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Backup Documents 03/11/2014 Item #16D8 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLi 6 0 8 TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Aiorney Office at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later than Monday preceding the Board meeting. **NEW** ROUTING SLIP Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office. Route to Addressee(s) (List in routing order) Office Initials Date 1. Jennifer A. Belpedio, Assistant County County Attorney Office Attorney 2. BCC Office Board of County "C�t Commissioners \C /.C/ 4\\A 3.3. Minutes and Records Clerk of Court's Office *(14 f � PRIMARY CONTACT INFORMATION t Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the addressees above,may need to contact staff for additional or missing information. Name of Primary Staff Esther Mae / \-\ovs �c Phone Number 252-8223 Contact/ Department f Agenda Date Item was 03/11/2014 J Agenda Item Number 16.D.8 Approved by the BCC Type of Document 1) Agreement(Agency Health Care " Number of Original 1) 4 originals Attached Administration) /Documents Attached 2) Agreement(Naples Community t/ 2) 3 originals t/ Hospital,Inc.) Please see attached document for routing copies PO number or account n/a number if document is to be recorded INSTRUCTIONS & CHECKLIST Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not appropriate. (Initial)/ Applicable) I. Does the document require the chairman's original signature? EM 2. Does the document need to be sent to another agency for additionalsigm.blreo If yes, EM provide the Contact Information(Name;Agency;Address;Phone on an attached sheet 3. Original document has been signed/initialed for legal sufficiency. (All documents to be EM signed by the Chairman,with the exception of most letters,must be reviewed and signed by the Office of the County Attorney. 4. All handwritten strike-through and revisions have been initialed by the County Attorney's EM Office and all other parties except the BCC Chairman and the Clerk to the Board 5. The Chairman's signature line date has been entered as the date of BCC approval of the EM document or the final negotiated contract date whichever is applicable. 6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's EM signature and initials are required. 7. In most cases(some contracts are an exception),the original document and this routing slip EM V should be provided to the County Attorney Office at the time the item is input into SIRE. Some documents are time sensitive and require forwarding to Tallahassee within a certain time frame or the BCC's actions are nullified. Be aware of your deadlines! 8. The document was approved by the BCC on 3/ti and all changes made during the EM V No c L a-.5c S meeting have been incorporated in the attached document. The County Attorney's Office has reviewed the changes,if applicable. 9. Initials of attorney verifying that the attached document is the version approved by the BCC,all changes directed by the BCC have been made,and the document is ready for the Chairman's signature. I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12 _„„ ; 1. 6 0 8 Ueunty of Collier CLERK OF THE`;CIRCUIT COURT Dwight E. Brock COLLIER COUNTY CO1 THOUSE Clerk of Courts Clerk of Courts 3315 TAMIAMI TRL E STE 102 , a, P.O.BOX 413044 Accountant NAPLES,FLORIDA A C !NAPLES,FLORIDA Auditor 34112-5324 * ?34101-3044 Custodian of County Funds Nicole Linn AHCA Medicaid Program Finance (MFP) 2727 Mahan Drive Mail Stop 23 Tallahassee, FL 32308 Ms. Linn, Attached for processing are four (4) original copies of the Letter of Agreement between Collier County and the State of Florida, through the Agency for Health Care Administration, approved by the Board of County Commissioners of Collier County, Florida on March 11, 2014. After the agreement(s) are fully executed, please return three (3) of the original documents to the Collier County Minutes and Records Department, that serves as Clerk to the Board, for the Official Record. I have included a mailing label for easier processing. Upon receipt of those original documents, I will forward them to the appropriate parties for further execution. If your office requires further information or you have questions, please do not hesitate to contact me at 239-252-8406. Sincerely, DWIGHT E. BROCK, CLERK Ann Jennejohn, Deputy Clerk Attachments Phone- (239) 252-2646 Fax- (239) 252-2755 Website- www.CollierClerk.com Email- CollierClerk @collierclerk.com 1613 • • 4 • O .1 =I fedex.com 1.800.G:FedEx 1.800.463.3339 _RIE:pc j 4/ N !