Agenda 09/24/2013 Item #11B 9/24/2013 11 .B.
EXECUTIVE SUMMARY
Recommendation to approve four agreements to allow participation in alternative
intergovernmental transfer programs (IGT): Two between the County and Agency for
Health Care Administration (AHCA), one each between the County and Physicians
Regional Medical Center and Naples Community Hospital; and an additional agreement
between Collier County and the David Lawrence Center and approve all necessary FY2014
budget amendments. The County's total budgeted appropriation increases to $5,413,268.
OBJECTIVE: To partner with Physicians Regional Medical Center and Naples Community
Hospital (collectively "the Hospitals") to enhance the quality of care and the health of low
income persons.
CONSIDERATIONS: The Agency for Health Care Administration (AHCA) is the State entity
that provides Medicaid services in Florida and operates the IGT programs. This is the third year
the County will participate in the program involving David Lawrence Center, the Health
Department and the hospitals. As more fully discussed below, Staff is seeking the further
expansion of this program to include EMS. Through agreements between local government and
AHCA, these programs take local funds and use them to obtain Federal matching dollars.
In recent years, the State Legislature has reduced Medicaid reimbursement rates to providers by
a substantial margin. This is significant not only in and of itself; but the Federal match is
dependent on the state funding. The State Legislature has created the IGT matching fund
programs. Funds are appropriated for the IGT match in Chapter 2013-40, Laws of Florida.
These programs allow communities to leverage existing dollars spent for health services to offset
the reductions in the state funding, and thereby obtaining a federal match. Similar to the
arrangement last year, the combination of Federal matching funds for the IGT programs will
provide funding to offset some of the Hospital Medicaid rate cuts so that the Hospitals can
continue to serve our community's uninsured and underinsured patients.
The Hospitals are community healthcare partners and serve as third party administrators for
Collier County. In addition to the benefit realized by the Hospitals, the County's contribution of
$5,413,268 will generate an additional $1,082,654 for our previous two partners (The David
Lawrence Center and the Health Department) as well as the proposed new participant, Collier
County Emergency Medical Services (EMS), as noted below.
The inclusion of EMS as a "partner" participant is a new element to the program this year.
County staff undertook efforts to confirm that the addition of EMS is allowable and acceptable
by AHCA and also will pass any audit scrutiny. Staff has received written email notification that
the inclusion of EMS is acceptable to AHCA (provided as backup to this agenda item); also as
backup the AHCA email confirmation of the underlying program authority is provided.
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9/24/2013 11 .B.
The allocation of County and matching funds is shown in the table below and has been agreed to
by each of the hospitals:
County IGT AHCA Total**
Commitment Matching (67.32% to Naples
(stated as "not Funds* Community
to exceed" in Hospital and
the agreements 32.68% to
with AHCA) Physicians Regional
from AHCA)
Budgeted Funds (DLC and $2,368,900 $3,362,772 $ 5,731,672
Health Department)
Collier County EMS $3,044,368 $4,321,632 $7,366,000
Total $5,413,268 $7,684,404 $13,097,672
Partners Funds to Partners From Hospital's General
Operating Funds and Non Profits
Collier County Health Department $ 929,020 from Physicians Regional
$ 528,620 from Naples Community Hospital
David Lawrence Center $1,385,040 from Naples Community Hospital
Collier County EMS *** $3,653,242 from David Lawrence Center
Total $6,495,922
*Matches based on most recent formulas and anticipated volumes of Medicaid patients
** Per the program, the entire amount of Medicaid funding is provided to the hospitals
*** The David Lawrence Center will provide a non-restricted contribution to EMS to maintain
or improve ambulance services to Collier County. A budget amendment will be required to
recognize and appropriate these funds.
The mechanics of this program are:
• Collier County utilizes a combination budgeted allowable general funds to be transferred
to AHCA up to the maximum amount stated in the letters of agreement between Collier
County and AHCA.
• By participation in these programs, AHCA matches/leverages the funds submitted by
Collier and distributes them to the hospitals, for the purpose outlined above (the hospitals
may only receive funds from AHCA upon submission of valid documentation of services
provided to Medicaid eligible clients)
• For the general fund budgeted funds, HHVS collects and validates invoices from DLC
and the Health Department and forwards them to the Hospitals; they, in turn, voluntarily
pay the partners from their operating funds. For the new component based on the
contribution to EMS from a not for profit entity (DLC), EMS will receive their
contribution via the terms of the agreement between DLC and Collier County EMS
without the need for an invoicing process. Collier County receives an enhancement of
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9/24/2013 11 .B.
$608,874 to assist with the burden of providing EMS services to the uninsured and
underinsured patients of Collier County.
Agreement changes from the prior year arrangements include:
• The Hospitals have agreed to a specified dollar amount in the agreements with Collier
County
• David Lawrence Center has agreed to a specified dollar amount in the agreement with
Collier County and has partnered with the Hospitals to help support the County EMS
program
• The Hospitals have agreed to bear any risk associated with
o Rate or model changes by AHCA
o Any variable that would impact their amounts received from AHCA
This arrangement also requires agreements between the County and David Lawrence Center and
the County and the Collier County Department of Health. On December 11, 2012, Agenda Item
No. 16D18 the Board approved an agreement with David Lawrence Center that will
automatically renew if this item is approved. On October 8, 2013, staff will present an
agreement with the Collier County Department of Health to the Board for consideration.
FISCAL IMPACT: The FY 14 County budget presently includes a $1,154,200 remittance for
the David Lawrence Center and a $1,258,100 remittance for the County Health Department.
These two remittances, less $43,400 of ineligible non-medical reimbursements, total $2,368,900
and represent the budgeted County General fund (001) commitment to the IGT program under
discussion.
The FY 14 EMS Fund (490)budget will be amended via budget amendment to include a
$3,653,242 financial contribution revenue budget from the David Lawrence Center, a$3,044,368
remittance/payment to AHCA, and a$608,874 net increase to EMS funds that will be transferred
to EMS Capital & Grant Fund (491) for future capital improvements. FY2014 budget
amendments will be necessary to establish the necessary receipt of revenue and appropriation
mechanism.
LEGAL CONSIDERATIONS: The indemnification language from prior years' contracts has
been strengthened in the proposed contracts to further protect the County. This item has been
approved as to form and legality and requires a majority vote. -JAB
GROWTH MANAGEMENT IMPACT: There is no growth management impact associated
with this executive summary.
RECOMMENDATION: To approve and authorize the Chair to sign four agreements to allow
for participation in the Alternative Intergovernmental Transfer programs, to sign a contribution
agreement with the David Lawrence Center, and to approve all necessary FY2014 budget
amendments.
Prepared by: Bendisa Marku, Accounting Supervisor, Housing, Human and Veteran Services
and Walter Kopka, Chief-EMS
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9/24/2013 11 .B.
COLLIER COUNTY
Board of County Commissioners
Item Number: 11.11.B.
Item Summary: Recommendation to approve four agreements to allow participation in
alternative intergovernmental transfer programs (IGT):Two between the County and Agency
for Health Care Administration (AHCA), one each between the County and Physicians Regional
Medical Center and Naples Community Hospital; and an additional agreement between Collier
County and the David Lawrence Center and approve all necessary FY2014 budget amendments.
The County's total budgeted appropriation increases to $5,413,268. (Len Price, Administrative
Services Administrator and Steve Carnell, Interim Public Services Administrator)
Meeting Date: 9/24/2013
Prepared By
Name: Bendisa Marku
Title: Operations Analyst,Wastewater
9/18/2013 9:44:21 AM
Approved By
Name: GrantKimberley
Title:Interim Director
Date: 9/18/2013 12:14:11 PM
Name: BayArtie
Title: Supervisor-Accounting,EMS Operations
Date: 9/18/2013 1:05:59 PM
Name: KopkaWalter
Date: 9/1 8/2013 1:34:44 PM
Name: AlonsoHailey
Title: Operations Analyst,Public Service Division
Date: 9/18/2013 1:48:22 PM
Name: BelpedioJennifer
Title:Assistant County Attorney,County Attorney
Date: 9/18/2013 2:42:12 PM
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9/24/2013 11 .B.
Name: CarnellSteve
Title: Purchasing/General Services Director
Date: 9/18/2013 2:42:27 PM
Name: KlatzkowJeff
Title: County Attorney
Date: 9/18/2013 3:39:07 PM
Name: FinnEd
Title: Senior Budget Analyst, OMB
Date: 9/18/2013 4:20:09 PM
Name: OchsLeo
Title: County Manager
Date: 9/18/2013 5:44:36 PM
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Letter of Agreement
THIS LETTER OF AGREEMENT made and entered into in duplicate on the day of
2013, 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$3,644,150.
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.
x. Medicaid LIP payments to Provider Access Systems (PAS) for Medicaid
and the uninsured in rural areas.
1
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9/24/2013 11 .B.
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
$3,644,150. The County will transfer payments to the State in the following manner:
a. The first quarterly payment in an amount not to exceed $911,039 for the months
of July, August, and September is due upon notification by the Agency.
b. Each successive payment in an amount not to exceed $911,037 is due as
follows, November 30, 2013, March 31, 2014 and June 15, 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.
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.
10. This Letter of Agreement covers the period of July 1, 2013 through June 30, 2014 and
shall be terminated June 30, 2014.
2
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9/24/2013 11 .B.
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
Signature Stacey Lampkin
Acting Assistant Deputy Secretary for Medicaid
Finance, Agency for Health Care Administration
G c, ►fl L.L.eR, ESQ
Name
C_H A1 R vi o v \ t■.J
Title
Approved as to form and legality
ATTEST:
DWIGHT E.BROCK,Clerk
Assistant Coiintyyttorney
By:
3
bJ
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9/24/2013 11 .B.
Local Government Intergovernmental _Transfers'°' ;
Program I Amount State Fiscal Year 2013-2014
LII Supplemental Payments
P
DSH
Nursing Home SMP
„y d x t Amount5s ._��
Automatic Buyback
Self-Funded Buyback
Automatic Exemption
Self-Funded Exemption
SWl
f Inpatient
Automatic DRG Add-On
Self-Funded DRG Add-On $3,644,150
Total Funding L X3,644,750',
4
S
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9/24/2013 11 .B.
Letter of Agreement
THIS LETTER OF AGREEMENT made and entered into in duplicate on the day of
2013, 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$1,769,118.
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.
x. Medicaid LIP payments to Provider Access Systems (PAS)for Medicaid
and the uninsured in rural areas.
1
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9/24/2013 11 .B.
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
$1,769,118. The County will transfer payments to the State in the following manner:
a. The first quarterly payment in an amount not to exceed $442,281 for the months
of July, August, and September is due upon notification by the Agency.
b. Each successive payment in an amount not to exceed $442,279 is due as
follows, November 30, 2013, March 31, 2014 and June 15, 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.
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.
10. This Letter of Agreement covers the period of July 1, 2013 through June 30, 2014 and
shall be terminated June 30, 2014.
2
CA
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9/24/2013 11 .B.
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
Signature Stacey Lampkin
Acting Assistant Deputy Secretary for Medicaid
Finance, Agency for Health Care Administration
Ec) (Z t q 41c. NI LL�2, �SCQ
Name
( - A\ 2vJo -
Title
Approved as to form and legality
ATTEST:
DWIGHT E. BROCK, Clerk CLA .r--�
Assistant County rney
By:
3
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9/24/2013 11 .B.
