Agenda 09/27/2022 Item #16D12 (Provide additional health care services to the low-income citizens of Collier County)09/27/2022
EXECUTIVE SUMMARY
Recommendation to approve a Low Income Pool (LIP) Letter of Agreement with the Agency for
Health Care Administration (ACHA), in the amount of $396,376.99 and a companion agreement
with Collier Health Services, Inc., (CHSI) to participate in the Medicaid Low Income Pool
Program, generating $595,805.72 in federal matching funds that will provide additional health
services for the citizens of Collier County; to authorize the County Manager or designee to sign and
execute the AHCA LIP Letter of Agreement; and to authorize the Chairman to execute the
companion agreement with CHSI.
OBJECTIVE: To provide additional health care services to the low-income citizens of Collier County.
CONSIDERATIONS: The Agency for Health Care Administration (AHCA) is a State entity that
provides Medicaid services in Florida and operates the Medicaid Low Income Pool (LIP) Program. The
LIP Program leverages local funds to obtain federal matching dollars. The County's participation in the
LIP Program is outlined in the attached LIP Letter of Agreement between Collier County and AHCA.
AHCA requested that the County execute the LIP Letter of Agreement using DocuSign; therefore, staff is
requesting that the Board authorizes the County Manager or designee to execute the agreement.
Collier Health Services, Inc. (CHSI) desires and is qualified to administer the LIP Program with AHCA
using County ad valorem tax dollars. The allocation of County and matching funds is as follows:
Collier County LIP IGT Federal Matching Funds Provided
to CHSI as Program Administrator
Total Funds Benefiting Low-
Income Persons
$396,376.99 $595,805.72 $992,182.71
CHSI will utilize the total funds under the LIP Program to provide additional healthcare services for low -
income individuals in Collier County. A companion agreement that outlines the contractual arrangement
between Collier County and CHSI is presented as part of this agenda item. These funds may only be
allocated to those Federally Qualified Health Centers (FQHC).
CHSI will make payments in an amount not to exceed $250,000 for eligible medical services authorized
by County staff.
FISCAL IMPACT: Funding in the amount of $396,376.99 is available within Community & Human
Services (CHS) FY23 Community Mental Health & LIP Support Cost Center (001-156010) for the
County’s contribution payment to the State of Florida Agency for Healthcare Administration by October
31, 2022.
GROWTH MANAGEMENT IMPACT: There is no Growth Management impact associated with this
action.
LEGAL CONSIDERATIONS: This item has been approved as to form and legality, and requires a
majority vote for Board approval. -DDP
RECOMMENDATION: To approve a Low Income Pool (LIP) Letter of Agreement with the Agency for
Health Care Administration (ACHA), in the amount of $396,376.99 and a companion agreement with
Collier Health Services, Inc., (CHSI) to participate in the Medicaid Low Income Pool Program,
generating $595,805.72 in federal matching funds that will provide additional health services for the
citizens of Collier County; to authorize the County Manager or designee to sign and execute the AHCA
16.D.12
Packet Pg. 1474
09/27/2022
LIP Letter of Agreement; and to authorize the Chairman to execute the companion agreement with CHSI.
Prepared By: Yahaira Magee, Management & Budget Analyst, Operations and Veteran Services Division
ATTACHMENT(S)
1. IGT_Provider_Questionnaire FY23 (XLSX)
2. Low Income Pool Agreement (PDF)
3. SFY2022-23_LIP_Model (PDF)
4. [1745398] CHSI Agreement FY23 - DDP Cert (PDF)
16.D.12
Packet Pg. 1475
09/27/2022
COLLIER COUNTY
Board of County Commissioners
Item Number: 16.D.12
Doc ID: 23428
Item Summary: Recommendation to approve a Low Income Pool (LIP) Letter of Agreement with
the Agency for Health Care Administration (ACHA), in the amount of $396,376.99 and a companion
agreement with Collier Health Services, Inc., (CHSI) to participate in the Medicaid Low Income Pool
Program, generating $595,805.72 in federal matching funds that will provide additional health services
for the citizens of Collier County; to authorize the County Manager or designee to sign and execute the
AHCA LIP Letter of Agreement; and to authorize the Chairman to execute the companion agreement
with CHSI.
