Backup Documents 09/25/2018 Item #16D14 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
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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. Maggie Lopez Community & Human
Services
2. Jennifer Belpedio County Attorney Office C el I. (I Ss
3. BCC Office Board of County P\S bc..`
Commissioners \1S/
4. Minutes and Records Clerk of Court's Office ct IA lib
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 Maggie Lopez Phone Number 239-252-4274
Contact/ Department
Agenda Date Item was 16D.14
Approved by the BCC 9 ZS kS rt
Type of Document LOA / fj5( . 'J r�eti+ Number of Original I , /� ectC1'1
Attached Documents Attached VT
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? ML Stamp OK if
S�pV�•p 6vcoli
Original is
ii NOT required
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 ML
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 ML
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 ML
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip ML
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 6/28/16 and all changes made during 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
BCC, all changes directed by the BCC have been made,and the document is ready for the .
Chairman's signature.
1: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
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MEMORANDUM
Date: September 27, 2018
To: Maggie Lopez, Supervisor
Community & Human Services Division
From: Teresa Cannon, Deputy Clerk
Minutes & Records Department
Re: Agreement with Healthcare Network of Southwest Florida
And LOA with Collier Health Services, Inc.
- "Low Income Pool Letter of Agreement"
Attached for your records is one (1) original of each document as referenced above,
(Item #16D14) adopted by the Board of County Commissioners on Tuesday,
September 25, 2018.
Please return a fully executed copy back to our office to be held in the
Board's Official Records.
If you have any questions, please feel free to contact me at 252-8411.
Thank you.
Attachment
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AGREEMENT t{
THIS AGREEMENT is made and entered on the • ' day of 2018,
by and between Collier County, Florida, a political subdivision of the State of Fldrida, hereinafter
referred to as "the County" and Collier Health Services, Inc., d/b/a Healthcare Network of
Southwest Florida, 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.
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.
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ARTICLE Il
PAYMENTS
The County shall make intergovernmental transfers, on behalf of Collier Health Services in
connection with the LIP program to the State of Florida, hereinafter referred to as "State", 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$605,978.00.
The County will transfer payments to the State in the following manner:
a. The payments for the months July 2018 —June 2019 are due by October 31, 2018,
to the State.
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 reflecting the
anticipated annual distributions for State Fiscal Year 2018-2019 (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.
2. Prompt payment of invoices as presented to the Center should be made within 30
business days of receipt from the County.
3. Copies of all checks issued are to be sent to the County for record keeping.
ARTICLE IV
TERMS OF AGREEMENT AND TERMINATION
1. The term of this Agreement shall be October 1, 2018 through September 30, 2019 with
no renewal, or to the date upon which all funds under the agreement are disbursed by
the Center, in accordance with Article VIII.
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, delivered by certified mail,
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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 VII
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.
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.
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2. Insurance Required: During the term of this agreement the Center shall procure and
maintain liability insurance coverage. The liability insurance coverage shall be in
amounts not less than $1,000,000 per person and $2,000,000 per incident of occurrence
•
for personal injury, death, and property damage or any other claims for damages caused
by or resulting from the activities under this Agreement. Such policies of insurance shall
name the County as an additional insured. The Center shall purchase all policies of
•
insurance from a financially responsibleduly insurer authorized to do business in the
• State of Florida. The Center shall be financially responsible for any loss due to failure to
•
obtain adequate insurance coverage and the failure to maintain such policies or
certificate in the amounts set forth herein shall constitute a breach of this agreement.
•
ARTICLE VIII
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 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 $570,485.00 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 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$570,485.00, 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 the paid from separate
funds.
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
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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 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.
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).
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IN WITNESS WHEREOF, the parties have executed this Agreement on the dates indicated
below.
ATTEST: BOARD OF CO . 1 Y.COMMISSI• . RS
S
Crystal K. Kinzel, Clerk COLLIER Ce NT LORID`
/
6,l , -�-
By: ,�
, Deputy Clerk 'Andy Solis, CHAIRMAN
Attest as to Chairman's signature only.
Attest as to Chairman's
signature only,.
COLLIER HEALTH SERVICES, INC.
d/b/a HEALTHCARE NETWORK OF
SOUTHWEST FLORIDA
Approved as to form and legality: By:
1
A ,� •
Title:
Jennifer A. Belpedio c);)
Assistant County Attorney - )-
Collier County Date:
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Low Income Pool Letter of Agreement
THIS LETTER OF AGREEMENT(LOA) is made and entered into in duplicate on the 7th day of
September 2018, by and between Collier County Board of County Corn issioners(the
"Board") on behalf of Collier Health Services, Inc. and the State of Florida, Agency for
Health Care Administration (the"Agency"), for good and valuable consideration,the receipt
and sufficiency of which is acknowledged.
DEFINITIONS
"Charity care"or"uncompensated charity care"means that portion of hospital charges reported
to the Agency for which there is no compensation, other than restricted or unrestricted revenues
provided to a hospital by local governments or tax districts regardless of the method of payment.
Uncompensated care includes charity care for the uninsured but does not include
uncompensated care for insured individuals, bad debt, or Medicaid and CHIP shortfall. The
state and providers that are participating in LIP will provide assurance that LIP claims include
only costs associated with uncompensated care that is furnished through a charity care program
and that adheres to the principles of the HFMA operated by the provider.
"Intergovernmental Transfers(IGTs)"means transfers of funds from a non-Medicaid
governmental entity(e.g., counties, hospital taxing districts, providers operated by state or local
government)to the Medicaid agency. IGTs must be considered a bona fide donation pursuant to
42 CFR§433.54.
"Low Income Pool (LIP)"means providing government support for safety-net providers for the
costs of uncompensated charity care for low-income individuals who are uninsured.
