Backup Documents 05/22/2018 Item #16D8 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1.
2.
3. County Attorney Office County Attorney Office JAB 5/22/18
4. BCC Office Board of County T1s b
Commissioners
5. Minutes and Records Clerk of Court's Office
C J *AM l2.:• '
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who crea d/prepared the Executive Summary. Primary contact information is needed in the event one of the
addressees above,may need to contact staff for addition or missing information.
Name of Primary Staff Kim Grant/Housi g Contact Information 239-252-6 87
Contact/Department
Agenda Date Item was May 22,2018 Agenda Item Number 16D8
Approved by the BCC
Type of Document First Amendment to the Agreement with Collier Number of Original 1
Attached Health Services,Inc.(CHSI)to participate in the Documents Attached
Medicaid Low Income Pool(LIP)Program to
clarify the billing and payment process
PO number or account
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature STAMP N/A
2. Does the document need to be sent to another agency for additional signatures? If yes, N/A
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be JAB
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's N/A
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the JAB
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's JAB
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip N/A
should be provided to the County Attorney Office at the time the item is input into SIRE.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on 5/22/2018 and all changes made during JAB
the meeting have been incorporated in the attached document. The County
Attorney's Office has reviewed the changes,if applicable.
9. Initials of attorney verifying that the attached document is the version approved by the j t ID
BCC,all changes directed by the BCC have been made,and the document is ready for the _7
Chairman's signature. N4/5/
D 8
MEMORANDUM
Date: May 23, 2018
To: Kim Grant, Director
Community & Human Services
From: Martha Vergara, Deputy Clerk
Minutes and Records Department
Re: 1st Amendment to Agreement between Collier County Board of
County Commissioners
Collier Hearth Services, Inc.
Attached for your records, one (1) scanned copy of the original document as
referenced above (Item #16D8) adopted by the Board of County Commissioners
Tuesday, May 22, 2018.
An original was kept by the Minutes and Records Department as part of the
Board's Official Records.
If you have any questions, you may contact me at 252-7240.
Thank you.
Attachment
160 8
FIRST AMENDMENT TO AGREEMENT BETWEEN
COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS
AND
COLLIER HEALTH SERVICES, INC.
THIS FIRST AMENDMENT TO AGREEMENT BETWEEN COLLIER COUNTY
BOARD OF COUNTY COMMISSIONERS AND COLLIER HEALTH SERVICES, INC.,
is entered this dal"( , date of 1�''1 a-i , 2018, by and between Collier
County Board of County Commissioners of Collier County, Florida(hereinafter referred to as the
"County"); and Collier Health Services, Inc., (hereinafter referred to as "Center"), collectively
referred to as the"Parties".
WITNESSETH:
WHEREAS, on September 26, 2017, the Board approved an Agreement with Collier
Health Services, Inc. (CHSI) to administer the Low-Income Pool Agreement (LIP) with Agency
for Health Care Administration(AHCA) using County ad valorem tax dollars; and
WHEREAS, the AHCA is a state entity that provides Medicaid services in Florida and
operates the LIP program which leverages local funds to obtain federal matching dollars, which
was outlined in the contract between Collier County and AHCA; and
WHEREAS, under the Agreement, CHSI will voluntarily make a payment to David
Lawrence Center in the amount of$434,988.00 and $68,640 to the National Alliance for Mental
Illness and will also make payment for eligible services managed and approved by the County in
the amount of$125,000, and
WHEREAS, this First Amendment is to amend "Article VIII, Billing Procedures" to
separate the billing procedures for each of the above payments.
NOW THEREFORE, in consideration of the mutual covenants and promises set forth
herein, the Agreement is modified as provided below:
1. "Article VIII, Billing Procedures" is amended to read:
1
16DB
ARTICLE VIII
BILLING PROCEDURES
The Center has a 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 invoiced to be paid to the Center.
The Center will not pay any invoices prior to the County's approval.
The Center will provide copies of checks for payments as they are remitted. The
Center shall also provide quarterly reports showing invoices paid and pending
payments.
The Center shall make payments on a voluntary basis in the amount of$628,628
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 for payment. The Center shall use reasonable efforts to pay invoices
approved by the County within thirty (30) days of receipt of County approved
invoices. Payments shall be made in accordance with this Agreement irrespective
of whether the Center has received funds from AHCA.
If the amount invoiced to the Center does not result in the amount of$628,628,
the Center will hold the funds for the County for the difference and voluntarily
make those payments to providers elected by the County until all funds are
exhausted.
County and Center acknowledge that this section does not require the use of Low
Income Pool funding for any voluntary payment that would be out of compliance
with the requirements for the use of Low Income Pool funding. The voluntary
payments contemplated under this section that are not for services that qualify for
Low Income Pool funding use are to be paid from a separate fund.
2. Except as modified by this First Amendment, all other terms and conditions of the
Agreement shall remain in full force and effect. If there is a conflict between the terms of
this First Amendment and the Agreement, the terms of this First Amendment shall
prevail.
IN WITNESS THEREOF, the County and the Center have executed this First
Amendment to Agreement Between Collier County Board of County Commissioners and Collier
Health Services, Inc., effective as of the date written above.
2
160 8
CENTER: COLLIER HEALTH SERVICES
By:
MIKE ELLIS
PRESIDENT AND CEO
1. 2040
ATTEST: BOARD OF ,MMISSIONERS
DWIGHT E. BROCIK, Clerk COLLIE' OU, TY,FLO '. 1'
/
,
: (1GWAL '
By: �i.. By: , iA I .
Attest as to ,Dep lr 1' DY SOL , C a IRMAN
signature only.
Approved as to form and legality:
Jenni er A. Belpedi
Assistant County Atto ey ���
S\
3