Meeting Date: 09/27/2022
Prepared by:
Title: – Operations & Veteran Services
Name: Jeff Newman
09/19/2022 4:20 PM
Submitted by:
Title: – Operations & Veteran Services
Name: Jeff Newman
09/19/2022 4:20 PM
Approved By:
Review:
Operations & Veteran Services Jeff Newman Additional Reviewer Completed 09/20/2022 2:53 PM
Growth Management Operations Support Yahaira Magee Additional Reviewer Completed 09/20/2022 2:53 PM
Public Services Department Todd Henry PSD Level 1 Reviewer Completed 09/20/2022 2:59 PM
Public Services Department Tanya Williams PSD Department Head Review Completed 09/20/2022 3:01 PM
County Attorney's Office Derek D. Perry Level 2 Attorney Review Completed 09/20/2022 3:04 PM
Office of Management and Budget Debra Windsor Level 3 OMB Gatekeeper Review Completed 09/20/2022 3:13 PM
County Attorney's Office Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Completed 09/20/2022 3:31 PM
Community & Human Services Maggie Lopez Additional Reviewer Completed 09/21/2022 9:18 AM
Office of Management and Budget Christopher Johnson Additional Reviewer Completed 09/21/2022 12:11 PM
County Manager's Office Dan Rodriguez Level 4 County Manager Review Completed 09/21/2022 2:56 PM
Board of County Commissioners Geoffrey Willig Meeting Pending 09/27/2022 9:00 AM
16.D.12
Packet Pg. 1476
IGT Provider Name:
Health Care Provider Name:
IGT Amount:
State Fiscal Year Ending:
1.
County
If other, please explain
2.
Yes
3.
Amount
396,377$
-$
-$
If other, please explain
a.
Yes
If no, please explain
4.Does your organization have taxing authority?
Yes
The County provides IGT to Heathcare Network of Southwest Florida.
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.
General Fund Ad Valorem Tax
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
6/30/2023
Collier County Services Inc., d/b/a Healthcare Network of SW
396,376.99$
16.D.12.a
Packet Pg. 1477 Attachment: IGT_Provider_Questionnaire FY23 (23428 : LIP Collier Health Services)
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
-$
-$
0.00%
i)
If no, please explain
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:
Ad valorem/property tax
3.5645 per $1000 value.
Property owners located within Collier County.
Total Tax Burden
Healthcare Provider Tax Burden
Is the tax broad based? A broad based tax can be defined as a tax that is imposed on at least
all health care items or services in the class or providers of such items or services furnished by
all non-Federal, non-public providers in the State, and is imposed uniformly, pursuant to 42
CFR § 433.68.
16.D.12.a
Packet Pg. 1478 Attachment: IGT_Provider_Questionnaire FY23 (23428 : LIP Collier Health Services)
ii)
No
If no, please explain
iii)
No
If no, please explain
iv)
No
If no, please explain
v)Does every tax paying entity receive a supplemental payment equal to or exceeding its tax cost?
If yes, please explain
6.
a.
No
b.
Amount
-$
-$
c.
No
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 $50,000 per year for a health care
organizational entity?
Total Revenue
Provider Related Donations
Are provider voluntary payments or in-kind services received by the organization as defined in 42
CFR § 433.52?
Is the tax uniform across all entities being taxed? Based on 42 CFR § 433.68, a health care-
related tax will be considered to be imposed uniformly even if it excludes Medicaid or Medicare
payments (in whole or in part), or both; or in the case of health care-related tax based on
revenue or receipts with respect to a class of items or services, if it excludes either Medicaid or
Medicare revenue with respect to a class of items or services, or both. The exclusion of
Medicaid revenue must be applied uniformly to all providers being taxed.
Is the tax generally redistributive and a waiver of the broad-based or uniform tax requirement
was granted in accordance with 42 CFR §433.68(e)?
Does the tax program comply with the hold harmless provisions included in 42 CFR §
433.68(f)?
Please answer the following regarding provider funds received from the healthcare entity and/or other
health care entities.
16.D.12.a
Packet Pg. 1479 Attachment: IGT_Provider_Questionnaire FY23 (23428 : LIP Collier Health Services)
If yes, please list the provider and payment amount.
Funding Source Amount
-$
-$
-$
d.
No
e.
7.
Yes
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
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
Jeffrey Newman
Yes - written
Were funds utilized for the IGT specifically appropriated by the organization's board?
16.D.12.a
Packet Pg. 1480 Attachment: IGT_Provider_Questionnaire FY23 (23428 : LIP Collier Health Services)
_LIP LOA SFY 2022-23
Low Income Pool 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
“Charity care” or “uncompensated charity care” means that portion of hospital charges reported
to the Agency for which there is no compensation, other than restricted or unrestricted revenues
provided to a hospital by local governments or tax districts regardless of the method of payment.
