Backup Documents 09/23/2014 Item #16D23 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 6 D ,
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 Attorney 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 routin&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 Attorney Office _a Q �4'�„
County Attorney Utz
2. BCC Office Board of County � q�� `�
Commissioners 1
3. Minutes and Records Clerk of Court's Office
PRIMARY CONTACT INFORMATION
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 Phone Number 252-8223
Contact/ Department
Agenda Date Item was 09/23/2014 Agenda Item Number 16.D.23
Approved by the BCC
Type of Document Item 1) LIP 6 LOA(Collier County on behalf Number of Original Item 1) 3 originals
Attached of Naples Community Hospital and the State Documents Attached
of FL Agency for Health Care Administration)
Item 2) LIP 6 LOA(Collier County on behalf Item 2) 3 originals
of Physicians Regional Medical Center and
the State of FL Agency for Health Care
Administration)
Item 3) Master Service Agreement(Naples Item 3) 1 original
Community Hospital)
Item 4) Indemnification Letter Agreement Item 4) 1 original
(Physicians Regional Medical Center)
Please see attached document for routing original documents
PO number or account number if document is to be recorded I N/A
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is appropriate. Yes N/A(Not
(Initial) Applicable)
1. Does the document require the chairman's original signature? EM
2. Does the document need to be sent to another agency for additional signatures? 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 v'
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
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 9/23/2014 and all changes made during the EM
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 VA°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
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
Item ID: 12987 1 6 D 2 3
AHCA: Please supply three originals each (6 in total) of the Agreements between Collier County and
the State of FL, Agency for Health Care Administration (Item 1. LIP 6 LOA on behalf of NCH-3 each;
and Item 2. LIP 6 LOA on behalf of PRMC-3 each). These will need to be sent to the address below for
signatures:
Tony Philpot
Director, Government Relations-Florida Community Health Systems
215 South Munroe Street, Suite 602
Tallahassee, FL 32301
Phone: (850) 702-0892
**Please request that AHCA (Mr. Philpot) send four signed original documents back to Collier
County (2 each of item #1 and Item #2).
NCH: Please supply 1 original of the Master Service Agreement between Collier County and Naples
Community Hospital to be held by the Clerk's office until the two original signed LIP 6 LOA's on
behalf of Naples Community Hospital from the State of FL, Agency for Health Care Administration
are returned.
Then send one of the State signed certified documents affixed with the provided label
marked "Attachment A" along with a certified document of the Collier County BOCC
signed Naples Community Hospital Master Service Agreement to the address for NCH
as provided below.
Sarah Fitzgerald
Healthcare Financial Group
3615 West Swann Avenue
Tamp, FL 33609
Phone: (813) 286-4455
PRMC: Please supply 1 original of the Indemnification Letter Agreement between Collier County and
Physicians Regional Medical Center to be held by the Clerk's office until the two original signed LIP 6
LOA's on behalf of Physicians Regional Medical Center from the State of FL, Agency for Health Care
Administration are returned.
Then send one of the State signed certified documents affixed with the provided label
marked "Attachment A" along with a certified document of the Collier County BOCC
signed Physicians Regional Medical Center Indemnification Letter Agreement to the
address for PRMC as provided below.
John Owens
Financial Healthcare Strategies, LLC
3019 N Shannon Lakes Drive, Ste 201
Tallahassee, FL 32309
Phone: (850) 668-8525
Then after retaining the Clerk's one original please send the remaining original and/or one certified
copy of each of these four documents to the address for HHVS below:
Housing, Human and Veteran Services, ATTN: Esther Mae
3339 Tamiami Trail East, Ste 211, Naples, FL 34112
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
Coun ty of Collier 160 2 3
CLERK OF THE CIRCUIT COURT
Dwight E. Brock COLLIER COL 74.11'11 COL`RMOLSE Clerk of Courts
Clerk of Courts 3315 FANI1AMi FRL E S FE I01~ • P.O. BOX 413044 .\ccountant
NAPLES. FLORIDA NAPLES, FLORIDA Auditor
34112-5324 * 34101-3044 Custodian of County Funds
September 26, 2014
Tony Philpot
Director Government Relations-Florida Community Health Systems
215 South Munroe Street, Suite #602
Tallahassee, FL 32301
Mr. Philpot
Enclosed find three (3) of each Letter of Agreements (Naples
Community Hospital and Physicians Regional) for additional signatures,
Approved by the Board of Collier County Commissioners on September
23, 2014.
