Agenda 09/24/2019 Item #16D 9 (CHS Agreement for participation in the Medicaid Low Income Pool Program)09/24/2019
EXECUTIVE SUMMARY
Recommendation to approve an agreement in the amount of $699,366 with the Agency for Health
Care Administration, approve an agreement with Collier Health Services, Inc., and authorize
necessary Budget Amendments to participate in the Medicaid Low Income Pool Program,
generating $800,685 in federal matching funds that will provide additional health services for the
citizens of Collier County.
OBJECTIVE: To provide additional health services to the low-income citizens of Collier County.
CONSIDERATIONS: The Agency for Health Care Administration (AHCA), is a State entity that
provides Medicaid services in Florida and operates the Medicaid Low Income Pool (LIP) Program. The
LIP Program leverages local funds to obtain federal matching dollars . The County's participation in the
LIP Program is outlined in the contractual arrangement between Collier County and AHCA, which is
presented as part of this Item.
Collier Health Services, Inc. (CHSI) desires and is qualified to administer the LIP Program with AHCA
using County ad valorem tax dollars. The allocation of County and matching funds is as follows:
Collier County LIP IGT Federal Matching Funds Provided
to CHSI as Program
Administrator
Total Funds Benefiting
Low-Income Persons
$699,366 $800,685 $1,500,051
CHSI will utilize the total funds under the LIP Program to provide additional healthcare services for low-
income individuals in Collier County. An agreement that outlines the contractual arrangement between
Collier County and CHSI on behalf of Collier Health Services, Inc., is presented as part of this Item.
CHSI will make the following voluntary payments: $226,601 for eligible services managed and approved
by County staff, $380,596 to the David Lawrence Center (DLC), and $108,169 to the National Alliance
for Mental Illness (NAMI) that will under no circumstance be paid out of the Low-Income Pool Funding
received by the Center.
In addition to the agreements with AHCA and CHSI, the County will also have an agreement that is
separate and apart with the DLC. On October 22, 2019, staff will present an agreement with DLC for
Board of County Commissioners (Board) consideration.
FISCAL IMPACT: A Budget Amendment in the amount of $87,266 will be transferred from within
Community & Human Services FY20 Mental Health Budget (001-156010) to FY20 Client Assistance
Budget (001-155930) to provide the additional funds needed to transfer the County’s match of $699,366
to the State of Florida Agency for Healthcare Administration by October 31, 2019.
GROWTH MANAGEMENT IMPACT: There is no Growth Management impact.
LEGAL CONSIDERATIONS: This item has been approved for form and legality and requires a
majority vote for Board action. - JAB
RECOMMENDATION: To approve and authorize the Chairman to sign an agreement in the amount of
$699,366 with the Agency for Health Care Administration, approve an agreement with Collier Health
16.D.9
Packet Pg. 1623
09/24/2019
Services, Inc., and authorize necessary Budget Amendments to participate in the Medicaid Low Income
Pool Program, generating $800,685 in federal matching funds that will provide additional health services
for the citizens of Collier County.
Prepared By: Maggie, Lopez, Manager of Financial & Operational Support, Community and Human
Services Division
ATTACHMENT(S)
1. Low Income Pool Letter of Agreement 2019_STAMPED (PDF)
2. CHSI Agreement 2019_STAMPED (PDF)
16.D.9
Packet Pg. 1624
09/24/2019
COLLIER COUNTY
Board of County Commissioners
Item Number: 16.D.9
Doc ID: 10084
Item Summary: Recommendation to approve an agreement in the amount of $699,366 with the
Agency for Health Care Administration, approve an agreement with Collier Health Services, Inc., and
authorize necessary Budget Amendments to participate in the Medicaid Low Income Pool Program,
generating $800,685 in federal matching funds that will provide additional health services for the citizens
of Collier County.
Meeting Date: 09/24/2019
Prepared by:
Title: Supervisor - Accounting – Community & Human Services
Name: Maggie Lopez
09/06/2019 1:41 PM
Submitted by:
Title: Manager - Federal/State Grants Operation – Community & Human Services
Name: Kristi Sonntag
09/06/2019 1:41 PM
Approved By:
Review:
Community & Human Services Kristi Sonntag Additional Reviewer Completed 09/10/2019 11:04 AM
Public Services Department Kimberley Grant Level 1 Reviewer Completed 09/10/2019 3:42 PM
Public Services Department Todd Henry Level 1 Division Reviewer Completed 09/10/2019 3:52 PM
Public Services Department Steve Carnell Level 2 Division Administrator Review Completed 09/10/2019 4:13 PM
County Attorney's Office Jennifer Belpedio Level 2 Attorney of Record Review Completed 09/16/2019 2:52 PM
Office of Management and Budget Valerie Fleming Level 3 OMB Gatekeeper Review Completed 09/16/2019 5:06 PM
Budget and Management Office Ed Finn Additional Reviewer Completed 09/17/2019 12:29 PM
County Attorney's Office Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Completed 09/17/2019 2:13 PM
County Manager's Office Leo E. Ochs Level 4 County Manager Review Completed 09/17/2019 2:36 PM
Board of County Commissioners MaryJo Brock Meeting Pending 09/24/2019 9:00 AM
16.D.9
Packet Pg. 1625
Low Income Pool Letter of Agreement
THIS LETTER OF AGREEMENT (LOA) is made and entered into in duplicate on the ---day of ___ 2019, by and between Collier County Board of Commissioners on behalf of
Collier Health Services, Inc. and the State of Florida, Agency for Health Care Administration
(the "Agency"), for good and valuable consideration, the receipt and sufficiency of which is
acknowledged.