Uncompensated care includes charity care for the uninsured but does not include
uncompensated care for insured individuals, bad debt, or Medicaid and Children’s Health
Insurance Program (CHIP) shortfall. The state and providers that are participating in Low
Income Pool (LIP) will provide assurance that LIP claims include only costs associated with
uncompensated care that is furnished through a charity care program and that adheres to the
principles of the Healthcare Financial Management Association (HFMA) operated by the
provider.
“Intergovernmental Transfers (IGTs)” means transfers of funds from a non-Medicaid
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.
“Low Income Pool (LIP)” means providing government support for safety-net providers for the
costs of uncompensated charity care for low-income individuals who are uninsured.
Uncompensated care includes charity care for the uninsured but does not include
uncompensated care for insured individuals, “bad debt,” or Medicaid and CHIP shortfall.
“Medicaid” means the medical assistance program authorized by Title XIX of the Social Security
Act, 42 U.S.C. §§ 1396 et seq., and regulations thereunder, as administered in Florida by the
Agency.
A. GENERAL PROVISIONS
1. Per House Bill 5001, the General Appropriations Act of State Fiscal Year 2022-23,
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
if the entire State Fiscal Year (SFY) 22-23 distribution is paid using the
enhanced Federal Medical Assistance Percentage (FMAP) per the Families First
Coronavirus Response Act or if a portion of the SFY22-23
distribution is paid after the expiration of the end of the enhanced FMAP.
a. The IGT Provider and the Agency have agreed that these IGT funds will only be
used to increase the provision of health services for the charity care of the IGT
Provider and the State of Florida at large.
b. The increased provision of charity care health services will be accomplished
through the following Medicaid programs:
i. LIP payments to hospitals, federally qualified health centers, Medical
School Physician Practices, community behavioral health providers, and
DocuSign Envelope ID: 40837122-D5CA-4432-9EAD-C68F9B01D971
$396,376.99
$396,376.99
Healthcare Network of SW Florida (Collier)
Healthcare Network of SW Florida (Collier)
Collier County BoCC
Collier County BoCC
16.D.12.b
Packet Pg. 1481 Attachment: Low Income Pool Agreement (23428 : LIP Collier Health Services)
_LIP LOA SFY 2022-23
rural health centers pursuant to the approved Centers for Medicare &
Medicaid Services Special Terms and Conditions.
2. The IGT Provider will return the signed LOA to the Agency no later than October 1,
2022.
3. The IGT Provider will pay IGT funds to the Agency in an amount not to exceed the total
of if the entire SFY22-23 distribution is paid prior to the end
of the public health emergency or if a portion of the SFY22-23
distribution is paid after the end of the public health emergency.
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.
a. Audits and Records
i. The IGT Provider agrees to maintain books, records, and documents
(including electronic storage media) pertinent to performance under this L
O A in accordance with generally accepted accounting procedures and
practices, which sufficiently and properly reflect all revenues and
expenditures of funds provided.
ii. The 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. The 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.
DocuSign Envelope ID: 40837122-D5CA-4432-9EAD-C68F9B01D971
Collier County BoCC
$396,376.99
Healthcare Network of SW Florida (Collier)
$396,376.99
16.D.12.b
Packet Pg. 1482 Attachment: Low Income Pool Agreement (23428 : LIP Collier Health Services)
_LIP LOA SFY 2022-23
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. The 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. The 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 charity care supplemental payments in order
to satisfy non-Medicaid, non-uninsured, and non-underinsured activities.
7. The IGT Provider agrees the following provision shall be included in any agreements
between the 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 (including LIP or DSH) 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.