Local Government Intergovernmental Transfers
Program / Amount State Fiscal Year2013-2014
Supplemental Payments
LIP
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 $1,769,118
Total Funding $1,769,118
4
0
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9/24/2013 11.B.
GrantKimberley
From: Behenna, Lecia [Lecia.Behenna @ahca.myflorida.com]
Sent: Wednesday, September 11, 2013 3:41 PM
To: GrantKimberley
Subject: FW: collier
Attachments: New Collier County Partnership,docx
Is this what you need....
I have reviewed the attached document it appears to be fine.
Lecia
From: Behenna, Lecia [mailto:Lecia.Behenna @ahca.myflorida.com]
Sent:Thursday,September 5, 2013 3:03 PM
To:Sarah Fitzgerald
Subject: RE: collier
Yes,the program looks acceptable.
From: Sarah Fitzgerald [mailto:sfCahfgflorida.com]
Sent:Thursday, September 05, 2013 9:20 AM
To: Behenna, Lecia
Subject: FW: collier
Importance: High
From:Sarah Fitzgerald
Sent:Wednesday,September 4, 2013 3:51 PM
To: 'Behenna, Lecia;John Owens(iowens @fhs-Ilc.com)
Cc: Nicole Maldonado (Nicole.maldonado @ahca.myflorida.com)
Subject: RE: collier
Importance: High
Hi Lecia,
Did you mean that the program looks acceptable to you?
Thanks,
Sarah
Saarah,F,t-3,cjeArcaxi.
Healthcare Financial Group
813/505-5300
From: Behenna, Lecia [mailto:Lecia.Behenna@ahca.myflorida.com]
Sent:Wednesday,September 4, 2013 3:28 PM
To:Sarah Fitzgerald;John Owens (lowens@fhs-llc.com)
Subject: RE: collier
It looks okay to me.
1
Packet Page -398-
9/24/2013 11 .B.
Thanks,
Lecia
From: Sarah Fitzgerald [mailto:sffthfgflorida.com]
Sent: Wednesday, September 04, 2013 3:06 PM
To: Behenna, Lecia; John Owens (iowensCa}fhs-Ilc.com)
Subject: collier
Sa.rraav TLt raid'
Healthcare Financial Group
3615 West Swann Avenue
Tampa, FL 33609
Office: 813/286-4455
Cell: 813/505-5300
2
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9/24/2013 11 .B.
Grant to EMS by new Collier County Partnership
Naples Community Hospital and Physician's Regional Medical Center(the Hospitals) recognize the
increasing burden of providing EMS services to the uninsured and/or underinsured patients located in
Collier County. As a partial solution, the Hospitals that are also located in Collier County are partnering
with a local not for profit health care entity to provide additional funds in the form of a grant to the
Emergency Medical Services (EMS) to provide assistance and help offset the increasing cost of providing
ambulance services for individuals with inadequate health insurance coverage. In this new partnership,
the Hospitals will make contributions to the local nonprofit which will then make grants to the County
EMS program. The amount of these grants will be primarily based upon historical EMS write offs for
individuals with insufficient health insurance coverage.
Intergovernmental Transfer(IGT)Program
For a number of years,Collier County has generously participated in the Medicaid IGT program to assist
the Hospitals in buying back their Medicaid shortfalls. For 2013-14,the County is considering an
increase in the County's level of participation in the IGT program, in recognition of the Hospitals'
increasing cost of providing care to the uninsured and/or underinsured patients. The County is under no
obligation to increase the IGT's made on behalf of the Hospitals. These additional IGTs made on the
Hospitals' behalf is unrelated and will not be dependent upon the grant provided to EMS by the not for
profit entity. The amount of the increased IGT's will not be equal to the amount that the Hospitals have
contributed to the local not for profit entity partnership. There will be no direct payments by the
Hospitals back to the County.
Packet Page -400-
9/24/2013 11 .B.
GrantKimberley
From: Behenna, Lecia [Lecia.Behenna @ahca.myflorida.corn]
Sent: Wednesday, September 11, 2013 8:46 AM
To: GrantKimberley
Subject: Collier County lGT Program-underlying statute and AHCA calculations
Attachments: 2013 GAA SB 1500.pdf; outpatient buybacks 2 SFY 1314.xlsx; DRG
Self Funded IGT Limits 13 14.xlsx
Kim, we understand that that the attached documents were requested during your discussions regarding the
Agency's Intergovernmental Transfer program.
1. 2013 GAA SB 1500.pdf—this file contains the underlying statute authorizing the program of
intergovernmental transfers from various local governments to obtain Federal matching funds to
reduce Medicaid cost shortfalls through the increase of hospital inpatient and outpatient Medicaid
rates. The specific language for the inpatient DRG Self Funded IGT program is highlighted on pages 55
& 56 and specific language for the outpatient program is highlighted on pages 58& 59.
2. outpatient buybacks 2 SFY 1314.xlsx—this file contains the calculation for the maximum amounts
allowed for each hospital under the outpatient trend adjustment buy-back program. Naples
Community Hospital is highlighted in blue on line 28 & Physicians Regional Medical Center (shown here
using the former name of Cleveland Clinic Florida Hospital Naples) is highlighted on line 156.
3. DRG Self Funded IGT Limits 13 14.xlsx—this file contains the calculation for the maximum amounts
allowed for each hospital under the inpatient DRG Self Funded IGT program. Naples Community
Hospital is highlighted in blue on line 30& Physicians Regional Medical Center is highlighted on line
161.
Thanks,
Lecia
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Packet Page -405-
9/24/2013 11 .B.
CONFERENCE REPORT ON SENATE BILL 1500
SECTION 3 - HUMAN SERVICES
SPECIFIC
APPROPRIATION
The moneys contained herein are appropriated from the named funds to the
Agency for Health Care Administration, Agency for Persons with
Disabilities, Department of Children and Families, Department of Elder
Affairs, Department of Health, and the Department of Veterans' Affairs
as the amounts to be used to pay the salaries, other operational
expenditures and fixed capital outlay of the named agencies.
AGENCY FOR HEALTH CARE ADMINISTRATION
PROGRAM: ADMINISTRATION AND SUPPORT
APPROVED SALARY RATE 11,968,804
163 SALARIES AND BENEFITS POSITIONS 249.00
FROM GENERAL REVENUE FUND 2,721,417
FROM ADMINISTRATIVE TRUST FUND . . 12,779,798
164 OTHER PERSONAL SERVICES
FROM GENERAL REVENUE FUND 79,599
FROM ADMINISTRATIVE TRUST FUND . . 809,860
165 EXPENSES
FROM GENERAL REVENUE FUND 150,680
FROM ADMINISTRATIVE TRUST FUND . 2,817,419
166 OPERATING CAPITAL OUTLAY
FROM GENERAL REVENUE FUND 180,923
FROM ADMINISTRATIVE TRUST FUND . . 514,701
166A LUMP SUM
LITIGATION EXPENSES
FROM ADMINISTRATIVE TRUST FUND . . 2,224,844
167 SPECIAL CATEGORIES
CONTRACTED SERVICES
FROM GENERAL REVENUE FUND 230,010
FROM ADMINISTRATIVE TRUST FUND . . 3,081,244
168 SPECIAL CATEGORIES
RISK MANAGEMENT INSURANCE
FROM GENERAL REVENUE FUND 33,820
FROM ADMINISTRATIVE TRUST FUND . . 262,937
169 SPECIAL CATEGORIES
LEASE OR LEASE-PURCHASE OF EQUIPMENT
FROM GENERAL REVENUE FUND 18,346
FROM ADMINISTRATIVE TRUST FUND . . 193,114
170 SPECIAL CATEGORIES
TRANSFER TO DEPARTMENT OF MANAGEMENT
SERVICES - HUMAN RESOURCES SERVICES
PURCHASED PER STATEWIDE CONTRACT
FROM GENERAL REVENUE FUND 23,437
FROM ADMINISTRATIVE TRUST FUND . . 73,728
171 DATA PROCESSING SERVICES
TECHNOLOGY RESOURCE CENTER - DEPARTMENT OF
MANAGEMENT SERVICES
FROM ADMINISTRATIVE TRUST FUND . . . 647,765
172 DATA PROCESSING SERVICES
SOUTHW00D SHARED RESOURCE CENTER
FROM ADMINISTRATIVE TRUST FUND . 25,206
173 DATA PROCESSING SERVICES
NORTHW00D SHARED RESOURCE CENTER
FROM ADMINISTRATIVE TRUST FUND . . . 740,756
4 Packet Page -406-
9/24/2013 11 .B.
CONFERENCE REPORT ON SENATE BILL 1500
SECTION 3 - HUMAN SERVICES
TOTAL: PROGRAM: ADMINISTRATION AND SUPPORT
FROM GENERAL REVENUE FUND 3,438,232
FROM TRUST FUNDS 24,171,372
TOTAL POSITIONS 249.00
TOTAL ALL FUNDS 27,609,604
PROGRAM: HEALTH CARE SERVICES
CHILDREN'S SPECIAL HEALTH CARE
Funds in Specific Appropriations 174 through 179 are provided to operate
the Florida KidCare Program. The Executive Office of the Governor may
authorize transfer of these resources between programs or agencies
pursuant to chapter 216, Florida Statutes, based on projections from the
Social Services Estimating Conference.
From the funds in Specific Appropriations 174 through 179 the Agency for
Health Care Administration shall seek federal approval to protect family
choice and allow children under 138 percent of the Federal Poverty Level
to enroll in either the Title XXI Children's Health Insurance Program
(CHIP) or the Title XIX Medicaid Program. Upon federal approval, the
agency may request to realign funding between the Title XIX and Title
XXI programs and is authorized to submit a budget amendment pursuant to
chapter 216, Florida Statutes to transfer funds as necessary to reflect
actual enrollment choices.
The agency is authorized to seek any necessary state plan amendment to
implement additional Title XXI administrative claiming for school health
services.
174 SPECIAL CATEGORIES
GRANTS AND AIDS - FLORIDA HEALTHY KIDS
CORPORATION
FROM GENERAL REVENUE FUND 4,115,718
FROM TOBACCO SETTLEMENT TRUST FUND 65,154,585
FROM MEDICAL CARE TRUST FUND . . . 169,886,443
Funds in Specific Appropriations 174 and 177 are provided to contract
with the Florida Healthy Kids Corporation to provide comprehensive
health insurance coverage, including dental services, to Title XXI
children eligible under the Florida KidCare Program and pursuant to
section 624.91, Florida Statutes. The corporation shall use local funds
to serve non-Title XXI children that are eligible for the program
pursuant to section 624.91(3) (b), Florida Statutes. The corporation
shall return unspent local funds collected in Fiscal Year 2012-2013 to
provide premium assistance for non-Title XXI eligible children based on
a formula developed by the corporation.
Funds in Specific Appropriations 174, 177, 178, and 179 reflect a
reduction of $18,153,658 from the General Revenue Fund and $44,504,580
from the Medical Care Trust Fund based on a transfer of children under
138 percent of the Federal Poverty Level that will transition from the
Title XXI Children's Health Insurance Program (CHIP) to the Title XIX
Medicaid Program, as authorized by the Federal Affordable Care Act.