� I, o l I p.m=ce k m x; , co r.; ,I I C - °II °I n �� �co ;I -II I 1 i I 1,', ,1 of Er! _� 1 A In C swum N 3 Mgr g• o!I o j, � Q., �Owo wea��. s ,r IN + .. y N y. cri • I I s3 m = N� I - - en ;C1�' - gals - i o 5 m a --9Z to Vf m sm etas. tit- fi ` gzn S ;, a'a o y n m o 711. -1 g 1 o� F. I. 2_ °3- 8O 6 Cl')m m-1 3 = o m <°s 8,...m n N.� y <; m! m a s it c17 a 'JC L., U, > (7� 3O d t � G n� tat N i�p C CT7 O -. _ 3 m s. z = R _ 3 is,a z£m H Lt'$ N CC)e. 4.CD .1 a o a 3 n 1 to m T. co. m 1 z s g i7s i--. O p .Z 3 A °mil Vt N Jt 21 m ° �m �3� o' VD d D x �S. i MiiIIMMIIMIIMEM ""4 • CD z mom' 9 Es _ ..� n o maaem `a ill C oa s2 O Y = lIl 03) Y 6E££'E94 OOS X3Pai09 can W07 } ---- W 1.3— v a -0 ) , 0 4;3 ,.., .. ,.. / a> QQ County 1608 y of Collier CLERK OF THECIRUIT COURT Dwight E. Brock COLLIER COUI I; 'Y COLTHOUSE Clerk of Courts Clerk of Courts Accountant 3315 TAMIAMI TRL E STE 102-, , P.O.BOX 413044 NAPLES,FLORIDA Auditor �f NAPLES,FLORIDA 34112-5324 •1_ 34101-3044 Custodian of County Funds April 7, 2014 Naples Community Hospital, Inc. 350 7th Street, North Naples, FL 34102 NCH Legal Department, Attached for your records is an original copy of the agreement between Collier County and Naples Community Hospital, Inc. for hospital services, designated primary health care services, specialty health care services and other health care services. Attached to the agreement is an original copy of the Low Income Pool (LIP Program) Letter of Agreement between the County and State of Florida AHCA ("Attachment A"). These agreements were approved by Collier County's Board of County Commissioners during their meeting held on Tuesday March 11, 2014. The Board will maintain an original copy of both agreements in their records and original copies have also been provided to the Collier County Housing, Human and Veteran Services Department. If your office requires further information or you have questions, please feel free to contact me at 239-252-8406. Sincerely, DWIGHT E. BROCK, CLERK Jt,L ,c? Ann Je lr ie.j.. ' Deputy Clerk Attachment Phone- (239) 252-2646 Fax- (239) 252-2755 Website- www.CollierClerk.com Email- CollierClerk @collierclerk.com 164 MEMORANDUM Date: April 7, 2014 To: Esther Mae, Accountant Housing, Human and Veteran Services Department From: Ann Jennejohn, Deputy Clerk Minutes & Records Department Re: An Agreement between Collier County and NCH, Inc. and a Letter of Agreement between Collier County and the Florida Agency for Health Care Administration for health services and for participation in the Low Income Pool (LIP) Program Attached for your records are fully executed original copies of both of the agreements referenced above, approved by the Board of County Commissioners (Item #16D8) on Tuesday, March 11, 2014. Our office has held original copies for the Board's Official Record and original copies of both agreements have also been mailed to the Accounting Department with Naples Community Hospital, Inc. If you have any questions, please call me at 252-8406. Thank you. Attachments 1608 AGREEMENT th THIS AGREEMENT is made and entered on the )► day of MA RCP , 2014, by and between Collier County, Florida, a political subdivision of the State of Florida, hereinafter referred to as "the County" and Naples Community Hospital, Inc., a Florida not for profit corporation herein after referred to as "Hospital". RECITALS: WHEREAS, Section 125.01(1)(e), Florida Statutes, authorizes the County to provide health welfare programs for the residents of Collier County to the extent not inconsistent with general or special law. WHEREAS, the establishment and maintenance of such programs are in the common interest of the people of Collier County. WHEREAS, The County desires the Hospital to become a community health partner to assist in providing payments for health prevention programs, and mental health services to residents of the County. WHEREAS, The Hospital desires to be a community health partner and is willing to voluntarily provide payments for such services, subject to the terms and conditions hereinafter set forth. NOW THEREFORE, in consideration of the covenants herein contained, the parties hereby agree as follows: ARTICLE I SERVICES TO BE PERFORMED 1. The Hospital shall provide documentation and monthly reports to the County related to payment for the delivery of hospital services, designated primary health care services, specialty health care services and other health care services. 