Agenda 06/08/2021 Item #16D13 (Advertise an Ordinance for Local Provider Participation Fund for Directed Payment Plan)06/08/2021
EXECUTIVE SUMMARY
Recommendation to authorize staff to advertise an Ordinance to establish a Local Provider
Participation Fund for the Directed Payment Program to be solely funded by assessments on
Collier County hospitals owned property or property used as a hospital, authorize the County
Manager or designee to sign the AHCA Letter of Agreement, and authorize necessary Budget
Amendments.
OBJECTIVE: To establish an Ordinance in support of area hospitals that provide health services to the
low-income citizens of Collier County.
CONSIDERATIONS: The County has participated in the State’s Intergovernmental Transfer Program
(IGT) with the Agency for Health Care Administration (AHCA) program since 2006. As a participant in
the IGT program, the County provides funding to support the federal matching program for
uncompensated care known as the Low-Income Pool Program (LIP). Since 2014, hospitals have elected to
no longer participate in the LIP program. However, the County continues to participate in the minor LIP
program with Collier Health Services, Inc., the County’s Federally Qualified Healthcare Center (FQHC).
A similar IGT program has recently been established by the Florida Legislature, known as the Directed
Payment Program (DPP).
Nationwide, and especially in Florida, hospitals continue to struggle with the shortfall in Medicaid
reimbursement rates. Hospitals in Collier County provide millions of dollars of care to persons who
qualify for Medicaid annually, because on average, Medicaid only covers 60% of the costs of the health
care services provided by Hospitals to eligible persons. As a direct result of continued revenue shortfalls,
during the FY 21 Florida Legislative session, Governor DeSantis, with the full support of the House and
Senate, approved the establishment of the Directed Payment Program (DPP). This program is available to
hospitals providing inpatient and outpatient services to Medicaid-managed care enrollees. It is the intent
of the DPP to offset hospitals’ Medicaid shortfalls and improve the quality of care provided to the Florida
Medicaid population. This program has been adopted by three Florida counties to date - Escambia,
Brevard, and Walton.
In April, County staff was approached by Collier County hospitals and requested participation in the
Directed Payment Program. The hospitals are supportive of the program and are aware of the assessment
process and have all agreed to participate. In order to participate, the County must establish a Local
Provider Participation Fund (LPPF) via ordinance. The proposed Ordinance establishes the parameters of
the LPPF program. At the request of the hospitals annually, the County will impose a non-ad valorem
assessment upon real property owned or used by the hospitals to help fund the non-federal share of the
State’s Medicaid Program. This assessment will provide additional funding for Medicaid payments to
close revenue shortfalls associated with the program. Leveraging additional federal support through the
DPP program will directly benefit the services delivered to Medicaid-eligible persons and support their
ability to provide critical health care programs. It is necessary to establish the LPPF program prior to July
to ensure that the hospitals will have the opportunity to secure all funds available in t he upcoming state
fiscal year.
The proposed ordinance will enable the County to levy a uniform non-ad valorem special assessment in
compliance with 42 C.F.R. 433.68(d). The assessment shall be fairly and reasonably apportioned among
each of the hospital’s properties within the County limits. Annually, the Board shall set the assessment in
amounts that in the aggregate will generate sufficient revenue to fund the non -federal share of Medicaid
payments associated with Local Services to be funded by the assessment. The assessment shall constitute
a lien upon the assessed properties. Revenue generated by the proposed assessment shall be held in a
16.D.13
Packet Pg. 1831
06/08/2021
separate account called the Local Provider Participation Fund (LPPF) and will be used only to: (1)
provide the Florida Agency for Health Care Administration the non-federal share for Medicaid payments
to be made directly or indirectly in support of hospitals serving Medicaid beneficiaries and (2) reimburse
the County for administrative costs associated with the implementation of the assessment authorized by
this Ordinance, as further specified in the forthcoming assessment resolution.
If at the end of the Fiscal Year, additional amounts remain in the Local Provider Participation Fund, the
Board is authorized to make a refund to assessed properties in proportion to amounts paid in during the
Fiscal Year.
If this item is approved, the proposed ordinance will be advertised and brought back to the Board with a
resolution adopting a non-ad valorem special assessment. The Tax Collector and Property Appraiser have
no responsibilities under the alternative assessment process that is proposed. The alternative method of
collection pursuant to F.S. 197.3631 states this method shall not require the tax collector or property
appraiser to perform those services as provided for in ss. 197.3632 and 197.3635. Pursuant to Section
197.3632 additional authority is granted to local governments to impose and collect non-ad-valorem
assessments supplemental to the home rule powers. In future years County staff may elect to recommend
that the Board update the ordinance and adopt a future resolution to implement a uniform assessment
process that involves the services of the Tax Collector and Property Appraiser. The Tax Collector and
Property Appraiser have been coordinated with and they have no objection to the adoption of the
program.