Please sign and return two (2) of each agreement to my office. I have
enclosed a return FedEx air bill for your convenience.
Any Questions, please contact me, 239-252-8411.
Thank you,
ecua&A.ot\_
eresa Cannon, Deputy Clerk
Phone- (239) 252-2646 Fax- (239) 252-2755
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16023
MEMORANDUM
Date: November 17, 2014
To: Esther Mae, Accountant
Housing, Human and Veteran Services Department
From: Teresa Cannon, Deputy Clerk
Minutes & Records Department
Re: Master Service Agreement and LIP 6 Letter of Agreement
w/Naples Community Hospital & Indemnification Letter
Agreement and LIP 6 Letter of Agreement w/Physicians Regional
Attached for your records are fully executed copies of both of the agreements
referenced above, approved by the Board of County Commissioners (Item #16D23)
on Tuesday, September 23, 2014.
Our office has held original copies for the Board's Official Record and sent Collier
Health Services an original.
If you have any questions, please call me at 252-8411.
Thank you.
Attachments
County of Collier i 60
2 3
CLERK OF THE CIRCUIT COURT
COLLIER COUNTYSOURiIIOUSE
3315 TAMIAMI TRL E STE 102 Dwight E. Brock-Glerk of Circuit Court P.O. BOX 413044
NAPLES, FL 34112-5324 NAPLES, FL 34101-3044
Clerk of Courts • Comptroller • Auditor 'ustodian of County Funds
November 17, 2014
Financial Heritage Strategies LLC
Attn: John Owens
Mr. Owns,
Enclosed is your certified original copy of the Indemnification Letter Agreement
and LIP 6 Letter of Agreement with Physicians Regional Medical Center approved
on Tuesday, September 23, 2014 by the Board of County Commissioners of
Collier County.
Please contact me if any questions, Thank you.
Clerk to the Board, Minutes & Records Department
0--CLA_AXX
Teresa Cannon, Senior Deputy Clerk
239-252-8411
Phone- (239) 252-2646 Fax- (239) 252-2755
Website- www.CollierClerk.com Email- CollierClerk @collierclerk.com
Coanty of Collier 16023
CLERK OF THE CIRCUIT COURT
COLLIER COUNTYr OURTHOUSE
3315 TAMIAMI TRL E STE 102 Dwight E. Brock-Gberk of Circuit Court P.O. BOX 413044
NAPLES, FL 34112-5324 NAPLES, FL 34101-3044
Clerk of Courts • Comptroller • Auditor ustodian of County Funds
November 17, 2014
Healthcare Finance Group
Attn: Sarah Fitzgerald
Ms. Fitzgerald,
Enclosed is your certified original copy of the Master Service Agreement and LIP
6 Letter of Agreement with Naples Community Hospital approved on Tuesday,
September 23, 2014 by the Board of County Commissioners of Collier County.
Please contact me if any questions, Thank you.
Clerk to the Board, Minutes & Records Department
36YAA-Use■-
Teresa Cannon, Senior Deputy Clerk
239-252-8411
•
Phone- (239) 252-2646 Fax- (239) 252-2755
Website- www.CollierClerk.com Email- CollierClerk@collierclerk.com collierclerk.com
161323
MASTER SERVICE AGREEMENT
THIS MASTER SERVICE AGREEMENT(AGREEMENT) is made and entered into this September r 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,
hereinafter referred to as"the 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;and
WHEREAS,the establishment and maintenance of such programs are In the common interest of
the people of Collier County:and
WHEREAS, the County desires the Hospital to become a Community Health partner to assist in
providing management advice, coordination of care, and support for health prevention programs, and
mental health services to residents of the County, where no existing state or federal resources are
available;and
WHEREAS, The Hospital desires to be a Community Health partner and is willing to voluntarily
provide support and oversight for such services in an effort to reduce non-emergent emergency
department utilization,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 quarterly reports to the County that support
Hospital's expenditures for the reimbursement to Collier partners as stated immediately below
for the delivery of services, designated primary health care services, specialty health care
services and other health care services including, but not limited to,the following services:
a. Immunization program provided by the Collier County Health Department
b. AIDS Prevention Program provided by the Collier County Health Department
c. Tuberculosis Program provided by the Collier County Health Department
d. Communicable Disease Program provided by the Collier County Health Department
e. Child Health Program provided by the Collier County Health Department
f. Healthy Start Prenatal Program provided by the Foundation for Women's Health
g. School Health Program provided by the Collier County Health Department
h. Adult Health Program provided by the Collier County Health Department
i. Dental Program provided by the Collier County Health Department.