175 SPECIAL CATEGORIES
CONTRACTED SERVICES
FROM GENERAL REVENUE FUND 565,852
FROM TOBACCO SETTLEMENT TRUST FUND 704,548
FROM GRANTS AND DONATIONS TRUST
FUND 391,572
FROM MEDICAL CARE TRUST FUND . . . 3,154,539
176 SPECIAL CATEGORIES
GRANTS AND AIDS - CONTRACTED SERVICES -
FLORIDA HEALTHY KIDS ADMINISTRATION
FROM GENERAL REVENUE FUND 1,385,084
FROM TOBACCO SETTLEMENT TRUST FUND 3,946,147
FROM MEDICAL CARE TRUST FUND . . . 13,070,463
177 SPECIAL CATEGORIES
GRANTS AND AIDS - FLORIDA HEALTHY KIDS
CORPORATION DENTAL SERVICES
FROM GENERAL REVENUE FUND 7,601,132
,Packet Page-407-
9/24/2013 11 .B.
CONFERENCE REPORT ON SENATE BILL 1500
SECTION 3 - HUMAN SERVICES
FROM MEDICAL CARE TRUST FUND . . . . 19,126,107
Funds in Specific Appropriation 177 are provided for Florida Healthy
Kids dental services to be paid a monthly premium of no more than $12.57
per member per month.
178 SPECIAL CATEGORIES
MEDIKIDS
FROM GENERAL REVENUE FUND 2,970,185
FROM TOBACCO SETTLEMENT TRUST FUND 9,571,956
FROM GRANTS AND DONATIONS TRUST
FUND 12,638,710
FROM MEDICAL CARE TRUST FUND . . . 30,752,524
179 SPECIAL CATEGORIES
CHILDREN'S MEDICAL SERVICES NETWORK
FROM GENERAL REVENUE FUND 21,248,228
FROM TOBACCO SETTLEMENT TRUST FUND 15,619,174
FROM GRANTS AND DONATIONS TRUST
FUND 2,337,513
FROM MEDICAL CARE TRUST FUND . . . 90,384,527
TOTAL: CHILDREN'S SPECIAL HEALTH CARE
FROM GENERAL REVENUE FUND 38,086,199
FROM TRUST FUNDS 436,738,808
TOTAL ALL FUNDS 474,825,007
EXECUTIVE DIRECTION AND SUPPORT SERVICES
From the funds in Specific Appropriations 180 through 194, the agency is
authorized to contract on a contingency fee basis for post-audit claims
analyses to identify and recover overpayments for the Medicaid program.
The state may pay the contractor a rate based on recoveries.
APPROVED SALARY RATE 31,425,047
180 SALARIES AND BENEFITS POSITIONS 744.00
FROM GENERAL REVENUE FUND 2,656,324
FROM MEDICAL CARE TRUST FUND . . . 39,358,513
181 OTHER PERSONAL SERVICES
FROM GENERAL REVENUE FUND 1,774,139
FROM MEDICAL CARE TRUST FUND . . . 23,694,586
182 EXPENSES
FROM GENERAL REVENUE FUND 899,820
FROM MEDICAL CARE TRUST FUND . . . 6,733,735
183 OPERATING CAPITAL OUTLAY
FROM GENERAL REVENUE FUND 45,391
FROM MEDICAL CARE TRUST FUND . . . 221,266
184 LUMP SUM
INTERNATIONAL CLASSIFICATION OF DISEASE-
10TH REVISION PROJECT
FROM MEDICAL CARE TRUST FUND . . . . 6,963,251
185 LUMP SUM
ENROLLMENT BROKER SERVICES
FROM MEDICAL CARE TRUST FUND _ . . . 19,574,560
From the funds in Specific Appropriation 185, $19,574,560 from the
Medical Care Trust Fund, of which $4,092,850 is nonrecurring, is
provided for Enrollment Broker Services as part of the implementation of
the Managed Medical Assistance component of the Statewide Medicaid
Managed Care program.
186 SPECIAL CATEGORIES
PHARMACEUTICAL EXPENSE ASSISTANCE
FROM GENERAL REVENUE FUND 50,000
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9/24/2013 11 .E3.
CONFERENCE REPORT ON SENATE BILL 1500
SECTION 3 - HUMAN SERVICES
187 SPECIAL CATEGORIES
TRANSFER TO DIVISION OF ADMINISTRATIVE
HEARINGS
FROM GENERAL REVENUE FUND 54,645
FROM MEDICAL CARE TRUST FUND . . . 54,645
188 SPECIAL CATEGORIES
CONTRACT NURSING HOME AUDIT PROGRAM
FROM GENERAL REVENUE FUND 827,653
FROM MEDICAL CARE TRUST FUND . . . 1,129,095
189 SPECIAL CATEGORIES
CONTRACTED SERVICES
FROM GENERAL REVENUE FUND 17,138,650
FROM GRANTS AND DONATIONS TRUST
FUND 1,070,535
FROM MEDICAL CARE TRUST FUND . . . 51,225,486
From the funds in Specific Appropriation 189, $1,000,000 in
nonrecurring funds from the Medical Care Trust Fund is provided for the
development of Florida Diagnostic Related Groups (DRG) for Medicaid
hospital inpatient services.
From the funds in Specific Appropriation 189, $760,000 in
nonrecurring funds from the Medical Care Trust Fund is provided to
continue the Enhanced Detection Technology project.
From the funds in Specific Appropriation 189, $3,000,000 in
nonrecurring funds from the Medical Care Trust Fund is provided for the
Public Benefits Integrity Data Analytics and Information Sharing
Initiative which will detect and deter fraud, waste, and abuse in
Medicaid and other public benefit programs within the state.
From the funds in Specific Appropriation 169, $420,000 in
nonrecurring funds from the Medical Care Trust Fund is provided to
contract for consultant services for Statewide Medicaid Managed Care
expansion.
189A SPECIAL CATEGORIES
GRANTS AND AIDS - CONTRACTED SERVICES
FROM MEDICAL CARE TRUST FUND . . . . 3,000,000
From the funds in Specific Appropriation 189A, $3,000,000 from the
Medical Care Trust Fund may be used by the agency to contract with the
Florida Medical Schools Quality Network created under section
409.975(2), Florida Statutes.
190 SPECIAL CATEGORIES
MEDICAID FISCAL CONTRACT
FROM GENERAL REVENUE FUND 20,680,291
FROM MEDICAL CARE TRUST FUND . . 55,115,954
FROM REFUGEE ASSISTANCE TRUST FUND 121,329
191 SPECIAL CATEGORIES
MEDICAID PEER REVIEW
FROM GENERAL REVENUE FUND 1,093,903
FROM MEDICAL CARE TRUST FUND . . . 4,403,348
192 SPECIAL CATEGORIES
RISK MANAGEMENT INSURANCE
FROM GENERAL REVENUE FUND 333,599
FROM MEDICAL CARE TRUST FUND . . . 556,670
193 SPECIAL CATEGORIES
LEASE OR LEASE-PURCHASE OF EQUIPMENT
FROM GENERAL REVENUE FUND 26,165
FROM MEDICAL CARE TRUST FUND . . . 180,781
194 SPECIAL CATEGORIES
TRANSFER TO DEPARTMENT OF MANAGEMENT
SERVICES - HUMAN RESOURCES SERVICES
PURCHASED PER STATEWIDE CONTRACT
FROM GENERAL REVENUE FUND 93,415
FROM MEDICAL CARE TRUST FUND . . . 178,211
,Packet Page -409-
9/24/2013 11 .B.
CONFERENCE REPORT ON SENATE BILL 1500
SECTION 3 - HUMAN SERVICES
TOTAL: EXECUTIVE DIRECTION AND SUPPORT SERVICES
FROM GENERAL REVENUE FUND 45,673,995
FROM TRUST FUNDS 213,581,965
TOTAL POSITIONS 744.00
TOTAL ALL FUNDS 259,255,960
MEDICAID SERVICES TO INDIVIDUALS
195 SPECIAL CATEGORIES
ADULT VISION AND HEARING SERVICES
FROM GENERAL REVENUE FUND 7,287,942
FROM MEDICAL CARE TRUST FUND . . . 15,992,069
FROM REFUGEE ASSISTANCE TRUST FUND 514,132
From the funds in Specific Appropriations 195, 197, 198, 201, 203,
215, 219, 222, and 223, $667,722,971 from the Medical Care Trust Fund is
provided for the increased reimbursement rates for primary care services
provided to eligible Medicaid recipients
196 SPECIAL CATEGORIES
CASE MANAGEMENT
FROM GENERAL REVENUE FUND 50,722,366
FROM MEDICAL CARE TRUST FUND . . . 73,091,733
FROM REFUGEE ASSISTANCE TRUST FUND 88,124
From the funds in Specific Appropriation 196, $1,088,797 from the
Medical Care Trust Fund is provided for Medicaid reimbursable services
that support children enrolled in contracted medical foster care
programs under the Department of Health. This funding is contingent
upon the availability of state matching funds in the Department of
Health in Specific Appropriation 548.
197 SPECIAL CATEGORIES
THERAPEUTIC SERVICES FOR CHILDREN
FROM GENERAL REVENUE FUND 93,771,239
FROM MEDICAL CARE TRUST FUND . . . 200,648,898
FROM REFUGEE ASSISTANCE TRUST FUND 2,024
198 SPECIAL CATEGORIES
COMMUNITY MENTAL HEALTH SERVICES
FROM GENERAL REVENUE FUND 30,859,080
FROM MEDICAL CARE TRUST FUND . . . 76,530,256
From the funds in Specific Appropriation 198, the Agency for Health '
Care Administration is authorized to work with the Department of
Children and Families and Florida county governments to develop a local
match program to fund Medicaid specialized substance abuse services
using local county funds. The public funds required to match Medicaid
funds for the specialized substance abuse services are limited to those
funds that are local public tax revenues and are made available to the
state for this purpose. As required by Medicaid policy, participating
counties shall make these services available to any qualified Florida
Medicaid beneficiary regardless of county of residence. Payment for
these services is contingent upon the local matching funds being
provided by participating counties.
From the funds in Specific Appropriation 198, $4,839,100 from the
Medical Care Trust Fund is provided for Medicaid specialized mental
health services. The agency is authorized to seek any necessary state
plan amendment or federal waiver required to include mental health
services for juveniles in the evidence based redirection program at the
Department of Juvenile Justice. The agency is authorized to work with
the department to develop a match program to fund Medicaid specialized
mental health services using existing funding within the Department of
Juvenile Justice. Payment for these services is contingent upon the
availability of state matching funds in the Department of Juvenile
Justice in Specific Appropriation 1091.
199 SPECIAL CATEGORIES
ADULT DENTAL SERVICES
FROM GENERAL REVENUE FUND 14,161,905
FROM MEDICAL CARE TRUST FUND . . . 20,103,532
FROM REFUGEE ASSISTANCE TRUST FUND 386,197
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200 SPECIAL CATEGORIES
DEVELOPMENTAL EVALUATION AND INTERVENTION/
PART C
FROM MEDICAL CARE TRUST FUND . . . . 9,611,211
FROM REFUGEE ASSISTANCE TRUST FUND 598
Funds in Specific Appropriation 200 are contingent on the
availability of state match being provided in Specific Appropriation
554.
201 SPECIAL CATEGORIES
EARLY AND PERIODIC SCREENING OF CHILDREN
FROM GENERAL REVENUE FUND 133,788,069
FROM MEDICAL CARE TRUST FUND . . . 220,036,906
FROM REFUGEE ASSISTANCE TRUST FUND 341,347
202 SPECIAL CATEGORIES
GRANTS AND AIDS - RURAL HOSPITAL FINANCIAL
ASSISTANCE PROGRAM
FROM GENERAL REVENUE FUND 1,220,185
FROM GRANTS AND DONATIONS TRUST
FUND 3,794,499
FROM MEDICAL CARE TRUST FUND . . . 5,370,577
Funds in Specific Appropriation 202 are provided for a federally
matched Rural Hospital Disproportionate Share program and a state funded
Rural Hospital Financial Assistance program as provided in section
409.9116, Florida Statutes.