Uncompensated care includes charity care for the uninsured but does not include
uncompensated care for insured individuals, "bad debt,"or Medicaid and CHIP shortfall.
"Medicaid" means the medical assistance program authorized by Title XIX of the Social Security
Act,42 U.S.C. §§ 1396 et seq., and regulations thereunder, as administered in Florida by the
Agency.
A. GENERAL PROVISIONS
1. Per House Bill 5001,the General Appropriations Act of State Fiscal Year 2018-2019,
passed by the 2018 Florida Legislature,the Board and the Agency agree that the Board
will remit IGT funds to the Agency in an amount not to exceed the total of$605,978.
a. The Board and the Agency have agreed that these iGT funds will only be used to
increase the provision of health services for the charity care of the Board and the
State of Florida at large.
b. The increased provision of charity care health services will be accomplished
through the following Medicaid programs:
i. LIP payments to hospitals,federally qualified health centers, Medical r'
School Physician Practices, community behavioral health providers, and
rural health centers pursuant to the approved Centers for Medicare&
Medicaid Services Special Terms and Conditions.
Collier County Board of County Comissioners 29152800_Collier Health Services, Inc.LOA SFY 2018-19
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d/b Ja- e_a.‘-t-1., Care Qe-41or &-4eorti. 1c�
1 6 D 1 4
2. The Board will return the signed LOA to the Agency no later than October 1, 2018.
3. The Board will pay IGT funds to the Agency in an amount not to exceed the total of
$605,978. The Board will transfer payments to the Agency in the following manner:
a. Per Florida Statute 409.908, annual payments for the months of July 2018
through June 2019 are due to the Agency no later than October 31, 2018 unless
an alternative plan is specifically approved by the agency.
b. The Agency will bill the Board when payment is due.
4. The Board and the Agency agree that the Agency will maintain necessary records and
supporting documentation applicable to health services covered by this LOA.
a. Audits and Records
i. The Board agrees to maintain books, records, and documents
(including electronic storage media) pertinent to performance under
this LOA in accordance with generally accepted accounting
procedures and practices,which sufficiently and properly reflect all
revenues and expenditures of funds provided.
ii. The Board agrees to assure that these records shall be subject at all
reasonable times to inspection, review, or audit by state personnel
and other personnel duly authorized by the Agency, as well as by
federal personnel.
Ili. The Board agrees to comply with public record laws as outlined in
section 119.0701, Florida Statutes.
b. Retention of Records
i. The Board agrees to retain all financial records, supporting documents,
statistical records, and any other documents (including electronic
storage media) pertinent to performance under this LOA for a period of
six (6) years after termination of this LOA, or if an audit has been
initiated and audit findings have not been resolved at the end of six
(6) years, the records shall be retained until resolution of the audit
findings.
ii. Persons duly authorized by the Agency and federal auditors shall have
full access to and the right to examine any of said records and
documents.
The rights of access in this section must not be limited to the
required retention period but shall last as long as the records are retained.
ii
c. Monitoring
Collier County Board of County Comissloners 29152800_Coilier Health Services, Inc.LOA SFY 2018-19
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i. The Board agrees to permit persons duly authorized by the Agency to
inspect any records, papers, and documents of the Board which are
relevant to this LOA.
d. Assignment and Subcontracts
i. The Board agrees to neither assign the responsibility of this LOA to
another party nor subcontract for any of the work contemplated under
this LOA without prior written approval of the Agency. No such
approval by the Agency of any assignment or subcontract shall be
deemed in any event or in any manner to provide for the incurrence of
any obligation of the Agency in addition to the total dollar amount
agreed upon in this LOA. All such assignments or subcontracts shall
be subject to the conditions of this LOA and to any conditions of
approval that the Agency shall deem necessary.
5. The Board and the Agency agree that any modifications to this LOA shall be in the
same form, namely the exchange of signed copies of a revised LOA.
6. The Board 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 charity care supplemental payments in order
to satisfy non-Medicaid, non-uninsured, and non-underinsured activities.
7. The Board agrees the following provision shall be included in any agreements between
the Board and local providers where IGT funding is provided pursuant to this LOA:
"Funding provided in this Agreement shall be prioritized so that designated IGT funding
shall first be used to fund the Medicaid program (including LIP or DSH) and used
secondarily for other purposes."
8. This LOA covers the period of July 1, 2018 through June 30, 2019 and shall be
terminated June 30, 2019.
9. This LOA may only be amended upon written agreement signed by both parties.
10. This LOA may be executed in multiple counterparts, each of which shall constitute an
original, and each of which shall be fully binding on any party signing at least one
counterpart.
Collier County Board of County Comissioners 29152800 Collier Health Services,Inc.LOA SFY 2018-19
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SFY 2018-2019 LIP Intergovernmental Transfers
Program IGT Amount
LIP Program $605,978
Total Funding $605,978
WITNESSETH:
IN WITNESS WHEREOF,the parties have caused this page Letter of Agreement to be
executed by their undersigned officials as duly authorized.
COLLIER COUNTY = +AR•."•F COON STATE OF FLORIDA,AGENCY FOR
COMISSIONERS / HEALTH CARE ADMINISTRATION
SIGNED SIGNED
BY: I a„' BY:
NAME: AtOp\J SOS--.i S NAME:
TITLE: A /0 TITLE:
DATE: \Ag, DATE:
Approved as to form and legality
Assistant County Atto �7
ATTEST:
-Y. AL K. KIN -L, CLERK
Deputy Clerk
tu.test as to Chairman's
signature only.
Colter County Board of County Comissioners_29152800_Collier Health Services, Inc. LOA SFY 2018-19