Agenda 11/13/2012 Item #16D1011/13/2012 Item 16.D.10.
EXECUTIVE SUMMARY
Recommendation to ratify the Chairman's execution of the revised Buyback agreement between the
County and Agency for Health Care Administration (AHCA) for additional eligible funding
leveraged under the alternative intergovernmental transfer programs (IGT); such funds identified
are already budgeted in the FY 2013 approved budget.
OBJECTIVE: To inform the Board of the final agreement amounts, after having located additional
eligible funds to leverage for the IGT arrangement, with Physicians Regional Medical Center and Naples
Community Hospital (collectively "the Hospitals ").
CONSIDERATIONS: The Agency for Health Care Administration (AHCA) is the State entity that
provides Medicaid services in Florida and operates the IGT programs. Through agreements between local
government and AHCA, these programs take local funds and use these funds to obtain Federal matching
dollars. At the October 9, 2012 meeting, Item 16132, approval was granted to enter into agreements for
this upcoming year. Also, in that executive surrnnary, the following was noted:
"Since two hospitals are now participating, greater participation in the AHCA programs may be
warranted considering the benefit such participation brings to these hospitals and the community. This
would require locating additional existing County budgeted funds already designated to fund allowable
health services, and including them in the AHCA programs. Should we be able to identify any such funds
that could also be reasonably managed under such an arrangement, staff will bring back agreements with
AHCA for greater amounts at a future board meeting."
Due to the statutory timeframe for submission of revised agreements at the October 23, 2012 meeting
(Item 16D 12), an item was approved to authorize the Chairman to sign revised agreements in order to
submit them to ACHA and have them processed by October 31, 2012.
Staff has worked closely with the Hospitals and AHCA in identification of additional funds that could be
leveraged for this arrangement. The additional funds being leveraged ($485,916), over the previous
approved amounts, include: (1) the additional $300,000 of funding allocated at the October 23, 2012
meeting to the David Lawrence Center, in support of Baker Act beds, (2) 583,400 in additional Health
Department funding elements for Sexually Transmitted Diseases and Public Health Preparedness and
Response, and S102,516 from the Human Services budget from funds allocated to serve persons with
incomes at or below the poverty level. We have been assured by AHCA, via each of the Hospitals'
AHCA consultants, that all of these items are eligible for the IGT programs.
The charts below show the original (b , s +Fi e fli ,,,,.',) and final financial figures for this arrangement.
*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
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County IGT
AHCA
Total **
Commitment
Matching Funds*
(50% to each
(budgeted general funds)
Hospital from
AHCA)
Total
� $2,097,484
S2 864 626
�, T,'VT..V�,T14
84 962 i � n
$2,583,400
$3,528,263
56,111,663
*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
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11/13/2012 Item 16.D.10.
Partners
Funds to Partners From Hospital's General
Operating Funds
Collier County Health Department
$1,357,560
$1,457,640
from Physicians Regional
David Lawrence Center
$1,025,040
$1.385,040 $1.385,040
from Naples Community Hospital
Social Services — HHVS Budget
X34 --
ffeffi Naples Hospital
;384
-C
$ 165,000
from Naples Community Hospital
$ 92,400
from Physicians Regional
Total
$3,100,080
($1,550,040 from each Hospital)
The only change from the previously approved agreements is the increased allocation amount. The
finalized agreements are provided as backup to this agenda item and were provided to the Hospitals for
their review and acceptance prior to requesting the Chairman's signature.
FISCAL IMPACT: There is no general fund impact anticipated with this item, as any funding utilized
for leverage would have been previously approved in the FY 13 budget.
LEGAL CONSIDERATIONS: AHCA's standard fonn agreement was used. Revisions to the
agreements with the Hospitals are not necessary. This item is legally sufficient and requires a majority
vote for Board action - JBW
GROWTH MANAGEMENT IMPACT: There is no growth management impact associated with this
executive summary.
