Agenda 09/27/2022 Item #16D 5 (Resolution - to authorize continued participation in the Local Provider Participation Fund for the Directed Payment Programs and commence participation in the Graduate Medical Education Program)09/27/2022
EXECUTIVE SUMMARY
Recommendation to enact a resolution to authorize continued participation in the Local Provider
Participation Fund for the Directed Payment Program and commence participation in the
Graduate Medical Education Program. These programs will be solely funded by assessments on
Collier County hospitals owned property or property used as a hospital in an amount not to exceed
$5,578,033. Authorize the County Manager to sign Letter of Agreement in an amount not to exceed
the total of $7,231,349 with the Agency for Health Care Administration and approve necessary
Budget Amendments.
OBJECTIVE: To enact a resolution in support of area hospitals that provide health services to the low -
income citizens of Collier County. Authorize the County Manager to sign the AHCA Letter of Agreement
and authorize necessary Budget Amendments.
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 was established by the Florida Legislature in FY2021 and is 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. In 2021, the program was adopted by Collier County and fourteen Florida counties.
On June 22, 2021, the Board of County Commissioners adopted Ordinance 2021-23, 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, for the purpose of establishing
and maintaining a system of funding for IGTs to support the non-federal share of Medicaid payments. On
September 28, 2021, the Board of Commissioners of Collier County approved Resolution 2021-197,
which established the 2021 Local Provider Participation Fund Special Assessment. The FY 2021
assessment of 1.11% of net patient revenue was collected and when matched by the federal matching
program, the Local Provider Participation Fund contributed $12,248,191 to support low-income patient
treatment in Collier County. AHCA has notified the County that the LPPF DPP assessment for FY 2022
will be .69% of net patient revenue and will collect a maximum of $5,578,033 from participating
Hospitals. This amount minus $150,000 in administrative expenses will be submitted to AHCA. The
Direct Payment Program letter of Agreement between Collier County and State of Florida AHCA
however permits an IGT in an amount not to exceed the total of $7,231,349.00.
Collier County hospitals are supportive of the DPP and have requested that the program be continued.
This year, NCH led local efforts to use the assessment to fund the Graduate Medical Education Program.
The Graduate Medical Education Program allows and provides funding to qualified participating hospitals
involved in graduate medical education, paving the way for payments designed to prepare the next
generation of healthcare providers in Florida. The hospitals are aware of the assessment process and have
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all agreed to participate. In order to participate, the County must establish a Local Provider Participation
Fund (LPPF) and Graduate Medical Education (GME) Program via resolution. The proposed resolution
supports the DPP and GME programs.
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 and GME
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 to ensure that the
hospitals will have the opportunity to secure all funds available in the upcoming state fiscal year.
The proposed resolution 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
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 beneficiarie s 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 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 F.S. 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 Boar d 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
previously been coordinated with and they have no objection to the adoption of the program.
DPP Local Intergovernmental Transfers
Program / Amount State Fiscal Year 2022-2023
Year One DPP IGTs $7,231,349
Total Funding $7,231,349
FISCAL IMPACT: The assessment of .69% of net patient revenue enacted by the resolution will take
hospital funds collected through a non-ad valorem assessment and direct those dollars to the Agency for
Health Care Administration (AHCA) to fund the non-federal share of the State’s Medicaid Program,
including the Direct Payment Program and Graduate Medical Education Program. This funding structure
ultimately results in enhanced funding returned to the hospitals. The information currently available
suggests the maximum assessment collected will be $5,578,031.89 from participating hospitals. The
collected assessment will be transmitted to AHCA and will not exceed the actual amount of assessment
dollars received by the County less administrative costs. No more than $150,000 will be retained for
administrative expenses.
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Hospital name Assessment Amount
NCH Baker Hospital
$3,389,348
Physicians Regional
$1,909,005
Landmark Hospital SW
$162,663
The Willough at Naples
$117,017
$5,578,033
Relative to budget administration, FY 23 budget amendments are necessary to establish budget within
Local Provider Participation Fund (169). The budget will include a revenue of $5,578,033 for receipt of
the FY 23 assessments paid by the hospitals as well as associated expenses of $5,428,033 for the
remittance of FY 23 program funds to AHCA, and $150,000 for reimbursement of County administrative
costs associated with the implementation of the assessment respectively. The Direct Payment Program
letter of Agreement between Collier County and State of Florida AHCA however permits an IGT in an
amount not to exceed the total of $7,231,349.00. In addition, a FY23 budget amendment is required to
recognize carryforward in the amount of $2,662,000 and establish a reserve in kind.
GROWTH MANAGEMENT IMPACT: There is no Growth Management impact.
LEGAL CONSIDERATIONS: The documents have an effective date of September 27, 2022. This item
is approved as to form and legality and requires a majority vote for Board action. - RTT
RECOMMENDATION: To enact a resolution to authorize continued participation in the Local Provider
Participation Fund for the Directed Payment Program and commence participation in the Graduate
Medical Education Program. Authorize the County Manager to sign the AHCA Letter of Agreement and
approve necessary Budget Amendments.
