Backup Documents 09/28/2021 Item #16D 3 160 3
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. 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. **NEW** ROUTING SLIP V, R 6 E- rAv
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already 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. Jeffrey Newman Operations and Veteran 9(23 12\
Services
2. County Attorney Office—JAB,ACA County Attorney Office Sk8
a
t i CidaiSval
3. BCC Office Board of County �6jgl -
Commissioners Q
L-x 4
4. Minutes and Records Clerk of Court's OfficeNft) 4 2•216;44W1
4115
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 Irene Takla,Operations and Veteran STAFF PERSON 239 252 5505
Contact/ Department Services Division PHONE#
Agenda Date Item was 09/28/2021 Agenda Item Number 16D 3
Approved by the BCC
Type of Document - DIRECTED PAYMENT PROGRAM Number of Original cR L-0A Ls-
Attached LETTER OF AGREEMENT Documents Attached l R E,S
- RESOLUTION
PO number or account 2D 21 — (C M
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? ir
2. Does the document need to be sent to another agency for additional signatures? If yes, L .
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
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 1.
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 ✓'
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 L-/
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip
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 above date and all changes made during I/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 re 'N/A is no-
BCC,all changes directed by the BCC have been made,and the document is ready for the opal option foil
Chairman's signature. ;this line;
160 3
Martha S. Vergara
From: Martha S. Vergara
Sent: Tuesday, September 28, 2021 4:30 PM
To: 'thomas.wallace@ahca.myflorida.com'; 'Taklalrene'
Subject: Directed Payment Program/LAO (Collier County)
Attachments: T Wallace - Directed Payments Program-LOA.pdf
Hello Thomas,
Attached is the requested LOA and certified resolution for your review.
If you have any questions feel free to contact Irene Takla at 239-252-5505.
Thanks,
Martha Vergara
BMR &VAB Senior Deputy Clerk
C.ck»r c°uR7, , Office: 239-252-7240
Fax: 239-252-8408
E-mail: martha.vergara@CollierClerk.com
Office of the Clerk of the Circuit Court
r _" & Comptroller of Collier County
se 3299 Tamiami Trail E, Suite #401
Naples, FL 34112
www.CollierClerk.com
i
1 6 D 3
Martha S. Vergara
From: Martha S. Vergara
Sent: Tuesday, September 28, 2021 4:27 PM
To: jeffrey.mistich@ahca.myflorida.com'
Subject: Directed Payment Program/Letter of Agreement (Collier County)
Attachments: J Mistich - Directed Payment Program-LOA.pdf
Hello Jeffrey,
Attached is the requested LOA and certified resolution for your review.
If you have any questions feel free to contact Irene Takla at 239-252-5505.
Thanks,
Martha Vergara
BMR&VAB Senior Deputy Clerk
cocttircovoct Office: 239-252-7240
°�, Fax: 239-252-8408
�� pr E-mail: martha.vergara@CollierClerk.com
Office of the Clerk of the Circuit Court
r & Comptroller of Collier County
4c.�. •
d`°' 3299 Tamiami Trail E, Suite #401
Naples, FL 34112
www.CollierClerk.com
i
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RESOLUTION NO. 2 0 21 — 197
AN ASSESSMENT RESOLUTION OF THE BOARD OF COUNTY
COMMISSIONERS OF COLLIER COUNTY, FLORIDA, AUTHORIZING
AND ADOPTING A NON-AD VALOREM SPECIAL ASSESSMENT WITHIN
THE COUNTY LIMITS FOR THE PURPOSE OF BENEFITING ASSESSED
PROPERTIES THROUGH ENHANCED MEDICAID PAYMENTS FOR
LOCAL SERVICES; FINDING AND DETERMINING THAT CERTAIN
REAL PROPERTY IS SPECIALLY BENEFITED BY THE ASSESSMENT;
COLLECTING THE ASSESSMENT AGAINST THE REAL PROPERTY;
ESTABLISHING A PUBLIC HEARING TO CONSIDER IMPOSITION OF
THE PROPOSED ASSESSMENT AND THE METHOD OF ITS
COLLECTION; AUTHORIZING AND DIRECTING THE PUBLICATION
OF NOTICES IN CONNECTION THEREWITH; PROVIDING FOR
CERTAIN OTHER AUTHORIZATIONS AND DELEGATIONS OF
AUTHORITY AS NECESSARY; AND PROVIDING AN EFFECTIVE DATE.
