Agenda 09/22/2020 Item #16D 9 (Agreement with Agency for Health Care Administration & CHS)16.D.9
09/22/2020
EXECUTIVE SUMMARY
Recommendation to approve an agreement in the amount of $584,907 with the Agency for Health
Care Administration and an agreement with Collier Health Services, Inc., and authorize necessary
Budget Amendments to participate in the Medicaid Low Income Pool Program, generating
$1,252,114 in federal matching funds that will provide additional health services for the citizens of
Collier County.
OBJECTIVE: To provide additional health care 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
$584,907
$1,252,114
$1,837,021
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.
These funds may only be allocated to those Federally Qualified Health Centers (FQHC).
CHSI will make the following voluntary payments: $276,884 for eligible medical services authorized by
County staff and $470,137 to the David Lawrence Center (DLC) 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 separate general fund
agreements with the DLC and National Alliance Mental Illness (NAMI) in support of mental health and
substance abuse services. Staff is intending on bringing agreements with DLC and NAMI to the Board for
approval in October.
FISCAL IMPACT: Funding in the amount of $584,907 is available within Community & Human
Services FY21 Community Mental Health & LIP Support Cost Center (001-156010) for the County's
contribution payment to the State of Florida Agency for Healthcare Administration by October 31, 2020.
GROWTH MANAGEMENT IMPACT: There is no Growth Management impact.
LEGAL CONSIDERATIONS: The LIP Agreement is an exhibit to the Agreement with Collier Health
Services, Inc. If Board approved, both agreements will be routed for Chairman signature and then the
signed LIP Agreement will be duplicated as an Exhibit to finalize the Agreement with Collier Health
Services, Inc. This item is approved for form and legality and requires a majority vote. - JAB
RECOMMENDATION: To approve and authorize the Chairman to sign an agreement in the amount of
Packet Pg. 1537
09/22/2020
16.D.9
$584,907 with the Agency for Health Care Administration and an agreement with Collier Health Services,
Inc., and authorize necessary Budget Amendments to participate in the Medicaid Low Income Pool
Program, generating $1,252,114 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. SFY20-21_LIP _Model (PDF)
2. LOA STAMPED_ (PDF)
3. CHSI Agreement FY21—STAMPED (PDF)
Packet Pg. 1538
16.D.9
09/22/2020
COLLIER COUNTY
Board of County Commissioners
Item Number: 16.13.9
Doe ID: 13471
Item Summary: Recommendation to approve an agreement in the amount of $584,907 with the
Agency for Health Care Administration and an agreement with Collier Health Services, Inc., and
authorize necessary Budget Amendments to participate in the Medicaid Low Income Pool Program,
generating $1,252,114 in federal matching funds that will provide additional health services for the
citizens of Collier County.
Meeting Date: 09/22/2020
Prepared by:
Title: Supervisor - Accounting — Community & Human Services
Name: Maggie Lopez
09/04/2020 8:01 AM
Submitted by:
Title: Manager - Federal/State Grants Operation — Community & Human Services
Name: Kristi Sonntag
09/04/2020 8:01 AM
Approved By:
Review:
Operations & Veteran Services
Community & Human Services
Public Services Department
Public Services Department
County Attorney's Office
Budget and Management Office
Office of Management and Budget
County Attorney's Office
County Manager's Office
Board of County Commissioners
Kimberley Grant
Level 1 Reviewer
Kristi Sonntag
CHS Review
Todd Henry
Level 1 Division Reviewer
Steve Carnell
Level 2 Division Administrator Review
Jennifer Belpedio
Level 2 Attorney of Record Review
Ed Finn
Additional Reviewer
Debra Windsor
Level 3 OMB Gatekeeper Review
Jeffrey A. Klatzkow Level 3 County Attorney's Office Review
Nick Casalanguida
Level 4 County Manager Review
MaryJo Brock
Meeting Pending
Completed
09/04/2020 9:08 AM
Completed
09/09/2020 9:39 AM
Completed
09/09/2020 10:33 AM
Completed
09/09/2020 11:13 AM
Completed
09/10/2020 1:54 PM
Completed
09/14/2020 4:38 PM
Completed
09/15/2020 8:18 AM
Completed
09/15/2020 10:29 AM
Completed
09/16/2020 8:37 AM
09/22/2020 9:00 AM
Packet Pg. 1539
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Low Income Pool Letter of Agreement
THIS LETTER OF AGREEMENT (LOA) is made and entered into in duplicate on the
day of 2020, by and between Collier County Board of County
Commissioners on behalf of Healthcare Network of Southwest Florida (Collier Health
Services), 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)" means transfers of funds from a non -Medicaid a
governmental entity e. counties, hospital taxing districts, providers operated b state or local J
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government) to the Medicaid agency. 1GTs must be compliant with 42 CFR Part 433 Subpart B. ti
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"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. of
Uncompensated care includes charity care for the uninsured but does not include w
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uncompensated care for insured individuals, "bad debt," or Medicaid and CHIP shortfall. 2
"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 the
Agency.