2. The Hospital and/or its sub-contractor shall provide timely responses to contract requirements. Responses to inquiries from the Public Services Division or designee regarding any aspect of payment of services being provided shall be as indicated below. a. Emergency room, secondary and tertiary care for those patients determined eligible by the County Human Services Department. b. Secondary and tertiary services shall be provided upon the referring physician or designated physician's order. The referral order shall distinguish between a referral for specific therapeutic services and a diagnostic workup. 1 1608 3. Nothing in this contract shall be construed to limit access for a patient to any service provided by a Health Services provider that is medically necessary and approved by the County. ARTICLE II PAYMENTS The County shall make intergovernmental transfers, on behalf of Naples Hospital in connection with the LIP program to the State of Florida in accordance with the Letter of Agreement between the County and the Agency for Health Care Administration. 1. The county will remit to the State an amount not to exceed a grand total of$250,000. The County will transfer payments to the State in the following manner: a. The first quarterly payment of$62,500 for the months of July, August, and September is due upon notification by the Agency. b. Each successive payment of$62,500 is due by June 1, 2014. c. The State will bill the County each quarter payments are due. 2. The following document is hereby incorporated by reference as Attachment A to this Agreement. a. Low Income Pool Agreement(LIP)with State of Florida AHCA (Attachment A). ARTICLE III CLAIMS VALUATION AND CLAIMS PROCESSING 1. As the claims processing entity, the Hospital will provide quarterly financial reports to the County in such detail as required by the County. ARTICLE IV TERMS OF AGREEMENT AND TERMINATION 1. The term of this Agreement shall be March 11, 2014 through March 10, 2015 with no renewal. 2. Either party may terminate this Agreement thirty (30) calendar days after receipt by the other party of written notice of intent to terminate. In the event of termination, the County shall pay for services rendered, prorated to the date of termination. 2 16 3. Upon breach of this Agreement, the aggrieved party may, by written notice of breach to the breaching party, terminate the whole or any part of this Agreement. Termination shall be upon no less than twenty-four(24) hours notice, in writing, delivered by certified mail, telegram or in person. Waiver by either party of breach of any provisions of this Agreement shall not be deemed to be a waiver of any other or subsequent breach and shall not be construed to be a modification of the terms of this Agreement. 4. It is further agreed that in the event general funds to finance all or part of this Agreement do not become available, the obligations of each party hereunder may be terminated upon no less than twenty-four(24) hours notice in writing to the other party. Said notice shall be delivered by certified mail, or in person. The County shall be the final authority as to the availability of funds and as to how any available funds will be allocated among its various service providers. ARTICLE V ASSIGNMENT The Hospital and/or its sub-contractor shall not assign or transfer this Agreement, or any interest, right or duty herein, without the prior written consent of the County, which consent shall not be unreasonably withheld by the County. Without obtaining prior consent by the County, the Hospital shall be allowed to assign or transfer this Agreement or any of the Hospital's obligations hereunder to affiliates or wholly owned subsidiaries of the Hospital. This Agreement shall run to the County and its successors. ARTICLE VI SUBCONTRACTING The parties agree that the Hospital shall be permitted to execute subcontracts for the purchase by the Hospital of such services, articles, supplies, and