WHEREAS,hospitals in Collier County's jurisdiction (the "Hospitals") annually provide
millions of dollars of uncompensated care to uninsured persons and those who qualify for
Medicaid because Medicaid, on average, covers only 60% of the costs of the health care services
actually provided by Hospitals to Medicaid-eligible persons, leaving hospitals with significant
uncompensated costs; and
WHEREAS, the State of Florida (the "State") received federal authority to establish the
Statewide Medicaid Managed Care Hospital directed payment program (the "DPP") to offset
hospitals' uncompensated Medicaid costs and improve quality of care provided to Florida's
Medicaid population; and
WHEREAS, Hospitals have asked Collier County (the "County") to impose a non-ad
valorem special assessment upon certain real property interests held by the Hospitals to help
finance the non-federal share of the State's Medicaid program; and
WHEREAS, the only real properties interests that will be subject to the non-ad valorem
assessments authorized herein are those belonging to the Hospitals; and
WHEREAS,the County recognizes that one or more of the Hospitals within the County's
boundaries may be located upon real property leased from governmental entities and that such
Hospitals may be assessed because courts do not make distinctions on the application of special
assessments based on"property interests"but rather on the distinction of the classifications of real
property being assessed; and
WHEREAS,the funding raised by the County assessment will,through intergovernmental
transfers ("IGTs") provided consistent with federal guidelines, support additional funding for
Medicaid payments to Hospitals; and
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WHEREAS, the County acknowledges that the Hospital properties assessed will benefit
directly and especially from the assessment as a result of the above-described additional funding
provided to said Hospitals; and
WHEREAS, the County has determined that a logical relationship exists between the
services provided by the Hospitals, which will be supported by the assessment, and the special and
particular benefit to the real property of the Hospitals; and
WHEREAS, the County has an interest in promoting access to health care for its low-
income and uninsured residents; and
WHEREAS, leveraging additional federal support through the above-described IGTs to
fund Medicaid payments to the Hospitals for health care services directly and specifically benefits
the Hospitals' property interests and supports their continued ability to provide those services; and
WHEREAS, imposing an assessment limited to Hospital properties to help fund the
provision of these services and the achievement of certain quality standards by the Hospitals to
residents of the County is a valid public purpose that benefits the health, safety, and welfare of the
citizens of the County; and
WHEREAS, the assessment ensures the financial stability and viability of the Hospitals
providing such services; and
WHEREAS, the Hospitals are important contributors to the County's economy, and the
financial benefit to these Hospitals directly and specifically supports their mission, as well as their
ability to grow, expand, and maintain their facilities in concert with the population growth in the
jurisdiction of the County; and
WHEREAS, the Board finds the assessment will enhance the Hospitals' ability to grow,
expand, maintain, improve, and increase the value of their Collier County properties and facilities
under all present circumstances and those of the foreseeable future; and
WHEREAS, the County is proposing a properly apportioned assessment by which all
Hospitals will be assessed at a uniform rate that is compliant with 42 C.F.R. § 433.68(d); and
WHEREAS, on June 22, 2021, the Board of County Commissioners adopted Ordinance
2001-23,enabling the County to levy a uniform non-ad valorem special assessment,which is fairly
and reasonably apportioned among the Hospitals' property interests within the County's
jurisdictional limits, to establish and maintain a system of funding for IGTs to support the non-
federal share of Medicaid payments, thus directly and specially benefitting Hospital properties.
NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY
COMMISSIONERS OF COLLIER COUNTY, FLORIDA:
Section 1. Definitions. As used in this Resolution, the following capitalized terms, not
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otherwise defined herein or in the Ordinance, shall have the meanings below, unless the context
otherwise requires.
Assessed Property means the real property in the County to which an Institutional Health
Care Provider holds a right of possession and right of use through an ownership or leasehold
interest, thus making the property subject to the Assessment.
Assessment means a non-ad valorem special assessment imposed by the County on
Assessed Property to fund the non-federal share of Medicaid and Medicaid managed care
payments that will benefit hospitals providing Local Services in the County.
Assessment Coordinator means the person appointed to administer the Assessment
imposed pursuant to this Article, or such person's designee.
Board means the Board of County Commissioners of Collier County, Florida.
Comptroller means the Collier County Comptroller, ex officio Clerk to the Board, or other
such person as may be duly authorized to act on such person's behalf.
County means Collier County, Florida.
Fiscal Year means the period commencing on October 1 of each year and continuing
through the next succeeding September 30, or such other period as may be prescribed by law as
the fiscal year for the County.
Institutional Health Care Provider means a private for-profit or not-for-profit hospital that
provides inpatient hospital services.
Local Services means the provision of health care services to Medicaid, indigent, and
uninsured members of the Collier County community.
Non-Ad Valorem Assessment Roll means the special assessment roll prepared by the
County.
Ordinance means the Collier County Local Provider Participation Fund Ordinance No.
20021-23.
Tax Collector means the Collier County Tax Collector.
Section 2. Authority. Pursuant to the Constitution of the State of Florida, Chapter 125
of the Florida Statutes, and the Collier County Local Provider Participation Fund Ordinance, the
Board is hereby authorized to impose a special assessment against private for-profit and not-for-
profit hospitals located within the County to fund the non-federal share of Medicaid payments
associated with Local Services.