A. GENERAL PROVISIONS
1. Per House Bill 5001, the General Appropriations Act of State Fiscal Year 2020-2021,
passed by the 2020 Florida Legislature, the Collier County Board of County
Commissioners and the Agency agree that the Collier County Board of County
Commissioners will remit IGT funds to the Agency in an amount not to exceed the
total of $584,907.
a. The Collier County Board of County 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 County 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 County Comm issioners_029152800�Heaithcare Network of Southwest Florida (Collier Health Services) M
SFY 2020 21
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i. LIP payments to hospitals, federally qualified health centers, Medical
School Physician Practices, community behavioral health providers, and
rural health centers pursuant to the approved Centers for Medicare &
Medicaid Services Special Terms and Conditions.
2. The Collier County Board of County Commissioners will return the signed LOA to the
Agency no later than October 1, 2020,
3. The Collier County Board of County Commissioners will pay IGT funds to the Agency in
an amount not to exceed the total of $584,907. The Collier County Board of County
Commissioners will transfer payments to the Agency in the following manner:
a. Per Florida Statute 409.908, annual payments for the months of July 2020
through June 2021 are due to the Agency no later than October 31, 2020 unless
an alternative plan is specifically approved by the agency.
b. The Agency will bill the Collier County Board of County Commissioners when
payment is due.
4. The Collier County Board of County Commissioners and the Agency agree that
the Agency will maintain necessary records and supporting documentation
applicable to health services covered by this LOA.
a. Audits and Records
i. The Collier County Board of County Commissioners agrees to
maintain books, records, and documents (including electronic storage M
media) pertinent to performance under this LOA in accordance with r
generally accepted accounting procedures and practices, which sufficiently
and properly reflect all revenues and expenditures of funds provided. �o
ii. The Collier County Board of County Commissioners agrees to
assure that these records shall be subject at all reasonable times to
inspection, review, or audit by state personnel and other personnel duly
authorized by the Agency, as well as by federal personnel.
iii. The Collier County Board of County Commissioners agrees to comply
with public record laws as outlined in section 119.0701, Florida Statutes.
b. Retention of Records
The Collier County Board of County Commissioners agrees to retain
all financial records, supporting documents, statistical records, and any
other documents (including electronic storage media) pertinent to
performance under this LOA for a period of six (6) years after termination
of this LOA, or if an audit has been initiated and audit findings have not
been resolved at the end of six (6) years, the records shall be retained
until resolution of the audit findings.
ii. Persons duly authorized by the Agency and federal auditors shall have
Collier County Board of County Commissioners_029152800_Healthcare Network of Southwest Florida (Collier Health Services) LOI
SFY 2020 21
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full access to and the right to examine any of said records and
documents.
