Backup Documents 11/12/2013 Item #16D13 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SL P
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO D 13
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNA
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URGENT ---AGREEMENT WITH AHCA MUST BE TO STATE BY
November 20, 2013
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. Jennifer A. Belpedio, Assistant County County Attorney Office (X�i--' 4442791
Attorney \ 115/13
2. BCC Office Board of County V,,--\\11\/
Commissioners l(5 r t
3. Minutes and Records Clerk of Court's Office
•
i
/.
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the
addressees above,may need to contact staff for additional or missing information.
Name of Primary Staff Esther Mae,Accountant Phone Number 252-8223
Contact/ Department Health,Huma and Veteran Services
Agenda Date Item was 11/12/13 Agenda Item Number 16.D.+
Approved by the BCC i
Type of Document Agreement( flier Health Services) Number of Original 2
Attached Letter of Agreement(AHCA) Documents Attached 3
PO number or account n/a
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? EM v"
2. Does the document need to be sent to another agency for additional signatures? EM
3. Original document has been signed/initialed for legal sufficiency. (All documents to be EM
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 EM
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 EM
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 EM
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip EM
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 the date mentioned above and all EM
changes made during the meeting have been incorporated in the attached document. r.<,?'
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
BCC,all changes directed by the BCC have been made,and the document is ready for Gl
Chairman's signature. c�� r t
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIII -2
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 6 D I
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
L le L.- /A t-+ C-f
3 copies of need to be sent to ACHA at the following address:
Nicole Maldonado
AHCA Medicaid Program Finance (MPF)
2727 Mahan Drive Mail Stop 23
Tallahassee, FL 32308
Phone: (850)412-4287
e /ft, e. "1"--
2 copies of re to be returned to:
Housing, Human and Veteran Services
ATTN: Esther Mae
3339 Tamiami Trail East, Ste 211
Naples, FL 34112
t:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
16013
MEMORANDUM
Date: November 26, 2013
To: Esther Mae, Accountant
Housing, Human and Veteran Services Department
From: Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re: A Letter of Agreement with the Agency for Health Care
Administration and an agreement with Collier Health Services
for participation in the Medicaid Low Income Pool Program
Attached is one original and one certified copy of the agreement referenced above,
(Item #16D13) approved by the Board of County Commissioners November 12, 2013.
The Minutes & Records has held the second original copy for the Official Record.
I've included a copy of the AHCA Letter of Agreement signed (only) by the Chairwoman.
The Letter(s) of Agreement requiring state signature were mailed to Nicole Maldonado
with the Medicaid Program Finance for further processing.
If you have any questions, please call me at 252-8406.
Thank you.
Attachments (3)
County of Collier 16013
CLERK OF THE`,CIR UIT COURT
Dwight E. Brock COLLIER COUI' Y COURTHOUSE Clerk of Courts
Clerk of Courts 3315 TAMIAMI TRL E STE 102 , P.O. BOX 413044 Accountant
NAPLES,FLORIDA NAPLES,FLORIDA Auditor
34112-5324 ''�1- 34101-3044 Custodian of County Funds
November 26, 2013
Nicole Maldonado
AHCA Medicaid Program Finance
2727 Mahan Drive Mail Stop 23
Tallahassee, FL 32308
Re: Letter of Agreement between Collier County and State of Florida
Ms. Maldonado,
Attached for further processing is an original and two certified copies of the
agreement referenced above, approved by the Collier County Board of County
Commissioners on November 12, 2013.
After the agreement(s) are signed, please return one of the original copies to the
Collier County Board Minutes and Records Department, thereby providing our
office a fully executed original document for the Official Record. I have included a
mailing label to facilitate processing.
Upon return, I will provide a copy to appropriate Collier County staff.
If I can provide additional assistance, please feel free to contact me at 239-252-8406.
Thank you.
DWIGHT E. BROCK, CLERK
at-W gTMC---D
Ann Jennej
Deputy Clerk
Attachments (3)
Phone- (239) 252-2646 Fax- (239) 252-2755
Website- www.CollierClerk.com Email- CollierClerk @collierclerk.com
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16D13
MEMORANDUM
Date: December 13, 2013
To: Esther Mae, Accountant
Housing, Human and Veteran Services Department
From: Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re: Signed Letter of Agreement with Florida's Agency for Health
Care Administration for participation in Medicaid's LIP Program
Attached for your records is a certified copy of the signed agreement referenced above,
(Item #16D13) approved by the Board of County Commissioners November 12, 2013.
The Minutes & Records has held the original agreement for the Official Record.
If you have any questions, please call me at 252 -8406.
Thank you.
Attachment
16013
J*
THIS,LETTER OF AGREEMENT made and entered into in duplicate on the �
L-2 day
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 15OO. the General Appropriations Act Vf State Fiscal Year 2O13-2O14.
passed bv the 2O13 Florida Legislature, County and the Agency, agree that County will
remit tothe 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 he used to
increase the provision of health services for the Medicaid, uninsured, and
underinsured people 0f the County and the State of Florida etlarge.
h 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, oua percentage of total hospital days, exceed 7.3
percent, and are trauma centers.
v. Inpatient DRG add-ons for teaching, specialty, chi|dnan's. public and
community hospital education program hospitals; hospitals whose charity
care and Medicaid days asa percentage of total adjusted hospital days
equals or exceeds 11 percent; or hospitals whose Medicaid dmya, 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.