From the funds in Specific Appropriation 202, the calculations of the
Medicaid Hospital Funding Programs for the 2013-2014 fiscal year are
incorporated by reference in Senate Bill 1502. The calculations are the
basis for the appropriations made in the General Appropriations Act.
203 SPECIAL CATEGORIES
FAMILY PLANNING
FROM GENERAL REVENUE FUND 1,887,794
FROM MEDICAL CARE TRUST FUND . . . 22,941,992
FROM REFUGEE ASSISTANCE TRUST FUND 55,362
204 SPECIAL CATEGORIES
GRANTS AND AIDS - SHANDS TEACHING HOSPITAL
FROM GENERAL REVENUE FUND 9,673,569
The funds in Specific Appropriation 204, shall be primarily
designated for transfer to the Agency for Health Care Administration's
Grants and Donations Trust Fund for use in the Medicaid or Low Income
Pool programs. Of these funds, up to $3,820,670 may be used in the Low
Income Pool program or to modify Medicaid inpatient and outpatient
reimbursements applied to Shands Healthcare System. The transfer of the
funds from the Low Income Pool program is contingent upon another local
government or healthcare taxing district providing an equivalent amount
of funds to be used in the Low Income Pool program. Should the Agency
for Health Care Administration be unable to use the full amount of these
designated funds, remaining funds may be used secondarily for payments
to Shands Teaching Hospital to continue the original purpose of
providing health care services to indigent patients through Shands
Healthcare System.
205 SPECIAL CATEGORIES
HEALTHY START SERVICES
FROM MEDICAL CARE TRUST FUND . . . 23,641,947
206 SPECIAL CATEGORIES
HOME HEALTH SERVICES
FROM GENERAL REVENUE FUND 72,189,495
FROM MEDICAL CARE TRUST FUND . . . 102,483,644
FROM REFUGEE ASSISTANCE TRUST FUND 252,413
From the funds in Specific Appropriation 206, $88,138 from the
General Revenue Fund, $125,116 from the Medical Care Trust Fund, and
$308 from the Refugee Assistance Trust Fund are provided for a rate
increase for Home Health Services provided by Licensed Practical Nurses
and Registered Nurses.
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SECTION 3 - HUMAN SERVICES
207 SPECIAL CATEGORIES
HOSPICE SERVICES
FROM GENERAL REVENUE FUND 73,471,065
FROM HEALTH CARE TRUST FUND . . . 42,000,000
FROM GRANTS AND DONATIONS TRUST
FUND 17,871,223
FROM MEDICAL CARE TRUST FUND . . . 189,286,041
From the funds in Specific Appropriation 207, $17,871,223 from the •
Grants and Donations Trust Fund and $25,369,094 from the Medical Care
Trust Fund are provided to buy back hospice rate reductions, effective
on or after January 1, 2008, and are contingent on the nonfederal share
being provided through nursing home quality assessments. Authority is
granted to buy back rate reductions up to, but no higher than, the
amounts available under the budgeted authority in this appropriation. In
the event that the funds are not available in the Grants and Donations
Trust Fund, the State of Florida is not obligated to continue
reimbursements at the higher amount.
207A SPECIAL CATEGORIES
GRADUATE MEDICAL EDUCATION
FROM GENERAL REVENUE FUND 33,056,000
FROM MEDICAL CARE TRUST FUND . , . 46,924,644
208 SPECIAL CATEGORIES
HOSPITAL INPATIENT SERVICES
FROM GENERAL REVENUE FUND 353,154,126
FROM GRANTS AND DONATIONS TRUST
FUND 647,646,325
FROM MEDICAL CARE TRUST FUND . . . 2,100,119,205
FROM PUBLIC MEDICAL ASSISTANCE
TRUST FUND 441,860,000
FROM REFUGEE ASSISTANCE TRUST FUND 4,404,914
From the funds in Specific Appropriation 208, $192,702 in
nonrecurring funds from the General Revenue Fund and $273,549 in
nonrecurring funds from the Medical Care Trust Fund are provided as a
special Medicaid payment for Winter Haven Hospital.
From the funds in Specific Appropriation 208, $1,500,000 in
nonrecurring funds from the General Revenue Fund and $2,129,325 in
nonrecurring funds from the Medical Care Trust Fund are provided as a
special Medicaid payment for Bethesda Hospital, Inc., located in Palm
Beach County.
From the funds in Specific Appropriation 208, $46,772,264 from the
Medical Care Trust Fund is provided to the Agency for Health Care
Administration to fund services for children in the Statewide Inpatient
Psychiatric Program. The program shall be designed to permit limits on
services, prior authorization of services, and selective provider
enrollment. The program must also include monitoring and quality
assurance, as well as discharge planning and continuing stay reviews, of
all children admitted to the program. The funding is contingent upon the
availability of state matching funds in the Department of Children and
Family Services in Specific Appropriations 340 and 363.
From the funds in Specific Appropriation 208, the calculations of the
Medicaid Hospital Funding Programs for the 2013-2014 fiscal year are
incorporated by reference in Senate Bill 1502. The calculations are the
basis for the appropriations made in the General Appropriations Act.
Funds in Specific Appropriation 208, are contingent upon the state
share being provided through grants and donations from state, county or
other governmental funds. In the event the state share provided through
grants and donations is not available the Agency for Health Care
Administration shall submit a revised hospital reimbursement plan to the
Legislative Budget Commission for approval.
From the funds in Specific Appropriation 208, the Agency for Health
Care Administration may establish a global fee for bone marrow
transplants and the global fee payment shall be paid to approved bone
marrow transplant providers that provide bone marrow transplants to
Medicaid beneficiaries.
From the funds in Specific Appropriation 208 and 213, the Agency for
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SECTION 3 - HUMAN SERVICES
Health Care Administration shall implement a process to reconcile the
difference between the amount of intergovernmental transfers used by or
on behalf of individual hospitals' Medicaid inpatient and outpatient
rate adjustments. Reconciliations may be incorporated in Letters of
Agreement for intergovernmental transfers for the 2013-2014 state fiscal
year.
From the funds in Specific Appropriation 208, $1,116,749 in
nonrecurring funds from the General Revenue Fund and $1,585,280 in
nonrecurring funds from the Medical Care Trust Fund are provided to
allow for exemptions from inpatient reimbursement ceilings for any
hospital that is classified as a sole community hospital under 42 C.F.R.
section 412.92 but is not classified as a rural hospital under section
395.602, Florida Statutes. The Medicaid Hospital Funding Programs for
Medicaid, Low Income Pool, Disproportionate Share Hospital, and Hospital
Exemptions Programs for the 2013-2014 fiscal year shall not be affected
by this proviso.
Any hospital that was exempt from the inpatient reimbursement ceiling in
the prior state fiscal year, due to their charity care and Medicaid days
as a percentage to total adjusted hospital days equaling or exceeding 11
percent, but no longer meets the 11 percent threshold, because of
updated audited DSH data, shall remain exempt from the inpatient
reimbursement ceilings for a period of two years.
From the funds in Specific Appropriations 208 and 222, $2,751,624
from the Grants and Donations Trust Fund and $3,906,068 from the Medical
Care Trust Fund are provided to make Medicaid payments for
multi-visceral transplant and intestine transplants in Florida. The
agency shall establish a global fee for these transplant procedures and
the payments shall be used to pay approved multi-visceral transplant and
intestine transplant facilities a global fee for providing transplant
services to Medicaid beneficiaries. Payment of the global fee is
contingent upon the nonfederal share being provided through grants and
donations from state, county or other governmental funds. The agency is
authorized to seek any federal waiver or state plan amendment necessary
to implement this provision.
From the funds in Specific Appropriation 208, $149,045,656 from the
Grants and Donations Trust Fund and $211,577,755 from the Medical Care
Trust Fund are provided for public hospitals, including any leased
public hospital determined to be covered under the state's sovereign
immunity; teaching hospitals, as defined in s. 408.07 or s. 395.805,
Florida Statutes, which have 70 or more full-time equivalent resident
physicians; hospitals that have graduate medical education positions
that do not otherwise qualify; and designated trauma hospitals to adjust
the prior Medicaid inpatient trend adjustment applied to their
individual hospital reimbursements and other Medicaid reductions to
their inpatient reimbursements. The payments under this proviso are
contingent on the state share being provided through grants and
donations from state, county, or other governmental funds. This section
of proviso does not include the adjustment of the Medicaid inpatient
trend adjustment applied to the individual state mental health
hospitals. In the event there is insufficient budget authority to fully
implement this section of proviso, the Agency is authorized to submit a
budget amendment in accordance with Chapter 216, Florida Statutes to
obtain additional budget authority to fully implement this policy.
From the funds in Specific Appropriation 208, $78,799,876 from the
Grants and Donations Trust Fund and $111,860,361 from the Medical Care
Trust Fund are provided for hospitals to adjust the prior Medicaid
inpatient trend adjustment applied to their individual hospital
reimbursements and other Medicaid reductions to their inpatient
reimbursements. The payments under this proviso are contingent on the
state share being provided through grants and donations from state,
county, or other governmental funds. Ten percent of the federal matching
funds earned through the use of intergovernmental transfers donated for
hospital-specific rate adjustments under this paragraph of proviso shall
be used by the Agency for Health Care Administration to fund an increase
in the base rate for all hospitals. This section of proviso does not
include the adjustment of the Medicaid inpatient trend adjustment
applied to the individual state mental health hospitals. In the event
there is insufficient budget authority to fully implement this section
of proviso, the Agency is authorized to submit a budget amendment in
accordance with chapter 216, Florida Statutes to obtain additional
budget authority to fully implement this policy.
From the funds in Specific Appropriation 208, $134,697,800 from the
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SECTION 3 - HUMAN SERVICES
Grants and Donations Trust Fund and $191,210,258; from the Medical-Care.
Trust Fund are provided for hospitals to allow for adjustments for
inpatient reimbursement limitations for any hospital that has local
funds available for intergovernmental transfers. The payments under this
proviso are contingent upon the state share-being,provided through
grants and donations from state, county, or other governmental funds.
Ten percent of the federal; matching funds earned through the use of
intergovernmental transfers donated for hospital-specific rate
adjustments under this paragraph of proviso shall be used by the Agency
for Health Care Administration to fund an,increase in the baseraterfor
all hospitals. In the event there°is insufficient budget authority to
fully implement this section of proviso, the Agency is authorized to
submit a budget amendment in accordance with chapter 216, Florida
Statutes to obtain additional budget authority to fully implement this
policy.
From the funds in Specific Appropriation 208, the agency shall
establish a Diagnosis Related Grouping reimbursement methodology for
hospital inpatient services as directed in section 409.905 (5) (c),
Florida Statutes. The calculations for the Diagnosis Related Grouping
reimbursement methodology are contained in the Medicaid Hospital Funding
Programs for the 2013-2014 fiscal year and are incorporated by reference
in Senate Bill 1502. The calculations are the basis for the
appropriations made in the General Appropriations Act.
