Backup Documents 09/27/2011 Item #16D6ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 606
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
ROUTING SLIP
Complete routing lines #I through #4 as appropriate for additional signatures, dates, and/or information needed. If the document is already complete with the
exception of the Chairman's si nature, draw aline through routing lines #1 through #4, complete the checklist, and forward to Ian Mitchell line #5).
Route to Addressee(s)
List in routing order
Office
Initials
Date
1. Ashlee Franco, Accounting
Supervisor
HHVS
ky
9/27/11
2. Ian Mitchell, Executive Manager
Board of County Commissioners
AF
9/27/11
3.
Contract Agreement
Number of
2 Agreements, 2
4.
an original signature from the
Documents Attached
copies of each
Chairman needed on each copy
agreement, 1
contracts, agreements, etc. that have been fully executed by all parties except the BCC
signature per doc.
PRIMARY CONTACT INFORMATION
(The primary contact is the holder of the original document pending BCC approval. 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, including Ian Mitchell needs to contact staff for additional or missing
information. All original documents needing the BCC Chairman's signature are to be delivered to the BCC office only after the BCC has acted to approve the
item.)
Name of Primary Staff
Contact
Ashlee Franco / Housing, Human and
Veteran Services
Phone Number
252 -2689
Please call or e-mail
for pick u
Agenda Date Item was
September 27, 2011
Agenda Item Number
16D 6 (Item #3065)
Approved by the BCC
Original document has been signed/ initialed for legal sufficiency. (All documents to be
AF
Type of Document
Contract Agreement
Number of
2 Agreements, 2
Attached
an original signature from the
Documents Attached
copies of each
Chairman needed on each copy
agreement, 1
contracts, agreements, etc. that have been fully executed by all parties except the BCC
signature per doc.
Chairman and Clerk to the Board and possibly State Officials.)
(total of 4
2.
All handwritten strike - through and revisions have been initialed by the County Attorney's
AF
signatures)
INSTRUCTIONS & CHECKLIST
I: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
Initial the Yes column or mark "N /A" in the Not Applicable column, whichever is
Yes
N/A (Not
appropriat e.
(Initial)
Applicable)
1.
Original document has been signed/ initialed for legal sufficiency. (All documents to be
AF
signed by the Chairman, with the exception of most letters, must be reviewed and signed
by the Office of the County Attorney. This includes signature pages from ordinances,
resolutions, etc. signed by the County Attorney's Office and signature pages from
contracts, agreements, etc. that have been fully executed by all parties except the BCC
Chairman and Clerk to the Board and possibly State Officials.)
2.
All handwritten strike - through and revisions have been initialed by the County Attorney's
AF
N/A
Office and all other parties except the BCC Chairman and the Clerk to the Board
3.
The Chairman's signature line date has been entered as the date of BCC approval of the
AF
document or the final negotiated contract date whichever is applicable.
4.
"Sign here" tabs are placed on the appropriate pages indicating where the Chairman's
AF
signature and initials are required.
5.
In most cases (some contracts are an exception), the original document and this routing slip
AF
should be provided to Ian Mitchell in the BCC office within 24 hours of BCC approval.
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!
6.
The document was approved by the BCC on 9/27/2011 (enter date) and all changes
AF
N/A
made during the meeting have been incorporated in the attached document. The
County Attorney's Office has reviewed the changes, if applicable.
I: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
wont , I 1h
MEMORANDUM
Date: September 28, 2011
To: Ashley Franco
Housing, Human and Veteran Services
From: Teresa Polaski, Deputy Clerk
Minutes & Records Department
Re: Contract Agreement and Letter of Agreement with Collier Health
Services, Inc.
Attached for your records are three (3) originals of the document referenced above
(Item #16D6) approved by the Collier County Board of County Commissioners on
Tuesday, September 27, 2011.
Please forward on for additional signatures and return a Fully Executed
Original to the Minutes & Records Department to be kept in the Board's
Official Records.
If you have any questions, please feel free to contact me at 252 -8411.
Thank you.
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 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 1
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:
a. Health prevention programs identified 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
s 1 i
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 September 30, 2012 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, 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
FA
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 § 768.28, sovereign immunity.
2. Insurance Required.
The Center maintains insurance as described in the attached Insurance 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 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 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 balance to the patient for any
difference between the Medicare rate and the amount the Center is paid pursuant to the County's
authorization.
3
ARTICLE IX
RECORDS
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 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.
4
16D6
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).
