Backup Documents 09/14/2021 Item #16E10 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 E 1 0
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting. da
�s�
**NEW** ROUTING SLIP An' `
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document i ready complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. County Attorney Office County Attorney Office
2. BCC Office Board of County (I a f1�
Commissioners J ( �- d\
3. Minutes and Records Clerk of Court's Office
PRIMARY CONTACT INFORMATION
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,may need to contact staff for additional or missing information.
Name of Primary Staff Erin Cook,Accounting Supervisor Contact Information 239-252-3756
Contact/Department EMS
Agenda Date Item was September 14,2021 Agenda Item Number 16.E. tO
Approved by the BCC
Type of Document 2 copies of the Letter of Agreement and Number of Original 3
Attached Resolution Documents Attached
2Zd 17`f
PO number or account
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature STAMP OK EC
2. Does the document need to be sent to another agency for additional signatures? If yes, EC
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be EC
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's EC
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the EC
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's EC
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip EC
should be provided to the County Attorney Office at the time the item is input into SIRE.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on 09/14/2021 and all changes made during EC N/A is not
the meeting have been incorporated in the attached document. The County an option for
Attorney's Office has reviewed the changes,if applicable. this line.
9. Initials of attorney verifying that the attached document is the version approved by the EC N/A is not
BCC,all changes directed by the BCC have been made,and the document is ready for the an option for
Chairman's signature. this line.
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4. AHCA would like all original copies mailed to them as well for execution.The address is listed here:
Agency for Health Care Administration
Medicaid Program Finance
Attn: Madison Pruett
2727 Mahan Drive
Building 3, Mail Stop#23
Tallahassee, FL 32308
1 6E10
CookErin
From: Pruett, Madison <Madison.Pruett@ahca.myflorida.com>
Sent: Tuesday, August 3, 2021 11:27 AM
To: CookErin; ButcherTabatha
Cc: Narode, Alissa; Taffuri, Luke; Kevin Coyle
Subject: PEMT SFY21-22 LOA
Attachments: Collier County_Collier County EMS_SFY2122_PEMT_LOA.pdf
Follow Up Flag: Follow up
Flag Status: Completed
EXTERNAL EMAIL:This email is from an external source. Confirm this is a trusted sender and use extreme caution when
opening attachments or clicking links.
Good afternoon,
Please see the attached LOA for the SFY 2021-22 Public Emergency Medical Transportation program.The LOA is due
back to the Agency no later than October 1, 2021.
Thanks,
Madison Pruett- MEDICAL/HEALTH CARE PROG ANALYST
Bldg 3 Rm 1331 - BUREAU OF MEDICAID PROGRAM FINANCE X
2727 MAHAN DR., TALLAHASSEE, FL. 32308
+1 850-412-4274 (Office) - (Fax)
Madison.Pruett@ahca.myflorida.com
Privacy Statement:This e-mail may include confidential and/or proprietary information,and may be used only by the person or entity to which it is addressed.If
the reader of this e-mail is not the intended recipient or his or her authorized agent,the reader is hereby notified that any dissemination,distribution or copying of
this e-mail is prohibited.If you have received this in error,please reply to the sender and delete it immediately.
1
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1
RESOLUTION NO. 2021- 1 7 4
RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS OF
COLLIER COUNTY,FLORIDA,TO AUTHORIZE COLLIER COUNTY
EMERGENCY MEDICAL SERVICES TO PARTICIPATE IN
INTERGOVERNMENTAL TRANSFERS WITH THE STATE OF
FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AND
THE SUPPLEMENTAL PAYMENT PROGRAM FOR MEDICAID
MANAGED CARE PATIENTS; AUTHORIZING THE CHAIRMAN TO
EXECUTE ALL REQUIRED AGREEMENTS AND DOCUMENTS TO
PARTICIPATE IN INTERGOVERNMENTAL TRANSFERS AND THE
SUPPLEMENTAL PAYMENT PROGRAM FOR MEDICAID
MANAGED CARE PATIENTS SUBJECT TO BOARD RATIFICATION.
WHEREAS, Collier County provides emergency ambulance transportation services
throughout Collier County; and
WHEREAS, the State of Florida has created a supplemental payment program for
Medicaid managed care patients who are transported to the hospital by public emergency
medical transportation providers and has appropriated an additional $54 million for this
program; and
WHEREAS, Collier County Emergency Medical Services ("EMS") transports more
than 1,500 Medicaid managed care patients annually to hospitals and receives approximately
$163 per patient for this service; and
WHEREAS, by participating in the supplemental payment program for Medicaid
managed care patients, EMS can substantially increase its Medicaid managed care patient
transport revenue and provide better services to the community,
NOW THEREFORE, IT IS RESOLVED BY THE BOARD OF COUNTY
COMMISSIONERS OF COLLIER COUNTY,FLORIDA,that:
1. Authorizes EMS to participate in intergovernmental transfers with the State of
Florida Agency for Health Care Administration and the supplemental payment program for
Medicaid managed care patients.
