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Agenda 09/27/2011 Item #16D6 9/27/2011 Item 16.0.6. r"\ EXECUTIVE SU~Y Rec9mmendation to approve and autho~ the Chairman to sign an agreement in the amount9f 5237,523 with the Agency for. Health Ca", Administration and an agreement with Collier Health Services (CBS) to participate in the Medicaid Low Income Pool. ProgrJ'm. Participation in this program win generate 5301,566 in Federal matching funds that win provide additional health services for the people of Collier Connty. oBJECTIVE: That the Board of County Commissioners approve and authorize the Chainnan to sign an agreement with the Agency for Health Care Administration (AHCA) to participate in the Medicaid Low Income Pool (LIP) program and sign an agreement with Collier Health Services to participate in LIP program for Federal Qualified Health Centers. I CONSIDERATIONS:ARCA 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: r"\ County IGT ~tcbing Total.. Commitment Funds. Total 5237.523 S301,566 $539.089 Partners Funds to Partners from Collier Healtb Services General Operating Funds Collier County Health Department (primadly) . $237.523 *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 paymeht of $237,523 to the Collier County Health Department 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 AReA. By participating in this program, it will allow CHS to receive $301,566 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 $237,523 to the State. These funds have already been budgeted in the Housing~ Human and Veteran Services, Fiscal Year 12 general fund Client Assistance budget. Participation in the LIP program will provide a total of $301,566 in matching funds that will be utilized by CHS for health related services for low income individuals in Collier County. Packet Page -1824- ",,-. . ~, ,.-., 9/27/2011 Item 16.0.6. LEGAL CONSIDERATIONS: This item is legally sufficient for Board action and requires a majority vote. - JBW GROWTH MANAGEMENT IMPACT: There is no growth management impact associated with this executive summary. RECOMMENDATION: Staff recommends that the Board of County Commissioners approve and authorize the Chairman to sign the agreement with Collier Health Services and the agreement with Agency for Health Care Administration. Prepared By: Ashlee Franco, Accounting Supervisor Housing, Human and Veteran Services Packet Page -1825- 9/27/2011 Item 16.0.6. ~ COLLIER COUNTY Board of County Commissioners Item Number: 16.D.6. Item Summary: Recommendation to approve and authorize the Chairman to sign an agreement in the amount of $237,523 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 $301,566 in Federal matching funds that will provide additional health services for the people of Collier County. Meeting Date: 9/27/2011 Prepared By Name: FrancoAshlee Title: VALUE MISSING 8/29/2011 5:17:45 PM ~ Submitted by Title: VALUE MISSING Name: FrancoAshlee 8/29/2011 5:17:46 PM Approved By Name: AlonsoHailey Title: Administrative Assistant,Domestic Animal Services Date: 8/30/2011 2:31 :23 PM Name: GrantKimberley Title: Interim Director, HHVS Date: 8/30/2011 3:42:07 PM Name: RamseyMarla Title: Administrator, Public Services Date: 8/31/201111:31:56AM ,-. Name: WhiteJennifer Title: Assistant County Attorney,County Attorney Packet Page -1826- ~ ~ --, Date: 9/19/2011 5:19:22 PM Name: PryorCheryl Title: Management! Budget Analyst, Senior,Office of Management & Budget Date: 9/20/2011 9:40:49 AM Name: KlatzkowJeff Title: County Attorney, Date: 9/20/2011 9:43:28 AM Name: OchsLeo Title: County Manager Date: 9/20/2011 3:45:29 PM Packet Page -1827- 9/27/2011 Item 16.0.6. 9/27/2011 Item 16.D.6. ~ Letter of Agreement THIS LETTER OF AGREEMENT made and entered into in duplicate on the 27th day of September 2011, 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 2000, the General Appropriations Act of State Fiscal Year 2011-2012, passed by the 2011 Florida Legislature, County and the Agency, agree that County will remit to the State an amount not to exceed a grand total of $237,523. 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 inpatient and outpatient reimbursement ceilings for teaching, specialty and community hospital education program hospitals. ~ iii. The removal of inpatient and 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 inpatient and outpatient reimbursement ceilings for hospitals whose Medicaid days, as a percentage of total hospital days, exceed 7,3 percent, and are trauma centers. v, Increase the annual cap on outpatient services for adults from $500 to $1,500, vi. Medicaid Low Income Pool (UP) payments to rural hospitals, trauma centers, specialty pediatric hospitals, primary care services and other Medicaid participating safety-net hospitals. vii. Medicaid LIP payments to hospitals in the approved appropriations categories. viii. Medicaid LIP payments to Federally Qualified Health Centers. ix. Medicaid LIP payments to Provider Access Systems (PAS) for Medicaid and the uninsured in rural areas. x. Medicaid LIP payments for the expansion of primary care services to low income, uninsured individuals. ...-...., LIP Letter of Agreement for SFY 2011-12 PacketPage-1828- 9/27/2011 Item 16.0.6. ~. 2. The County will pay the State an amount not to exceed the grand total amount of $237,523. The County will transfer payments to the State in the following manner: a. The first quarterly payment of $59,383 for the months of July, August, and September is due upon notification by the Agency. b. Each successive payment of $59,380 is due as follows, November 30, 2011, March 31, 2012 and June 15, 2012. 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 September 30,2011, to be effective for SFY 2011- 2012. 4. Attached are the DSH and LIP schedules reflecting the anticipated annual distributions for State Fiscal Year 2011-2012. 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. Tile 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. -, LIP Letter of Agreement for SFY 2011-12 Packet Page -1829- ; I 9/27/2011 Item 16.0.6. ~ This Letter of Agreement covers the period of July 1, 2011 through June 30,2012. 