Agenda 11/12/2013 Item #16D13n
rag
11/1212013 16.D.13.
EXECUTIVE SUMMARY
Recommendation to approve an agreement in the amount of $191,515 with the Agency for Health
Care Administration and an agreement with Collier Health Services (CHS) to participate in the
Medicaid Low Income Pool Program. Participation in this program will generate $271,866 in
Federal matching funds that will provide additional health services for the citizens of Collier
County.
OBJECTIVE: To provide additional health services for the citizens of Collier County.
CONSIDERATIONS: AHCA is a State entity that provides Medicaid services in Florida and operates
the Medicaid Low Income Pool (LIP) program. The LIP program (per the attached agreement) takes
local funds and uses these funds to obtain Federal matching dollars as follows:
The allocation of County and matching funds is shown in the table below:
Partners
County IGT
Commitment
Matching
Funds*
Total **
Total
$191515
$271866
1 S463,381
Partners
Funds to Partners from Collier Health Services
General Operating Funds
Collier County Health Department
(primarily)
$191515
*Match based on most recent formulas
** Per the program, the entire amount of Medicaid funding is provided to CHS
Collier Health Services (CHS) desires to be a Community Health partner and is willing to voluntarily
provide payment of $191,515 for health related services for the County's low income residents. CHS is a
Federal Qualified Health Center and has qualified to participate in the Low Income Pool program with the
AHCA. By participating in this program, it will allow CHS to receive $271,866 in additional Federal
funds that will be utilized for additional healthcare services for low income individuals in Collier County.
FISCAL IMPACT: The County will remit $191,515 to the State. These funds have already been
budgeted in the Housing, Human and Veteran Services, Fiscal Year 14 General Fund Client Assistance
budget (001- 155930). Participation in the LIP program will provide a total of $271,866 in matching
funds that will be utilized for health related services for low income individuals in Collier County.
LEGAL CONSIDERATIONS: The indemnification language from last year's CHS contract has
been strengthened in the proposed contract with CHS. The indemnification language is from the
hospital agreements that were approved by the Board on September 24, 2013 (Agenda Item No.
11B) for participation in the intergovernmental transfer program. Accordingly, this item has
been approved for form and legality and requires a majority vote for Board action. — JAB
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11/12/2013 16.D.13.
GROWTH MANAGEMENT IMPACT: None
RECOMMENDATION: The Board of County Commissioners approves and authorize the Chairman to
sign the agreement with Collier Health Services and the agreement with Agency for Health Care
Administration.
Prepared By: Bendisa Marku, Accounting Supervisor, Housing, Human, and Veterans Services
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11/12/2013 16.D.13.
COLLIER COUNTY
Board of County Commissioners
Item Number: 16.16.D.16.D.13.
Item Summary: Recommendation to approve an agreement in the amount of $191,515
with the Agency for Health Care Administration and an agreement with Collier Health Services
(CHS) to participate in the Medicaid Low Income Pool Program. Participation in this program
will generate $271,866 in Federal matching funds that will provide additional health services for
the citizens of Collier County.
Meeting Date: 11/12/2013
Prepared By
Name: AlonsoHailey
Title: Operations Analyst, Public Service Division
10/29/2013 3:04:39 PM
Submitted by
Title: Operations Analyst,Wastewater
Name: Bendisa Marku
10/29/2013 3:04:40 PM
Approved By
Name: AlonsoHailey
Title: Operations Analyst, Public Service Division
Date: 10/29/2013 3:28:54 PM
Name: Bendisa Marku
Title: Operations Analyst,Wastewater
Date: 10/30/2013 3:38:51 PM
Name: GrantKimberley
Title: Interim Director
Date: 10/30/2013 3:47:50 PM
Name: BelpedioJennifer
Title: Assistant County Attorney,County Attorney
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Date: 10/30/2013 5:01:51 PM
Name: CarnellSteve
Title: Purchasing /General Services Director
Date: 10/31/2013 6:47:10 AM
Name: RobinsonErica
Date: 10/31/2013 8:23:54 AM
Name: KlatzkowJeff
Title: County Attorney
Date: 10/31/2013 9:14:13 AM
Name: StanleyTherese
Title: Management/Budget Analyst, Senior,Office of Manage
Date: 10/31/2013 2:59:53 PM
Name: FinnEd
Title: Senior Budget Analyst, OMB
Date: 10/31/2013 4:44:13 PM
Name: OchsLeo
Title: County Manager
Date: 11/2/2013 10:31:11 AM
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11/12/2013 16.D.13.
11/12/2013 16.D.13.