2. Authorizes the Collier County Chairman to execute any and all agreements and
documents necessary for EMS to participate in intergovernmental transfers or the Medicaid
managed care supplemental payment program subject to ratification by this Board.
CAO•
[21-EMS-01059/1657023/1] 1
THIS RESOLUTION ADOPTED on this Ilk of &piQrAbe' ,2021 after
motion, second and majority vote favoring adoption.
ATTEST: BOARD O COUNTY COMMISSIONERS
CRYSTAL K. KTNZEL, CLERK COLLIE C TY, FLORID
By:
Attest as to Chain
uty C r i
r
Penny Taylor, hair
s'
Appro *orm and legality:
Jeffre . K
County tt ey
1-EMS-01059/1657023/11 2 C[2 O)
co,coURT
Crystal K. Kinzel 1 6 E 10
pro ier Count
o *.SA
of the Circuit Court and Comptroller
3315 Tamiami Trail East, Suite 102
v A Naples, Florida 34112-5324
September 20, 2021
Agency for Health Care Administration
Medicaid Program Finance
Attn: Madison Pruett
2727 Mahan Drive
Building 3, Mail Stop #23
Tallahassee, FL 32308
Re: PEMT STY21-22 LOA
Transmitted herewith are two (2) original agreements w/one (1) certified
resolution of the above referenced document, as adopted by the Collier County
Board of County Commissioners of Collier County, Florida on Tuesday,
September 14, 2021, during Regular Session.
Once fully executed please forward one to the Board's Minutes and Records
Department, we have included an envelope for your convenience.
Very truly yours,
CRYSTAL K. KINZEL, CLERK
Martha Vergara, Deputy Clerk
Phone-(239)252-2646 Fax-(239)252-2755
Website-www.CollierClerk.com Email-CollierClerk@collierclerk.com
1 6E ! O
RESOLUTION NO. 2021- 17 4
RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS OF
COLLIER COUNTY,FLORIDA,TO AUTHORIZE COLLIER COUNTY
EMERGENCY MEDICAL SERVICES TO PARTICIPATE IN
INTERGOVERNMENTAL TRANSFERS WITH THE STATE OF
FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION AND
THE SUPPLEMENTAL PAYMENT PROGRAM FOR MEDICAID
MANAGED CARE PATIENTS; AUTHORIZING THE CHAIRMAN TO
EXECUTE ALL REQUIRED AGREEMENTS AND DOCUMENTS TO
PARTICIPATE IN INTERGOVERNMENTAL TRANSFERS AND THE
SUPPLEMENTAL PAYMENT PROGRAM FOR MEDICAID
MANAGED CARE PATIENTS SUBJECT TO BOARD RATIFICATION.
WHEREAS, Collier County provides emergency ambulance transportation services
throughout Collier County; and
WHEREAS, the State of Florida has created a supplemental payment program for
Medicaid managed care patients who are transported to the hospital by public emergency
medical transportation providers and has appropriated an additional $54 million for this
program; and
WHEREAS, Collier County Emergency Medical Services ("EMS") transports more
than 1,500 Medicaid managed care patients annually to hospitals and receives approximately
$163 per patient for this service; and
WHEREAS, by participating in the supplemental payment program for Medicaid
managed care patients, EMS can substantially increase its Medicaid managed care patient
transport revenue and provide better services to the community,
NOW THEREFORE, IT IS RESOLVED BY THE BOARD OF COUNTY
COMMISSIONERS OF COLLIER COUNTY, FLORIDA,that:
1. Authorizes EMS to participate in intergovernmental transfers with the State of
Florida Agency for Health Care Administration and the supplemental payment program for
Medicaid managed care patients.
2. Authorizes the Collier County Chairman to execute any and all agreements and
documents necessary for EMS to participate in intergovernmental transfers or the Medicaid
managed care supplemental payment program subject to ratification by this Board.
CA®t2I-F.MS-01059/1657023'11
1 6E10
THIS RESOLUTION ADOPTED on this i of St Amber"J ,2021 after
motion, second and majority vote favoring adoption.
ATTEST: BOARD OF COUNTY COMMISSIONERS
CRYSTAL K. KINZEL, CLERK COLLIE C TY, FLORID
By: Ali
+rt1�
Attest as to Cha "
h' C '-r` Penny Taylor hair
si , . .
