Backup Documents 09/14/2010 Item #16D 4ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 b 0
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. Original documents should be hand delivered to the Board Office. The completed routing slip and original
documents are to be forwarded to the Board,Oftice only fa ter the Board has taken action on the item J
ROUTING SLIP
Complete routing lines #1 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 #1 through #4, complete the checklist, and forward to Sue Filson (line #5).
Route to Addressee(s)
List in routing order
Office
Initials
Date
1. Terri Daniels
Housing, Human and Veteran
Services
(Initial )
9/17/10
2.
September 14, 2010
Agenda Item Number
16D4
3.
signed by the Chairman, with the exception of most letters, must be reviewed and signed
4. Ian Mitchell, Manager
Board of County Commissioners
Number of Original
3
5. Minutes and Records
Clerk of Court's Office
Documents Attached
PRIMARY CONTACT INFORMATION
(The primary contact is the holder of the original document pending 13CC 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 Sue Filson, need 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
Terri Daniels
Phone Number
252 -2689
Contact
appropriate.
(Initial )
Applica ble)
Agenda Date Item was
September 14, 2010
Agenda Item Number
16D4
Approved by the BCC
signed by the Chairman, with the exception of most letters, must be reviewed and signed
Type of Document
Agreement- Agency for Health Care
Number of Original
3
Attached
Administration
Documents Attached
INSTRUCTIONS & CHECKLIST
I: Forms/ County Forms/ BCC Forms / Original Documents Routing Slip W WS 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
appropriate.
(Initial )
Applica ble)
1.
Original document has been signed/initialed for legal sufficiency. (All documents to be
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,
v+
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
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
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
signature and initials are required.
5.
In most cases (some contracts are an exception), the original document and this routing slip
should be provided to Sue Filson 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 awar of our deadlines!
6.
The document was approved by the BCC on (enter date) and all changes
made during the meeting have been incorpora e i t e attached document. The
County Attorney's Office has reviewed the changes, if applicable.
I: Forms/ County Forms/ BCC Forms / Original Documents Routing Slip W WS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
16D
MEMORANDUM
Date: September 23, 2010
To: Terri Daniels, Grants Supervisor
Human Services Department
From: Martha Vergara, Deputy Clerk
Minutes & Records Department
Re: Agreement — Agency for Health Care
Administration
Attached, please find one (3) original as referenced above (Agenda
Item #16D4), approved by the Board of County Commissioners on
Tuesday, September 14, 2010.
Please return a fully executed copy once all signatures
have been obtained for the Board's permanent records.
If you should have any questions, please call 252 -7240.
Thank you
16D
Letter of Agreement
THIS LETTER OF AGREEMENT made and entered into in duplicate on the 14th day
of September 2010, by and between Collier County (the County), and the State of Florida,
through its Agency for Health Care Administration (the Agency),
1. Per House Bill 5001, the General Appropriations Act of State Fiscal Year 2010 -2011,
passed by the 2010 Florida Legislature, County and the Agency, agree that County will remit
to the State an amount not to exceed a grand total of $2,488,228.
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.
16D
The County will pay the State an amount not to exceed the grand total amount of
$2,488,228. The County will transfer payments to the State in the following manner:
a) The first quarterly payment of $622,057 for the months of July, August,
and September is due upon notification by the Agency.
b) Each successive payment of $622,057 is due as follows, November 1,
2010, March 31, 2011 and June 15, 2011.
c) The State will bill the County each quarter payments are due.
3. The enhanced FMAP is in effect for the first six months of SFY 2010 -11. Any payments
made by the Agency on or after January 1, 2011, will not be eligible for the enhanced
FMAP. Therefore, the County will be responsible for funding the State share required as a
result of the reduced FMAP. If funding is not adequate due to the FMAP change, the State
will reduce the rate to the level of funded by the County.
4. Timelines: This agreement must be signed and submitted to the Agency no later than May
31, 2011, to be effective for SFY 2011.
5. Attached are the DSH and LIP schedules reflecting the anticipated annual distributions for
State Fiscal Year 2010 -2011.
6. 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.
7. 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.
8. 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.
9. 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.
10. This Letter of Agreement covers the period of July 1, 2010 through June 30, 2011.
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WITNESSETH:
IN WITNESS WHEREOF the parties have duly executed this Letter of Agreement on the day
and year above first written.
ATTEST:
DWIGHT E. BROCK, Clerk
Bfs
y Clerk
Ato Ow I
i t 'watwo M'1
Approved as to form and
legal sufficiency
Assis nt County Attorney���
Collier County
BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY. FLORIDA
By' yT
Fred W. Coyle, Chairman,J
Board of County Commissioners
Date: September 14, 2010
STATE OF FLORIDA:
M
Phil E. Williams
Assistant Deputy Secretary for Medicaid Finance
Agency for Health Care Administration
Date: September 14, 2010
Local Government Inter
overnmental Transfers
Program / Amount State Fiscal Year 2010 -2011
DSH
LIP, Exemptions & SWI
$2,488,228
Nursing Home SMP
Total Funding
$2,488,228
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