DEFINITIONS
"Charity care" or "uncompensated charity care" means that portion of hospital charges reported
to the Agency for which there is no compensation, other than restricted or unrestricted revenues
provided to a hospital by local governments or tax districts regardless of the method of payment.
Uncompensated care includes charity care for the uninsured but does not include
uncompensated care for insured individuals, bad debt, or Medicaid and Children's Health
Insurance Program (CHIP) shortfall. The state and providers that are participating in Low
Income Pool (LIP) will provide assurance that LIP claims include only costs associated with
uncompensated care that is furnished through a charity care program and that adheres to the
principles of the Healthcare Financial Management Association (HFMA) operated by the
provider.
"Intergovernmental Transfers (IGTs)" me ans transfers of funds from a non-Medicaid
governmental entity (e.g., counties, hospital taxing districts, providers operated by state or local
government) to the Medicaid agency. IGTs must be considered a bona fide donation pursuant to
42 CFR § 433.54.
"Low Income Pool (LIP)" means providing government support for safety-net providers for the
costs of uncompensated charity care for low-income individuals who are uninsured.
Uncompensated care includes charity care for the uninsured but does not include
uncompensated care for insured individuals, "bad debt," or Medicaid and CHIP shortfall.
"Medicaid" means the medical assistance program authorized by Title XIX of the Social Security
Act, 42 U.S.C. §§ 1396 et seq., and regulations thereunder, as administered in Florida by th e
Agency.
A. GENERAL PROVISIONS
1.Per Senate Bill 2500, the General Appropriations Act of State Fiscal Year 2019-2020,
passed by the 2019 Florida Legislature, the Collier County Board of Commissioners and
the Agency agree that the Collier County Board of Commissioners will remit IGT funds to
the Agency in an amount not to exceed the total of $699,366.
a.The Collier County Board of Commissioners and the Agency have agreed that
these IGT funds will only be used to increase the provision of health services for
the charity care of the Collier County Board of Commissioners and the State of
Florida at large.
b.The increased provision of charity care health services will be accomplished
through the following Medicaid programs:
Collier County Board of Commissioners_29152800_Collier Health Services, Inc. LOA SFY 2019-20
16.D.9.b
Packet Pg. 1626 Attachment: Low Income Pool Letter of Agreement 2019_STAMPED (10084 : LIP Agreement with AHCA & CHSI)
16.D.9.b
Packet Pg. 1627 Attachment: Low Income Pool Letter of Agreement 2019_STAMPED (10084 : LIP Agreement with AHCA & CHSI)
16.D.9.b
Packet Pg. 1628 Attachment: Low Income Pool Letter of Agreement 2019_STAMPED (10084 : LIP Agreement with AHCA & CHSI)
16.D.9.b
Packet Pg. 1629 Attachment: Low Income Pool Letter of Agreement 2019_STAMPED (10084 : LIP Agreement with AHCA & CHSI)
16.D.9.c
Packet Pg. 1630 Attachment: CHSI Agreement 2019_STAMPED (10084 : LIP Agreement with AHCA & CHSI)
ARTICLE II
PAYMENTS
The County shall make intergovernmental transfers, on behalf of Collier Health Services in
connection with the LIP program to the State of Florida, hereinafter referred to a s "State", in
accordance with the Letter of Agreement between the County and the Agency for Health Care
Administration.
1.The county will remit to the State an amount not to exceed a grand total of $699,366.00.
The County will transfer payments to the State in the following manner:
a.The payments for the months July 2019 - June 2020 are due by October 31, 2019,
to the State.
2.The following document is hereby incorporated by reference as Attachment A tothis
Agreement.
a.Low Income Pool Agreement (LIP) with State of Florida AHCA reflecting the
anticipated annual distributions for State Fiscal Year 2019-2020 (Attachment A).
ARTICLE Ill
CLAIMS VALUATION AND CLAIMS PROCESSING
1.As the claims processing entity, the Center will provide qu arterly financial reports to the
County in such detail as required by the County.
2.Prompt payment of invoices as presented to the Center should be made within 30
business days of receipt from the County.
3.Copies of all checks issued ar e to be sent to the County for record keeping.
ARTICLE IV
TERMS OF AGREEMENT AND TERMINATION
1.The term of this Agreement shall be October 1, 2019 through September 30, 2020 with
no renewal, or to the date upon which all funds under the agreement are disbursed by
the Center, in accordance with Article VIII.
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,
2
16.D.9.c
Packet Pg. 1631 Attachment: CHSI Agreement 2019_STAMPED (10084 : LIP Agreement with AHCA & CHSI)
16.D.9.c
Packet Pg. 1632 Attachment: CHSI Agreement 2019_STAMPED (10084 : LIP Agreement with AHCA & CHSI)
16.D.9.c
Packet Pg. 1633 Attachment: CHSI Agreement 2019_STAMPED (10084 : LIP Agreement with AHCA & CHSI)
16.D.9.c
Packet Pg. 1634 Attachment: CHSI Agreement 2019_STAMPED (10084 : LIP Agreement with AHCA & CHSI)
16.D.9.c
Packet Pg. 1635 Attachment: CHSI Agreement 2019_STAMPED (10084 : LIP Agreement with AHCA & CHSI)