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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 se ?,i;;csrs ut =t+ f-e ,.�.s s�.a �s-.tti_F t it t;..Ctit,,Srt ie,i , .,c a.ait tht, .ri tit{ ".k19is- it$ ,. ;it, `, it;Si. pLw,i e,` ,.. uS±a.S ,,t .S „ ,i?�i�. t �C S�,i�!d� iEtt i :1,3112? l,7 il':7E" 3.1:S; 3t i.9', t R, , qtr+51 d n„ I i�a . €rrE„+r 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 °'� Spar. You must Q m* N 1,6013 .09, &V% Q carp ( 'i, G O z oI N �^�f'_j co X O ru LU E Ln Ln +� u �, P_ Q' � O Vol CO t �� e ... 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'o . a t � x X 60 W � I 8. • W.B. w: n G HI a A 01� f c 4 0 °x H I III b J T 0 s s a w� �J P, ..a ir c n c N 0 �O T, N a s 6 s 8 8 i J r � e ' Fair N C-2 6£EMV'008 t x3PajoJ 008,1 W03'XOPE4 0 s s a w� �J P, ..a ir c n c N 0 �O T, N a s 6 s 8 8 i J 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