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 $191,515.
a. The County and the Agency have agreed that these funds will only be used to
increase the provision of health services for the Medicaid, uninsured, and
underinsured people of the County and the State of Florida at large.
b. The increased provision of Medicaid, uninsured, and underinsured funded health
services will be accomplished through the following Medicaid programs:
i. The Disproportionate Share Hospital (DSH) program.
ii. The removal of outpatient reimbursement ceilings for teaching, specialty
and community hospital education program hospitals.
iii. The removal of outpatient reimbursement ceilings for hospitals whose
charity care and Medicaid days as a percentage of total adjusted hospital
days equals or exceeds 11 percent.
iv. The removal of outpatient reimbursement ceilings for hospitals whose
Medicaid days, as a percentage of total hospital days, exceed 7.3
percent, and are trauma centers.
v. Inpatient DRG add -ons for teaching, specialty, children's, public and
community hospital education program hospitals; hospitals whose charity
care and Medicaid days as a percentage of total adjusted hospital days
equals or exceeds 11 percent; or hospitals whose Medicaid days, as a
percentage of total hospital days, exceed 7.3 percent, and are trauma
centers.
vi. The annual cap increase on outpatient services for adults from $500 to
$1,500.
vii. Medicaid Low Income Pool (LIP) payments to rural hospitals, trauma
centers, specialty pediatric hospitals, primary care services and other
Medicaid participating safety -net hospitals.
viii. Medicaid LIP payments to hospitals in the approved appropriations
categories.
ix. Medicaid LIP payments to Federally Qualified Health Centers.
Collier County_Collier Health Services - Health Care Network of SW FL_LIP Letter of Agreement for SFY 2013 -14
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11 /12/2013 16. D.13.
x. Medicaid LIP payments to Provider Access Systems (PAS) for Medicaid
and the uninsured in rural areas.
A. 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
$191,515. The County will transfer payments to the State in the following manner:
a. The first quarterly payment of $47,881 for the months of July, August, and
September is due upon notification by the Agency.
b. Each successive payment of $47,878 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.
Collier County_Collier Health Services - Health Care Network of SW FL LIP Letter of Agreement for SFY 2013 -14
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11/12/2013 16.D.13.
10. This Letter of Agreement covers the period of July 1, 2013 through June 30, 2014 and
shall be terminated June 30, 2014.
REMAINDER OF PAGE INTENTIONALLY LEFT BLANK
SIGNATURE PAGE TO FOLLOW
Collier County_Collier Health Services - Health Care Network of SW FL_LIP Letter of Agreement for SFY 2013 -14
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CA,
11/12/2013 16.D.13.
WITNESSETH:
IN WITNESS WHEREOF the parties have duly executed this Letter of Agreement on the day
and year above first written.
Collier County
(Health Care Network of SW FL
/ Collier Health Services)
Signature
Georgia A. Hiller, Esq.
Chairwoman
ATTEST:
DWIGHT E. BROCK Cwt
By: -- -
State of Florida
Stacey Lampkin
Assistant Deputy Secretary for Medicaid Finance,
Agency for Health Care Administration
Approved as to form and I%dity
2� Sze
Assis nt County A ey
%01
Collier County_Collier Health Services - Health Care Network of SW FL LIP Letter of Agreement for SFY 2013 -14
CA
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11 /12/2013 16. D.13.
11/12/2013 16.D.13.
AGREEMENT
THIS AGREEMENT is made and entered on the day of 2013, by and
between Collier County, Florida, a political subdivision of the State of Florida, hereinafter
referred to as "the County" and Collier Health Services, Inc., a Florida not for profit
incorporated under the laws of the State of Florida, and a Federal Health Qualified Center
hereinafter referred to as "Center".
RECITALS:
WHEREAS, Section 125.01(1)(e), Florida Statutes, authorizes the County to provide
health welfare programs for the residents of Collier County to the extent not inconsistent with
general or special law.
WHEREAS, the establishment and maintenance of such programs are in the common
interest of the people of Collier County.
WHEREAS, The County desires the Center to become a community health partner to
assist in providing payments for health prevention programs, and mental health services to
residents of the County.
WHEREAS, The Center 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 Center shall provide documentation and monthly reports to the County related to
payment for the delivery of hospital services, designated primary health care services,
specialty health care services and other health care services.
2. The Center and /or its sub - contractor shall provide timely responses to contract
requirements. Responses to inquiries from the Public Services Division or designee
regarding any aspect of payment of services being provided shall be as indicated
below.
a. Emergency room, secondary and tertiary care for those patients determined
eligible by the County Human Services Department.
b. Secondary and tertiary services shall be provided upon the referring physician
or designated physician's order. The referral order shall distinguish between a
referral for specific therapeutic services and a diagnostic workup.
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11/12/2013 16.D.13.
3. Nothing in this contract shall be construed to limit access for a patient to any service
^ provided by a Health Services provider that is medically necessary and approved by
the County.
ARTICLE II
PAYMENTS
The County shall make intergovernmental transfers, on behalf of Collier Health Services
in connection with the LIP program to the State of Florida in accordance with the Letter of
Agreement between the County and the Agency for Health Care Administration.