Prepared By: Jeffrey Newman, Financial and Operational Support Manager, Operations & Veterans
Services Division
ATTACHMENT(S)
1. Resolution (CAO stamped) - agenda ID 23160 (PDF)
2. 1. Ordinance 2021-23 (PDF)
3. 1. Resolution 2021-197 (PDF)
4. Year 2 Presentation_Collier (PPTX)
5. DPP _SFY_22-23_LOA (PDF)
6. legal ad - agenda ID 23160 (PDF)
7. Image_001 (PDF)
8. IGT questionnaire statewide DDP 9 19 2022 (XLSX)
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09/27/2022
COLLIER COUNTY
Board of County Commissioners
Item Number: 16.D.5
Doc ID: 23160
Item Summary: Recommendation to enact a resolution to authorize continued participation in the
Local Provider Participation Fund for the Directed Payment Program and commence participation in the
Graduate Medical Education Program. These programs will be solely funded by assessments on Collier
County hospitals owned property or property used as a hospital not to exceed $5,578,033. Authorize the
County Manager to sign Letter of Agreement in an amount not to exceed the total of $7,231,349 with the
Agency for Health Care Administration and provide necessary Budget Amendments
Meeting Date: 09/27/2022
Prepared by:
Title: – Operations & Veteran Services
Name: Jeff Newman
08/31/2022 7:54 AM
Submitted by:
Title: – Operations & Veteran Services
Name: Jeff Newman
08/31/2022 7:54 AM
Approved By:
Review:
Operations & Veteran Services Jeff Newman Additional Reviewer Completed 08/31/2022 8:05 AM
Public Services Department Jeff Newman PSD Level 1 Reviewer Completed 09/06/2022 2:52 PM
Community & Human Services Kristi Sonntag Additional Reviewer Completed 09/06/2022 2:53 PM
Public Services Department Tanya Williams PSD Department Head Review Completed 09/07/2022 11:45 AM
Grants Erica Robinson Level 2 Grants Review Completed 09/07/2022 1:28 PM
County Attorney's Office Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Completed 09/07/2022 2:11 PM
Office of Management and Budget Laura Zautcke Level 3 OMB Gatekeeper Review Completed 09/07/2022 2:58 PM
Grants Therese Stanley Additional Reviewer Completed 09/12/2022 12:42 PM
Office of Management and Budget Christopher Johnson Additional Reviewer Completed 09/16/2022 10:50 AM
Community & Human Services Maggie Lopez Additional Reviewer Completed 09/21/2022 8:40 AM
County Attorney's Office Ronald Tomasko Additional Reviewer Completed 09/21/2022 11:38 AM
County Manager's Office Dan Rodriguez Level 4 County Manager Review Completed 09/21/2022 3:12 PM
Board of County Commissioners Geoffrey Willig Meeting Pending 09/27/2022 9:00 AM
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Packet Pg. 1247 Attachment: Resolution (CAO stamped) - agenda ID 23160 [Revision 1] (23160 : AHCA: Local Provider Participation Fund - Direct Payment
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Packet Pg. 1251 Attachment: Resolution (CAO stamped) - agenda ID 23160 [Revision 1] (23160 : AHCA: Local Provider Participation Fund - Direct Payment
ORDINANCE NO.2021- 9 3
AN ORDINANCE OF THE BOARD OF COUNTY COMMISSIONERS OF
COLLIER COUNTY,FLORIDA,TO BE CODIFIED IN CHAPTER 114 AS
ARTICLE VI OF THE COLLIER COUNTY CODE OF LAWS AND
ORDINANCES AUTHORIZING THE CREATION OF THE COLLIER
COUNTY LOCAL PROVIDER PARTICIPATION FUND ("FUND")
UNDER THE AUTHORITY OF SECTION 1(F), ARTICLE VIII OF THE
CONSTITUTION OF THE STATE OF FLORIDA SPECIFYING THE
METHOD OF SETTING AND COMPUTING ANNUAL NON-AD
VALOREM SPECIAL ASSESSMENTS TO BE DEPOSITED INTO THE
FUND AND SPECIFYING AUTHORIZED USES FOR THE FUND;
PROVIDING FOR CONFLICT AND SEVERABILITY; PROVIDING FOR
INCLUSION IN THE CODE OF LAWS AND ORDINANCES; AND
PROVIDING FOR AN EFFECTIVE DATE OF JULY 1, 2021 UNLESS
THE ENABLING LEGISLATION IS NOT APPROVED BY THE
GOVERNOR OF THE STATE OF FLORIDA.
RECITALS:
WHEREAS, the hospitals in Collier County's jurisdiction (the "Hospitals") annually
provide millions of dollars of uncompensated care to persons 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("Medicaid shortfall");and
WHEREAS, the State of Florida(the"State")has received federal authority to establish
the Statewide Medicaid Managed Care hospital directed payment program (the"DPP") to offset
hospitals' Medicaid shortfall and improve quality of care provided to Florida's Medicaid
population;and
WHEREAS,impacted Hospitals have asked Collier County (the"County")to impose an
assessment upon certain real property owned by the Hospitals to help finance the non-federal
share of the State's Medicaid program; and
WHEREAS, the only properties to be assessed in these localities are the real property
sites of such Hospitals;and
WHEREAS, the County recognizes that one or more 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
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Packet Pg. 1252 Attachment: 1. Ordinance 2021-23 (23160 : AHCA: Local Provider Participation Fund - Direct Payment Program)
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 to address the Medicaid shortfall;and
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
Medicaid 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 under-insured residents;and
WHEREAS, leveraging additional federal support through the above-described IGTs to
fund payments to the Hospitals for health care services provided to Medicaid eligible persons
directly and specifically benefits the Hospitals' properties and supports their continued ability to
provide those services;and
WHEREAS, imposing an assessment limited to Hospital properties to help fund the
provision of Medicaid 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 Medicaid services;and
WHEREAS, the Hospitals are important contributors to the overall 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 County finds the assessment will enhance the Hospitals' ability to grow,
expand, maintain, improve and increase the value of their 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 a uniform amount that is compliant with 42 C.F.R. §433.68(d);and
WHEREAS, the adoption of this Ordinance will enable the County to levy a uniform
non-ad valorem special assessment, which is fairly and reasonably apportioned among the
Hospitals' properties 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 that will directly and
specially benefit Hospital properties.
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Packet Pg. 1253 Attachment: 1. Ordinance 2021-23 (23160 : AHCA: Local Provider Participation Fund - Direct Payment Program)
WHEREAS, for the first year of the assessment the County finds that the alternative
method, as specified in § 197.3631, Fla. Stat., for the assessment and collection of the non-ad
valorem special assessment is appropriate but in future tax years may elect to use the uniform
method if approved by the Board.
NOW, THEREFORE, BE IT ORDAINED BY THE BOARD OF COUNTY
COMMISSIONERS OF COLLIER COUNTY,FLORIDA,that:
SECTION 1. Chapter 126 of the Collier County Code of Laws and Ordinances, is hereby
amended,by adding a new Article VI as follows:
Sec. 126-211. -Title
This Article VI shall be known and may be cited as the "Collier County Local Provider
Participation Fund Ordinance."
Sec. 126-212.-Authority.
Pursuant to Article VIII, Section 1(0 of the Constitution of the State of Florida and Florida
Statutes 125, 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.
Sec. 126-213.-Purpose.
The non-ad valorem special assessment authorized by this Article shall be imposed, levied,
collected,and enforced against Assessed Properties located within the County.Proceeds from the
Assessment shall be used to benefit Assessed Properties through enhanced Medicaid payments
for Local Services. When imposed, the Assessment shall constitute a lien upon the Assessed
Properties equal in rank and dignity with the liens of all state,county,district,or municipal taxes
and other non-ad valorem assessments. Failure to pay may cause foreclosure proceedings, which
could result in loss of title, to commence. The Assessment shall be computed and assessed only
in the manner provided in this Ordinance.
Sec. 126-214. -Alternative Method.
This Ordinance shall be deemed to provide an additional and alternative method, as specified in
197.3631, Fla. Stat., for the assessment and collection of the non-ad valorem special
assessment described herein. The Ordinance shall be regarded as supplemental and additional to
powers conferred by other laws and shall not be regarded as in derogation of any powers now
existing or which may exist hereafter.This Ordinance,being necessary for the health,safety,and
welfare of the inhabitants of the County, shall be liberally construed to effect the purposes
hereof.