j. Community Mental Health Services provided by the David Lawrence Center, Inc.
k. Other health related programs and services
2. The County and Hospital shall on a quarterly basis review the utilization of the services
enumerated above and Hospital shall make suggested changes for improvement of the delivery
and access to care and services provided.
1
2014 Agreement with Naples Community Hospital
161323
ARTICLE II
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.
2. As part of the claims processing entity,the Hospital will provide quarterly reports to the County
with suggestions to improve access to services, to better coordinate care and services by and
among providers, and to reduce emergency department utilization for non-emergent care.
ARTICLE III
TERMS OF AGREEMENT AND TERMINATION
1. The term of this Agreement shall be October 1,2014 through September 30,2015.
2. Either party may terminate this Agreement thirty (30) calendar days after receipt by the other
party of written notice of intent to terminate.
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,facsimile,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.
ARTICLE IV
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 V
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.
2
2014 Agreement with Naples Community Hospital
CS)
16U23H
ARTICLE VI
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 reduce any other rights
or remedies which otherwise may be available to an indemnified party or person described in
this paragraph.
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.
2. 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 VII
BILLING PROCEDURES
The County shall provide the Hospital with invoices 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 shall make payments on a voluntary basis in the amount of $1,650,000 to specific
healthcare programs and services, such as the mental health programs of the David Lawrence Center,
specified health programs of the Collier County Health Department, and other social service providers
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 Hospital has received funds from AHCA.
If the amount invoiced to Hospital does not result in the amount of$1,650,000 the Hospital will credit
County for the difference and voluntarily make those payments to providers elected by County upon
invoice by the County in Year 2015-2016.
ARTICLEVIII
RECORDS
3
2014 Agreement with Naples Community Hospital
16023 3
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 IX
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 X
OTHER CONDITIONS
1. Any alterations,variations, modifications or waivers of provision 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 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 WITHNESS WHEREOF,the parties have executed this Agreement on the dates first written above.
4
2014 Agreement with Naples Community Hospital
1 A n 2 3
,,,,, , „,..„, "
ATTEST: ry-\03 °.B..470 BOARD OF COUNTY COMMISSIONERS
DWIGHT E.BROCK,CL K' OF COLLII R COUN FLORIDA
B _ B • ►fir _"
Attest as to Chal'A`k� U . CLERK By:
TOM HENNING •
Sloiiaturr3 --,4
CHAIRMAN
Approval for form and legality:
A 4..)Jennifer A. Belpedi� o v J \''
Assistant County Attorney \^\
') NAPLES COMMUNTIY HOSPITAL, INC.,A FLORIDA
I f` NOT FOR PROFIT CORPORATION
BY: /1/n--
14e v��vppCsvpe✓. �/�
Title: G�.i ey-- �'5Tit�7`
5
2014 Agreement with Naples Community Hospital
T9)
Attachment A 60 2 3
5oF so 211114
MEDID
LIP 6 Letter of Agreement `
PROGRAM FINANCE
THIS LETTER OF AGREEMENT (LOA) made and entered into in duplicate on the o. day
of t2014, by and between Collier County (the County) on behalf of Naples Community
Hospit I, and the State of Florida, through its Agency for Health Care Administration (the
Agency),
1. Per House Bill 5001, the General Appropriations Act of State Fiscal Year 2014-2015,
passed by the 2014 Florida Legislature, County and the Agency, agree that County will
remit to the State an amount not to exceed a grand total of$1,370,738. Please note this
amount may include credits from prior year's IGT reconciliations (a breakdown can be
found below). The LOA's original amount prior to credits was $2,369,133.