IN WITHNESS WHEREOF, the parties have executed this Agreement on the dates indicated below.
ATTEST:
DWIGHT BROCK, Clerk
11#ti an i 4 tia- non
00ature on,
Approved as to form and
legal sufficiency
Assistan ounty Attorney
Collier County
BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY, FLORIDA
By:
Fred W. Coyle, Chairm
Date: September 27, 2011
COLLIER HEALTH SERVICES
M
Sandra E. Steele, CFO
Date
5
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1606
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
ROUTING SLIP
Complete routing lines #I through #4 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 #I through #4, complete the checklist, and forward to Ian Mitchell (line #5).
Route to Addressee(s)
List in routing order
Office
Initials
Date
1. Ashlee Franco, Accounting
Supervisor
HHVS
Initial)
10/3/11
2. Clerk of Courts
Minutes and Records Dept., 4h Fl.
AF
for vick u
3.
September 27, 2011
Agenda Item Number
16D 6
4.
by the Office of the County Attorney. This includes signature pages from ordinances,
Type of Document
Contract Agreement
Number of
1 Agreement
Attached
an original signature from the
Documents Attached
PRIMARY CONTACT INFORMATION
(The primary contact is the holder of the original document pending BCC approval. 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, including Ian Mitchell needs to contact staff for additional or missing
information. All original documents needing the BCC Chairman's signature are to be delivered to the BCC office only after the BCC has acted to approve the
item.)
Name of Primary Staff
Ashlee Franco / Housing, Human and
Phone Number
252 -2689
Contact
Veteran Services
Initial)
Please call or e-mail
1.
Original document has been signed/ initialed for legal sufficiency. (All documents to be
AF
for vick u
Agenda Date Item was
September 27, 2011
Agenda Item Number
16D 6
Approved by the BCC
by the Office of the County Attorney. This includes signature pages from ordinances,
Type of Document
Contract Agreement
Number of
1 Agreement
Attached
an original signature from the
Documents Attached
Chairman needed on each copy
INSTRUCTIONS & CHECKLIST
I: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
Initial the Yes column or mark "N /A" in the Not Applicable column, whichever is
Yes
N/A (Not
a ro riate.
Initial)
Applicable)
1.
Original document has been signed/ initialed for legal sufficiency. (All documents to be
AF
signed by the Chairman, with the exception of most letters, must be reviewed and signed
by the Office of the County Attorney. This includes signature pages from ordinances,
resolutions, etc. signed by the County Attorney's Office and signature pages from
contracts, agreements, etc. that have been fully executed by all parties except the BCC
Chairman and Clerk to the Board and possibly State Officials.)
2.
All handwritten strike - through and revisions have been initialed by the County Attorney's
AF
N/A
Office and all other parties except the BCC Chairman and the Clerk to the Board
3.
The Chairman's signature line date has been entered as the date of BCC approval of the
AF
document or the final negotiated contract date whichever is applicable.
4.
"Sign here" tabs are placed on the appropriate pages indicating where the Chairman's
AF
signature and initials are required.
5.
In most cases (some contracts are an exception), the original document and this routing slip
AF
should be provided to Ian Mitchell in the BCC office within 24 hours of BCC approval.
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!
6.
The document was approved by the BCC on 9/27/2011 (enter date) and all changes
AF
N/A
made during the meeting have been incorporated in the attached document. The
County Attorne 's Office has reviewed the changes, if applicable.
I: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
•r.
Letter of Agreement
RECEIVED
SEP 30 2011
MEDICAID
PROGRAM ANALYSIS
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 (LIP) 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
16D6
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. 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.
LIP Letter of Agreement for SFY 2011 -12
16D6
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
-;?'� Cj
Fred W. Coyle
Chairman
CAa 1 row S
✓�iti�atuR�! s� � �
LIP Letter of Agreement for SFY 2011 -12
State of Florida
Phil E. Williams
Assistant Deputy Secretary for Medicaid Finance,
Agency for Health Care Administration
AWOVOd as to form & legal Sufflclancy
Assistant County Attorney
RECEIVED
SEP 3 0 2011
MEDICAID
PROGRAM ANALYSIS
Local Government Inter
overnmental Transfers
Program / Amount
State Fiscal Year 2011 -2012
DSH
LIP, Exemptions & SWI
237523
Nursing Home SMP
Total Funding
$237,523
RECEIVED
SEP 3 0 2011
MEDICAID
PROGRAM ANALYSIS
LIP Letter of Agreement for SFY 2011 -12