Sec. 126-215. -Definitions.
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Packet Pg. 1254 Attachment: 1. Ordinance 2021-23 (23160 : AHCA: Local Provider Participation Fund - Direct Payment Program)
When used in this Ordinance, the following terms shall have the meanings below, unless the
context clearly requires otherwise:
Annual Final Assessment Resolution means the resolution described in Sections 126-224
and 126-225 hereof, which shall be the final proceeding for the imposition of an Assessment,
establishing the rate for the non-ad valorem assessment for a specific Fiscal Year.
Assessed Property means an Institutional Health Care Provider holding a right of
possession and right of use of real property in the County 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
Institutional Health Care Providers located in the County limits to fund the non-federal share of
Medicaid and Medicaid managed care payments directed to hospitals providing Local Services in
the County.
Assessment Coordinator means the person appointed by the County Manager or designee
to administer the Assessment imposed pursuant to this Article,or such person's designee.
Assessment Resolution means the resolution described in Section 126-219 hereof.
Board means the Board of County Commissioners of Collier County,Florida.
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 inpatient and outpatient hospital 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 as it
may be codified in Chapter 114 as Article VI in the Collier County Code of Laws and
Ordinances.
Tax Collector means the Collier County Tax Collector.
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Packet Pg. 1255 Attachment: 1. Ordinance 2021-23 (23160 : AHCA: Local Provider Participation Fund - Direct Payment Program)
Sec. 126-216.-Interpretation.
Unless the context indicates otherwise, the terms "hereof," "hereby," "herein," "hereto,"
hereunder"and similar terms refer to this Article.The term"hereafter"means after and the term
heretofore"means before the effective date of the Ordinance.
Sec. 126-217. -Assessment.
Pursuant to § 125.01, Fla. Stat., the Board is hereby authorized to create a non-ad valorem
special assessment that shall be imposed, levied, collected, and enforced against Assessed
Property to fund the non-federal share of Medicaid payments benefitting Assessed Properties
providing Local Services in the County. Funds generated as a result of the Assessment shall be
held in a separate account called the local provider participation fund and shall be available to be
used only to: (1) provide to 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
Assessment Resolution.
The Assessment will be broad based, and the amount of the Assessment must be uniformly
imposed on each Assessed Property. The Assessment may not hold harmless any Institutional
Health Care Provider, as required under 42 U.S.C. § 1396b(w). As set forth in Section 126-213,
the Assessment shall constitute a lien upon the Assessed Properties equal in rank and dignity
with the liens of all state, county, district, or municipal taxes and other non-ad valorem
assessments. In addition to other remedies available at law or equity, the enforcement of the
aforesaid Assessment shall be at the same time and in like manner as ad valorem taxes and
subject to all ad valorem tax enforcement procedures afforded to the official annual real property
tax notice.
Creation and implementation of the Assessment will not result in any additional pecuniary
obligation on the County, Board,or County residents. The Assessment shall be imposed, levied,
collected, and enforced against only Assessed Properties, and the Assessment Resolution shall
provide that the County's administrative costs shall be reimbursed from the collected amounts.
The County's administrative costs shall not exceed$150,000.
Any reasonable expenses the County incurs to collect delinquent assessments, including any
attorney's fees incurred as a result of contracting with an attorney to represent the county in
seeking and enforcing the collection of delinquent assessments, are not subject to the limitation
on administrative costs.
Sec. 126-218.-Computation of Assessment.
The annual Assessment shall be specified for each Assessed Property. 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.
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Packet Pg. 1256 Attachment: 1. Ordinance 2021-23 (23160 : AHCA: Local Provider Participation Fund - Direct Payment Program)
The amount of the Assessment required of each Assessed Property may not exceed an amount
that,when added to the amount of other required assessments, equals an amount of revenue that
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 the Florida Hospital Uniform Reporting System, as
available from the Florida Agency for Health Care Administration.
Sec. 126-219. -Assessment Resolution.
The Assessment Resolution shall describe: (a)the Medicaid payments proposed for funding from
proceeds of the Assessment; (b) the benefits to the Assessment Properties associated with the
Assessment; (c) the methodology for computing the assessed amounts; and (d) the method of
collection,including how and when the Assessment must paid.
Sec. 126-220.-Non-Ad Valorem Assessment Roll.
The Assessment Coordinator shall prepare, or direct the preparation of, the Non-Ad Valorem
Assessment Roll,which shall contain the following:
a) The names of the Assessed Properties;and
b) The Assessment rate and amount of the Assessment to be imposed against each
Assessed Property based on the Assessment Resolution.
The Non-Ad Valorem Assessment Roll shall be retained by the Assessment Coordinator and
shall be open to public inspection. The foregoing shall not be construed to require that the
Assessment Roll be in printed form if the amount of the Assessment for each Assessed Property
can be determined by use of a computer terminal available to the public.
Sec. 126-221. -Notice by Publication.
Upon completion of the Non-Ad Valorem Assessment Roll, the Assessment Coordinator shall
publish once in a newspaper of general circulation within the County a notice stating that theBoard, at a regular, adjourned, or special meeting on a certain day and hour, not earlier than 20
calendar days from such publication, will hear objections of all interested persons to approve the
aforementioned Non-Ad Valorem Assessment Roll. Such notice shall include:
a) The Assessment rate;
b) The procedure for objecting to the Assessment rate;
c) The method by which the Assessment will be collected;and
d) A statement that the Non-Ad Valorem Special Assessment Roll is available for
inspection at the Office of the Assessment Coordinator.
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Packet Pg. 1257 Attachment: 1. Ordinance 2021-23 (23160 : AHCA: Local Provider Participation Fund - Direct Payment Program)
Sec. 126-222.-Notice by Mail.
In addition to the published notice required by Section 126-221, but only for the first fiscal year
in which an Assessment is imposed by the Board against Assessed Properties, the Assessment
Coordinator shall provide notice of the proposed Assessment by first class mail to the Assessed
Properties. Such notice shall include:
a) The purpose of the Assessment;
b) The Assessment rate to be levied against each Assessed Property;
c) The unit of measurement applied to determine the Assessment;
d) The total revenue to be collected by the County from the Assessment;
e) A statement that failure to pay the Assessment will cause a tax certificate to be issued
against the property or foreclosure proceedings,either of which may result in a loss of
title to the property;
f) A statement that all affected and/or interested parties have a right to appear at the
hearing and to file written objections with the Board within 20 days of the notice;and
g) The date,time,and place of the hearing.
