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Agenda 12/01/2009 Item #16D 1 Agenda Item No. 16D1 December 1, 2009 Page 1 of9 EXECUTIVE SUMMARY Recommendation to approve and authorize the Chairman to sign an agreement with the Agency for Health Care Administration in the amount of $2,221,077 to participate in the Medicaid Low Income Pool Program for services provided on behalf of the Housing and Human Services Department in order to generate an additional $567,347 in Federal matching funds. OBJECTIVE: That the Board of County Commissioners approve and authorize the Chairman to sign an agreement with the Agency for Health Care Administration (AHCA) to participate in the Medicaid Low Income Pool (LIP) program. CONSIDERATIONS: The Agency for Health Care Administration (AHCA) is the State entity that provides Medicaid services in Florida and operates the Hospital Low Income Pool (LIP) program. This program takes local funds and through an agreement between local government and AHCA uses these funds to obtain Federal matching dollars. .<-" These dollars are returned to the community through an inpatient hospital in the form of special medicaid payments in order to provide enhanced services to low-income individuals. Physician's Regional Medical Center will continue to participate in this program to receive these special Medicaid payments and scrve as the Third Party Administrator for Collier County. The Board of County Commissioners approved an agreement with Physicians Regional Medical Center on November 11, 2009 outlining the costs associated with the administration of this agreement. The Agreement with AHCA is for $2,221,077 of existing funds within the Housing and Human Services Department, Health Department and Mental Health FY 2009-10 budgets. The FYIO County budget for this program was prepared based on information from AHCA that the match percentage would remain at 15% for the FYI0 program year. After receiving the agreement and allocation from AHCA for the FYI0 program year, the match will be funded at 15% as previously anticipated. However, Collier County will receive $234,185 in additional funding based on a funding formula that AHCA utilizes that takes into consideration the level of Medicaid and Charity Care Physicans Regional Medical Center provides to the community. The allocation of County and AHCA matching funds is shown in the table below: -. , Program County LIP AJICA Additional Total AHCA Total Commitment Match at AHCA Match Revenues Allocation 15% Revcnue County Health $1,067,000 $160,050 0 $160,050 $1,227,050 Department David Lawrence $ 899,300 $134,895 0 $134,895 $1,034,195 Center Social Services $754,777 $38,217 $234,185 $272,402 $527,179 Total $2,221,077 $333,162 $234,185 $567,347 $2,788,424 .. ...,~. ,-" .". """"",.~,,>,,,", Agenda Item No. 16D1 December 1, 2009 Page 2 of9 FISCAL IMPACT: The $2,221,077 to be sent to AHCA is currently budgeted in fund 001. Participation in the Low Income Payment Program will provide a total of $567,347 in additional revenue for heaIthcare resources to Collier County. LEGAL CONSIDERATIONS: The State requires that the County sign this agreement first. This item has been reviewed by the County Atlomey's Office and is legally sufficient for Board action. - CMG GROWTH MANAGEMENT IMPACT: There is no growth management impact associated with this executive summary. RECOMMENDA TION: Staff recommends that the Board of County Commissioners approve and authorize the Chairman to sign the Agreement with the Agency on Health Care Administration. Prepared by: Terri Daniels, Accounting Supervisor, Housing and Human Services Department .--'" ,."" Agenda Item No. 16D1 December 1, 2009 Page 3 of9 COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS Item Number: Item Summary: 16D1 Recommendation to approve and authorize the Chairman to sign an agreement with the Agency for Health Care Administration in the amount of $2.221 ,077 to participate in the Medicaid Low Income Pool Program for services provided on behalf of the Housing and Human Services Department in order to generate an additional $567,347 in Federal matching funds. Meeting Date: 12/1/20099:00:00 AM Prepared By Terri A. Daniels Supervisor - Accounting Date Public Services Division Human Services 11/5/20096:18:12 PM A pproved By Marcy Krumbine Director. Housing & Human Services Date Public Services Division Human Services 11/9/20092:46 PM Approved By Marla Ramsey Administrator - Public Services Date Public Services Division Public Services Division 11/10120092:43 PM Approved By Colleen Greene Assistant County Attorney Date County Attorney County Attorney 11/12120098:44 AM Approved By Kathy Carpenter Executive Secretary Date Public Services Public Services Admin. 