equipment, which is both necessary and incidental to the performance of the work, required under this Agreement. However, the Hospital expressly understands that it shall assume the primary responsibility for performing the services outlined in Article I of this Agreement. ARTICLE VII INSURANCE, SAFETY AND INDEMNIFICATION 1. Indemnity. To the maximum extent permitted by Florida law, the Hospital and/or its sub- contractor shall indemnify and hold harmless the County against any claims, damages, losses, and expenses, including reasonable attorneys' fees and costs, arising out of or resulting from the Hospital's failure to pay for services or performance under this Agreement. This indemnification obligation shall not be construed to negate, abridge or 3 1608 reduce any other rights or remedies which otherwise may be available to an indemnified party or person described in this paragraph. 2. Hospital shall jointly and severally indemnify and hold harmless Collier County for all claims, demands, actions, suits, losses, costs, charges, expenses, damages and liabilities whatsoever which the County may pay, sustain, suffer or incur by reason of or in connection with this agreement including payment of all legal costs, including but not limited to, attorney's fees paid by the County. 3. Insurance Required: During the term of this agreement the Hospital shall procure and maintain liability insurance coverage. The liability insurance coverage shall be in amounts not less than $1,000,000 per person and $2,000,000 per incident of occurrence for personal injury, death, and property damage or any other claims for damages caused by or resulting from the activities under this Agreement. Such policies of insurance shall name the County as an additional insured. The Hospital shall purchase all policies of insurance from a financially responsible insurer duly authorized to do business in the State of Florida. The Hospital shall be financially responsible for any loss due to failure to obtain adequate insurance coverage and the failure to maintain such policies or certificate in the amounts set forth herein shall constitute a breach of this agreement. ARTICLE VIII BILLING PROCEDURES The Hospital has standard, acceptable billing procedures that the Hospital will utilize in the performance of its obligations under this Agreement. The County shall direct the Hospital to make payments pursuant to this Agreement once the County has verified the validity of the invoices to be paid by the Hospital. The Hospital will not pay any invoices prior to the County's approval. The Hospital will provide copies of checks for payments as they are remitted. The Hospital shall also provide quarterly reports showing invoices paid and pending payments. The Hospital shall make payments on a voluntary basis in the amount of$250,000 to specific healthcare programs and services that are pre-approved by the County for payment. The Hospital shall use reasonable efforts to pay invoices approved by the County within thirty (30) days of County approval. Payments shall be made in accordance with this Agreement irrespective of whether the Hospital has received funds from AHCA. If the amount invoiced to the Hospital does not result in the amount of$250,000, the Hospital will credit the County for the difference and voluntarily make those payments to providers elected by the County in the following year. 4 1608 ARTICLE IX RECORDS 1. The Hospital and/or its sub-contractor shall keep orderly and complete records of its accounts and operations related to the services provided under this Agreement for the entire term of the Agreement plus three (3) years. The Hospital and/or its sub-contractor shall keep open these records to inspection by County personnel at reasonable hours during the entire term of this Agreement. If any litigation, claim or audit is commenced prior to the expiration of the three (3) year period and extends beyond this period the records must remain available until any litigation, claim or audits have been resolved. Any person duly authorized by the County shall have full access to and the right to examine any of said records during said period. Access to PHI shall be in compliance with federal laws and HIPAA. ARTICLE X CIVIL RIGHTS 1. There will be no discrimination against any employee or person served on account of race, color, sex, age, religion, ancestry, national origin, handicap or marital status in the performance of the Agreement. 