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 Low Income Pool (LIP) Program.
2. The County will pay the State an amount not to exceed the grand total amount of
$1,370,738. The County will transfer payments to the State in the following manner:
a. The first quarterly payment of$342,683 for the months of July, August, and
September is due upon notification by the Agency.
b. Each successive payment of$342,685 is due as follows, November 30, 2014,
March 31, 2015 and May 25, 2015.
c. The State will bill the County when each quarterly payment is due.
3. Timelines: This agreement must be signed, submitted, and received by the Agency no
later than October 1, 2014 for all providers listed on Table 2a of the House Bill 5001 in
order to be effective for SFY 2014-2015. Should funding not be secured by October 1,
2014 the Agency will execute with other local governmental entities by October 31,
2014. House Bill 5001 Specific Appropriation 212 language is as follows:
In order for the agency to certify the qualified nonfederal share of matching
funds, a local governmental entity must submit a final, executed letter of
agreement to the agency, which must be received by October 1, 2014 and
provide the total amount of nonfederal share of matching funds authorized by the
entity under this paragraph or the General Appropriations Act. If Table 2a funds
are not secured by October 1, 2014, the Agency for Health Care Administration
may execute letters of agreement with other local governmental entities by
October 31, 2014.
4. Attached is the LIP 6 schedule reflecting the anticipated annual distributions for State
Fiscal Year 2014-2015.
16132 3
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 LOA. 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 LOA shall be in the same
form, namely the exchange of signed copies of a revised LOA.
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. This LOA covers the period of July 1, 2014 through June 30, 2015 and shall be
terminated June 30, 2015.
LIP 6 Local lnf ove 11 infers (IG "s)
IGTs Needed Prior to Credits $2,369,134
SFY 1213 IGT Rec Credits $120,220
SFY 1314 IGT Rec Credits $878,176
it A S S r �. ,
$w...,�r _ 1�,370 73B
WITNESSETH:
IN WITNESS WHEREOF the parties have duly executed this LOA on the day and year above
first written.
Collier Count State of Florida SEP 3 0 2014
MEDICAID
PROGRAM FINANCE
om Henning, Chairman • Stac y Lamki
Assistant Deputy Secretary for Medicaid Finance,
Agency for Health Care Administration
ATTEST: Approved to form and legality
DWI? T E.BROC Clerk
Assistant County Attorney nom\
.test as to rm n s� �
signature
611111 PHYSICIANS REGIONAL
1 6 El 3
MEDICAL CENTER • COLLIER BOULEVARD
September 17, 2014
Tom Henning, Chairman
Collier County Board of Commissioners
Collier County Government
3299 Tamiami Trail East
Naples, FL 34112
Re: Indemnification Letter Agreement
Dear Chairman Henning:
Physicians Regional Medical Center("PRMC") is aware that Collier County, pursuant to a Letter of
Agreement("LOA") with Florida's Agency for Health Care Administration ("AHCA") is intending to provide funds
that may be used by AHCA as the non-federal share of Medicaid payments to PRMC. PRMC is greatly
appreciative of any support provided by Collier County.
The purpose of this Indemnification Letter Agreement is for PRMC to acknowledge that although PRMC
does not believe the risk to be substantial, there could be some risk for Collier County providing the non-federal
share. Thus, in acknowledgement of that risk, PRMC, to the maximum extent permitted by Florida law, shall
indemnify and hold harmless Collier County against any claims, damages, losses, and expenses, including
reasonable attorneys' fees and costs, arising out of or resulting from any failure by PRMC associated with
Collier County's provision of funding to AHCA as the non-federal share of Medicaid payments to PRMC. This
indemnification obligation shall not be construed to negate, abridge or reduce any other rights or remedies
which otherwise may be available to Collier County. PRMC shall 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 Collier County's provision
of funding to AHCA as the non-federal share of Medicaid payments to PRMC including payment of all legal
costs, including but not limited to, attorney's fees paid by the County.