Section 3. Special Assessment. The non-ad valorem special assessment discussed
herein shall be imposed, levied, collected, and enforced against Assessed Properties located within
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the County. Proceeds from the Assessment shall be used to benefit Assessed Properties through a
directed payment program that will benefit the Assessed Properties for Local Services.
When imposed, the Assessment shall constitute a lien upon the Assessed Properties owned
by Hospitals and/or a lien upon improvements on the Property made by Hospital leaseholders equal
in rank and dignity with the liens of all state, county, district, or municipal taxes and other non-ad
valorem assessments. Payments made by Assessed Properties may not be passed along to patients
of the Assessed Property as a surcharge or as any other form of additional patient charge. Failure to
pay may cause foreclosure proceedings, which could result in loss of title, to commence.
Section 4. Assessment Scope, Basis, and Use. Funds generated from the Assessment
shall be used only to:
1. Provide to the Florida Agency for Health Care Administration the non-federal share for
Medicaid managed care hospital directed 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 the Ordinance.
If,at the end of the Fiscal Year, additional amounts remain in the local provider participation fund,
the Board is hereby authorized either(a)to refund to Assessed Properties, in proportion to amounts
paid in during the Fiscal Year, all or a portion of the unutilized local provider participation fund,
or(b)if requested to do so by the Assessed Properties,to retain such amounts in the fund to transfer
to the Agency in the next fiscal year for use as the non-federal share of Medicaid hospital
payments.
If, after the Assessment funds are transferred to the Agency, the Agency returns some or all of the
transferred funding to the County (including, but not limited to, a return of the non-federal share
after a disallowance of matching federal funds), the Board is hereby authorized to refund to
Assessed Properties, in proportion to amounts paid in during the Fiscal Year, the amount of such
returned funds.
Section 5. Computation of Assessment. The Assessment shall equal 1.11% of net
patient revenue for each Assessed Property specified in the attached Non-Ad Valorem Assessment
Roll. The amount of the Assessment required of each Assessed Property may not exceed an amount
that, when added to the amount of other hospital assessments levied by the state or local
government, exceeds the maximum percent of the aggregate net patient revenue of all Assessed
Hospitals in the County permitted by 42 C.F.R. § 433.68(f)(3)(i)(A). Assessments for each
Assessed Property will be derived from data contained in cost reports and/or in the Florida Hospital
Uniform Reporting System, as available from the Florida Agency for Health Care Administration.
Section 6. Timing and Method of Collection. The amount of the assessment is to be
collected pursuant to the Alternative Method outlined in §197.3631, Fla. Stat.
4 �(�
1 6D 3
The County shall provide Assessment bills by first class mail to the owner of each affected
Hospital. The bill or accompanying explanatory material shall include: (1) a reference to this
Resolution, (2) the total amount of the hospital's Assessment for the appropriate period, (3) the
location at which payment will be accepted, (4) the date on which the Assessment is due, and (5) a
statement that the Assessment constitutes a lien against assessed property and/or improvements equal
in rank and dignity with the liens of all state, county, district or municipal taxes and other non-ad
valorem assessments.
No act of error or omission on the part of the Comptroller, Property Appraiser, Tax
Collector, Assessment Coordinator, Board, or their deputies or employees shall operate to
release or discharge any obligation for payment of the Assessment imposed by the Board under
the Ordinance and this resolution.
Section 7. Public Hearing. As required by §197.3631, Fla. Stat. the Board has heard
and considered objections of all interested persons prior to rendering a decision on the Assessment
and attached Non-Ad Valorem Assessment Roll.
Section 8. Responsibility for Enforcement. The County and its agent, if any, shall
maintain the duty to enforce the prompt collection of the Assessment by the means provided herein.
The duties related to collection of assessments may be enforced at the suit of any holder of
obligations in a court of competent jurisdiction by mandamus or other appropriate proceedings or
actions.
Section 9. Severability. If any clause, section, or provision of this resolution is
declared unconstitutional or invalid for any reason or cause, the remaining portion hereof shall be in
full force and effect and shall be valid as if such invalid portion thereof had not been incorporated
herein.
Section 10. Effective Date. This Resolution to be effective immediately upon adoption.
This Resolution duly adopted this 28th day of September, 2021.
ATTEST: BOARD OF COUNTY COMMISSIONERS
CRYSTAL K. KINZEL, CLERK COLLIER 0 TY, FLORID
By W L( By:
Attest � �Ch implh UTY CL K PENNY TA OR, CHAIRPERSON
Approved as to foriii and legality:
Jenni er A. Belpedio f?.\
Assistant County Attorney `��
0.