From the funds in Specific Appropriation 208, the agency shall, by
June 30, 2014, perform a reconciliation and apply positive or negative
adjustments to the transitional payments to any hospital that qualified
for a transitional payment. The reconciliation shall compare actual
payments to baseline payments to determine qualified hospitals and the
applicable transition payment amount on an individual hospital basis.
Any unearned transitional funds shall be redistributed to increase
hospital inpatient base rates on a statewide basis. Adjustments applied
must maintain budget neutrality. The agency shall also submit a report
by March 1, 2014 providing preliminary numbers on actual payments
compared to the baseline payments that delineates lump sum payments and
claims based on payments by hospital. The report shall be submitted to
the Governor, President of the Senate, and the Speaker of the House of
Representatives.
From the funds in Specific Appropriation 208, the agency shall apply
a four percent adjustment for anticipated case mix increases from
improved documentation and coding through the implementation of
Diagnosis Related Grouping. The agency shall also apply a one percent
adjustment for real case mix change. By February 28, 2014, the agency
shall perform a reconciliation and apply positive or negative
adjustments to the reimbursements. Effective March 1, 2014, adjustments
will be performed prospectively from the recalculation of individual
hospital base rates to be applied for the remainder of the fiscal year.
Adjustments applied must maintain budget neutrality on an annual basis.
The reconciliation shall not include the lump sum transitional payments.
209 SPECIAL CATEGORIES
REGULAR DISPROPORTIONATE SHARE
FROM GENERAL REVENUE FUND . . 750,000
FROM GRANTS AND DONATIONS TRUST
FUND 95,243,343
FROM MEDICAL CARE TRUST FUND . . . 132,998,411
Funds in Specific Appropriation 209 shall be used for a
Disproportionate Share Hospital Program as provided in sections 409.911,
409.9113, and 409.9119, Florida Statutes, and are contingent on the
state share being provided through grants and donations from state,
county, or other government entities.
From the funds in Specific Appropriation 209, the calculations of the
Medicaid Hospital Funding Programs for the 2013-2014 fiscal year are
incorporated by reference in Senate Bill 1502. The calculations are the
basis for the appropriations made in the General Appropriations Act.
210 SPECIAL CATEGORIES
LOW INCOME POOL
FROM GENERAL REVENUE FUND 9,208,486
FROM GRANTS AND DONATIONS TRUST
FUND 404,194,640
FROM MEDICAL CARE TRUST FUND . . . 586,846,674
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From the funds in Specific Appropriation 210, the calculations of the
Medicaid Hospital Funding Programs for the 2013-2014 fiscal year are
incorporated by reference in Senate Bill 1502. The calculations are the
basis for the appropriations made in the General Appropriations Act.
From the funds in Specific Appropriation 210, the agency is
authorized to transfer a hospital's low-income pool payments between the
various low-income programs listed in this specific appropriation if it
is required to obtain approval of the low-income pool payment
methodology from the Centers for Medicare and Medicaid Services. Any
transfer of funds, however, is contingent on the hospital's net
low-income pool payments under the low-income pool plan remaining
unchanged.
From the funds in Specific Appropriation 210, in the event that the
amount of approved nonfederal share of matching funds is not provided by
local governmental entities, the agency may re-allocate low-income pool
funds between programs described within this specific appropriation as
necessary to ensure sufficient nonfederal matching funds. No
re-allocation, under this provision, of low-income pool funds may occur
if the level of program increase for any provider access system exceeds
the amount of the additional increases in the local nonfederal share
match that their local governments transfer to the state Medicaid
program, and for which the provider access system would have otherwise
received.
From the funds in Specific Appropriation 210, the agency may make
low-income pool Medicaid payments to hospitals in an accelerated manner
that is more frequent than on a quarterly basis subject to the
availability of state, local and federal funds.
Funds provided in Specific Appropriation 210, are contingent upon the
nonfederal share being provided through grants and donations from state,
county or other governmental funds. In the event the nonfederal share
provided through grants and donations is not available to fund the
Medicaid low-income payments for eligible Medicaid providers, known as
provider access systems, the agency shall submit a revised low-income
pool plan to the Legislative Budget Commission for approval.
Distribution of such funds provided in Specific Appropriation 210 is
contingent upon approval from the Centers for Medicare and Medicaid
Services.
211 SPECIAL CATEGORIES
FREESTANDING DIALYSIS CENTERS
FROM GENERAL REVENUE FUND 7,431,719
FROM MEDICAL CARE TRUST FUND . . . 10,549,697
Funds in Specific Appropriation 211 are for the inclusion of
freestanding dialysis clinics in the Medicaid program. The agency shall
limit payment to $125.00 per visit for each dialysis treatment.
Freestanding dialysis facilities may obtain, administer and submit
claims directly to the Medicaid program for End-Stage Renal Disease
pharmaceuticals subject to coverage and limitations policy. All
pharmaceutical claims for this purpose must include National Drug Codes
(NDC) to permit the invoicing for federal and/or state supplemental
rebates from manufacturers. Claims for drug products that do not
include National Drug Code information are not payable by Florida
Medicaid unless the drug product is exempt from federal rebate
requirements.
From the funds in Specific Appropriation 211, the Agency for Health
Care Administration shall work with dialysis providers, managed care
organizations, and physicians to ensure that all Medicaid patients with
End Stage Renal Disease (ESRD) are educated and assessed by their
physician and dialysis provider to determine their suitability for
peritoneal dialysis (PD) as a modality choice. Further, the agency shall
consult with the dialysis community concerning suitable voluntary
reporting to the state Medicaid program on members' PD suitability.
212 SPECIAL CATEGORIES oft
HOSPITAL INSURANCE BENEFITS
FROM GENERAL REVENUE FUND 75,584,600
FROM MEDICAL CARE TRUST FUND . . . 107,296,115
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213 SPECIAL CATEGORIES
HOSPITAL OUTPATIENT SERVICES
FROM GENERAL REVENUE FUND 218,346,658
FROM GRANTS AND DONATIONS TRUST
FUND 183,698,474
FROM MEDICAL CARE TRUST FUND . . . 721,703,240
FROM PUBLIC MEDICAL ASSISTANCE
TRUST FUND 105,000,000
FROM REFUGEE ASSISTANCE TRUST FUND 2,725,366
From the funds in Specific Appropriation 213, $394,685 in
nonrecurring funds from the General Revenue Fund and $560,274 in
nonrecurring funds from the Medical Care Trust Fund are provided as a
special Medicaid payment for Winter Haven Hospital.
From the funds in Specific Appropriation 213, $4,380,183 from the
General Revenue Fund, $6,217,888 from the Medical Care Trust Fund, and
$58,167 from the Refugee Assistance Trust Fund are provided to restore
the reduction in outpatient hospital reimbursement rates.
From the funds in Specific Appropriation 213, the calculations of the
Medicaid Hospital Funding Programs for the 2013-2014 fiscal year are
incorporated by reference in Senate Bill 1502. The calculations are the
basis for the appropriations made in the General Appropriations Act.
From the funds in Specific Appropriation 213, $26,673,305 from the
Grants and Donations Trust Fund and $37,864,089 from the Medical Care
Trust Fund are provided so that the agency may amend its current
facility fees and physician services to allow for payments to hospitals
providing primary care to low-income individuals and participating in
the Primary Care Disproportionate Share Hospital (DSH) program in Fiscal
Year 2003-2004 provided such hospital implements an emergency room
diversion program so that non-emergent patients are triaged to lesser
acute settings; or a public hospital assumed the fiscal and operating
responsibilities for one or more primary care centers previously
operated by the Florida Department of Health or the local county
government. Any payments made to qualifying hospitals because of this
change shall be contingent on the state share being provided through
grants and donations from counties, local governments, public entities,
or taxing districts, and federal matching funds. This provision shall be
contingent upon federal approval of a state plan amendment.
From the funds in Specific Appropriation 213, $7,182,339 from the
Grants and Donations Trust Fund and $10,195,689 from the Medical Care
Trust Fund program are provided to increase the outpatient cap for
adults from $1,000 to $1,500 per year.
From the funds in Specific Appropriation 213, $35,241,725 from the
Grants and Donations Trust Fund and $50,027,389 from the Medical Care
Trust Fund are provided for public hospitals, including any leased
public hospital found to have sovereign immunity, teaching hospitals as
defined in section 408.07 (45) or 395.805, Florida Statutes, which have
seventy or more full-time equivalent resident physicians, hospitals with
graduate medical education positions that do not otherwise qualify, and
designated trauma hospitals to buy back the Medicaid outpatient trend
adjustment applied to their individual hospital rates and other Medicaid
reductions to their outpatient rates up to actual Medicaid outpatient
cost. The payments under this proviso are contingent on the state share
being provided through grants and donations from state, county or other
governmental funds. This section of proviso does not include the buy
back of the Medicaid outpatient trend adjustment applied to the
individual state mental health hospitals. In the event there is
insufficient budget authority to fully implement this section of
proviso, the Agency is authorized to submit a budget amendment in
accordance with Chapter 216, Florida Statutes to obtain additional
budget authority to fully implement this policy.
From the funds in Specific Appropriation 213, $472,119 in
nonrecurring funds from the General Revenue Fund and $670,197 in
nonrecurring funds from the Medical Care Trust Fund are provided to
allow for exemptions from outpatient reimbursement ceilings>for any
hospital that is classified as a sole community hospital under 42 C:F.R.
section 412.92 but is not classified as a 'rural hospital under section
395.602, Florida Statutes. The Medicaid Hospital Funding Programs for
Medicaid, Low Income Pool, Disproportionate Share Hospital, and,Hospital
Exemptions Programs for the 2013-2014 fiscal year shall not be affected
by this proviso.
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SECTION 3 HUMAN SERVICES
From the funds in Specific Appropriation 213, $29,028,632 from the
Grants and Donations Trust Fund and $28,431,644 from the Medical Care
Trust Fund are provided for hospitals to buy back the Medicaid
outpatient trend adjustment applied to their individual hospital rates
and other Medicaid reductions to their outpatient rates up to actual
Medicaid outpatient cost. The payments under this proviso are contingent
on the state share being provided through grants and donations from
state, county, or other governmental funds. This section of proviso does
not include the buy back: of the Medicaid outpatient trend adjustment
applied to the individual state mental health hospitals.. In the event
there is insufficient'budget authority to fully implement this section
of proviso, the Agency is authorized to submit a budget amendment in
accordance with Chapter 216, Florida Statutes to obtain additional
budget authority to fully implement this policy.
From the funds in Specific Appropriation 213, $24,614,732 from.the
Grants and Donations Trust Fund and $34,941,842 from the Medical Care
Trust Fund are provided for hospitals to allow for exemptions from
outpatient reimbursement limitations for any hospital that has local
funds available for intergovernmental transfers. The payments.under this
proviso are contingent upon the state share being provided through
grants and donations from state, county, or other governmental funds.
This section of proviso does not include the buy back of the_Medicaid
inpatient trend adjustment applied to the'individual state mental health
hospitals. In the event there is insufficient budget authority to fully
implement this section of proviso, the Agency is authorized to submit a
budget amendment in accordance with Chapter 216, Florida Statutes to
obtain additional budget authority to fully implement this proviso.
