Backup Documents 12/15/2009 Item #16D 1
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 16 D 1
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 Office only lifter the Board has taken action on the item.)
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
excention of the Chairman's si17;'ature, draw a line throul1h nlUtinp lines #1 throuP'h #4, comnlete the checklist, and forward to Sue Filson line #St
Route to Ad~tessee(s) Office Initials Date
(List in routing: order
I. Terri Daniels Housing Human Services 6/23/10
2. c,o \\een (5y eenL- CDlLV1~ A-tlnVYl~ CfYl b u/'Z3/1D
3.
4.
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5. Ian Mitchell, Manager Board of County Commissioners l-A fe I 'L~J,O
6. Minutes and Records Clerk of Court's Office
PRIMARY CONT ACT INFORMATION
(The primary contact is the holder of the original document pending Bee 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 Bee oftice only after the Bee has acted to approve the
item.'
Name of Primary Staff Terri Daniels Phone Number 252-2689
Contact
Agenda Date Item was December 15,2009 Agenda Item Number 1601
Annroved bv the BCC
Type of Document Agreement ~L C;ollier Health Services Number of Original 2
Attached AlITeement - CA Documents Attached 2
1.
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark "N/A" in the Not Applicable column, whichever is
a ro riate.
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 fi'om ordinances,
resolutions, etc. signed by the County Attorney's Office and signature pages trom
contracts, agreements, etc. that have been fully executed by all parties except the BCC
Chairman and Clerk to the Board and ossibl State Officials.)
All handwritten strike-through and revisions have been initialed by the County Attorney's
Office and all other arties exce t the BCC Chairman and the Clerk to the Board
The Chairman's signature line date has been entered as the date ofBCC approval of the
document or the final ne otiated contract date whichever is a licable.
"Sign here" tabs are placed on the appropriate pages indicating where the Chairman's
si nature and initials are re uired.
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 trame or the BCC's actions are nullified. Be aware of our deadlines!
The document was approved by the BCC on_I 2/15/09 (enter date) and all
changes made during the meeting have been incorporated in the attached document.
The Count Attorne 's Office has reviewed the chan es, if a licable.
Yes
(Initial
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I: Formsl County Formsl Bee Formsl Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
1601
MEMORANDUM
Date:
June 23, 2010
To:
Terri Daniels, Grants Supervisor
Human Services Department
From:
Ann Jennejohn, Deputy Clerk
Minutes & Records Department
Re:
Agreements with Collier Health Services
(CHS) and the Agency for Health Care
Administration (AHCA) to participate in the
Low Income Pool Program
Attached are two (2) original agreements, referenced above (Item #16Dl),
approved by the Board of County Commissioners on December 15, 2009
After further processing we would please request that an original is
returned to our office for the Board's Official Record.
If you have any questions, please call me at 252-8406.
Thank you.
Attachments (2)
16D 1
Letter of Agreement
THIS LETTER OF AGREEMENT made and entered into in duplicate on the J S""- day
of acemlt2009, 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 2600, the General Appropriations Act of State Fiscal Year 2009-2010,
passed by the 2009 Florida Legislature, County and the Agency, agree that County will remit
to the State an amount not to exceed a grand total of $207,127.
a) The County and the Agency have agreed that these funds will only be used to
increase the provision of health seNices 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 seNices 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 seNices for adults from $500 to
$1,500.
vi. Medicaid Low Income Pool (LIP) payments to rural hospitals, trauma
centers, specialty pediatric hospitals, primary care seNices 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 seNices to
low income, uninsured individuals.
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1601
2. The County will pay the State an amount not to exceed the grand total amount of $207,127.
The County will transfer payments to the State in the following manner:
a) The first quarterly payment of $51 ,784 for the months of July, August, and
September is due upon notification by the Agency.
b) Each successive payment of $51 ,781 is due no later than, December 31,
2009, March 31, 2010 and June 15, 2010.
c) The State will bill the County each quarter payments are due.
3. Attached are the DSH and LIP schedules reflecting the anticipated annual distributions for
State Fiscal Year 2009-2010.
4. 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.
5. 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.
6. 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.
7. 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. This Letter of Agreement covers the period of July 1,2009 through June 30, 2010.
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16 D 1
WITNESSETH:
IN WITNESS WHEREOF the parties have duly executed this Letter of Agreement on the day
and year above first written.
..
BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY, FLORIDA
~ ~..
Don a I~a, '&airrRIr ........'11_
Board of County Commissioners
ATTEST: .
DWIGHT f;.,.E;lR@~i Clerk:
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By:
.eputy
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By:
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Date: December 15.2009
STATE OF FLORIDA:
Approved as to form and
legal sufficiency
By:
~~
Assistant County Attorney
Collier County
Phil E. Williams
Assistant Deputy Secretary for Medicaid Finance
Agency for Health Care Administration
Date: December 15, 2009
ltem# \(ob\
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Date (o-oYiO
Rec'd
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1601
Local Government Intergovernmental Transfers
Proaram I Amount State Fiscal Year 2009-2010
DSH
LIP, Exemptions & SWI 207,127
Nursing Home SMP
Total Fundina $207,127
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1601
"
AGREEMENT
THIS AGREEMENT is made and entered on the JS-Jo- day of _~ 2009, 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 to contract with the Center to provide payments for health
care services for the medically needy residents of the County.
WHEREAS, The Center 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 Center shall provide payment up to $207,127 for the following services in the manner as
described :
a. The Center and/or its sub-contractor shall provide payments for 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. The Center and/or its sub-contractor shall provide payments for 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.
2. The obligation of the Center 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 Center by the state or county in advance of the
obligation of the Center to provide any services or to pay for any services. In the event that sufficient
designated funds are not on deposit with the Center, the Center shall have no obligations under this
Agreement.
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1601
ARTICLE II
PAYMENTS
1. The County shall make four quarterly payments to the State of Florida under the Inter
Governmental Transfer Program (IGT):
The County will transfer payments to the State in the following manner:
a) The first quarterly payment of $51,784 for the months of July, August, and
September is due upon notification by the State.
b) Each successive payment of $51 ,781 is due no later than, December 31,
2008, March 31, 2009 and June 15, 2009.
c) The State will bill the County each quarter payments are due.
2. 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.
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, 2009 through September 30, 2010 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. 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.
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16D 1
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. 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, l' .1.:.""
rules or regulations occurs in payments made pursuant to this Agreement. (ollier COJnf4's ir1dtlnflIllC/:t'IU"
. i~ ~j,iut 10 11& limits of'
2. Insurance Required. i 11.oe. 26 I ~were.itJ1"I Iml11W1'~'
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 Heaith 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.
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1601
For the health care 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.
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.
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.
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16D 1
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).
IN WITHNESS WHEREOF, the parties have executed this Agreement on the dates indicated below
ATTEST: .
DWIGHTE;,SRPCK. Clerk
'.....':~:,1:,< "
By:"
.D.....u
Attftf'" t
. t "Jtft
(
By:
t
Donna Fiala, Chairman
ij'jj\' "
Date: December 15. 2009
COLLIER HEALTH SERVICES
Approved as to form and
legal sufficiency
By:
~~
Assistant County Attorney
Collier County
Richard B. Akin, President and CEO
Date
December 15, 2009
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