FISCAL IMPACT: The Directed Payment Program is a funding mechanism that takes hospital funds
collected through a non-ad valorem assessment and directs those dollars to the Agency for Health Care
Administration (AHCA) to fund the non-federal share of the State’s Medicaid Program ultimately
resulting in enhanced funding returned to the hospitals. AHCA is currently working on the
implementation plan for the Directed Payment Program. Once AHCA finalizes its modeling the amount
of non-federal share (the assessment) needed to fund the Directed Payment Program will become
available. The information currently available suggests the assessment will be between $10 and $20
million with the amount transmitted to AHCA being no more than the actual amount of assessment
dollars received by the County less administrative costs. No more than $150,000 will be retained for
administrative expenses.
Relative to budget administration, a budget amendment is necessary that establishes a Local Provider
Participation Fund. The budget will include a revenue account for receipt of assessments paid by the
hospitals and expense accounts for the remittance of program funds to AHCA and reimbursement of
County administrative costs associated with implementation of the assessment. Advertising fees are
expected to be $650.
GROWTH MANAGEMENT IMPACT: There is no Growth Management impact.
LEGAL CONSIDERATIONS: The documents have an effective date of July 1, 2021, but are
contingent on approval of the enabling legislation by the Governor of the State of Florida. This item is
approved as to form and legality and requires a majority vote for Board action. - JAB
RECOMMENDATION: To authorize staff to advertise an Ordinance to establish a Local Provider
Participation Fund for the Directed Payment Program to be solely funded by assessments on hospital -
owned property or property used as a hospital, authorize county manager or designee to sign the AHCA
Letter of Agreement, and authorize necessary Budget Amendments.
Prepared By: Kristi Sonntag, Director, Community and Human Services Division
16.D.13
Packet Pg. 1832
06/08/2021
ATTACHMENT(S)
1. Ordinance (PDF)
16.D.13
Packet Pg. 1833
06/08/2021
COLLIER COUNTY
Board of County Commissioners
Item Number: 16.D.13
Doc ID: 16076
Item Summary: Recommendation to authorize staff to advertise an Ordinance to establish a Local
Provider Participation Fund for the Directed Payment Program to be solely funded by assessments on
Collier County hospitals owned property or property used as a hospital, authorize county manager or
designee to sign the AHCA Letter of Agreement, and authorize necessary budget amendments.
Meeting Date: 06/08/2021
Prepared by:
Title: Manager - Federal/State Grants Operation – Community & Human Services
Name: Kristi Sonntag
05/27/2021 8:26 AM
Submitted by:
Title: Manager - Federal/State Grants Operation – Community & Human Services
Name: Kristi Sonntag
05/27/2021 8:26 AM
Approved By:
Review:
Community & Human Services Kristi Sonntag CHS Review Completed 05/27/2021 8:27 AM
Operations & Veteran Services Kimberley Grant Additional Reviewer Completed 05/27/2021 8:39 AM
Community & Human Services Maggie Lopez Additional Reviewer Completed 05/27/2021 9:14 AM
Public Services Department Dan Rodriguez Public Services Department Completed 05/27/2021 10:57 AM
Grants Erica Robinson Level 2 Grants Review Completed 05/27/2021 11:08 AM
Public Services Department Dan Rodriguez PSD Department Head Completed 05/27/2021 11:44 AM
County Attorney's Office Jennifer Belpedio Level 2 Attorney of Record Review Completed 05/27/2021 2:02 PM
Office of Management and Budget Debra Windsor Level 3 OMB Gatekeeper Review Completed 05/27/2021 2:14 PM
Grants Therese Stanley Additional Reviewer Completed 05/27/2021 5:24 PM
Budget and Management Office Ed Finn Additional Reviewer Completed 06/01/2021 12:26 PM
County Attorney's Office Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Completed 06/01/2021 1:41 PM
County Manager's Office Sean Callahan Level 4 County Manager Review Completed 06/01/2021 2:46 PM
Board of County Commissioners Geoffrey Willig Meeting Pending 06/08/2021 9:00 AM
16.D.13
Packet Pg. 1834
16.D.13.a
Packet Pg. 1835 Attachment: Ordinance (16076 : LPPF Hospital AHCA Assessment)
16.D.13.a
Packet Pg. 1836 Attachment: Ordinance (16076 : LPPF Hospital AHCA Assessment)
16.D.13.a
Packet Pg. 1837 Attachment: Ordinance (16076 : LPPF Hospital AHCA Assessment)
16.D.13.a
Packet Pg. 1838 Attachment: Ordinance (16076 : LPPF Hospital AHCA Assessment)
16.D.13.a
Packet Pg. 1839 Attachment: Ordinance (16076 : LPPF Hospital AHCA Assessment)
16.D.13.a
Packet Pg. 1840 Attachment: Ordinance (16076 : LPPF Hospital AHCA Assessment)
16.D.13.a
Packet Pg. 1841 Attachment: Ordinance (16076 : LPPF Hospital AHCA Assessment)
16.D.13.a
Packet Pg. 1842 Attachment: Ordinance (16076 : LPPF Hospital AHCA Assessment)
16.D.13.a
Packet Pg. 1843 Attachment: Ordinance (16076 : LPPF Hospital AHCA Assessment)
16.D.13.a
Packet Pg. 1844 Attachment: Ordinance (16076 : LPPF Hospital AHCA Assessment)