Backup Documents 01/27/2009 Item #16D 9
160 9
MEMORANDUM
Date:
February 13, 2009
To:
Terri Daniels, Grants Supervisor
Human Services Department
From:
Martha Vergara, Deputy Clerk
Minutes & Records Department
Re:
CHSI Agreement 2008-09 (AHCA)
Attached, please find three (3) originals as referenced above
(Agenda Item #16D9), approved by the Board of County
Commissioners on Tuesday, January 27, 2009.
Please return any fully executed original documents back to the
Minutes & Records Department for the Board's Record.
If you should have any questions, please call 252-7240,
Thank you.
160
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
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 Oftice. The completed routing slip and original
documents are to be forwarded to the Board Otlice only after the Board has taken action on the item.)
ROUTING SLIP
9
Complete routing lines #1 through #4 as appropriate for additional signatures, dates, and/or information needed. If the document is already complete with the
excf"Tltion of the Chairman's sionature, draw a line throuvh routintr lines #1 throup"h #4, comnlete the checklist, and forward to Sue Filson line #51.
~oute to Ad~)ressee(s) Office Initials Date
List in routina order
1. Terri Daniels Housing and Human Services 2/13/09
2,
3,
4.
5. Sue Filson, Executive Manager Board of County Commissioners
6. Minutes and Records Clerk of Court's Office
PRIMARY CONTACT INFORMATION
(The primary contact is the holder of the original document pending Bee approval. Normally the primary contact is the person who crcated/prepared the executive
summary. Primary contact information is needed in the event one of the addressees above, including Sue Filson, nced to contact staff for additional or missing
information. All original document<; needing the Bee Chaimlan's signature are \0 be dclivered to the Bee office 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 January 27, 2009 Agenda Item Number 16D9
Annroved bv the BCC
Type of Document CHSI Agreement 2008-09 (AHCA) Number of Original 3
Attached Documents Attached
1.
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark "NI A" in the Not Applicable column, whicbever 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 Offiee of the County Attomey. 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 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 Totiated 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 frame or the BeC's actions are nullified. Be a are 0 ur deadlines!
The document was approved by the BCe on enter date) and all changes
made during the meeting have been incorporate III a tached document. The
Count Attoroe 's Office has reviewed the chao es, if a licable.
Yes
(Initial)
N/A(Not
A licable)
2.
3.
4.
5.
6.
{Ii
!
I: Forms/ County Forms/ Bee Forms! Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
160 9
AGREEMENT
THIS AGREEMENT is made and entered on the 27th day of Januarv 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 $232,683 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
160 9
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.
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 $55,401 for the months of July, August, and
September is due upon notification by the Stale.
b) Each successive payment of $55,401 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, 2008 through September 30, 2009 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 10
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 obiigations of each party hereunder may be terminated
2
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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 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.
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.
3
16D 9
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 health care 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.
ARTICLE IX
RECORDS
1. The Center and/or its sub-contractor shall keep orderly and compiete 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
4
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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 Ihe 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 Portabiiity and Accountability Act of 1996 (HIPAA).
IN WITHNESS WHEREOF, the parties have executed this Agreement on the dates indicated below.
COLLIER COUNTY
HOUSING AND HUMAN SERVICES
BY:
ATTE~Tj)' r:~ "~O .
DWIGHT E:SROCK\ Clerk
.. ~.'
BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY, FLORIDA
1,0 ~
Don~a~ha
By:
Date: January 27, 2009
COLLIER HEALTH SERVICES. INC.
Approved as to form and
legal sufficiency:
By:
liJ~~Ill/iAA (J
Assistant Co nty Attorney
Collier County
Richard B. Akin, President and CEO
Date
January 27, 2009
5
160 9
MEMORANDUM
Date:
February 13, 2009
To:
Terri Daniels, Grants Supervisor
Human Services Department
From:
Martha Vergara, Deputy Clerk
Minutes & Records Department
Re:
AHCA Agreement 2008-09 (CHSI)
Attached, please find three (3) originals as referenced above
(Agenda Item #16D9), approved by the Board of County
Commissioners on Tuesday, January 27, 2009.