2. It is expressly understood that, upon receipt of evidence of such discrimination, the County shall have the right to terminate this Agreement for breach of agreement. 3. The Hospital and/or its sub-contractor shall comply with Title VI of the Civil Rights Act of 1964 (42 USC 2000d) in regard to persons served. 4. The Hospital and/or its sub-contractor shall comply with Title VII of the Civil Rights Act of 1964 (42 USC 2000c) in regard to employees or applicants for employment. 5. The Hospital and/or its sub-contractor shall comply with Section 504 of the Rehabilitation Act of 1973 in regard to employees or applicants for employment and clients served. ARTICLE XI OTHER CONDITIONS 1. Any alterations, variations, modifications or waivers of provisions of this Agreement shall only be valid when they have been reduced to writing, duly signed and attached to the original of this Agreement. The parties agree to renegotiate the Agreement if revision of any applicable laws or regulations makes changes in the Agreement necessary. 2. This Agreement contains all the terms and conditions agreed upon by the parties. All items incorporated by reference are as though physically attached. No other 5 1608 agreements, oral or otherwise, regarding the subject matter of this Agreement, shall be deemed to exist or to bind any of the parties hereto. 3. The Hospital and/or its sub-contractor shall obtain and possess throughout the term of this Agreement all licenses and permits applicable to its operations under federal, state, and local laws, and shall comply with all fire, health and other applicable regulatory codes. 4. The Hospital and/or its sub-contractor agrees to comply with all applicable requirements and guidelines prescribed by the County for recipients of funds. 5. The Hospital and/or its sub-contractor agree to safeguard the privacy of information pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA). IN WITNESS WHEREOF, the parties have executed this Agreement on the dates indicated below. ATTEST: BOARD OF COUNTY COMMISSIONERS DWIGH ' BROCK, Clerk COLLIER COUTNY, FLO'',IDA v � By: - i .� /__w��,, Q L • By: Attest as t0 Clerk Tom Henning, Chairman, sign ature only Attes as to Chairnl s signature only. NAPLES COMMUI Y / 2.'I AL/ I0 C. Approved as to form and legality: By: a �' �.. Title: t C� 9 (\ t yCtZ l Cn Jennifer A. Belpedio Assistant County Attorney Collier County Date: (1! l kg 6 Attachment A Letter of Agreement 1608 THIS LETTER OF AGREEMENT made and entered into in duplicate on the )44 day of /�A2e N 2014, by and between Collier County (the County), and the State of Florida, through its Agency for Health Care Administration (the Agency), 1. Per Senate Bill 1500, the General Appropriations Act of State Fiscal Year 2013-2014, passed by the 2013 Florida Legislature, County and the Agency, agree that County will remit to the State an amount not to exceed a grand total of$250,000. a. The County and the Agency have agreed that these funds will only be used to increase the provision of health services for the Medicaid, uninsured, and underinsured people of the County and the State of Florida at large. b. The increased provision of Medicaid, uninsured, and underinsured funded health services will be accomplished through the following Medicaid programs: i. The Disproportionate Share Hospital (DSH) program. ii. The removal of outpatient reimbursement ceilings for teaching, specialty and community hospital education program hospitals. iii. The removal of outpatient reimbursement ceilings for hospitals whose charity care and Medicaid days as a percentage of total adjusted hospital days equals or exceeds 11 percent. iv. The removal of outpatient reimbursement ceilings for hospitals whose Medicaid days, as a percentage of total hospital days, exceed 7.3 percent, and are trauma centers. v. Inpatient DRG add-ons for teaching, specialty, children's, public and community hospital education program hospitals; hospitals whose charity care and Medicaid days as a percentage of total adjusted hospital days equals or exceeds 11 percent; or hospitals whose Medicaid days, as a percentage of total hospital days, exceed 7.3 percent, and are trauma