Notice shall be mailed at least 20 calendar days prior to the hearing to each Assessed Property at
such address as is shown on the Assessment Roll. Notice shall be deemed mailed upon delivery
thereof to the possession of the United States Postal Service. The Assessment Coordinator may
provide proof of such notice by affidavit. Failure of the Assessed Property to receive such notice,
because of mistake or inadvertence, shall not affect the validity of the Assessment Roll or release
or discharge any obligation for payment of the Assessment imposed by the Board pursuant to
this Article.
Sec. 126-223. -Adoption of Assessment Resolution and Non-Ad Valorem Assessment Roll.
At the time named in the notice, the Board shall receive and consider any written objections of
interested persons. All objections to the Assessment Resolution and Non-Ad Valorem
Assessment Roll shall be made in writing and filed with the Assessment Coordinator at or before
the time or adjourned time of such hearing. At the date and time named in the notice,the Board
may adopt the Assessment Resolution and Non-Ad Valorem Assessment Roll which shall:
a) Set the rate of the Assessment to be imposed;
b) Approve the Non-Ad Valorem Assessment Roll,with such amendments as it deems just
and right;and
c) Affirm the method of collection.
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Packet Pg. 1258 Attachment: 1. Ordinance 2021-23 (23160 : AHCA: Local Provider Participation Fund - Direct Payment Program)
Sec. 126-224.-Annual Final Assessment Resolution.
The Board may revise the Non-Ad Valorem Assessment Roll during the Fiscal Year to modify
the Assessment rate. However, the Board must adopt an Annual Final Assessment Resolution
during the Fiscal Year to memorialize the final rate applicable for the Fiscal Year.
Sec. 126-225.-Effect of Annual Final Assessment Resolution.
The adoption of the Annual Final Assessment Resolution shall be the final adjudication of the
issues presented(including,but not limited to, the method of apportionment and Assessment, the
Assessment rate, the initial rate of Assessment, the Non-Ad Valorem Assessment Roll, and the
levy and lien of the Assessments), unless proper steps shall be initiated in a court of competent
jurisdiction to secure relief within 20 days from the date of Board action on the Annual Final
Assessment Resolution. The Non-Ad Valorem Assessment Roll shall be delivered to the Tax
Collector or such other official as the Board by resolution shall designate.
Sec. 126-226. -Method of Collection.
The amount of the assessment is to be collected pursuant to the Alternative Method, as specified
in the Assessment Resolution.
Sec. 126-227.-Refunds.
If, at the end of the Fiscal Year, additional amounts remain in the local provider participation
fund, the Board is hereby authorized to make refund to Assessed Properties in proportion to
amounts paid in during the Fiscal Year for all or a portion of the unutilized local provider
participation fund.
Sec. 126-228.-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.
Sec. 126-229, -Correction of Errors and Omissions.
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
provision of this Chapter.
Page 8oflO
0
16.D.5.b
Packet Pg. 1259 Attachment: 1. Ordinance 2021-23 (23160 : AHCA: Local Provider Participation Fund - Direct Payment Program)
SECTION 2. APPLICABILITY.
It is hereby intended that this Ordinance shall constitute a uniform Iaw applicable in all
unincorporated areas of Collier County, Florida, and to all incorporated areas of Collier County
where there is no existing conflict of law or municipal ordinance.
SECTION 3. SEVERABILITY.
In the event this Ordinance conflicts with any other Ordinance of Collier County or other
applicable law, deemed a separate, distinct and independent provision and such holding shall
not affect the validity of the remaining portion.
SECTION 4. RESOLUTION OF CONFLICT OF LAWS.
In all instances where Florida law, as evidenced by the Florida Administrative Code, Florida
Statutes, applicable case law, or otherwise mandates standards or requirements that are stricter
than the provisions of this Ordinance, or where a matter is addressed by Florida law that is not
addressed by this Ordinance, then said law shall govern. In situations where this Ordinance
addresses a matter in a manner that is stricter than that of Florida law, the provisions of this
Ordinance shall control.
SECTION 5. INCLUSION IN THE COLLIER COUNTY CODE.
The provisions of this Ordinance shall be included and incorporated in the Collier County Code,
as an addition or amendment thereto, and shall be appropriately renumbered to conform to the
uniform numbering system of the Collier County Code, once established. The word "ordinance"
may be changed to "section," "article," or other appropriate word or phrase necessary to
accomplish such intentions.
SECTION 6. FILING OF ORDINANCE.
In accordance with the provisions of§ 125.66,Fla. Stat.,a certified copy of this Ordinance shall
be filed with the Florida Department of State.
SECTION 7. EFFECTIVE DATE.
This Ordinance shall become effective July 1, 2021 unless the enabling legislation is not
approved by the Governor of the State of Florida.
PASSED AND 13ULY ADOPTED by the Board of County Commissioners of Collier County,
Florida,this aorday of J u,ne, ,2021.
Page 9 of 10
16.D.5.b
Packet Pg. 1260 Attachment: 1. Ordinance 2021-23 (23160 : AHCA: Local Provider Participation Fund - Direct Payment Program)
ATTEST: BOARD OF COUNTY COMMISSIONERS
CRYSTAL K KINZEL,CLERK COLLIER O Y, FLORIDA
By—:)(By:
DEPUT PENNY TAYL ,CHAIRP SON
Attest as to Chaim an's •••.
signature only.
Approved as to form
and legality:
e i r A.Bel edio 1Jna p 5PAssistantCountyAtto
I i
This ordinance flied with t1'xs:
Secr tort' of State's
day of
and acknowledgement of that
filing received ihis
day
By Deouty C erk,
Page 10 of 10
0G
16.D.5.b
Packet Pg. 1261 Attachment: 1. Ordinance 2021-23 (23160 : AHCA: Local Provider Participation Fund - Direct Payment Program)
r .
FLORIDA DEPARTMENT Of STATE
RON DESANTIS LAUREL M. LEE
Governor Secretary of State
July 1, 2021
Ms. Martha Vergara, BMR & VAB Senior Deputy Clerk
Office of the Clerk of the Circuit Court
Comptroller of Collier County
3329 Tamiami Trail E, Suite#401
Naples, Florida 34112
Dear Ms. Vergara:
Pursuant to the provisions of Section 125.66, Florida Statutes, this will acknowledge receipt of your
electronic copy of Collier County Ordinance No. 2021-23, which was filed in this office on July 1, 2021.