214 SPECIAL CATEGORIES
RESPIRATORY THERAPY SERVICES
FROM GENERAL REVENUE FUND 7,752,707
FROM MEDICAL CARE TRUST FUND 11,006,669
215 SPECIAL CATEGORIES
NURSE PRACTITIONER SERVICES
FROM GENERAL REVENUE FUND 2,728,881
FROM MEDICAL CARE TRUST FUND . . 5,837,168
216 SPECIAL CATEGORIES
BIRTHING CENTER SERVICES
FROM GENERAL REVENUE FUND 621,687
FROM MEDICAL CARE TRUST FUND . . . 882,520
217 SPECIAL CATEGORIES
OTHER LAB AND X-RAY SERVICES
FROM GENERAL REVENUE FUND 52,165,659
FROM MEDICAL CARE TRUST FUND . . . 74,053,551
FROM REFUGEE ASSISTANCE TRUST FUND 1,050,818
218 SPECIAL CATEGORIES
PATIENT TRANSPORTATION
FROM GENERAL REVENUE FUND 57,168,780
FROM MEDICAL CARE TRUST FUND . . . 81,153,938
FROM REFUGEE ASSISTANCE TRUST FUND 52,616
219 SPECIAL CATEGORIES
PHYSICIAN ASSISTANT SERVICES
FROM GENERAL REVENUE FUND 5,484,355
FROM MEDICAL CARE TRUST FUND . . . 12,939,600
FROM REFUGEE ASSISTANCE TRUST FUND 22,846
220 SPECIAL CATEGORIES
PERSONAL CARE SERVICES
FROM GENERAL REVENUE FUND 19,954,274
FROM MEDICAL CARE TRUST FUND . . 28,326,090
221 SPECIAL CATEGORIES
PHYSICAL REHABILITATION THERAPY
FROM GENERAL REVENUE FUND 4,381,243
FROM MEDICAL CARE TRUST FUND . . . . 6,220,364
222 SPECIAL CATEGORIES
PHYSICIAN SERVICES
FROM GENERAL REVENUE FUND 302,586,950
FROM HEALTH CARE TRUST FUND . . . 19,200,000
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SECTION 3 - HUMAN SERVICES
FROM TOBACCO SETTLEMENT TRUST FUND 61,738,330
FROM GRANTS AND DONATIONS TRUST
FUND 271,824
FROM MEDICAL CARE TRUST FUND . . . 1,090,020,926
FROM PUBLIC MEDICAL ASSISTANCE
TRUST FUND 60,800,000
FROM REFUGEE ASSISTANCE TRUST FUND 4,162,793
From the funds in Specific Appropriation 222, the agency is
authorized to continue the physician lock-in program for recipients who
participate in the pharmacy lock-in program.
From the funds in Specific Appropriation 222, $120,000,000 from the
Medical Care Trust Fund is provided for special Medicaid payments for
services provided by doctors of medicine and osteopathy as well as other
licensed health care practitioners acting under the supervision of those
doctors pursuant to existing statutes and written protocols employed by
or under contract with a medical school in Florida. The expansion of
existing programs to increase federal reimbursements through Upper
Payment Limit (UPL) provisions, shall be contingent upon the
availability of state match from existing state funds or local sources
that do not increase the current requirement for state general revenue
or tobacco settlement funds. The agency is authorized to seek a Florida
Title XIX State Plan Amendment necessary to implement these payments.
From the funds in Specific Appropriation 222, the Agency for Health
Care Administration shall seek federal approval to implement a
supplemental payment program for medical school faculty who provide
services to Medicaid beneficiaries enrolled in capitated managed care
plans so that such payments may be made directly to physicians employed
by or under contract with the state's medical schools for costs
associated with graduate medical education or their teaching mission.
The agency shall amend its Medicaid policies as necessary to implement
this program. Nothing herein shall be construed as requiring capitated
managed care plans to fund the state share of the supplemental payments.
From the funds in Specific Appropriation 222, $661,280 from the
General Revenue Fund and $938,720 from the Medical Care Trust Fund are
provided to make Medicaid payments for vagus nerve stimulation devices,
outside of the hospital inpatient reimbursements, for beneficiaries
diagnosed with epilepsy, effective July 1, 2013. The cost of the device
would thereafter be excluded from allowable costs for hospital
reimbursements.
223 SPECIAL CATEGORIES
PREPAID HEALTH PLANS
FROM GENERAL REVENUE FUND 1,258,939,403
FROM HEALTH CARE TRUST FUND . . . 485,600,000
FROM MEDICAL CARE TRUST FUND . . . 2,684,278,732
FROM REFUGEE ASSISTANCE TRUST FUND 22,863,755
From the funds in Specific Appropriation 223, $876,037 from the
General Revenue Fund, $1,232,053 from the Medical Care Trust Fund, and
$11,525 from the Refugee Assistance Trust Fund are provided to restore
the reduction to Health Maintenance Organization and Provider Service
Network capitation payments as a result of reducing the reimbursement of
outpatient hospital rates, effective September 1, 2012.
From the funds in Specific Appropriation 223, $9,563,931 from the
General Revenue Fund, of which $4,781,966 is nonrecurring, $13,577,712
from the Medical Care Trust Fund, of which $6,788,856 is nonrecurring,
and $127,008 from the Refugee Assistance Trust Fund, of which $63,504 is
nonrecurring, are provided to Health Maintenance Organization and
Provider Service Network capitation payments as a result of increased
hospital inpatient reimbursements related to the implementation of the
Diagnosis Related Grouping reimbursement methodology.
224 SPECIAL CATEGORIES
PRESCRIBED MEDICINE/DRUGS
FROM GENERAL REVENUE FUND 259,620,949
FROM HEALTH CARE TRUST FUND . . . 71,100,000
FROM GRANTS AND DONATIONS TRUST
FUND 916,367,885
FROM MEDICAL CARE TRUST FUND . . 263,737,720
FROM REFUGEE ASSISTANCE TRUST FUND 4,393,827
From the funds in Specific Appropriation 224, the Agency for Health
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SECTION 3 - HUMAN SERVICES
Care Administration may continue to contract with the existing provider
for the Medicaid Prescribed Drug rebate program.
225 SPECIAL CATEGORIES
MEDICARE PART D PAYMENT
FROM GENERAL REVENUE FUND 501,171,138
226 SPECIAL CATEGORIES
PRIVATE DUTY NURSING SERVICES
FROM GENERAL REVENUE FUND 60,883,168
FROM MEDICAL CARE TRUST FUND . . . 86,432,856
From the funds in Specific Appropriation 226, $3,878,652 from the
General Revenue Fund and $5,506,332 from the Medical Care Trust Fund are
provided for a rate increase for Private Duty Nursing services provided
by Licensed Practical Nurses.
227 SPECIAL CATEGORIES
RURAL HEALTH SERVICES
FROM GENERAL REVENUE FUND 59,665,133
FROM MEDICAL CARE TRUST FUND . . . 84,705,132
FROM REFUGEE ASSISTANCE TRUST FUND 236,153
From the funds in Specific Appropriation 227, Federally Qualified
Health Centers will be reimbursed an encounter rate per visit up to a
maximum of one each, medical, dental, and behavioral health per day.
Centers that provide dental and behavioral health services in addition
to primary health care, shall make all reasonable efforts to accommodate
the medical needs of their clients within one day.
228 SPECIAL CATEGORIES
SPEECH THERAPY SERVICES
FROM GENERAL REVENUE FUND 21,924,807
FROM MEDICAL CARE TRUST FUND . . . 31,123,757
FROM REFUGEE ASSISTANCE TRUST FUND 2,584
229 SPECIAL CATEGORIES
MEDIPASS SERVICES
FROM GENERAL REVENUE FUND 9,010,433
FROM MEDICAL CARE TRUST FUND . . . 12,792,174
FROM REFUGEE ASSISTANCE TRUST FUND 74,106
230 SPECIAL CATEGORIES
SUPPLEMENTAL MEDICAL INSURANCE
FROM GENERAL REVENUE FUND 555,944,679
FROM MEDICAL CARE TRUST FUND . . . 780,473,779
FROM REFUGEE ASSISTANCE TRUST FUND 155
231 SPECIAL CATEGORIES
OCCUPATIONAL THERAPY SERVICES
FROM GENERAL REVENUE FUND 14,404,157
FROM MEDICAL CARE TRUST FUND . . . 20,448,060
FROM REFUGEE ASSISTANCE TRUST FUND 163
232 SPECIAL CATEGORIES
CLINIC SERVICES
FROM GENERAL REVENUE FUND 34,681,469
FROM GRANTS AND DONATIONS TRUST
FUND 9,544,804
FROM MEDICAL CARE TRUST FUND . . . 62,781,404
FROM REFUGEE ASSISTANCE TRUST FUND 564,084
From the funds in Specific Appropriation 232, $9,544,804 from the
Grants and Donations Trust Fund and $13,549,326 from the Medical Care
Trust Fund are provided to buy back clinic services rate adjustments,
effective on or after July 1, 2008, and are contingent on the nonfederal
share being provided through grants and donations from state, county or
other governmental funds. Authority is granted to buy back rate
reductions up to, but not higher than the amounts available under the
authority appropriated in this line. In the event that the funds are
not available in the Grants and Donations Trust Fund, the State of
Florida is not obligated to continue reimbursements at the higher
amount.
From the funds in Specific Appropriation 232, the Agency for Health
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SECTION 3 - HUMAN SERVICES
Care Administration shall apply a recurring methodology to establish
rates taking into consideration the reductions imposed on or after
October 1, 2008 in the following manner: (1) the agency shall divide the
total amount of each recurring reduction imposed by the number of visits
originally used in the rate calculation for each rate setting period on
or after October 1, 2008, which will yield a rate reduction per diem for
each rate period; (2) the agency shall multiply the resulting rate
reduction per diem for each rate setting period on or after October 1,
2008 by the projected number of visits used in establishing the current
budget estimate which will yield the total current reduction amount to
be applied to current rates; (3) in the event the total current
reduction amount is greater than the historical reduction amount, the
agency shall hold the rate reduction to the historical reduction amount.
233 SPECIAL CATEGORIES
MEDICAID SCHOOL REFINANCING
FROM MEDICAL CARE TRUST FOND . . . . 97,569,420
From the funds in Specific Appropriation 233, the Agency for Health
Care Administration shall conduct a study to determine the fiscal impact
of Medicaid school health cost settlement. The study shall be completed
by December 31, 2013, and the agency is authorized to seek a Medicaid
state plan amendment to allow a Medicaid cost settlement program to
maximize federal Medicaid funds through Medicaid claiming for school
districts.
TOTAL: MEDICAID SERVICES TO INDIVIDUALS
FROM GENERAL REVENUE FUND 4,415,654,170
FROM TRUST FUNDS 13,708,186,576
TOTAL ALL FUNDS 18,123,840,746
MEDICAID LONG TERM CARE
The Agency for Health Care Administration shall submit a budget
amendment in accordance with the provisions of chapter 216, Florida
Statutes to realign funding based on the implementation of the Statewide
Medicaid Managed Care Long Term Care Program as authorized in chapter
2011-134, Laws of Florida. The funding realignment shall reflect the
actual enrollment changes due to the transfer of beneficiaries from
fee-for-service to capitated managed care plans for long term care
services.
234 SPECIAL CATEGORIES
ASSISTIVE CARE SERVICES
FROM MEDICAL CARE TRUST FUND . . . . 26,179,861
Funds in Specific Appropriation 234 are provided to implement
Medicaid coverage for Assistive Care Services and are contingent on the
availability of state match being provided in Specific Appropriation
397.