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HayesJessica
From: Taklalrene
Sent: Tuesday, September 28, 2021 8:54 AM
To: BelpedioJennifer; Martha S.Vergara
Cc: HayesJessica
Subject: RE: Routing of Item 16D3 9/28 -REQUEST FOR PRIORITY IN PRIORITY DOCS MUST BE
TO AHCA BY 10/1
Thank you,Jennifer.
Martha,the contact information and address is as shown in below table:
Contact Name Jeffrey Mistich
Agency Name Bureau of Medicaid Program Finance
Agency for Health Care Administration
Address 2727 Mahan Dr. Bldg 3 Mailstop#23
Tallahassee, FL 32308
Phone 850-412-4119
We would like to email the documents to ACHA before 10/1 to the following recipients as well and please copy me in
the email.
Thomas.Wallace@ahca.mvflorida.com
jeffrev.mistich@ahca.mvflorida.com
Please let me know if you have any questions.
Thank you
Respectfully,
Irene Takla
Accountant
&9tY
Public Services Department
Operations and Veteran Services Division
Supporting operational excellence for all PSD divisions through transparency, accountability,and leadership.
3339 Tamiami Trail E Suite 212,Bldg H
Naples, FL 34112
Office Phone:239-252-5505
Irene.Takla@colliercountyfl.gov
How is our customer service? Please take our brief survey here.
1
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BelpedioJennifer
From: Taklalrene
Sent: Wednesday, September 22, 2021 8:23 AM
To: BelpedioJennifer
Cc: GrantKimberley; NewmanJeffrey
Subject: RE: RLS 21-GRC-01224 Directed Payment Program LOA - Non-Ad Valorem Special
Assessment
Attachments: AHCA Contact Information.pdf
Good morning Jennifer,
Please find attached AHCA contact information.
Respectfully,
Irene Takla
Accountant
Co
Public Services Department
Operations and Veteran Services Division
Supporting operational excellence for all PSD divisions through transparency, accountability, and leadership.
3339 Tamiami Trail E Suite 212, Bldg H
Naples, FL 34112
Office Phone:239-252-5505
Irene.Takla@colliercountyfl.gov
How is our customer service? Please take our brief survey here.
From:Taklalrene
Sent: Wednesday, September 22, 2021 8:05 AM
To: BelpedioJennifer<Jennifer.Belpedio@colliercountyfl.gov>
Cc: GrantKimberley<Kimberley.Grant@colliercountyfl.gov>; NewmanJeffrey<Jeffrey.Newman@colliercountyfl.gov>
Subject: RE: RLS 21-GRC-01224 Directed Payment Program LOA- Non-Ad Valorem Special Assessment
Good morning Jennifer, I Ns TR V crio S
Please find attached the Routing slip requested. Please let me know if it looks good or anything needs to be changed.
We will need two (2) original documents from the "Directed Payment Program Letter of Agreement" and one (1) original
document from "Resolution".
Can we get the executed version on 9/28 to email it to AHCA in order to meet our deadline with them? I have attached
the communication with AHCA and they mention that it should work with them.
Please let me know if you have any issues or concerns.
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BelpedioJennifer
From: Wallace, Thomas J. <Thomas.Wallace@ahca.myflorida.com>
Sent: Tuesday, September 21, 2021 3:32 PM
To: Taklalrene;jeffrey.mistich@ahca.myflorida.com
Cc: Colleen Ernst
Subject: RE: Directed Payment Program Letter of Agreement
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.
Irene,
I think this should work as long as the LOA is executed on your end. Below is our physical address.
BUREAU OF MEDICAID PROGRAM FINANCE
2727 MAHAN DR. Bldg 3 Mailstop#23
TALLAHASSEE, FL. 32308
Thanks,
Tom
From:Taklalrene <Irene.Takla@colliercountyfl.gov>
Sent:Tuesday, September 21, 2021 3:10 PM
To:jeffrey.mistich@ahca.myflorida.com
Cc: Colleen Ernst<colleen@ahcv.com>; Wallace, Thomas J. <Thomas.Wallace@ahca.myflorida.com>
Subject: Directed Payment Program Letter of Agreement
Good afternoon Jeffrey,
Since the DPP LOA has to be at AHCA by 10/1, can Collier County email you an executed version of the "Directed
Payment Program Letter of Agreement" till we send the executed LOA by mail?
We will have the approved LOA on 9/28 and I just want to make sure that the deadline is met.
Please let me know if you have any concerns.
Thank you
Respectfully,
Irene Takla
Accountant
Co Ter County
Public Services Debar tr r rent
Operations and Veteran Services Division
Suppor►ing operational excellence for all PSD divisions through transparency, accountability, and leadership.
3339 Tamiami Trail E Suite 212, Bldg H
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Directed Payment Program Letter of Agreement
THIS LETTER OF AGREEMENT(LOA) is made and entered into in duplicate on the
day of 2021, by and between Collier County LPPF on behalf of Region 8, 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.