Sincerely,
Anya Grosenbaugh
Program Administrator
AG/lb
R. A. Gray Building • 500 South Bronough Street • Tallahassee, Florida 32399-0250
Telephone: (850) 245-6270
16.D.5.b
Packet Pg. 1262 Attachment: 1. Ordinance 2021-23 (23160 : AHCA: Local Provider Participation Fund - Direct Payment Program)
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 ("1GTs") provided consistent with federal guidelines, support additional funding for
Medicaid payments to Hospitals; and
C,gQ
1
16.D.5.c
Packet Pg. 1263 Attachment: 1. Resolution 2021-197 (23160 : AHCA: Local Provider Participation Fund - Direct Payment Program)
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
CA0
16.D.5.c
Packet Pg. 1264 Attachment: 1. Resolution 2021-197 (23160 : AHCA: Local Provider Participation Fund - Direct Payment Program)
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
3 11Q
16.D.5.c
Packet Pg. 1265 Attachment: 1. Resolution 2021-197 (23160 : AHCA: Local Provider Participation Fund - Direct Payment Program)
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.
lf,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 9Q
16.D.5.c
Packet Pg. 1266 Attachment: 1. Resolution 2021-197 (23160 : AHCA: Local Provider Participation Fund - Direct Payment Program)
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:By:
Attest as to CSairdiafillUTY CL PENNY TA OR, CHAIRPERSON
sir natu:n cr 1y,
Approved as to form and legality:
1 Y t,Crystal+..K inzel,Cleft(of Courts and for oiiier C:unty
do hearby:ertify..at the ao re i,istrurn nt is a true a...;correct
llllll
Jenni er A. Belpedio ` rd` cop of:`te,origina led'in Clier County,Flo%a
Deputy Clerk
Assistant County Attorney By: in`\\
5
70
16.D.5.c
Packet Pg. 1267 Attachment: 1. Resolution 2021-197 (23160 : AHCA: Local Provider Participation Fund - Direct Payment Program)
Local Provider
Pa rticipation
Fund
Ye ar 1 Review, Year 2 Preparation
16.D.5.d
Packet Pg. 1268 Attachment: Year 2 Presentation_Collier (23160 : AHCA: Local Provider Participation Fund - Direct
Agenda
u 2021 Directed Payment Program Summary
u 2022 Directed Payment Program Process
u 2022 Directed Payment Program Changes
u Opportunities beyond the Directed Payment Program
u 2022 County Ti meline
16.D.5.d
Packet Pg. 1269 Attachment: Year 2 Presentation_Collier (23160 : AHCA: Local Provider Participation Fund - Direct
2021 Directed Payment Program
Summary
16.D.5.d
Packet Pg. 1270 Attachment: Year 2 Presentation_Collier (23160 : AHCA: Local Provider Participation Fund - Direct
Medicaid Overview
•Medicaid is the nation’s public health insurance program for low-
income children, families, elders, and people with disabilities.
•1 in 5 Florida residents is enrolled.
•The program supports the health care system and safety-net and
increases the state’s capacity to address health challenges.
16.D.5.d
Packet Pg. 1271 Attachment: Year 2 Presentation_Collier (23160 : AHCA: Local Provider Participation Fund - Direct
Medicaid
Overview
•Medicaid is jointly funded
by the states and federal
government.
•The state contributes, and
the federal government
provides matching funds.
16.D.5.d
Packet Pg. 1272 Attachment: Year 2 Presentation_Collier (23160 : AHCA: Local Provider Participation Fund - Direct
Pr ogram Review
u Collier County’s Local Provider Participation Fund is a non-ad valorem
special assessment that allows nonpublic hospitals in the jurisdiction
to access available federal dollars.
u The assessment qualifies as a “provider tax” under federal law that is
eligible for federal match because it is:
u Broad Based
u Uniform
u Entails No Hold-Harmless Guarantee
u Does Not Exceed 6% of revenues
16.D.5.d
Packet Pg. 1273 Attachment: Year 2 Presentation_Collier (23160 : AHCA: Local Provider Participation Fund - Direct
LPPFs who funded DPP in 2021
u In 2021, 15 Florida
counties adopted Local
Pr ovider Participation
Fund ordinances and
passed resolutions levying
non-ad valorem special
assessments for the
hospital directed payment
program.
u Nonpublic hospitals in 8 of
the state’s Medicaid
Managed Care Regions
participated.
u All Public hospitals across
Florida participated.
16.D.5.d
Packet Pg. 1274 Attachment: Year 2 Presentation_Collier (23160 : AHCA: Local Provider Participation Fund - Direct
2020-21
Ti meline
Re view
16.D.5.d
Packet Pg. 1275 Attachment: Year 2 Presentation_Collier (23160 : AHCA: Local Provider Participation Fund - Direct
Flow of Funds for DPPs
u After submission of the IGTs, the Agency for Health Care
Administration applied the matching funds and distributed sums to the
managed care organizations for dispersal to hospitals across the state.
u Hospitals began receiving the added Medicaid reimbursement in
February 2022 and received all DPP Ye ar 1 funds by the end of March
2022.
16.D.5.d
Packet Pg. 1276 Attachment: Year 2 Presentation_Collier (23160 : AHCA: Local Provider Participation Fund - Direct
Florida Managed Medicaid Plans
servicing each region
1 2 3 4 5 6 7 8 9 10 11 Total
Aetna Better Health X X X 3
Community Care Plan X 1
Florida Community Care X X X X X X X X X X X 11
Humana Medical Plan X X X X X X X X X X X 11
Lighthouse Health P lan X X 2
Miami Children's X X 2
Molina Healthc are X X 2
Pres tige X X 2
Simply Healthcare X X X X X 5
Staywell X X X X X X X X X X 10
Suns hine Health X X X X X X X X X X X 11
United Healthcare X X X X 4
Vivida Health X 1
Re gion
MCO
16.D.5.d
Packet Pg. 1277 Attachment: Year 2 Presentation_Collier (23160 : AHCA: Local Provider Participation Fund - Direct
Money to Yo ur County’s
Hospitals
u Hospitals in Collier County received $12
million from this program.
u The funds received enabled your healthcare
leaders to provide care to the most
vulnerable in your community and to sustain
initiatives designed to meet medical needs.
16.D.5.d
Packet Pg. 1278 Attachment: Year 2 Presentation_Collier (23160 : AHCA: Local Provider Participation Fund - Direct
2022 Directed Payment Program
Pr ocess
16.D.5.d
Packet Pg. 1279 Attachment: Year 2 Presentation_Collier (23160 : AHCA: Local Provider Participation Fund - Direct
State Budget Authority
u In March 2022, Florida’s legislature adopted a budget with proviso
language that:
•Directs AHCA to seek federal reauthorization for the Directed
Pa yment Program
•Re quires AHCA to submit a request for state legislative authority
(via the legislative budget commission) to move funds to again
implement the program, if approved
16.D.5.d
Packet Pg. 1280 Attachment: Year 2 Presentation_Collier (23160 : AHCA: Local Provider Participation Fund - Direct
Federal Preprint Submission
u At the federal level, the Directed Payment Program reauthorization is
under review.
u The Agency for Health Care Administration submitted the preprint in
January 2022.
u In early March, CMS engaged the state with requests for additional
detail on Year 1 implementation, indicating the application is under
active consideration.
u Questions related to the resolution passage dates, the rates for each
assessment, and projections for Year 2.