235 SPECIAL CATEGORIES
HOME AND COMMUNITY BASED SERVICES
FROM GENERAL REVENUE FUND 85,539,818
FROM GRANTS AND DONATIONS TRUST
FUND 2,463,268
FROM MEDICAL CARE TRUST FUND . . . 1,057,550,542
Funds in Specific Appropriations 235 and 244 for the Developmental
Services Waiver, the Aged and Disabled Waiver, the Project AIDS Care
Waiver, and the Nursing Home Diversion Waiver may be used for
reimbursement for services provided through agencies licensed pursuant
to section 400.506, Florida Statutes.
From the funds in Specific Appropriation 235, $8,141,838 from the
General Revenue Fund and $11,557,746 from the Medical Care Trust Fund
are provided to serve elders in the Aged and Disabled Adult Home and
Community Based Services Waiver. Individuals from the waitlist who are
assessed at a priority score of five or higher shall be enrolled first.
From the funds in Specific Appropriation 235, $2,463,268 in
nonrecurring funds from the Grants and Donations Trust Fund and
$3,496,733 in nonrecurring funds from the Medical Care Trust Fund are
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SECTION 3 - HUMAN SERVICES
provided for the Channeling Waiver.
236 SPECIAL CATEGORIES
ASSISTED LIVING FACILITY WAIVER
FROM GENERAL REVENUE FUND 15,398,443
FROM MEDICAL CARE TRUST FUND . . . 21,858,860
237 SPECIAL, CATEGORIES
INTERMEDIATE CARE FACILITIES/MENTALLY
RETARDED - SUNLAND CENTER
FROM MEDICAL CARE TRUST FUND . . . . 91,958,103
From the funds in Specific Appropriations 237, 238, and 239, the
Agency for Health Care Administration, in consultation with the Agency
for Persons with Disabilities, is authorized to transfer funds, in
accordance with the provisions of chapter 216, Florida Statutes, to
Specific Appropriation 267 for the Developmental Disabilities Home and
Community based waiver, Tier 1 through 3; Family Supported Living Waiver
(Tier 4); and the Developmental Disabilities Individual Budget Waiver.
Priority for the use of these funds will be given to the planning and
service areas with the greatest potential for transition success.
238 SPECIAL CATEGORIES
INTERMEDIATE CARE FACILITIES/
DEVELOPMENTALLY DISABLED COMMUNITY
FROM GENERAL REVENUE FUND 85,477,736
FROM GRANTS AND DONATIONS TRUST
FUND 15,083,253
FROM MEDICAL CARE TRUST FUND . . . 142,751,349
From the funds in Specific Appropriation 238, $15,083,253 from the
Grants and Donations Trust Fund and $21,411,431 from the Medical Care
Trust Fund are provided to buy back intermediate care facilities for the
developmentally disabled rate reductions, effective on or after October
1, 20D8 and are contingent on the nonfederal share being provided
through intermediate care facilities for the developmentally disabled
quality assessments. Authority is granted to buy back rate reductions
up to, but not higher than, the amounts available under the budgeted
authority in this line. In the event that the funds are not available
in the Grants and Donations Trust Fund, the State of Florida is not
obligated to continue reimbursements at the higher amount.
The recurring methodology to be utilized by the agency to establish
rates taking into consideration the cuts imposed on or after October 1,
2008, shall be to compare the average unit appropriation with actual
average unit cost as follows: 1) the average unit appropriation shall be
determined by dividing the total appropriation in Specific Appropriation
238 by the total bed days for the past fiscal year; 2) the total actual
cost as generated based on the October 1 and April 1 rate settings shall
be divided by the total bed days for the past fiscal year to determine
the actual unit cost; 3) the actual unit cost shall be reduced to a
Reduced Actual Unit Cost by the same percentage used to calculate the
Legislative Appropriation to account for client participation
contributions; 4) no negative adjustment to the rates paid to providers
shall occur so long as the Reduced Actual Unit Cost is equal to or less
than the average unit appropriation; 5) and in the event the Reduced
Actual Unit Cost is greater than the average unit appropriation a
prorated reduction shall be imposed on all rates after all Quality
Assessment Fee funds have been exhausted to cover the rate reductions.
239 SPECIAL CATEGORIES
NURSING HOME CARE
FROM GENERAL REVENUE FUND 539,897,130
FROM HEALTH CARE TRUST FUND . _ . 270,000,000
FROM GRANTS AND DONATIONS TRUST
FUND 418,691,778
FROM MEDICAL CARE TRUST FUND . . . 1,776,707,264
From the funds in Specific Appropriation 239, $4,547,201 from the
Grants and Donations Trust Fund and $6,454,979 from the Medical Care
Trust Fund are provided for the purpose of maximizing federal revenues
through the continuation of the Special Medicaid Payment Program for
governmentally funded nursing homes. Any requests pursuant to chapter
216, Florida Statutes, by the Agency for Health Care Administration to
increase budget authority to expand existing programs using increased
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SECTION 3 - HUMAN SERVICES
federal reimbursement through these provisions, shall be contingent upon
the availability of state match from existing state funds or local
sources that do not increase the current requirement for state general
revenue. The agency is authorized to seek federal Medicaid waivers as
necessary to implement this provision.
From the funds in Specific Appropriation 239, the Agency for Health
Care Administration, in consultation with the Department of Health, is
authorized to transfer funds, in accordance with the provisions of
chapter 216, Florida Statutes, to Specific Appropriation 235
specifically for slots under the Model Waiver, Specific Appropriation
235 Home and Community Based Services Waiver, Specific Appropriation 236
Assisted Living Facility Waiver, Specific Appropriation 244 Capitated
Nursing Home Diversion Waiver, and Specific Appropriation 532 Brain and
Spinal Cord Home and Community Based Services Waiver to transition the
greatest number of appropriate eligible beneficiaries from skilled
nursing facilities to community-based alternatives in order to maximize
the reduction in Medicaid nursing home occupancy. Priority for the use
of these funds will be given to the planning and service areas with the
greatest potential for transition success.
From the funds in Specific Appropriation 239, $412,362,977 from the
Grants and Donations Trust Fund and $585,369,849 from the Medical Care
Trust Fund are provided to buy back nursing facility rate reductions,
effective on or after January 1, 2008, and are contingent on the non
federal share being provided through nursing home quality assessments.
Authority is granted to buy back rate reductions up to, but not higher
than the amounts available under the budgeted authority in this line.
In the event that the funds are not available in the Grants and
Donations Trust Fund, the State of Florida is not obligated to continue
reimbursements at the higher amount.
Funds in Specific Appropriation 239 reflect a reduction of $1,699,820
from the General Revenue Fund and $2,412,979 from the Medical Care Trust
Fund as a result of eliminating the AIDS Supplemental Payment to Nursing
Homes.
From the funds in Specific Appropriation 239, $1,038,000 from the
General Revenue Fund and $1,473,493 from the Medical Care Trust Fund are
provided to create a supplemental payment for the care of medically
complex, technologically dependent adults residing in Nursing Homes.
241 SPECIAL CATEGORIES
STATE MENTAL HEALTH HOSPITAL PROGRAM
FROM MEDICAL CARE TRUST FUND . . . . 9,034,830
242 SPECIAL CATEGORIES
MENTAL HEALTH HOSPITAL DISPROPORTIONATE
SHARE
FROM MEDICAL CARE TRUST FUND . . . . 70,126,164
243 SPECIAL CATEGORIES
T.S. HOSPITAL DISPROPORTIONATE SHARE
FROM MEDICAL CARE TRUST FUND . . . 2,382,533
244 SPECIAL CATEGORIES
CAPITATED NURSING HOME DIVERSION WAIVER
FROM GENERAL REVENUE FUND 150,660,544
FROM MEDICAL CARE TRUST FUND . . . 213,870,173
From the funds in Specific Appropriation 244, $2,270,921 from the
General Revenue Fund and $3,223,687 from the Medical Care Trust Fund are
provided to expand the current Nursing Home Diversion program by the
greatest number of slots permissible under the additional funding.
Individuals from the waitlist who are assessed at a priority score of
four or higher shall be enrolled first.
245 SPECIAL CATEGORIES
PROGRAM OF ALL-INCLUSIVE CARE FOR THE
ELDERLY (PACE)
FROM MEDICAL CARE TRUST FUND . . . . 30,402,775
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SECTION 3 - HUMAN SERVICES
TOTAL: MEDICAID LONG TERM CARE
FROM GENERAL REVENUE FUND 876,973,671
FROM TRUST FUNDS 4,149,060,753
TOTAL ALL FUNDS 5,026,034,424
PROGRAM; HEALTH CARE REGULATION
HEALTH CARE REGULATION
APPROVED SALARY RATE 28,391,240
246 SALARIES AND BENEFITS POSITIONS 659.00
FROM GENERAL REVENUE FUND 108,895
FROM HEALTH CARE TRUST FUND . . 37,654,989
247 OTHER PERSONAL SERVICES
FROM HEALTH CARE TRUST FUND . . . 555,144
248 EXPENSES
FROM GENERAL REVENUE FUND 22,440
FROM HEALTH CARE TRUST FUND . . . 8,018,278
249 OPERATING CAPITAL OUTLAY
FROM HEALTH CARE TRUST FUND . . . . 87,054
250 SPECIAL CATEGORIES
TRANSFER TO DIVISION OF ADMINISTRATIVE
HEARINGS
FROM HEALTH CARE TRUST FUND . . . . 350,130
251 SPECIAL CATEGORIES
CONTRACTED SERVICES
FROM HEALTH CARE TRUST FUND . . . . 4,711,027
FROM QUALITY OF LONG-TERM CARE
FACILITY IMPROVEMENT TRUST FUND . . 1,000,000
252 SPECIAL CATEGORIES
EMERGENCY ALTERNATIVE PLACEMENT
FROM HEALTH CARE TRUST FUND . . . . 806,629
253 SPECIAL CATEGORIES
MEDICAID SURVEILLANCE
FROM HEALTH CARE TRUST FUND . . . . 111,820
254 SPECIAL CATEGORIES
RISK MANAGEMENT INSURANCE
FROM HEALTH CARE TRUST FUND . . . . 785,392
255 SPECIAL CATEGORIES
LEASE OR LEASE-PURCHASE OF EQUIPMENT
FROM HEALTH CARE TRUST FUND . . . . 140,269
256 SPECIAL CATEGORIES
TRANSFER TO DEPARTMENT OF MANAGEMENT
SERVICES - HUMAN RESOURCES SERVICES
PURCHASED PER STATEWIDE CONTRACT
FROM GENERAL REVENUE FUND 789
FROM HEALTH CARE TRUST FUND . . . 235,011
257 SPECIAL CATEGORIES
STATE OPERATIONS - AMERICAN RECOVERY AND
REINVESTMENT ACT OF 2009
FROM HEALTH CARE TRUST FUND . . . . 640,071
258 SPECIAL CATEGORIES
GRANTS AND AIDS - CONTRACTED SERVICES -
AMERICAN RECOVERY AND REINVESTMENT ACT OF
2009
FROM HEALTH CARE TRUST FUND . . . . 86,721,009
From the funds in Specific Appropriation 258, $76,578,879 in
nonrecurring funds from the Health Care Trust Fund is provided for
incentive payments to eligible Medicaid providers and hospitals for the
adoption and meaningful use of certified electronic health records
technology.
