Harbinson, Becky 2114 [email protected] 211 Manager
Hamlin, John 2227 [email protected] Quality Coordinator
Henderson, Joy 2230 [email protected] ADRC Supervisor
Hinojosa, Gloria 2217 [email protected] Grants Management Coordinator
Margis, Kathy 2204 [email protected] ADRC Manager
Marshall, Kellie 2233 [email protected] Nutrition Supervisor
Malone, Jennifer 2201 [email protected] Chief Operating Officer
Olund, Gary 2311 [email protected] President/CEO
Parker, Vernadine 2245 [email protected] Outreach & Education Coordinator
Peek, Robert 2221 [email protected] HCBS Manager
Robinson, Gloria 2430 [email protected] Energy Assistance Program Supervisor
Shelton, Eric 2300 [email protected] Director of Information Technology
Schoon, Anna 2314 [email protected] Director of Planning and Development
Keim, Kathy 2205 [email protected] Field Supervisor – Lake County
Olehy, Jenifer 219-895-
0283
[email protected] Field Supervisor – Newton, Jasper,
Pulaski, Starke Counties
Crawford, Pat 219-808-
8534
[email protected] Field Supervisor – Porter County