11/12/20099:32 AM Approved By OMS Coordinator Date County Attorney County Attorney 11/17/20099:03 AM Approved By Jeff Klatzkow County Attorney Date 11/17f2009 2:52 PM Approved By Sherry Pryor Management! Budget Analyst, Senior Date Office of Management & Budget Office of Management & Budget 11/17/20098:58 PM Approved By John A. Yonkosky Director. Management and Budget Date ,._- Office of Management & Budget Office of Management & Budget 11/19/20098:59 AM "---"_.,,, ,--. ~",,~."..- ,--.--,-->_.~~-_..>,.",- -,,.,~----~- Agenda Item No. 16D1 December 1, 2009 Page 4 of 9 AGREEMENT THIS AGREEMENT is made and entered into this by and between Collier County, Florida, a political subdivision of the State of Florida, hereinafter referred to as "the County" and Naples HMA, Inc., a Florida corporation d/b/a Physicians Regional Medical Center, hereinafter referred to as "the Hospital". 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; and WHEREAS, the establishment and maintenance of such programs are in the best interest of the people of Collier County; and WHEREAS, the County desires to contract with the Hospital to provide payments for health prevention programs, and mental health services to residents of the County; and WHEREAS, the Hospital is willing to 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 Hospital shall provide payment for the following services in the manner as described in Attachment A, Scope of Services: a. Collier County Health Department i. Immunization program ii. AIDS Prevention Program III. Tuberculosis Program iv. Communicable Disease Program v. Child Health Program VI, Healthy Start Prenatal Program provided by the Foundation for Women's Health School Health Program Adult Health Program Dental Program x. Physician Led Access Network (PLAN) .. VIl. VIII. . IX. b. Community Mental Health Services provided by the David Lawrence Center, Inc. c. Hospital agrees to fund other health related programs and services as directed by the County. I Agenda Item No. 16D1 December 1, 2009 Page 5 of 9 2. The obligation of the Hospital to provide any services pursuant to this Agreement, or to pay for services provided by other parties approved by the County pursuant to this Agreement, shall be contingent upon designated funds being paid to Hospital by AHCA or County in advance of the obligation of the Hospital to provide any services or to pay for any services. In the event that sufficient designated funds are available with the Hospital, the Hospital shall have no obligations under this Agreement. ARTICLE II PAYMENTS I. The County shall make quarterly payments to the State of Florida, Agency for Health Care Administration (AHCA) under the Inter-Governmental Transfer Program (IGT). 2. Funding provided in this Agreement shall be prioritized so that designated funding shall first be used to fund the Medicaid program (including Low Income Pool) and used secondarily for other purposes. ARTICLE III TERMS OF AGREEMENT AND TERMINATION -- 1. The term of this Agreement shall be October I, 2009 through September 30, 2010 with two annual renewals. 2. Either party may terminate this Agreement thirty with (30) calendar days written notice to the other party. In the event of termination, the County shall pay for services rendered, prorated to the date of termination. The County shall continue to pay for any inpatient receiving services on the date of termination until the discharge of such payment. 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. ~ 2 -...._,,-- ~_... -..~ ~~_...- - -...-.-.....- .. ---.' '.'...--........ , ........-,.. Agenda Item No. 16D1 December 1, 2009 Page 6 of 9 ARTICLE IV ASSIGNMENT 1. The Hospital 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. The Hospital shall be allowed to assign or transfer this Agreement or any of the Hospital's obligations hereunder to affiliates or wholly owned subsidiaries of the Hospital without obtaining prior written consent. This Agreement shall run to the County and its successors. ARTICLE V SUBCONTRACTING 1. The parties agree that the Hospital shall be permitted to execute subcontracts for the purchase by the Hospital 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 Hospital expressly understands that it shall assume the primary responsibility for performing the services