Please acknowledge receipt of this Indemnification Letter Agreement by signing below and returning a
copy to me.
Sincerely,
`f..
Scott Lowe, CEO
Physicians Regional Medical Center
ACKNOWLEDGED /
Approved as to form and legality
Tom Henning, Chairman, •ard of County Commissioners •
Ass'stantCounty A y
for Collier County �,' -
orrrlrlo t0= j` .
8 J Q6g9LLIER BOULEVARD, NAPLES, FL 3' r 37 ij o WGIONALCOLLIER.COM
e st as to Chairm
sicrnature only.
Attachment A RECEIVED 150 2 3
S E P 3 0 2014
LIP 6 Letter of Agreement MEN`,``IN
PROGRAM FINANCE
THIS LETTER OF AGREEMENT (LOA) made and entered into in duplicate on the 3 lay
of S.gL.t2014, by and between Collier County (the County) on behalf of Physician's Regional
Medical Center, and the State of Florida, through its Agency for Health Care Administration (the
Agency),
1. Per House Bill 5001, the General Appropriations Act of State Fiscal Year 2014-2015,
passed by the 2014 Florida Legislature, County and the Agency, agree that County will
remit to the State an amount not to exceed a grand total of$1,029,562. Please note this
amount may include credits from prior year's IGT reconciliations (a breakdown can be
found below). The LOA's original amount prior to credits was $1,362,791.
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 Low Income Pool (LIP) Program.
2. The County will pay the State an amount not to exceed the grand total amount of
$1,029,562. The County will transfer payments to the State in the following manner:
a. The first quarterly payment of$257,389 for the months of July, August, and
September is due upon notification by the Agency.
b. Each successive payment of$257,391 is due as follows, November 30, 2014,
March 31, 2015 and May 25, 2015.
c. The State will bill the County when each quarterly payment is due.
3. Timelines: This agreement must be signed, submitted, and received by the Agency no
later than October 1, 2014 for all providers listed on Table 2a of the House Bill 5001 in
order to be effective for SFY 2014-2015. Should funding not be secured by October 1,
2014 the Agency will execute with other local governmental entities by October 31,
2014. House Bill 5001 Specific Appropriation 212 language is as follows:
In order for the agency to certify the qualified nonfederal share of matching
funds, a local governmental entity must submit a final, executed letter of
agreement to the agency, which must be received by October 1, 2014 and
provide the total amount of nonfederal share of matching funds authorized by the
entity under this paragraph or the General Appropriations Act. If Table 2a funds
are not secured by October 1, 2014, the Agency for Health Care Administration
may execute letters of agreement with other local governmental entities by
October 31, 2014.
4. Attached is the LIP 6 schedule reflecting the anticipated annual distributions for State
Fiscal Year 2014-2015.
S
1 6D 2
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 LOA. 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 LOA shall be in the same
form, namely the exchange of signed copies of a revised LOA.
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. This LOA covers the period of July 1, 2014 through June 30, 2015 and shall be
terminated June 30, 2015.
LIP 6 L ocal Intergovern mental`Transfers (IGTs) ,
4 . ,4. :,` we .' State Fiscal Year 2014-2015 ' ,
IGTs Needed Prior to Credits $1,362,791
SFY 1213 IGT Rec Credits $333,229
SFY 1314 IGT Rec Credits 0
�. �� _:=� � $'{ 029562'
.Total rFundin o:A '' �. .e _ .� .f... ,.- E . ,
WITNESSETH:
IN WITNESS WHEREOF the parties have duly executed this LOA on the day and yeeE I ED
first written.
SEP302014
Collier County State of Florida
MEDICAID
PROGRAM FINANCE
Tom Henning, Chairman arley Lam IZi
' Assistant Cieputy Secretary for Medicaid Finance,
Agency for Health Care Administration
ATTEST: Approved as to form and legality
DWIG E. BROCK lark
M Assistant County Attorney t �
eft as to Chairman's
6); -•".S q ture only.
• k