Please return any fully executed original documents back to the
Minutes & Records Department for the Board's Record.
If you should have any questions, please call 252-7240.
Thank you.
,._.,._._------,,-,..~.~"'"._~~_._-,-,,--_.,_._-_._~--..,"-----.'"
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 16 D 9
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 Oflicc The completed routing slip and original
documents are to be forwarded to the Board Oft1ce only aftu the Board has takcn 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 signature, draw a line throueh routin\? lines #1 through #4, complete the checklist, and forward to Sue Filson line #5).
Route to Addressee(s) Office Initials Date
(List in routing order)
1. Terri Daniels Housing and Human Services 2/13/09
2.
3.
4.
5. Sue Filson, Executive Manager Board of County Commissioners
6. Minutes and Records Clerk of Court's Office
PRIMARY CONTACT 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 staiT for additional or missing
information. All original documents needing the Bee Chairman's signature are to he delivered to the Bee office 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 January 27, 2009 Agenda Item Number 16D9
Approved by the BCC
Type of Document AHCA Agreement 2008-09 (CHSI) Number of Original 3
Attached Documents Attached
1.
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark UN/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 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 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 Cbairman 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 Iicable.
"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 ofBCC approvaL
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be war 0 our deadlines!
The document was approved by the BCC on (enter date) and all changes
made during the meeting have been in corpora ed in the attached document. The
County Attorne 's Office has reviewed the chan es, if a Iicable.
Yes
(Initial
2.
3.
4.
5.
6.
~
I: Forms/ County Forms/ BCe Forms! Original Documents Routing Slip WWS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
160 9
Letter of Agreement
THIS LETTER OF AGREEMENT made and entered into in duplicate on the 27th day of
Januarv 2009, 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 2008-2009,
passed by the 2008 Florida Legislature, County and the Agency, agree that County will remit
to the State an amount not to exceed a grand total of $221 ,603.
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 health 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.
Letter of Agreement for SFY 2008-09
Collier Health Services, Inc.
160 9
2. The County will pay the State an amount not to exceed the grand total amount of $221,603.
The County will transfer payments to the State in the following manner:
a) The first quarterly payment of $55,401 for the months of July, August, and
September is due upon notification by the Agency.
b) Each successive payment of $55,401 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.
3. The anticipated annual distribution for State Fiscal Year 2008-2009 for Collier Health
Services, Inc, is $496,868.
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, 2008 through June 30, 2009.
Lt,;l~(:;, of Agreement for SFY 2008-09
Collier Health Services, Inc.
16D 9
WITNESSETH:
IN WITNESS WHEREOF the parties have duly executed this Letter of Agreement on the day
and year above first written.
, i' ....7
A TTES'I": ),
DWICHT 6. BROCK,",?lerk
,~
~?LL1. ~l.~ 1. h../
By. f\.UA;.. . :y-
Deputy CI.i>fk,'
"'.' '.,..' ".., I
.~It ...".,Ckfi ,
,t",atwt 0111.
Approved as to form and
legal sufficiency
c~~o
Assistant CoJnty Attorney
Collier County
Letter of Agreement for SFY 2008-09
Collier Health Services, fnc.
COLLIER COUNTY HOUSING AND HUMAN SERVICES
BY:
BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY, FLORIDA
&,,,~ .JL~
Donna F1ala~ hairman
Board of County Commissioners
By:
Date: January 27, 2009
STATE OF FLORIDA:
By:
Phil E. Williams
Assistant Deputy Secretary for Medicaid Finance
Agency for Health Care Administration
Date: January 27. 2009
160 9
Local Government Intergovernmental Transfers
Proaram I Amount State Fiscal Year 2008-2009
DSH
LIP $221,603
ExemDtions
Statewide Issues
Nursinq Home SMP
Total Fundina $221,603
Letter of Agreement for SFY 2008-09
Collier Health Services, Inc.