outlined in Article I of this Agreement. ARTICLE VI INSURANCE, SAFETY AND INDEMNIFICATION 1. Indemnity. The Hospital 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 Hospital's failure to pay for services as directed by the County. The County shall indemnify the Hospital 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. The County's liability is subject to the provision of section 768.28, F.S. 2. Insurance Required. During the teUIl of this agreement the Hospital 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 or 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 Hospital shall submit written evidence of having procured all insurance policies required herein no later than 10 days after the effective date of this Agreement and shall submit written evidence of such insurance policies to the County Housing and Human Services Director and to the County's Risk Management office. The Hospital shall purchase all policies of insurance from a financially responsible insurer duly authorized to do business in the State of Florida. The Hospital shall be financially responsible for any loss due to failure to obtain adequate insurance coverage and the failure 3 ^"",,~'i."'''__;__ -,__'._ Agenda Item No. 16D1 December 1, 2009 Page 7 of9 ','-." to maintain such policies or certificate in the amounts set forth herein shall constitute a breach of this agreement. ARTICLE VII BILLING PROCEDURES The Hospital has standard, acceptable billing procedures that the Hospital will utilize in the performance of its obligations under this Agreement. The County shall direct the Hospital to make payments pursuant to this Agreement once the County has verified the validity of the invoices to be paid by the Hospital. The Hospital will not pay any invoices prior to the County's approval. The Hospital shall make payments to specific healthcare programs and services, such as the mental health programs ofthe David Lawrence Mental Health Center and the Collier County Health Department that are pre-approved by the County for payment. The Hospital 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 Hospital, the Hospital 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 Hospital. The Hospital has the right to bill the balance to the patient for any difference between the Medicare rate and the amount the hospital is paid pursuant to the County's authorization. ,-- For providing Third Party Administrator (TP A) services, the Hospital shall be compensated monthly and in advance at the rate of $5,000.00 (five thousand dollars) per month not to exceed $60,000 annually. The Hospital will deduct its compensation from the match revenue it receives from AHCA. ARTICLE VIII RECORDS 1. The Hospital shaII provide quarterly financial reports to the County in such detail as required by the County. 2. The Hospital 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 Hospital 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 HIP AA. _A_., 4 -_.- .,<-- ,-.....-..~' __h_'.___.~___~ -.-- '" ,-.---- --~-~" '~--'- Agenda Item No. 16D1 December 1, 2009 Page 8 of 9 ARTICLE IX CNIL RIGHTS I. 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 Hospital and/or its sub-contractor shall comply with Title VI of the Civil Rights Act of1964 (42 USC 2000d) in regard to persons served. 4. The Hospital 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. The Hospital 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 X 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 Hospital 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 Hospital and/or its sub-contractor agrees to comply with all applicable requirements and guidelines prescribed by the County for recipients of funds. 5. The Hospital and/or its sub-contractor agree to safeguard the privacy of information pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIP AA). 5 _. _'".., _." ,_._,," "''''~~';"<'''M~'',,","_.'''''''~_' .. _...._.._.<.._-_..~~.._~-."._.....~,...,.-.^"-~.. IN WITIlNESS WHEREOF, the parties have executed this Agreement on the dates indicated below. . December 1, 2009 Page 9 of 9 _. ArrEST: DWIGHT E. BROCK, Clerk BOARD OF COUNTY COMMISSIONERS COLLIER COUNTY, FLORIDA Donna Fiala, Chairman Board of County Commissioners By: Deputy Clerk By: Date: November 10, 2009 NAPLES HMA, INC., d/b/a A FLORIDA CORPORATION AND PHYSICIANS REGIONAL MEDICAL CENTER: Geoffrey Mobius, Chief Executive Officer Physicians Regional Medical Center Approved as to form and legal sufficiency By: ,..'~' Date: November 10. 2009 - - ,,'*------_.