RECOMMENDATION: Ratify the Chainnan's execution of the revised agreement with AHCA (the
only revision proposed is to reflect increased funding amounts).
Prepared by: Bendisa Marku, Accounting Supervisor, Housing, Human and Veteran Services
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11/13/2012 Item 16.D.10.
COLLIER COUNTY
Board of County Commissioners
Item Number: 16.D.10.
Item Summary: Recommendation to ratify the Chairman's execution of the revised
Buyback agreement between the County and Agency for Health Care Administration (AHCA) for
additional eligible funding leveraged under the alternative intergovernmental transfer
programs (IGT); such funds identified are already budgeted in the FY 2013 approved budget.
Meeting Date: 11/13/2012
Prepared By
Approved By
Name: AlonsoHailey
Title: Operations Analyst, Public Service Division
Date: 11/2/2012 9:27:52 AM
Name: WhiteJennifer
Title: Assistant County Attorney,County Attorney
Date: 11/2/2012 10:08:07 AM
Name: CarnellSteve
Title: Director - Purchasing /General Services,Purchasing
Date: 11/2/2012 10:52:21 AM
Name: KlatzkowJeff
Title: County Attorney
Date: 11 /2/2012 11:45:59 AM
Name: StanleyTherese
Title: Management /Budget Analyst, Senior,Office of Manage
Date: 11/5/2012 3:01:31 PM
Name: PryorCheryl
Title: Management/ Budget Analyst, Senior,Office of Manag
Date: 11/5/2012 4:31:29 PM
Name: KlatzkowJeff
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Title: County Attorney
Date: 11/6/2012 8:17:59 AM
Name: OchsLeo
Title: County Manager
Date: 11/6/2012 12:02:55 PM
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11/13/2012 Item 16.D.1O.
11/13/2012 Item 16.D.10.
Letter of Agreement
THIS LETTER OF AGREEMENT made and entered into in duplicate on the 23`d day of October,
2012, by and between Collier County, (the County) and the State of Florida, through its Agency
for Health Care Administration, (the Agency),
1. Per House Bill 5001, the General Appropriations Act of State Fiscal Year 2012 -2013,
passed by the 2012 Florida Legislature, the County and the Agency agree that the
County will remit to the State an amount not to exceed a grand total of $1,453,770.
a. The County and the Agency have agreed that these funds will only be used to
increase the provision of Medicaid funded health services to the people of the
County and the State of Florida at large.
b. The increased provision of Medicaid funded health services will be accomplished
through the buyback of the Medicaid inpatient and outpatient trend adjustments
up to the actual Medicaid inpatient and outpatient cost but not to exceed the
amount specified in the Appropriations Act 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, designated trauma hospitals and
hospitals not previously included in the GAA.
2. The County will pay the State an amount not to exceed the grand total amount of
$1,453,770. The County will transfer payments to the State in the following manner:
a. The first quarterly payment of $363,444, for the months of July, August, and
September, is due upon notification by the Agency.
b. Each successive payment of $363,442 is due as follows, November 30, 2012,
March 31, 2013 and June 15, 2013.
c. The State will bill the County each quarter payments are due.
3. Timelines: This agreement must be signed and submitted to the Agency no later than
October 26, 2012, to be effective for SFY 2012 -2013.
4. The County and the State agree that the State will maintain necessary records and
supporting documentation applicable to Medicaid 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.
5. 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.
6. The County confirms that there are no pre - arranged agreements (contractual or
otherwise) between the respective counties, taxing districts, and /or the hospitals to re-
direct any portion of these aforementioned Medicaid supplemental payments in order to
satisfy non - Medicaid activities.
SFY 2012 -13 Buyback LOA
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11/13/2012 Item 16.D.10.
7. This Letter of Agreement is contingent upon the State Medicaid Hospital Reimbursement
Plan reflecting 2012-13 legislative appropriations being approved by the federal Centers
for Medicare and Medicaid Services.
8. 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 2011 -12 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
2012 -13) LOAs.