Appro ,•I, . and legality:
Jeffre K�:t3C W
County '' • ey
•
•
I,Crystal K Kin7el,Clerk of Carts and for Jollier C^unty
do hc;id .o?!fry..iat the ..•:a i..strurT t is a tn,ra a J correct
apy ot'`ie original filet,'i C�.!her County,Fiord
By:__ e�yec...� - - Deputy Clerk
Da; :
12I-tiMS-01059/1657023/II 7 C
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Public Emergency Medical Transportation Letter of Agreement
THIS LETTER OF AGREEMENT (LOA) is made and entered into in duplicate on the 1401
day of&, 021, by and between Collier County on behalf of Collier County EMS, 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
"Intergovernmental Transfers (IGTs)" means 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 compliant with 42 CFR Part 433 Subpart B.
"Medicaid" means the medical assistance program authorized by Title XIX of the Social Security
Act, 42 US.C. §§ 1396 et seq., and regulations thereunder, as administered in Florida by the
Agency.
"Public Emergency Medical Transportation (PEMT)," pursuant to the General Appropriation Act,
Laws of Florida 2021-111, is the program that provides supplemental payments for eligible Public
Emergency Medical Transportation (PEMT) entities that meet specified requirements and provide
emergency medical transportation services to Medicaid beneficiaries.
A. GENERAL PROVISIONS
1. Per Senate Bill 2500, the General Appropriations Act of State Fiscal Year 2021-2022,
passed by the 2021 Florida Legislature, the Collier County and the Agency agree that
the Collier County will remit IGT funds to the Agency in an amount not to exceed the total
of $374,673.75. The Collier County and the Agency have agreed that these IGT funds
will only be used for the PEMT program.
2. The Collier County will return the signed LOA to the Agency.
3. The Collier County will pay IGT funds to the Agency in an amount not to exceed the
total of$374,673.75. The Collier County will transfer payments to the Agency in the
following manner:
a. Per Florida Statute 409.908, annual payments for the months of July 2021
through June 2022 are due to the Agency no later than October 31, 2021 unless
an alternative plan is specifically approved by the agency.
b. The Agency will bill the Collier County when payment is due.
4. The Collier County and the Agency agree that the Agency will maintain necessary
records and supporting documentation applicable to health services covered by this LOA
in accordance with public records laws and established retention schedules.
a. AUDITS AND RECORDS
i. Collier County agrees to maintain books, records, and documents (including
Collier County_Collier County EMS_PEMT LOA_SFY 2021-22 CAP
?
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electronic storage media) pertinent to performance under this LOA in accordance
with generally accepted accounting procedures and practices, which sufficiently
and properly reflect all revenues and expenditures of funds provided.
ii. Collier County 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. Collier County agrees to comply with public record laws as outlined in section
119.0701, Florida Statutes.
b. RETENTION OF RECORDS
i. The Collier County 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 full access
to and the right to examine any of said records and documents.
iii. 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. Collier County agrees to permit persons duly authorized by the Agency to inspect
any records, papers, and documents of the Collier County which are relevant to
this LOA.
d. ASSIGNMENT AND SUBCONTRACTS
i. The Collier County 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 and the Agency agree that any modifications to this LOA shall be in
the same form, namely the exchange of signed copies of a revised LOA.
6. Collier 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 supplemental payments in order to satisfy non-
Medicaid, non-uninsured, and non-underinsured activities.
� I
Collier County_Collier County EMS_PEMT LOA_SFY 2021-22 CEO)
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7. Collier County agrees the following provision shall be included in any agreements
between Collier County and local providers where IGT funding is provided pursuant to
this LOA. Funding provided in this agreement shall be prioritized so that designated IGT
funding shall first be used to fund the Medicaid program and used secondarily for other
purposes.
8. This LOA covers the period of July 1,2021 through June 30,2022 and shall be terminated
June 30, 2022.
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.
PEMT Local Intergovernmental Transfers
Program /Amount State Fiscal Year 2021-2022
Minimum Fee Schedule/MCO IGTs $374,673.75
Total Funding $374,673.75
IN WITNESS WHEREOF, the parties have caused this page Letter of Agreement to be
executed by their undersigned officials as duly authorized. •
_
Collier County STATE OF FLORIDA,AGENCY FOR
HEALTH CARE ADMINISTRATION
SIGNED SIGNED
BY: 0-11-4/8BY: • cp,,,(-JAL,.
NAME: l?,arvr� 7Ct _ NAME: Tom Wallace
TITLE: Chat( TITLE: Deputy Secretary for Medicaid
DATE: •��/-pZ' DATE: 10/19/2021
ATTEST
CRYSTAL.K.11,EL.CLERKC Approved and legality
Attest as to Chairma Jc17rey A.Klat o , ty Attorney
siqn
2tUrp e+nly.
Collier County_Collier County EMS_PEMT LOA_SFY 2021-22 X '