"Directed Payment Program (DPP)," pursuant to the General Appropriation Act, Laws of Florida
2021-111, is the program that provides direct supplemental payments to eligible public and private
entities that provide inpatient and outpatient services to Medicaid managed care recipients.
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 LPPF and the Agency agree
that the Collier County LPPF will remit IGT funds to the Agency in an amount not to
exceed the total of$6,687,755. The Collier County LPPF and the Agency have agreed
that these IGT funds will only be used for the DPP program.
2. The Collier County LPPF will return the signed LOA to the Agency.
3. The Collier County LPPF will pay IGT funds to the Agency in an amount not to exceed
the total of$6,687,755. The Collier County LPPF 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 LPPF when payment is due.
4. The Collier County LPPF 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 LPPF agrees to maintain books, records, and documents
(including electronic storage media) pertinent to performance under this LOA in
Collier County LPPF_Region 8_DPP LOA_SFY 2021-22 Q
160 3
accordance with generally accepted accounting procedures and practices, which
sufficiently and properly reflect all revenues and expenditures of funds provided.
ii. Collier County LPPF 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 LPPF agrees to comply with public record laws as outlined in
section 119.0701, Florida Statutes.
b. RETENTION OF RECORDS
i. The Collier County LPPF 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 LPPF agrees to permit persons duly authorized by the Agency to
inspect any records, papers, and documents of the Collier County LPPF which are
relevant to this LOA.
d. ASSIGNMENT AND SUBCONTRACTS
i. The Collier County LPPF 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 LPPF 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 LPPF 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.
Collier County LPPF Region 8_DPP LOA_SFY 2021-22
160 3
7. Collier County LPPF agrees the following provision shall be included in any agreements
between Collier County LPPF 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.
_ PP Local Intergovernmental Transfers - -�
Pro ram!Amount State Fiscal Year 2021-2022
Year One DPP IGTs
Total Fundin — $6,687,755�— — — — — — —�—— $6,687,755
IN WITNESS WHEREOF, the parties have caused this page Letter of Agreement to be
executed by their undersigned officials as duly authorized.
Collier County PF
STATE OF FLORIDA,AGENCY FOR
HEALTH CARE ADMINISTRATION
SIGNED
BY: 4?_ SIGNED r
BY:
NAME: Jr ''� '- 1111
)A NIU Z _ NAME: �Qm � � 1 In n,•
TITLE: C� }� 1Z
TITLE: i • f0 V ee6 J
DATE: g 2�8 ,a
DATE: p t 202.
' n
ATTEST
CRUSTAL K.KIN 1„cLERK
Approved as to form and legality
BY;
8i1t104->:t):UQ.A
Attest as to.C*rrna-n
ii � - -
signfure on(y,.. Assistant County qtt ()
oo\
Collier County LPPF_Region 8_DPP LOA_SFY 2021-22
Crystal K. Kinzel 1 6 D 3
.�c`�c�,T covRT�� Collier County
Clerk of the Circuit Court and Comptroller
� r 3315 Tamiami Trail East, Suite 102
Naples, Florida 34112-5324
COUNT'?. '0
September 29, 2021
Agency for Health Care Administration
Directed Payment Program Letter of Agreement
Attn: Jeffrey Mistich
2727 Mahan Drive
Building 3, Mail Stop #23
Tallahassee, FL 32308
Re: Directed Payment Program Letter of Agreement and Certified Resolution
Transmitted herewith are one (1) scanned original agreement 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 28, 2021, during Regular Session.
Once fully executed please forward a copy to the Board's Minutes and
Records Department for the Boards Records to out e-mail:
minutesandrecords(&,collierclerk.com.
Very truly yours,
CRYSTAL K. KINZEL, CLERK
Martha Vergara, Deputy Cl rk
Phone-(239)252-2646 Fax-(239) 252-2755
Website-www.CollierClerk.com Email-CollierClerk@collierclerk.com
Crystal K. Kinzel 1 6 Q 3
�C`sC') U ) Collier County
O
o� Clerk of the Circuit Court and Comptroller
0 3315 Tamiami Trail East, Suite 102
Naples, Florida 34112-5324
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R COUNT(
September 29, 2021
Agency for Health Care Administration
Directed Payment Program Letter of Agreement
Attn: Thomas Wallace
2727 Mahan Drive
Building 3, Mail Stop #23
Tallahassee, FL 32308
Re: Directed Payment Program Letter of Agreement and Certified Resolution
Transmitted herewith are one (1) scanned original agreement 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 28, 2021, during Regular Session.
Once fully executed please forward a copy to the Board's Minutes and
Records Department for the Boards Records to out e-mail:
minutesandrecords(a,collierclerk.com.