ili. The rights of access in this section must not be limited to the required
retention period but shall last as long as the records are retained.
c. Monitoring
i. The Collier County Board of County Commissioners agrees to
permit persons duly authorized by the Agency to inspect any records,
papers, and documents of the Collier County Board of County
Commissioners which are relevant to this LOA.
d. Assignment and Subcontracts
The Collier County Board of County Commissioners agrees to
neither assign the responsibility of this LOA to another party nor
subcontract for any of the work contemplated under this LOA without
prior written approval of the Agency. No such approval by the Agency of
any assignment or subcontract shall be deemed in any event or in any
manner to provide for the incurrence of any obligation of the Agency in
addition to the total dollar amount agreed upon in this LOA. All such
assignments or subcontracts shall be subject to the conditions of this
LOA and to any conditions of approval that the Agency shall deem
necessary.
5. This LOA may only be amended upon written agreement signed by both parties.
The Collier County Board of County Commissioners and the Agency agree that any
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modifications to this LOA shall be in the same form, namely the exchange of signed
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copies of a revised LOA.
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6. The Collier County Board of County Commissioners confirms that there are no pre-
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arranged agreements (contractual or otherwise) between the respective counties, taxing
districts, and/or the providers to re- direct any portion of these aforementioned charity
yl
care supplemental payments in order to satisfy non -Medicaid, non -uninsured, and non-
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underinsured activities.
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7. The Collier County Board of County Commissioners agrees the following provision
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shall be included in any agreements between the Collier County Board of County
s
Commissioners and local providers where IGT funding is provided pursuant to this
LOA: "Funding provided in this Agreement shall be prioritized so that designated IGT
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funding shall first be used to fund the Medicaid program (including LIP or DSH) and used
secondarily for other purposes."
8. This LOA covers the period of July 1, 2020 through June 30, 2021 and shall be
terminated June 30, 2021.
9. This LOA may be executed in multiple counterparts, each of which shall constitute an
original, and each of which shall be fully binding on any party signing at least one
counterpart.
Collier County Board of County Comm issioners_029152800_Healthcare Network of Southwest Florida (Collier Health Services) LOI
SFY 2020 21
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LIP Local Intergovernmental
Transfers (IGTs)
Program 1 Amount
State Fiscal Year 2019-2020
LIP Program
$584,907
Total Funding
$584,907
WITNESSETH:
IN WITNESS WHEREOF, the parties have caused this page Letter of Agreement to be
executed by their undersigned officials as duly authorized.
Collier County Board of County Commissioners
SIGNED
BY:
NAME:
TITLE:
DATE:
ATTEST
CRYSTAL K. KINZEL, CLERK
STATE OF FLORIDA, AGENCY FOR
HEALTH CARE ADMINISTRATION
SIGNED
BY:
NAME:
TITLE:
DATE:
gpproved as to form and lcg:111ty
Assistant County Atwrncy
Collier County Board of County Commissioners_029152800_Healthcare Network of Southwest Florida (Collier Health Services) LOE
SFY 2020 21
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16.D.9.c
AGREEMENT
This AGREEMENT is made and entered into on the day of 2020 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., dlb/a Healthcare Network of
Southwest Florida, 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 Q
welfare programs for the residents of Collier County to the extent not inconsistent with general or r
special law. 3
WHEREAS, the establishment and maintenance of such programs are in the common
interest of the people of Collier County. aEi
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WHEREAS, The County desires the Center to become a community health partner to assist
in providing payments for health prevention programs, and mental health services to residents of Q
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the County. J
WHEREAS, The Center desires to be a community health partner and is willing to
voluntarily provide payments for such services, subject to the terms and conditions hereinafter set M
forth.
NOW THEREFORE, in consideration of the covenants herein contained, the parties hereby a
agree as follows:
ARTICLE I
SERVICES TO BE PERFORMED
1. The Center shall provide documentation and monthly reports to the County related to
payment for the delivery of hospital services, designated primary health care services,
specialty health care services and other health care services.