16.D.5.d
Packet Pg. 1281 Attachment: Year 2 Presentation_Collier (23160 : AHCA: Local Provider Participation Fund - Direct
2022
Pr ojected
Ti meline
16.D.5.d
Packet Pg. 1282 Attachment: Year 2 Presentation_Collier (23160 : AHCA: Local Provider Participation Fund - Direct
Opportunities beyond the
Directed Payment Program
16.D.5.d
Packet Pg. 1283 Attachment: Year 2 Presentation_Collier (23160 : AHCA: Local Provider Participation Fund - Direct
Additional Opportunities
u As a federally
authorized “provider
tax,” assessments
collected by
Florida’s local
governments qualify
for federal match
for any Medicaid
supplemental
payment program
approved by the
federal government.
16.D.5.d
Packet Pg. 1284 Attachment: Year 2 Presentation_Collier (23160 : AHCA: Local Provider Participation Fund - Direct
Additional Opportunities
u Other supplemental payment programs approved for Florida’s
nonpublic Medicaid providing hospitals include:
u The Low Income Pool (LIP) –a fund designed to provide
supplemental funding to hospitals, clinics, and other entities to
improve access to health care services for the provision of
healthcare services to the uninsured and underinsured
u The Disproportionate Share Pr ogram (DSH) –a payment used to
compensate hospitals that have provided a disproportionate share
of hospital services to Medicaid and/or uninsured individuals.”
u Graduate and Indirect Graduate Medical Education Programs
(GME/IME) –payments designed to prepare the next generation of
healthcare providers in Florida
16.D.5.d
Packet Pg. 1285 Attachment: Year 2 Presentation_Collier (23160 : AHCA: Local Provider Participation Fund - Direct
Wa lton & City of Orlando
u Since 2018, the City of Orlando has levied
a special assessment against nonpublic
hospitals to provide the non-federal share
for the Low Income Pool program.
u Wa lton County enacted a similar
assessment in 2020 and used it for the Low
Income Pool and Graduate Medical
Education.
u The mechanism is the same: the local
governments collect from nonpublic
hospitals to fund the nonfederal share. As
with your current program, these
jurisdictions send the money to AHCA via
IGT.
16.D.5.d
Packet Pg. 1286 Attachment: Year 2 Presentation_Collier (23160 : AHCA: Local Provider Participation Fund - Direct
Flow of Funds –Non DPPs
Public Hospitals
(IGT Payments)
Non-Public Hospitals
Local Provider Tax*
CMS
(Federal Match)
AHCA
(State Share funded by
IGT’s and Local
Provider Tax)AHCA
Public HospitalsNon-Public HospitalsCounty
(Local Provider
Participation Fund)
Non-Directed Payments are paid
directly by the state agency to the
hospitals
16.D.5.d
Packet Pg. 1287 Attachment: Year 2 Presentation_Collier (23160 : AHCA: Local Provider Participation Fund - Direct
Future Proposal
u Yo ur county may have the opportunity to set a rate that
unlocks federal supplemental payments for programs
beyond the Medicaid Hospital Directed Payment Program.
u The County could follow the same process from 2021:
u A s ingle resolution vote
u A s ingle assessment
u All hospitals would again receive advance notice of the
proposed rate. All would have the opportunity to object.
u Nothing mandates that the County move forward with the
recommendation if any potential payer objects.
16.D.5.d
Packet Pg. 1288 Attachment: Year 2 Presentation_Collier (23160 : AHCA: Local Provider Participation Fund - Direct
2022 County Ti meline
16.D.5.d
Packet Pg. 1289 Attachment: Year 2 Presentation_Collier (23160 : AHCA: Local Provider Participation Fund - Direct
Re sources for Re solution Passage
u Like last year, the Legislative Budget Commission must
authorize the Agency for Health Care Administration to
call for IGTs. The Agency prepares the amendment in
August for September consideration.
u To facilitate passage of a 2022 resolution, the County
will once again receive:
u Draft agenda item
u Draft mail notice, with invoice
u Draft publication notice
u Draft invoices
u Draft LOA questionnaire responses
16.D.5.d
Packet Pg. 1290 Attachment: Year 2 Presentation_Collier (23160 : AHCA: Local Provider Participation Fund - Direct
Ti meline for Resolution Passage
u The deadline for mail notice and notice by publication is 20 days
before the September 27 resolution vote:
u The target date for Collier County’s assessment resolution is:
u The LOA deadline for all IGTs is:
September 7, 2022
September 27, 2022
October 1, 2022
16.D.5.d
Packet Pg. 1291 Attachment: Year 2 Presentation_Collier (23160 : AHCA: Local Provider Participation Fund - Direct
Re sults of County Efforts
u Collier County’s hospitals wish to express
gratitude for the County’s efforts to
establish a Local Provider Participation
Fund.
u This continued partnership enables their
success as care providers and community
partners.
u Last year, this assessment unlocked an
additional $1.2 billion in available federal
funds. Continuing to draw down available
resources ensures Collier County’s
hospitals will remain competitive
providers, reliable employers, and
healthcare leaders.
16.D.5.d
Packet Pg. 1292 Attachment: Year 2 Presentation_Collier (23160 : AHCA: Local Provider Participation Fund - Direct
Questions?
16.D.5.d
Packet Pg. 1293 Attachment: Year 2 Presentation_Collier (23160 : AHCA: Local Provider Participation Fund - Direct
_DPP LOA_SFY 2022-23
Directed Payment Program Letter of Agreement
THIS LETTER OF AGREEMENT (LOA) is made and entered into in duplicate on the ______
day of _______ 2022, by and between (the “IGT
Provider”) on behalf of , 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
2021-156, 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 House Bill 5001, the General Appropriations Act of State Fiscal Year 2022-
2023,passed by the 2022 Florida Legislature, the IGT Provider and the Agency agree that
the IGT Provider will remit IGT funds to the Agency in an amount not to exceed the total
of . The IGT Provider and the Agency have agreed that these IGT
funds will only be used for the DPP program.
2. The IGT Provider will return the signed LOA to the Agency.
3. The IGT Provider will pay IGT funds to the Agency in an amount not to exceed the total
of . The IGT Provider will transfer payments to the Agency in the
following manner:
a. Per Florida Statute 409.908, annual payments for the months of July 2022
through June 2023 are due to the Agency no later than October 31, 2022, unless
an alternative plan is specifically approved by the agency.
b. The Agency will bill the IGT Provider when payment is due.