1. The county will remit to the State an amount not to exceed a grand total of $191,515.
The County will transfer payments to the State in the following manner:
a. The first quarterly payment of $47,881 for the months of July, August, and
September is due upon notification by the State.
b. Each successive payment of $47,878 is due no later than, November 30, 2013,
March 31, 2014 and June 15, 2014.
c. The State will bill the County each quarter payments are due.
2. The following document is hereby incorporated by reference as Attachment A to this
Agreement.
10-11 a. Low Income Pool Agreement (LIP) with State of Florida AHCA (Attachment A).
ARTICLE III
CLAIMS VALUATION AND CLAIMS PROCESSING
1. As the claims processing entity, the Center 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
with no renewal.
2. Either party may terminate this Agreement thirty (30) calendar days after receipt by
the other party of written notice of intent to terminate. In the event of termination, the
County shall pay for services rendered, prorated to the date of termination. '
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,
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11/12/2013 16.D.13.
delivered by certified mail, telegram or in person. Waiver by either party of breach of
any provisions of this Agreement shall not be deemed to be a waiver of any other or
subsequent breach and shall not be construed to be a modification of the terms of
this Agreement.
4. It is further agreed that in the event general funds to finance all or part of this
Agreement do not become available, the obligations of each party hereunder may be
terminated upon no less than twenty -four (24) hours notice in writing to the other
party. Said notice shall be delivered by certified mail, telegram or in person. The
County shall be the final authority as to the availability of funds and as to how any
available funds will be allocated among its various service providers.
ARTICLE V
ASSIGNMENT
The Center 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 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 VI
SUBCONTRACTING
The parties agree that the Center shall be permitted to execute subcontracts for the
purchase by the Center 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 Center expressly understands that it shall assume the
primary responsibility for performing the services outlined in Article I of this
Agreement.
ARTICLE VIII
INSURANCE, SAFETY AND INDEMNIFICATION
Indemnity. To the maximum extent permitted by Florida law, the Center 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 Center'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.
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11/12/2013 16.D.13.
Center shall jointly and severally indemnify and hold harmless Collier County for all
^ claims, demands, actions, suits, losses, costs, charges, expenses, damages and
liabilities whatsoever which the County may pay, sustain, suffer or incur by reason of
or in connection with this agreement including payment of all legal costs, including but
not limited to, attorney's fees paid by the County.
2. Insurance Required.
The Center maintains insurance that fully satisfies the insurance requirements of the
County.
ARTICLE IIIV
BILLING PROCEDURES
The Center has standard, acceptable billing procedures that the Center will utilize in the
performance of its obligations under this Agreement.
The County shall direct the Center to make payments pursuant to this Agreement once the
County has verified the validity of the invoices to be paid by the Center. The Center will not
pay any invoices prior to the County's approval.
The Center will provide monthly reports showing invoices paid and pending payments.
The Center shall make payments on a voluntary basis in the amount of $191,515 to specific
healthcare programs and services that are pre - approved by the County for payment. The
Center shall use reasonable efforts to pay invoices approved by the County within thirty (30)
days of County approval.
For the healthcare services provided by the Center, the Center shall be reimbursed at the
federally approved Medicare rates.
If the amount invoiced to the Center does not result in the amount of $191,515, the Center
will credit the County for the difference and voluntarily make those payments to providers
elected by the County in the following year.
ARTICLE IX
RECORDS
1. The Center 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 Center and /or its sub-
contractor shall keep open these records to inspection by County personnel at
reasonable hours during the entire term of this Agreement. If any litigation, claim or
audit is commenced prior to the expiration of the three (3) year period and extends
beyond this period the records must remain available until any litigation, claim or
audits have been resolved. Any person duly authorized by the County shall have full
access to and the right to examine any of said records during said period. Access to
10-11 PHI shall be in compliance with federal laws and HIPAA.
4
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11 /12/2013 16. D.13.
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 Center 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 Center 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 Center 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
Any alterations, variations, modifications or waivers of provisions of this Agreement
shall only be valid when they have been reduced to writing, duly signed and attached
to the original of this Agreement. The parties agree to renegotiate the Agreement if
revision of any applicable laws or regulations makes changes in the Agreement
necessary.
2. This Agreement contains all the terms and conditions agreed upon by the parties. All
items incorporated by reference are as though physically attached. No other
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 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 Center and /or its sub - contractor agrees to comply with all applicable
requirements and guidelines prescribed by the County for recipients of funds.
5. The Center and /or its sub - contractor agree to safeguard the privacy of information
Pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
5
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11/12/2013 16.D.13.
IN WITNESS WHEREOF, the parties have executed this Agreement on the dates
indicated below.
ATTEST:
DWIGHT E. BROCK, Clerk
By:
, Deputy Clerk
Approved as to form and legality:
Jennifer A. Belpedio
Assistant County Attorney
Collier County o, ►3
BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY, FLORIDA
By:
Georgia A. Hiller, Esq. Chairwoman
Date:
COLLIER HEALTH SERVICES, INC.
By:
Sandra E. Steele, CFO
Date:
6
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11/12/2013 16.D.13.
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