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 Fred W. Coyle Chairman Phil E. Williams Assistant Deputy Secretary for Medicaid Finance, Agency for Health Care Administration ~ ,ATTEST: DWIGHT E. BROCK, Clerk Approved a~ to form & leg21i SuffIciency .-:. .. \,..i. y, ..,.__ _____._Sl-:n~ . -.. '"s~i$tar(t County AttOfl1I?Y -.:J 'E.,:0""':> '\ ~'t... ~ 6 . w~ \ \" L ---.. LIP Letter of Agreement for SFY 2011-12 Packet Page -1830- 9/27/2011 Item 16.0.6. ~ Local Government Inter overnmental Transfers Pro ram I Amount State Fiscal Year 2011-2012 DSH LIP, Exem tions & SWI 237,523 Nursin Home SMP Total Fundin $237,523 ~ ---... LIP Letter of Agreement for SFY 2011.12 Packet Page -1831- 9/27/2011 Item 16.0.6. ,-... AGREEMENT THIS AGREEMENT is made and entered on the 27th day of September 2011, 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 underthe 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 quarterly 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 including, but not limited to, the following services: 2, Health prevention programsidentified by the County to the Collier County Health Department b, The Center and/or its sub-contractor shall provide timely responses to contract requirements, Responses to inquiries from the Public Services Division, County Health Department or designee regarding any aspect of payment of services being provided shall be as indicated below. c. Emergency room, secondary .and tertiary care for those patients determined eligible by the County Human Services Department. d. 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. e. Nothing in this contract shall be construed to limit access for a patient to any service provided by the Center that is medically necessary and approved by the County. ARTICLE II ,..-., PAYMENTS 1 PacketPage-1832- 9/27/2011 Item 16.0.6. ~ 1. 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: The County will transfer payments to the State in the following manner: a) The first quarterly payment of $59,383 for the months of July, August, and September is due upon notification by the State. b) Each successive payment of $59,380 is due no later than, November 30, 2011, March 31, 2012 and June 15,2012. 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 1. 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, 2011 through Sept:>mber 3D, 2012 with no renewal. 2, Either party may terminate this Agreement thirty (30) calendar days cfter receipt by the other party of written notice of intent to terminate. In the event of termination, the County shall pay ror 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, 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 allo,cated 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 th~' County, which consent 2 Packet Page -1833- 9/27/2011 Item 16.0.6. ~ 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 ~ 1. Indemnity. The Center and/or its sub-contractor shall indemnify the County against any claims, damages, losses, and expenses, including reasonable attorneys' fees and costs, arising out of, resulting from the Center's failure to pay for services as directed by the County. The County shall indemnify the Center against any claims, damages, losses, and expenses, including reasonable attorneys' fees and costs, arising out of, resulting from or in any way connected with the performance of the County's responsibilities :under this Agreement including the County's review of all invoices to insure that no violations of state of federal laws, rules or regulations occurs in payments made pursuant to this Agreement. Collier County's indemnification is subject to the limits of 9 768.28, sovereign immunity. 2, Insurance Required. The Center maintains insurance as described in the attached InSlrance Exhibit that fully satisfies the insurance requirements of the County, .ARTICLE IIIV BilLING PROCEDURES The Center has standard, acceptable billing procedures that the Center will uU;ze in the performance of its obligations under this Agreement. The County shall direct the Center to make payments pursuant to this Agreem'3nt 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 shall make payments to specific healthcare programs and services, such as the health programs at the Collier County Health Department 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. The County shall be responsible for verifying invoices for such services prior to reimbursement to the Center. The Center has the right to bill the balal1r;;e to the patient for any -.. difference between the Medicare rate and the amount the Center is paid purs\.ant to the County's authorization. 3 Packet Page -1834- " 9/27/2011 Item 16.0.6. ,-..... 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 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 ser(9d on account of race, color, sex, age, religion, ancestry, national origin, handicap otmarital 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 'I J OTHER CONDITIONS 1. Any alterations, variations, modifications or waivers of provisions of t:-Jis Agreement shall only be valid when they have been reduced to writing, duly signed and ctt?ched to the original of this Agreement. The parties agree to renegotiate the Agreement if r"!vision 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. ' 4 Packet Page -1835- ~ ~ ~ 9/27/2011 Item 16.0.6. 5. The Center and/or its sub-contractor agree to safeguard the privacy c:" information pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAi'. .' IN WITHNESS WHEREOF, the parties have executed this Agreement on the:ates indicated below. ATTEST: DWIGHT E. BROCK, Clerk BOARD OF COUNTY COMMISSIONERS COLLIER COUNTY, FLORIDA By: By: Deputy Clerk Fred W. Coyle, Chairman Date: Seotember 27,2011 COLLIER HEALTH SERVICES Approved as to form and legal sufficiency Assista~~;?tt~ Collier County By: Sandra E. Steele, CFO '.:,- ,I Date .ttl 5 Packet Page -1836-