4. The IGT Provider 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. IGT Provider agrees to maintain books, records, and documents (including
DocuSign Envelope ID: E3FFE20D-F565-4C4F-AC3B-A33C0D29C3C1
Region 8
Region 8
Collier County
$7,231,349.00
$7,231,349.00
Collier County
16.D.5.g
Packet Pg. 1294 Attachment: DPP _SFY_22-23_LOA (23160 : AHCA: Local Provider Participation Fund - Direct Payment Program)
_DPP LOA_SFY 2022-23
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. IGT Provider 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. IGT Provider agrees to comply with public record laws as outlined in section
119.0701, Florida Statutes.
b. RETENTION OF RECORDS
i. The IGT Provider 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. IGT Provider agrees to permit persons duly authorized by the Agency to inspect
any records, papers, and documents of the IGT Provider which are relevant to this
LOA.
d. ASSIGNMENT AND SUBCONTRACTS
i. The IGT Provider 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 IGT Provider 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. IGT Provider 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.
DocuSign Envelope ID: E3FFE20D-F565-4C4F-AC3B-A33C0D29C3C1
Collier County
Region 8
16.D.5.g
Packet Pg. 1295 Attachment: DPP _SFY_22-23_LOA (23160 : AHCA: Local Provider Participation Fund - Direct Payment Program)
_DPP LOA_SFY 2022-23
7. IGT Provider agrees the following provision shall be included in any agreements between
IGT Provider 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, 2022 through June 30, 2023 and shall be terminated
September 30, 2023, which includes the states certified forward period.
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 2022-2023
Estimated IGTs
Total Funding Not to Exceed
IN WITNESS WHEREOF, the parties have caused this page Letter of Agreement to be
executed by their undersigned officials as duly authorized.
IGT Provider STATE OF FLORIDA, AGENCY FOR
HEALTH CARE ADMINISTRATION
SIGNED
BY:
SIGNED
BY:
NAME: NAME:
TITLE: TITLE:
DATE: DATE:
DocuSign Envelope ID: E3FFE20D-F565-4C4F-AC3B-A33C0D29C3C1
Yahaira Magee
$7,231,349.00
Region 8
$7,231,349.00
Collier County
16.D.5.g
Packet Pg. 1296 Attachment: DPP _SFY_22-23_LOA (23160 : AHCA: Local Provider Participation Fund - Direct Payment Program)
16.D.5.h
Packet Pg. 1297 Attachment: legal ad - agenda ID 23160 (23160 : AHCA: Local Provider Participation Fund - Direct Payment Program)
BffuplexButlu B{rrur
PARTOf THE USATODAY NETWORK
CC HOUSINGHUMAN VETE
3299 TAMIAMI TRL E STETOO
NAPLES FL34112-
Account
1304214
Sales Rep: KTheodore
AD#
0005401 21 5
Net Amount
$602.00
Tax Amount
$0.00
Total Amount
$602.00
Payment Method
lnvoice
Pavment Amount
$0.00
OrderCreated 0910212022
Amount Due
$602.00
Order Taker: KTheodore
Product # lns Column Agate Lines Start Date End Date
NDN-Naples Daily News
N DN-na plesnews.com
2.00
2.00
172
172
0910412022
09t04t2022
091o412022
09t04t2022
- ALL TRANSACTIONS CONSIDERED PAID IN FULL UPON CLEARANCE OF FINANCIAL INSTITUTION
,|
,|
16.D.5.i
Packet Pg. 1298 Attachment: Image_001 (23160 : AHCA: Local Provider Participation Fund - Direct Payment Program)
Text ofAd: 09/02/2022
NOTICE OF HEARING REGARDING IMPOSING AND
COLLECTING A NON-AD VALOREM SPECIAL ASSESSMENT
Notice is hereby qiven that the Board of County Commissionersof (ollier County, Florida, will (onduct a publia hearinq to con-
sider the approial ot the impo3ition and tollection oI; non-ad
valorem ipecial assessment aqainst each private forprofit andnot-for-profit hospital that provides inpaiient ho5pital services
and that holds a riqht ol posse33ion and riqht of use to realproperty in the County (ea(h, an "Assessed Property"). The ai-
sessment is intended to tinance interqovehmental transfeBprovided (onsigtent with federal quidelineg that fund the non-tederal share of (ertain Medicaial and/or Medicaid managed(are payments. As a result the assessment directly and spe(ially
benetrts As3esJed Propertiei and supports the provision ofhe.lth (are iervi(es to Medicaid, indiqent, and uninsured mem-
berJ of the County's community.
The hearing will be held at Administration Building, located at
1299 Tamiami Trail Eart, Suite 301, Napler, FL 34112-5746, on
September 27. 2022, at 9 a.m., or as soon thereafter as the mat-
ter can be heard. At that time, the Board will re(eive public
comment on the proposed spe(ial assessment,
An ofli(e designated by the County has prepared the Non.Ad
Valorem A5sessment Roll being considered lor approval. The roll(ontains the names o{ the Assersed Properties and the asgers-
ment rate and amount of the 5pecial assessment to be imposedaqainn each Aqsesied Property, The Non.Ad Valorem Alsess.
ment Roll is available for inspection at the Collier County Opera-tions & Veterans Services, lo(ated at 3139 Tamiami Trail East
Suite 212, Naples, FL 34'112. The assessment rate set forth in the
Non-Ad Valorem A$ersment Roll to be levied against the netpatient revenue of each Assested Property is .59%.
At the date and l,me eet fonh in this notice. the Board o{ Coun-
ty Commissioners may: (1) approve the Non-Ad Valorem Asress-
ment Roll, with su(h amendments as it deems iust and riqht;
and (2) adopt a resolution (the 'Asressment Reaolurion") thatds(ribes (a) the Medicaid payments proposed ,or Iundinq from
proceeds of the assersment, (b) the benetfis to the Ajrersed
Propertier, (c) the methodoloqy for computing the assersed
amount5, and (d) the method ol (ollection, in(luding how and
when the assessment is to be paid.
All interested personr have e right to appear at the hearing andto file written obiedions with the Eoard prior to the resolution
vote. All obiections to the Non.Ad Valorem Aisessment Roll be-
ing considered lor approval mult be made in writing, and frledwith the County, at or before the vote. Written objedions
should be sent to the ettention of the Offi.e o{ the a$erlment
Coordinator at Collier County Operations & Veterans Servi(el,
lo(ated at 3339 Tamiami Trail East Suite 212, Naples, FL 34r 12.