2. The Center and/or its sub -contractor shall provide timely responses to contract
requirements. Responses to inquiries from the Public Services Division or designee
regarding any aspect of payment of services being provided shall be as indicated below.
a. Emergency room, secondary andtertiary care for those patients determined eligible
by the County Human Services Department.
b. 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.
3. Nothing in this contract shall be construed to limit access for a patient to any service
provided by a Health Services provider that is medically necessary and approved by the
County.
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16.D.9.c
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 as "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 $584,907.00.
The County will transfer payments to the State in the following manner:
a. The payments for the months July 2020 - June 2021 are due by October 31, 2020,
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 2020-2021 (Attachment A).
ARTICLE III
CLAIMS VALUATION AND CLAIMS PROCESSING
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1. As the claims processing entity, the Center will provide quarterly financial reports to the
County in such detail as required by the County. o
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 are 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, 2020 through September 30, 2021 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.
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,
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16.D.9.c
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.
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 Vll
INSURANCE, SAFETY AND INDEMNIFICATION
Indemnity. To the maximum extent permitted by Florida law, the Center and/or its sub-
contractor shall indemnify and hold harmless the County against any claims, damages,
losses, and expenses, including reasonable attorneys' fees and costs, arising out of or
resulting from the Center's failure to pay for services or performance under this
Agreement. This indemnification obligation shall not be construed to negate, abridge or
reduce any other rights or remedies which otherwise may be available to an indemnified
party or person described in this paragraph.
Center shall jointly and severally indemnify and hold harmless Collier County for all
claims, demands, actions, suits, losses, costs, charges, expenses, damages and
liabilities whatsoever which the County may pay, sustain, suffer or incur by reason of or
in connection with this agreement including payment of all legal costs, including but not
limited to, attorney's fees paid by the County.
3
16.D.9.c
2. Insurance Required: During the term of this agreement the Center 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 of 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 Center shall purchase all policies of
insurance from a financially responsible insurer duly authorized to do business in the State
of Florida. The Center shall be financially responsible for any loss due to failure to obtain
adequate insurance coverage and the failure to maintain such policies or certificate in the
amounts set forth herein shall constitute a breach of this agreement.
ARTICLE Vlll
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 Zi
County has verified the validity of the invoices to be paid by the Center. The Center will not r
pay any invoices prior to the County's approval,
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The Center will provide copies of checks for payments as they are remitted. The Center shall o
also provide quarterly reports showing invoices paid and pending payments. w
The Center shall make payments on a voluntary basis in the amount of $747.021.00 to
specific healthcare programs and services 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 receipt of County approved invoices. Payments shall be made in accordance with
this Agreement irrespective of whether the Center has received funds from AHCA.
If the amount invoiced to the Center does not result in the amount of $747,021.00. the
Center will hold the funds for the County for the difference and voluntarily make those
payments to providers elected by the County until all funds are exhausted.
County and Center acknowledge that this section does not require the use of Low -Income Pool
funding for any voluntary payment that would be out of compliance with the requirements for the
use of Low -Income Pool funding. The voluntary payments contemplated under this section that
are not for services that qualify for Low Income Pool funding use are to the paid from separate
funds.
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
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16.D.9.c
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.
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.
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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 clientsserved. w
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.
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.
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),
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16.D.9.c
IN WITNESS WHEREOF, the parties have executed this Agreement on the dates indicated
below.
ATTEST:
Crystal K. Kinzel, Clerk
L:3a
,Deputy Clerk
Attest as to Chairman's signature only.
Approved as to form and legality:
Jennifer A. Belpedio
Assistant County Attorney
BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY, FLORIDA
By:
Burt L. Saunders, CHAIRMAN
COLLIER HEALTH SERVICES, INC.
d/b/a HEALTHCARE NETWORK OF
SOUTHWEST FLORIDA
:O
Title:
Date:
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