Very truly yours,
CRYSTAL K. KINZEL, CLERK
Martha Vergara, Deputy Cle k
�J
Phone-(239) 252-2646 Fax-(239)252-2755
Website-www.CollierClerk.com Email-CollierClerkPcollierclerk.com
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RESOLUTION NO. 2021 — 197
AN ASSESSMENT RESOLUTION OF THE BOARD OF COUNTY
COMMISSIONERS OF COLLIER COUNTY, FLORIDA, AUTHORIZING
AND ADOPTING A NON-AD VALOREM SPECIAL ASSESSMENT WITHIN
THE COUNTY LIMITS FOR THE PURPOSE OF BENEFITING ASSESSED
PROPERTIES THROUGH ENHANCED MEDICAID PAYMENTS FOR
LOCAL SERVICES; FINDING AND DETERMINING THAT CERTAIN
REAL PROPERTY IS SPECIALLY BENEFITED BY THE ASSESSMENT;
COLLECTING THE ASSESSMENT AGAINST THE REAL PROPERTY;
ESTABLISHING A PUBLIC HEARING TO CONSIDER IMPOSITION OF
THE PROPOSED ASSESSMENT AND THE METHOD OF ITS
COLLECTION; AUTHORIZING AND DIRECTING THE PUBLICATION
OF NOTICES IN CONNECTION THEREWITH; PROVIDING FOR
CERTAIN OTHER AUTHORIZATIONS AND DELEGATIONS OF
AUTHORITY AS NECESSARY; AND PROVIDING AN EFFECTIVE DATE.
WHEREAS, hospitals in Collier County's jurisdiction (the "Hospitals") annually provide
millions of dollars of uncompensated care to uninsured persons and those who qualify for
Medicaid because Medicaid, on average, covers only 60% of the costs of the health care services
actually provided by Hospitals to Medicaid-eligible persons, leaving hospitals with significant
uncompensated costs; and
WHEREAS, the State of Florida (the "State") received federal authority to establish the
Statewide Medicaid Managed Care Hospital directed payment program (the "DPP") to offset
hospitals' uncompensated Medicaid costs and improve quality of care provided to Florida's
Medicaid population; and
WHEREAS, Hospitals have asked Collier County (the "County") to impose a non-ad
valorem special assessment upon certain real property interests held by the Hospitals to help
finance the non-federal share of the State's Medicaid program; and
WHEREAS, the only real properties interests that will be subject to the non-ad valorem
assessments authorized herein are those belonging to the Hospitals; and
WHEREAS,the County recognizes that one or more of the Hospitals within the County's
boundaries may be located upon real property leased from governmental entities and that such
Hospitals may be assessed because courts do not make distinctions on the application of special
assessments based on"property interests"but rather on the distinction of the classifications of real
property being assessed; and
WHEREAS,the funding raised by the County assessment will, through intergovernmental
transfers ("IGTs") provided consistent with federal guidelines, support additional funding for
Medicaid payments to Hospitals; and
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WHEREAS, the County acknowledges that the Hospital properties assessed will benefit
directly and especially from the assessment as a result of the above-described additional funding
provided to said Hospitals; and
WHEREAS, the County has determined that a logical relationship exists between the
services provided by the Hospitals,which will be supported by the assessment, and the special and
particular benefit to the real property of the Hospitals; and
WHEREAS, the County has an interest in promoting access to health care for its low-
income and uninsured residents; and
WHEREAS, leveraging additional federal support through the above-described IGTs to
fund Medicaid payments to the Hospitals for health care services directly and specifically benefits
the Hospitals' property interests and supports their continued ability to provide those services; and
WHEREAS, imposing an assessment limited to Hospital properties to help fund the
provision of these services and the achievement of certain quality standards by the Hospitals to
residents of the County is a valid public purpose that benefits the health, safety,and welfare of the
citizens of the County; and
WHEREAS, the assessment ensures the financial stability and viability of the Hospitals
providing such services; and
WHEREAS, the Hospitals are important contributors to the County's economy, and the
financial benefit to these Hospitals directly and specifically supports their mission, as well as their
ability to grow, expand, and maintain their facilities in concert with the population growth in the
jurisdiction of the County; and
WHEREAS, the Board finds the assessment will enhance the Hospitals' ability to grow,
expand, maintain, improve, and increase the value of their Collier County properties and facilities
under all present circumstances and those of the foreseeable future; and
WHEREAS, the County is proposing a properly apportioned assessment by which all
Hospitals will be assessed at a uniform rate that is compliant with 42 C.F.R. § 433.68(d); and
WHEREAS, on June 22, 2021. the Board of County Commissioners adopted Ordinance
2001-23,enabling the County to levy a uniform non-ad valorem special assessment,which is fairly
and reasonably apportioned among the Hospitals' property interests within the County's
jurisdictional limits, to establish and maintain a system of funding for IGTs to support the non-
federal share of Medicaid payments. thus directly and specially benefitting Hospital properties.
NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY
COMMISSIONERS OF COLLIER COUNTY, FLORIDA:
Section 1. Definitions. As used in this Resolution, the following capitalized terms, not
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otherwise defined herein or in the Ordinance, shall have the meanings below, unless the context
otherwise requires.
Assessed Property means the real property in the County to which an Institutional Health
Care Provider holds a right of possession and right of use through an ownership or leasehold
interest, thus making the property subject to the Assessment.
Assessment means a non-ad valorem special assessment imposed by the County on
Assessed Property to fund the non-federal share of Medicaid and Medicaid managed care
payments that will benefit hospitals providing Local Services in the County.
Assessment Coordinator means the person appointed to administer the Assessment
imposed pursuant to this Article, or such person's designee.
Board means the Board of County Commissioners of Collier County, Florida.
Comptroller means the Collier County Comptroller, ex officio Clerk to the Board, or other
such person as may be duly authorized to act on such person's behalf.
County means Collier County, Florida.
Fiscal Year means the period commencing on October 1 of each year and continuing
through the next succeeding September 30, or such other period as may be prescribed by law as
the fiscal year for the County.
Institutional Health Care Provider means a private for-profit or not-for-profit hospital that
provides inpatient hospital services.
Local Services means the provision of health care services to Medicaid, indigent, and
uninsured members of the Collier County community.
Non-Ad Valorem Assessment Roll means the special assessment roll prepared by the
County.
Ordinance means the Collier County Local Provider Participation Fund Ordinance No.
20021-23.
Tax Collector means the Collier County Tax Collector.
Section 2. Authority. Pursuant to the Constitution of the State of Florida, Chapter 125
of the Florida Statutes, and the Collier County Local Provider Participation Fund Ordinance, the
Board is hereby authorized to impose a special assessment against private for-profit and not-for-
profit hospitals located within the County to fund the non-federal share of Medicaid payments
associated with Local Services.
Section 3. Special Assessment. The non-ad valorem special assessment discussed
herein shall be imposed, levied, collected, and enforced against Assessed Properties located within
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the County. Proceeds from the Assessment shall be used to benefit Assessed Properties through a
directed payment program that will benefit the Assessed Properties for Local Services.
When imposed, the Assessment shall constitute a lien upon the Assessed Properties owned
by Hospitals and/or a lien upon improvements on the Property made by Hospital leaseholders equal
in rank and dignity with the liens of all state, county, district, or municipal taxes and other non-ad
valorem assessments. Payments made by Assessed Properties may not be passed along to patients
of the Assessed Property as a surcharge or as any other form of additional patient charge. Failure to
pay may cause foreclosure proceedings, which could result in loss of title, to commence.
Section 4. Assessment Scope, Basis,and Use. Funds generated from the Assessment
shall be used only to:
1. Provide to the Florida Agency for Health Care Administration the non-federal share for
Medicaid managed care hospital directed 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 the Ordinance.
If,at the end of the Fiscal Year, additional amounts remain in the local provider participation fund,
the Board is hereby authorized either(a)to refund to Assessed Properties,in proportion to amounts
paid in during the Fiscal Year, all or a portion of the unutilized local provider participation fund,
or(b)if requested to do so by the Assessed Properties,to retain such amounts in the fund to transfer
to the Agency in the next fiscal year for use as the non-federal share of Medicaid hospital
payments.
If, after the Assessment funds are transferred to the Agency, the Agency returns some or all of the
transferred funding to the County (including. but not limited to, a return of the non-federal share
after a disallowance of matching federal funds), the Board is hereby authorized to refund to
Assessed Properties, in proportion to amounts paid in during the Fiscal Year, the amount of such
returned funds.
Section 5. Computation of Assessment. The Assessment shall equal 1.11% of net
patient revenue for each Assessed Property specified in the attached Non-Ad Valorem Assessment
Roll.The amount of the Assessment required of each Assessed Property may not exceed an amount
that, when added to the amount of other hospital assessments levied by the state or local
government, exceeds the maximum percent of the aggregate net patient revenue of all Assessed
Hospitals in the County permitted by 42 C.F.R. § 433.68(f)(3)(i)(A). Assessments for each
Assessed Property will be derived from data contained in cost reports and/or in the Florida Hospital
Uniform Reporting System, as available from the Florida Agency for Health Care Administration.
Section 6. Timing and Method of Collection. The amount of the assessment is to be
collected pursuant to the Alternative Method outlined in §197.3631, Fla. Stat.
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The County shall provide Assessment bills by first class mail to the owner of each affected
Hospital. The bill or accompanying explanatory material shall include: (1) a reference to this
Resolution, (2) the total amount of the hospital's Assessment for the appropriate period, (3) the
location at which payment will be accepted, (4) the date on which the Assessment is due, and (5) a
statement that the Assessment constitutes a lien against assessed property and/or improvements equal
in rank and dignity with the liens of all state, county, district or municipal taxes and other non-ad
valorem assessments.