9. This Letter of Agreement covers the period of July 1, 2012 through June 30, 2013 and
shall be terminated June 30, 2013.
SFY 2012 -13 Buyback LOA
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11/13/2012 Item 16.D.10.
WITNESSETH:
IN WITNESS WHEREOF the parties have duly executed this Letter of Agreement on the day
and year above first written.
Collier County
_ J
Signature
PA?,D C0`/L_E
Name
C,�Ai &W \tJ
Title
r�
f' �1fiTssT:
D . .E. BROCK, Clerk
:B
>is to Cho tnwe
SFY 2012 -13 Buyback LOA
State of Florida
Phil E. Williams
Assistant Deputy Secretary for Medicaid Finance,
Agency for Health Care Administration
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Appmved as to farm & legal Sutf4Cion0y
As stant County Attorney
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11/13/2012 Item 16.D.10.
Letter of Agreement
THIS LETTER OF AGREEMENT made and entered into in duplicate on the 9 4% day of
Q_tt , 2012, by and between Collier County, (the County) and the State of Florida, through
its Agency for Health Care Administration, (the Agency),
1. Per House Bill 5001, the General Appropriations Act of State Fiscal Year 2012-
2013, passed by the 2012 Florida Legislature, the County and the Agency agree
that the County will remit to the State an amount not to exceed a grand total of
$1,129,630.
a. The County and the Agency have agreed that these funds will only be used
to increase the provision of Medicaid funded health services to the people
of the County and the State of Florida at large.
b. The increased provision of Medicaid funded health services will be
accomplished through the removal of inpatient and outpatient
reimbursement ceilings for public hospitals, or any leased public hospital
found to have sovereign immunity, hospitals with graduate medical
education positions that do not qualify for the elimination of the inpatient
and outpatient ceilings under any section of the General Appropriations Act
(GAA), that provide services to Medicaid recipients or hospitals not
previously included in the GAA.
2. The County will pay the State an amount not to exceed the grand total amount of
$1,129,630. The County will transfer payments to the State in the following
manner:
a. The first quarterly payment of $282,409, for the months of July, August, and
September, is due upon notification by the Agency.
b. Each successive payment of $282,407 is due as follows, November 30,
2012, March 3.1, 2013 and June 15, 2013.
c. The State will bill the County each quarter payments are due.
3. Timelines: This agreement must be signed and submitted to the Agency no later
than October 9, 2012, to be effective for SFY 2012 -2013.
4. The County and the State agree that the State will maintain necessary records and
supporting documentation applicable to Medicaid 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.
5. 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.
6. The County confirms that there are no pre - arranged agreements (contractual or
otherwise) between the respective counties, taxing districts, and/or the hospitals to
SFY 2012 -13 Public Exemptions LOA Page I
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11/13/2012 Item 16.D.10.
re- direct any portion of these aforementioned Medicaid supplemental payments in
order to satisfy non - Medicaid activities.
7. This Letter of Agreement is contingent upon the State Medicaid Hospital
Reimbursement Plan reflecting 2012 -13 legislative appropriations being approved
by the federal Centers for Medicare and Medicaid Services.
8. 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
2011 -12 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 2012 -13) LOAs.
9. This Letter of Agreement covers the period of July 1, 2012 through June 30, 2013
and shall be terminated June 30, 2013,
SFY 2012 -13 Public Exemptions LOA
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11/13/2012 Item 16.D.10.
WITNESSETH:
IN WITNESS WHEREOF the parties have duly executed this Letter of Agreement on the day
and year above first written,
Collier County
Signature
FRED 1-0, C-01' k--E
Name
Title
TATTEsx
L�PROCK aft
t
SFY 2012 -13 Public Exemptions LOA
State of Florida
Phil Williams
Assistant Deputy Secretary for Medicaid Finance,
Agency for Health Care Administration
AOPWMd Its t* i0 m & legal Suf#CW cy
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Ai s— nt County Attorney
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