centers. vi. The annual cap increase on outpatient services for adults from $500 to $1,500. vii. Medicaid Low Income Pool (LIP) payments to rural hospitals, trauma centers, specialty pediatric hospitals, primary care services and other Medicaid participating safety-net hospitals. viii. Medicaid LIP payments to hospitals in the approved appropriations categories. ix. Medicaid LIP payments to Federally Qualified Health Centers. Collier County_Naples Community Hospital_LIP LOA SFY 2013-14 MAR 2 0 2014 1608 x. Medicaid LIP payments to Provider Access Systems (PAS) for Medicaid and the uninsured in rural areas. xi. Medicaid LIP payments for the expansion of primary care services to low income, uninsured individuals. 2. The County will pay the State an amount not to exceed the grand total amount of $250,000. The County will transfer payments to the State in the following manner: a. The first quarterly payment of$62,500 for the months of July, August, and September is due upon notification by the Agency. b. Each successive payment of $62,500 is due by June 1, 2014. c. The State will bill the County each quarter payments are due. 3. Timelines: This agreement must be signed, submitted, and received to the Agency no later than October 1, 2013, for self-funded exemptions, buybacks and DRG add-ons, to be effective for SFY 2013-2014. s 4. Attached are the DSH and LIP schedules reflecting the anticipated annual distributions for State Fiscal Year 2013-2014. 5. The County and the State agree that the State will maintain necessary records and supporting documentation applicable to Medicaid, uninsured, and underinsured health services covered by this Letter of Agreement. Further, the County and State agree that the County shall have access to these records and the supporting documentation by requesting the same from the State. 6. The County and the State agree that any modifications to this Letter of Agreement shall be in the same form, namely the exchange of signed copies of a revised Letter of Agreement. 7. The County confirms that there are no pre-arranged agreements (contractual or otherwise) between the respective counties, taxing districts, and/or the providers to re- direct any portion of these aforementioned Medicaid supplemental payments in order to satisfy non-Medicaid, non-uninsured, and non-underinsured activities. 8. The County agrees the following provision shall be included in any agreements between the County and local providers where funding is provided for the Medicaid program. Funding provided in this agreement shall be prioritized so that designated funding shall first be used to fund the Medicaid program (including LIP) and used secondarily for other purposes. 9. The Agency will reconcile the difference between the amount of the IGTs used by or on behalf of individual hospitals' buybacks of their Medicaid inpatient and outpatient trend adjustments or exemptions from reimbursement limitations for SFY 2012-13 and an estimate of the actual annualized benefit derived based on actual days and units of service provided. Reconciliation amount may be incorporated into current year (SFY 2013-14) LOAs. Collier County_Naples Community Hospital_LIP LOA SFY 2013-14 1608 10. This Letter of Agreement covers the period of July 1, 2013 through June 30, 2014 and shall be terminated June 30, 2014. Collier County_Naples Community Hospital_LIP LOA SFY 2013-14 0 1608 WITNESSETH: IN WITNESS WHEREOF the parties have duly executed this Letter of Agreement on the day and year above first written. Collier County State of Florida el 4' I Signature Stacey La p in Assistant Deputy Secretary for Medicaid Finance, Agency for Health Care Administration To tJG Name C-ta Al2mA� Title ATT E a :,.� DWIGHT.E. BROCK, Clerk Approved as to form and legality By: dI p c� Attest a h.t '�an's 1 • Assistant County • ttorney signature,only. 315111 Collier County_Naples Community Hospital_LIP LOA SFY 2013-14 G�' 1608 Local Government Intergovernmental Transfers Program /Amount State Fiscal Year 2013-2014 Supplemental Payments LIP $250,000 DSH Nursing Home SMP Outpatient Amounts Automatic Buyback Self-Funded Buyback Automatic Exemption Self-Funded Exemption SWI Inpatient Amounts Automatic DRG Add-On Self-Funded DRG Add-On Total Funding $250,000 Collier County_Naples Community Hospital_LIP LOA SFY 2013-14 C.../