The amount o{ the arses3ment is to be collected pursuant an ad-
ditional and alternative method, a5 specified in 5 197.3531, Fla.
Stat., {or the assegsment and (ollection of the non.ad valorem
special assersment. Detaik will be in(luded in the A5ressment
R€solution-
lf you are a peBon with disability who needs any ac(ommoda-
tion to parti(ipate in this pro(eedinq, you are entitled, at no
cort to you, to the provision o{ (ertain assistance. Please (ontad
Collier County Fa(ilitiee Manaqement Division at (239) 252-8380
at leatt thre€ day5 prior to the publi( hearing if you need tpe-
cial a(commodationr.
Collier County, FLORIDA
Lin of Affected Properties:
The special ai3essment is to be levied aqainrt ea(h private ,orprofrt and not-for-profit hospital operatinq under a Florida hos-pital license affrliated with the followinq providers of inpatient
hospital services that holds a riqht of poasession and riqht of ure
to real property in collier county, Florida.
Physi(ians Regional Medical center
6101 Pine Ridqe Rd
Naplei, FL 34119
Par<el#: 80570080001
Landmark Hospital ol Soulhwen Florida
l28S Creekside Blvd
N.pler, FL 34109
Par.elfi 29331180512
NCH Baker Hospital
150 7th st N
Naples, FL 34102
Parcel#:14038a8000O
The Willough at Naples
9001 TamiamiTrail East
Naples, FL 33862
Par(el#:5510O120000
Pub Date:rnbet 4, 2022; #5401215
16.D.5.i
Packet Pg. 1299 Attachment: Image_001 (23160 : AHCA: Local Provider Participation Fund - Direct Payment Program)
IGT Provider Name:
Health Care Provider Name:
IGT Amount:
State Fiscal Year Ending:
1.
County
If other, please explain
2.
No
3.
Amount
2,653,387$
4,577,962$
If other, please explain
a.
Yes
If no, please explain
4.Does your organization have taxing authority?
Yes
Intergovernmental Transfers Questionnaire
Does your organization have a relationship with the provider for which you contribute IGTs as named in
the preamble of the enclosed Letter of Agreement (LOA)?
What type of governmental entity is your organization considered? (county, city, hospital taxing district,
or other)
Source
If yes, please describe your relationship, including services provided to/by the provider to/by the
organization and any other financial transactions between the provider and the organization.
Collier County
6/30/2022
N/A
-$
Please describe the source of the IGT funding for your organization, including whether the source is
from a tax, a provider donation, or other funds. Provide the amount of funding from each source.
Verify whether the funds are public funds as defined by 42 CFR § 433.51, and exclude any federal
funds.
special assessment (CFY2022)
special assessment (CFY2021)
16.D.5.j
Packet Pg. 1300 Attachment: IGT questionnaire statewide DDP 9 19 2022 (23160 : AHCA: Local Provider Participation Fund - Direct Payment Program)
5.If the source of IGT funding is from taxes, please answer the following questions:
a.Is the tax a state, county, city, or hospital district tax?
County
If other, please explain
b.What entities are taxed?
c.What is the tax structure (i.e. property tax, percentage of revenue, assessment, etc.)?
d.What is the amount or percent of the tax?
e.
Amount
5,578,033$
100.00%
i)
Yes
If no, please explain
CFY2022 Tax Burden
Healthcare Provider Tax Burden
Is the tax broad based? A broad based tax can be defined as a tax that is imposed on at least
all health care items or services in the class or providers of such items or services furnished by
all non-Federal, non-public providers in the State, and is imposed uniformly, pursuant to 42
CFR § 433.68.
Does at least 85% of the burden of the tax revenue fall on health care providers as defined in 42
CFR §433.55? (Provide the total tax revenue and the health care provider tax burden) If so, please
answer the following questions:
special assessment
0.69% of Net Patient of Revenue
Licensed non-public hospitals in Collier County
16.D.5.j
Packet Pg. 1301 Attachment: IGT questionnaire statewide DDP 9 19 2022 (23160 : AHCA: Local Provider Participation Fund - Direct Payment Program)
ii)
Yes
If no, please explain
iii)
No
If no, please explain
iv)
Yes
If no, please explain
v)Does every tax paying entity receive a supplemental payment equal to or exceeding its tax cost?
If yes, please explain
6.
a.
No
b.
Amount
-$
-$
c.
No
Are provider voluntary payments or in-kind services received by the organization as defined in 42
CFR § 433.52?
No waiver was requested
Is the tax uniform across all entities being taxed? Based on 42 CFR § 433.68, a health care-
related tax will be considered to be imposed uniformly even if it excludes Medicaid or Medicare
payments (in whole or in part), or both; or in the case of health care-related tax based on
revenue or receipts with respect to a class of items or services, if it excludes either Medicaid or
Medicare revenue with respect to a class of items or services, or both. The exclusion of
Medicaid revenue must be applied uniformly to all providers being taxed.
Is the tax generally redistributive and a waiver of the broad-based or uniform tax requirement
was granted in accordance with 42 CFR §433.68(e)?
Does the tax program comply with the hold harmless provisions included in 42 CFR §
433.68(f)?
The county is not involved in the distribution of funds following federal match. The county is not
in position to speak to the ultimate distribution to hospitals from the managed care
organizations.
Please answer the following regarding provider funds received from the healthcare entity and/or other
health care entities.
How much of the organization’s revenue is received from provider-related donations (Provide the
total revenue and the provider-related donation amounts)?
Do individual provider donations exceed $5,000 per year or $50,000 per year for a health care
organizational entity?
Total Revenue
Provider Related Donations
16.D.5.j
Packet Pg. 1302 Attachment: IGT questionnaire statewide DDP 9 19 2022 (23160 : AHCA: Local Provider Participation Fund - Direct Payment Program)
If yes, please list the provider and payment amount.
Funding Source Amount
-$
-$
-$
d.
e.
7.
No
If yes, provide the board minutes and date of the appropriation.
I certify that the statements and information contained
in this submittal are true, accurate, and complete.
Signature of Officer or Administrator
Title
Date
No
Were funds utilized for the IGT specifically appropriated by the organization's board?
Does any portion of the provider donation constitute as a “bona fide donation” pursuant to 42 CFR
§ 433.54? 42 CFR § 433.54 requires donations will not be returned to the individual provider, the
provider class, or related entity under a hold harmless provision.
Is there an agreement between the IGT provider and the health care entity? If so, please specify
whether the agreement is written and provide the details.
Provider Name
16.D.5.j
Packet Pg. 1303 Attachment: IGT questionnaire statewide DDP 9 19 2022 (23160 : AHCA: Local Provider Participation Fund - Direct Payment Program)