0�N� v�� K�od��dLovv|noonlePool U_|P1payn�entehorural hospitals, trauma
��0����0� centers, specialty pediatric hospitals, primary care services and other
Medicaid participating safety-net hospitals.
DEC 32013
viii, Medicaid LIP payments to hospitals in the approved appropriations
MEDICAID categories.
PROGRAM FINANCE
ix. Medicaid LIP payments to Federally Qualified Health Centers,
(,'olliercotint�'-COIliel-lleillth Services- Healtb Care Network of SW F1,
16D13
x, Medicaid LIP payments to Provider Access Systems (RAS) for Medicaid
and the uninsured in rural areas.
xi Medicaid LIP payments for the expansion of primary care services (olow
inuomne, uninsured individuals.
2. The County will pay the State Gn 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 iu due upon notification by the Agency.
b, Each successive payment of$47.878is due as follows, November 3O.2O13.
March 31.2O14 and June 15.2O14.
o, The State will bill the County each quarter payments are due,
3, Timelines: This agreement must be signed, aubmdted, and received hothe Agency no
later than October 1, 2013, for self-funded exemptions, buybacks and DRG add-ons, to
be effective for 8FY2013-2O14�
4, Attached are the DSH and LIP schedules reflecting the anticipated annual distributions
for State Fiscal Year 2O13-2O14.
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 ofAgreement, 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,
O, The County and the State agree that any modifications to this Letter of Agreement shall
bein the same form, namely the exchange of signed copies ofo revised Letter of
Agreement.
`
7, The County confirms that there are nopre-arranged agreements (contractual or
otherwise) between the respective counties, taxing districts, and/or the providers to re-
direct any portion of these aforementioned Medicaid mupp|annonte| payments in order to
satisfy non-K8edioaid.non'uninnurod. and non-underinsured activities.
O, 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,
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 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) L{)Aa,
Col|ku Cw��oUerUealthService`'8ealth CareNm*m ol'SWH`pPLetter ol'Agreemen/6x 2013-14
16013
1O. This Letter 0f Agreement covers the period of July 1.2O13 through June 3O,20l4and
shall be terminated June 30, 2014,
col ioCmuuy��oU~,8cuN Services 'UeabbCare Neworkof'SW FI, L H' Leaer of Agreement for SFYl0\3'11
16013
WITNESSETH:
IN WITNESS WHEREOF the parties have duly executed this Letter of Agreement on the day
and year above first written,
Collier County r. 1�
(Healtb Ca Netvyork of SW FL
Colli94-ap-jth Services)
State of Florida
Stacey Lamp n
Assistant Deputy Secret y for Medicaid Finance,
Agency for Health Care Administration
Approved as to fon-n and IQ314
State of Florida
County of COLLIER
I HEREBY CEKtFq-firWT this is a true and
'niei%Qn file in
fi
, -"'�M4 k,4-qprdyrzqf Collier County
h n, offic' I se
! Ui niv se
al th!g,
ay,(:
DWIG4 E, B�CCK. CLt< X OF COURTS
D.C.
Col I ier County Collier 14calth Services -I Icalth Care NeiNNork of SW F L LIP P LeVer of'A-reemeni For SF 2011-14
16D13
Local Governmept "ter pyqrr�qTr�tal Transfers
Program 1 Amount i Slate Fiscal Year 2013-2014
.... .. .. .......... . ....... .
Supplen ntalPayments
LIP ..
191 5151
DSH
........... . . ....... . ............
Nursing Home SMP
Outpat ent Amounts,
Automatic Buyback_
Self-Funded Buyback
.............. . ..... . .....
Automatic Exemption
Self-Funded Exemption
__...__._.. ...__..._......._.__.._......_i
SWI
Inpatient Amounts
Automatic DRG Add-On
Self-Funded DRG Add-On
....Total Funding. $191,5151
Collier Countyj,'ollier Health Services - Health Care Network of SW FL-1.11' Letter of Agreement for SFY 2013-14
AGREEMENT 16 D 13
AA,i
THIS AGREEMENT is made and entered on the /. day of / Q' 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.
1
16D13
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.
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,
2
16D13
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
1. 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.
3
l6Ui3 Li: 3
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
PHI shall be in compliance with federal laws and HIPAA.
4
16013
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
1. 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
16013
IN WITNESS WHEREOF, the parties have executed this Agreement on the dates
indicated below.
ATTEST: z' BOARD OF ••UNTY COMMISSIONERS
DWIGHT E.‘BROCK; Clerk, COLLIER COUNT , FL"RID'
y ac
By I h,. '_e A By. _ r,
d1,e puty Clerk Georgia . Hiller, sq. Chairwoman
Attest`as ?' ' :1 ; 's
signature only.
Date:
COLLIER HEALTH SERVICES, INC.
Approved as to form and legality: •
By: 2s/fUt-k-
Sandra E. Steele, CFO
Jennifer A. Belp 'o
Assistant County ttorney
Collier County Date: ft f 1S-"�i
6