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SECTION 3 - HUMAN SERVICES
TOTAL; HEALTH CARE REGULATION
FROM GENERAL REVENUE FUND 132,124
FROM TRUST FUNDS 141,816,823
TOTAL POSITIONS 659.00
TOTAL ALL FUNDS 141,948,947
TOTAL: AGENCY FOR HEALTH CARE ADMINISTRATION
FROM GENERAL REVENUE FUND 5,379,958,391
FROM TRUST FUNDS 18,673,556,297
TOTAL POSITIONS 1,652.00
TOTAL ALL FUNDS 24,053,514,688
TOTAL APPROVED SALARY RATE . . . 71,785,091
AGENCY FOR PERSONS WITH DISABILITIES
PROGRAM: SERVICES TO PERSONS WITH DISABILITIES
HOME AND COMMUNITY SERVICES
APPROVED SALARY RATE 9,715,998
259 SALARIES AND BENEFITS POSITIONS 280.50
FROM GENERAL REVENUE FUND 7,061,349
FROM OPERATIONS AND MAINTENANCE
TRUST FUND 5,571,540
FROM SOCIAL SERVICES BLOCK GRANT
TRUST FUND 153,433
260 OTHER PERSONAL SERVICES
FROM GENERAL REVENUE FUND 1,748,739
FROM OPERATIONS AND MAINTENANCE
TRUST FUND 1,771,141
FROM SOCIAL SERVICES BLOCK GRANT
TRUST FUND 422,396
261 EXPENSES
FROM GENERAL REVENUE FUND 907,982
FROM OPERATIONS AND MAINTENANCE
TRUST FUND 1,113,286
FROM SOCIAL SERVICES BLOCK GRANT
TRUST FUND 193,061
262 OPERATING CAPITAL OUTLAY
FROM GENERAL REVENUE FUND 9,060
FROM OPERATIONS AND MAINTENANCE
TRUST FUND 26,334
263 SPECIAL CATEGORIES
GRANT AND AID INDIVIDUAL AND FAMILY
SUPPORTS
FROM GENERAL REVENUE FUND 3,080,000
FROM SOCIAL SERVICES BLOCK GRANT
TRUST FUND 12,106,771
Funds in Specific Appropriation 263 expended for developmental
training programs shall require a 12.5 percent match from local sources.
In-kind match is acceptable provided there are no reductions in the
number of persons served or level of services provided.
From the funds in Specific Appropriation 263, $500,000 from
nonrecurring general revenue funds is provided for supported employment
services for individuals on the waiting list for the Developmental
Disabilities Medicaid Waiver programs in Specific Appropriation 267. The
supported employment services shall be provided in a manner consistent
with the same rules and regulations governing these services in the
Developmental Disabilities Medicaid Waiver programs, and may
additionally be used toward obtaining and maintaining paid or unpaid
internships.
264 SPECIAL CATEGORIES
ROOM AND BOARD PAYMENTS FOR
1 DEVELOPMENTALLY DISABLED
FROM GENERAL REVENUE FUND 2,839,201
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AGREEMENT
THIS AGREEMENT is made and entered into this September 24, 2013 by and between Collier
County, Florida, a political subdivision of the State of Florida, hereinafter referred to as"the County" and
David Lawrence Mental Health Center, Inc. d/b/a David Lawrence Center, a Florida not-for-profit
corporation, hereinafter referred to as"the Center".
RECITALS:
WHEREAS, Section 125.01(1)(e), Florida Statutes, authorizes the County to provide emergency
medical services (EMS) 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 Center to become a community health partner to assist with
services to the uninsured and underinsured residents of the County, where no existing state or federal
resources are available;and
WHEREAS, The Center desires to be a community health partner and is willing to voluntarily
provide financial assistance 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
CONTRIBUTION OF FUNDS
The Center will provide a financial contribution or donation in the amount of$3,653,242 (three million
six hundred fifty three thousand two hundred forty-two dollars) to the County to help offset the cost of
EMS services to the uninsured and underinsured residents of the county.
ARTICLE II
PAYMENTS
There are no pre-arranged agreements (contractual or otherwise) between the County and the Center
to re-direct any portion of Medicaid supplemental payments in order to satisfy non-Medicaid services.
ARTICLE III
TERMS OF AGREEMENT AND TERMINATION
1. The term of this Agreement shall be October 1, 2013 through September 30, 2014.
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.
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ARTICLE IV
ASSIGNMENT
The Center 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 Center shall be allowed to assign or transfer this
Agreement or any of the Center's obligations hereunder to affiliates or wholly owned subsidiaries of the
Center. This Agreement shall run to the County and its successors.
ARTICLE V
SUBCONTRACTING
There are no subcontracts applicable to this Agreement.
ARTICLE VI
INSURANCE, SAFETY AND INDEMNIFICATION
1. Indemnity. To the maximum extent permitted by Florida law, David Lawrence Center 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 Center's
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.
2. Insurance Required. During the term of this agreement the Center 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
Center shall purchase all policies of insurance from a financially responsible insurer duly authorized
to do business in the State of Florida. The Center 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 Center will make payment as noted in Article I of this Agreement, to the County on behalf of the
EMS department. Payments will be made as follows:
$1,826,621 on October 15, 2013,
$913,311 on January 15, 2014,and
$913,310 on May 15,2014.
ARTICLE VIII
RECORDS
The Center 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
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Center 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. David Lawrence Center shall comply with Title VI of the Civil Rights Act of 1964 (42 USC 2000d) in
regard to persons served.
4. David Lawrence Center shall comply with Title VII of the Civil Rights Act of 1964 (42 USC 2000c) in
regard to employees or applicants for employment.
5. David Lawrence Center 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 Center 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 Center agrees to comply with all applicable requirements and guidelines prescribed by the
County for recipients of funds.
5. The Center agrees to safeguard the privacy of information pursuant to the Health Insurance
Portability and Accountability Act of 1996(HIPAA).
REMAINDER OF PAGE INTENTIONALLY LEFT BLANK
SIGNATURE PAGE(S)TO FOLLOW
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IN WITNESS WHEREOF,the parties have executed this Agreement on the dates for mentioned above.
BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY
By:
Georgia A. Hiller, Esq.,
Chairwoman
ATTEST:
DWIGHT E. BROCK,CLERK
By:
, Deputy Clerk
The David Lawrence Mental Health
Center, Inc. d/b/a David Lawrence
Center
By:
Title:
ATTEST:
By:
"77
Approved as to form and legality isw�
Assistant County Attorney �7
�C2-'
4
S
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AGREEMENT
THIS AGREEMENT is made and entered into this 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 payments 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 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
SERVICES TO BE PERFORMED
1. The Hospital shall provide documentation and quarterly reports to the County that support may'
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 such as, 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.
ARTICLE II
PAYMENTS
1. The County shall make Intergovernmental Transfers, on behalf of the Hospital, in connection with
the State's Medicaid Programs — specifically the self funding of inpatient DRG payments and
buyback of the Medicaid outpatient trend adjustments - to the State of Florida in accordance with
1
2013 Agreement with Naples Community Hospital/IGT
Packet Page -429-
9/24/2013 11 .B.
the Letter(s) of Agreement between the County and the Agency for Health Care Administration
(AHCA).
2. There are no pre-arranged agreements (contractual or otherwise) between the County and the
Hospital to re-direct any portion of Medicaid supplemental payments in order to satisfy non-
Medicaid activities.
3. The following document is hereby incorporated by reference as an attachment to this Agreement:
Letter of Agreement with AHCA-Attachment A
ARTICLE III
CLAIMS VALUATION AND CLAIMS PROCESSING
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 October 1,2013 through September 30, 2014.
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 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
2
2013 Agreement with Naples Community Hospital/IGT
Cq
Packet Page-430-
9/24/2013 11 .B.
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 reduce any other rights or remedies which otherwise may be
available to an indemnified party or person described in this paragraph.
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 VIII
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 $1,913,660 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$1,913,660 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 2014-2015.
ARTICLE IX
RECORDS
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,
3
2013 Agreement with Naples Community Hospital/IGT
cq
Packet Page -431-
9/24/2013 11 .B.
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 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.
S. 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).
REMAINDER OF PAGE INTENTIONALLY LEFT BLANK
SIGNATURE PAGE(S)TO FOLLOW
4
2013 Agreement with Naples Community Hospital/IGT
CA
Packet Page-432-
9/24/2013 11.B.
IN WITNESS WHEREOF,the parties have executed this Agreement on the dates first written above.
ATTEST: BOARD OF COUNTY COMMISSIONERS
DWIGHT E. BROCK,CLERK OF COLLIER COUNTY, FLORIDA
By: By:
, DEPUTY CLERK GEORGIA A. HILLER, ESQ.
CHAIRWOMAN
Approval for form and legality:
Jennifer A. Belpedio
Assistant County Attorney \'�j 4.
0.N
NAPLES COMMUNITY HOSPITAL, INC.,A FLORIDA
NOT FOR PROFIT CORPORATION
By:
Title:
5
2013 Agreement with Naples Community Hospital/IGT
Packet Page-433-
9/24/2013 11 .B.
AGREEMENT
THIS AGREEMENT is made and entered into this by and between Collier County, Florida,
a political subdivision of the State of Florida, hereinafter referred to as "the County" and Naples HMA,
L.L.C. d/b/a as Physicians Regional HealthCare System, a Florida Limited liability company, 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 payments 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 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 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 such as, 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.
a
ARTICLE II
PAYMENTS
1. The County shall make Intergovernmental Transfers, on behalf of the Hospital, in connection with
the State's Medicaid Programs — specifically the self funding of inpatient DRG payments and
buyback of the Medicaid outpatient trend adjustments -to the State of Florida in accordance with
1
2013 Agreement with Naples HMA/IGT
Packet Page-434-
9/24/2013 11 .B.
the Letter(s) of Agreement between the County and the Agency for Health Care Administration
(AHCA).
2. There are no pre-arranged agreements (contractual or otherwise) between the County and the
Hospital to re-direct any portion of Medicaid supplemental payments in order to satisfy non-
Medicaid activities.
3. The following document is hereby incorporated by reference as an attachment to this Agreement:
Letter of Agreement with AHCA-Attachment A
ARTICLE III
CLAIMS VALUATION AND CLAIMS PROCESSING
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 October 1, 2013 through September 30, 2014.
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 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
2
2013 Agreement with Naples HMA/IGT
GP
Packet Page-435-
9/24/2013 11 .B.
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 reduce any other rights or remedies which otherwise may be
available to an indemnified party or person described in this paragraph.
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 VIII
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$929,020 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 $929,020 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 2014-2015.
ARTICLE IX
RECORDS
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,
3
2013 Agreement with Naples HMA/IGT
OA
Packet Page-436-
9/24/2013 11 .B.
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 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).
REMAINDER OF PAGE INTENTIONALLY LEFT BLANK
SIGNATURE PAGE(S)TO FOLLOW
4
2013 Agreement with Naples HMA/IGT
CP
Packet Page -437-
9/24/2013 11 .B.
IN WITNESS WHEREOF,the parties have executed this Agreement on the dates first written above.
ATTEST: BOARD OF COUNTY COMMISSIONERS
DWIGHT E. BROCK,CLERK OF COLLIER COUNTY, FLORIDA
By: By:
, DEPUTY CLERK GEORGIA A. HILLER, ESQ.
CHAIRWOMAN
Approval for form and legality:
Jennifer A. Belpedio AV°1\�
Assistant County Attorney - ?/
Naples HMA, LLC., d/b/a Physicians Regional
Healthcare System, a Florida limited liability
company
By:
Title:
5
2013 Agreement with Naples HMA/IGT
GP
Packet Page-438-