No act of error or omission on the part of the Comptroller, Property Appraiser, Tax
Collector, Assessment Coordinator, Board, or their deputies or employees shall operate to
release or discharge any obligation for payment of the Assessment imposed by the Board under
the Ordinance and this resolution.
Section 7. Public Hearing. As required by §197.3631, Fla. Stat. the Board has heard
and considered objections of all interested persons prior to rendering a decision on the Assessment
and attached Non-Ad Valorem Assessment Roll.
Section 8. Responsibility for Enforcement. The County and its agent, if any, shall
maintain the duty to enforce the prompt collection of the Assessment by the means provided herein.
The duties related to collection of assessments may be enforced at the suit of any holder of
obligations in a court of competent jurisdiction by mandamus or other appropriate proceedings or
actions.
Section 9. Severability. If any clause, section, or provision of this resolution is
declared unconstitutional or invalid for any reason or cause, the remaining portion hereof shall be in
full force and effect and shall be valid as if such invalid portion thereof had not been incorporated
herein.
Section 10. Effective Date. This Resolution to be effective immediately upon adoption.
This Resolution duly adopted this 28th day of September. 2021.
ATTEST: BOARD OF COUNTY COMMISSIONERS
CRYSTAL K. KINZEL, CLERK COLLIER 0 TV, FLORID
By: 1 \ltialAke By:
Attest as to CliwI UTY CL K PENNY TA OR, CHAIRPERSON
sirnit;r l only.
Approved as to form and legality:
11c
I,Crystal K.Kmzel,Clerk of Courts-r.and-far,;oitier C:unty
do hearby:.ertify..at!the a x. a strurn nt is a true a...;correct
Jenni er A. Belpedio ♦ cop of.`Ierriglna fer n C-,'.Iter County,Flo.•a
Assistant County Attorney \\� By. '� Deputy Clerk
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Directed Payment Program Letter of Agreement
THIS LETTER OF AGREEMENT (LOA) is made and entered into in duplicate on the a }k
day of '2021, by and between Collier County LPPF on behalf of Region 8, 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.
"Directed Payment Program (DPP)," pursuant to the General Appropriation Act, Laws of Florida
2021-111, is the program that provides direct supplemental payments to eligible public and private
entities that provide inpatient and outpatient services to Medicaid managed care recipients.
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 LPPF and the Agency agree
that the Collier County LPPF will remit IGT funds to the Agency in an amount not to
exceed the total of $6,687,755. The Collier County LPPF and the Agency have agreed
that these IGT funds will only be used for the DPP program.
2. The Collier County LPPF will return the signed LOA to the Agency.
3. The Collier County LPPF will pay IGT funds to the Agency in an amount not to exceed
the total of$6,687,755. The Collier County LPPF 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 LPPF when payment is due.
4. The Collier County LPPF 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 LPPF agrees to maintain books, records, and documents
(including electronic storage media) pertinent to performance under this LOA in
Collier County LPPF_Region 8_DPP LOA_SFY 2021-22 C
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accordance with generally accepted accounting procedures and practices, which
sufficiently and properly reflect all revenues and expenditures of funds provided.
ii. Collier County LPPF 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 LPPF agrees to comply with public record laws as outlined in
section 119.0701, Florida Statutes.
b. RETENTION OF RECORDS
i. The Collier County LPPF 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 LPPF agrees to permit persons duly authorized by the Agency to
inspect any records, papers, and documents of the Collier County LPPF which are
relevant to this LOA.
d. ASSIGNMENT AND SUBCONTRACTS
i. The Collier County LPPF 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 LPPF 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 LPPF 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.
Collier County LPPF_Region 8_DPP LOA_SFY 2021-22
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7. Collier County LPPF agrees the following provision shall be included in any agreements
between Collier County LPPF 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.
DPP Local Intergovernmental Transfers
Program /Amount State Fiscal Year 2021-2022
Year One DPP IGTs
Total Funding $6,687,755
$6,687,755
IN WITNESS WHEREOF, the parties have caused this page Letter of Agreement to be
executed by their undersigned officials as duly authorized.
Collier County PF STATE OF FLORIDA, AGENCY FOR
HEALTH CARE ADMINISTRATION
SIGNED
BY: SIGNED
BY:
NAME: •Pz rV Ny T' y Ly
NAME:
TITLE: C%A '
TITLE:
DATE:
DATE:
ATTEST • .
CRYSTAL K.MN L;CLERK
Approved as to form and legality
B ;
Attest as to. ad an
signature cry:. Assistant County Att
a\`
Collier County LPPF_Region 8_DPP LOA_SFY 2021-22
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