DocuSign Envelope ID: 40837122-D5CA-4432-9EAD-C68F9B01D971
Healthcare Network of SW Florida (Collier)
Collier County BoCC
16.D.12.b
Packet Pg. 1483 Attachment: Low Income Pool Agreement (23428 : LIP Collier Health Services)
_LIP LOA SFY 2022-23
LIP Local Intergovernmental Transfers (IGTs)
Program / Amount State Fiscal Year 2022-2023
Estimated IGTs
Total Funding Not to Exceed
WITNESSETH:
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: 40837122-D5CA-4432-9EAD-C68F9B01D971
Yahaira Magee
$396,376.99
Healthcare Network of SW Florida (Collier)
Collier County BoCC
$396,376.99
16.D.12.b
Packet Pg. 1484 Attachment: Low Income Pool Agreement (23428 : LIP Collier Health Services)
Self-Funded Tiers Model
$1,424,324,282 Total
0.6005 FMAP
0.3995 SMAP
$855,306,728 Federal
$0 State GR
$569,017,554 Local
Tier 1 - FQHCs/RHCs
Tier 1 - Central Receiving Systems
Tier Payments:
Group 1 - Self-Funded Model
Tier 1 - paid 8.5% of charity care cost
Tier 2 - paid 100% of charity care cost
Tier 3 - paid 100% of charity care cost
Tier 4 - paid 8.5% of charity care cost
Tier 5 - paid 1% of charity care cost
Group 2
Tier 1 - paid 100% of charity care cost
Group 3
Tier 1 - paid 26.94% of charity care cost
Group 4
Tier 1 - paid 100% of charity care cost
SFY 2022-23 LIP Model Summary
Model includes the following assumptions:
Tier 1 - Medical Schools
Group 1 - Hospitals
Group 2 - Medical School Physician Practices
LIP Program pays providers based on their charity care cost. Hospitals are ranked from high to low based on their percentage of charity care
costs to commercial costs as well as statutory designations and ownership status. Providers are divided into tiers based on the level of charity
care cost to commercial costs and are paid a prescribed percentage of their charity care cost.
Tier 2 - All Public Hospitals, All Children's Hospitals, RPICC Hospitals, Statutory Teaching Hospitals with UC ratio greater than or equal to 6.5%,
and Private Hospitals with UC ratio greater than or equal to 51.5%.
Tier 3 - High UCC Statutory Teaching Hospitals w/UCC greater than 6.5% & not in a tiers above
Tier 5 - All remaining hospitals with minimum 1% Medicaid utlization
Tier 1 - Private Hospitals with a Uncompensated Care (UC) ratio greater than or equal to 17% and less than 51.5%
Hospital charity care costs are calculated using 2020 Healthcare Provider Cost Reporting Information System data from worksheet S-10
(Hospital Uncompensated and Indigent Care).
Per the Special Terms and Conditions (STCs), hospitals are required to have at least 1% Medicaid utilization to be eligible for LIP.
Tier 4 - Low UCC Statutory Teaching Hospitals, w/UCC 6.5% or less
Group 4 - Behavioral Health Providers
Group 3 - Federally Qualified Health Centers (FQHCs)/Rural Health Clinics (RHCs)
1 of 6
Agency for Health Care Administration
Bureau of Medicaid Program Finance
9/18/2022
16.D.12.c
Packet Pg. 1485 Attachment: SFY2022-23_LIP_Model (23428 : LIP Collier Health Services)
101826 010182600 AdventHealth Fish Memorial 7,186,722$ 3,710 8.30% 19.85% 1 8.50% 610,871$ -$ -$ -$ 610,871$ 8.50%
101028 010102800 AdventHealth Tampa 21,772,218$ 19,060 15.44% 21.52% 1 8.50% 1,850,639$ 925,320$ -$ 925,320$ 925,319$ 4.25%
101494 010149400 AdventHealth Zephyrhills 6,425,569$ 4,541 12.31% 20.39% 1 8.50% 546,173$ -$ -$ -$ 546,173$ 8.50%
101231 010123100 Baptist Medical Center - Nassau 3,412,155$ 1,034 9.60% 17.27% 1 8.50% 290,033$ -$ -$ -$ 290,033$ 8.50%
120413 012041300 Bartow Regional Medical Center 4,796,401$ 1,486 11.90% 33.46% 1 8.50% 407,694$ -$ -$ -$ 407,694$ 8.50%
109592 010959200 Bayfront Health Dade City 3,835,306$ 1,358 11.83% 22.42% 1 8.50% 326,001$ -$ -$ -$ 326,001$ 8.50%
100099 010009900 Cape Canaveral Hospital 8,720,061$ 4,004 16.41% 17.29% 1 8.50% 741,205$ -$ -$ -$ 741,205$ 8.50%
101184 010118400 Cleveland Clinic Martin North Hospital 23,188,154$ 8,998 8.71% 20.06% 1 8.50% 1,970,993$ -$ -$ -$ 1,970,993$ 8.50%
101206 000100024 Fishermen's Hospital 934,205$ 1 4.17% 21.82% 1 8.50% 79,407$ -$ -$ -$ 79,407$ 8.50%
100081 010008100 Holmes Regional Medical Center 30,873,013$ 19,326 15.03% 22.88% 1 8.50% 2,624,206$ -$ -$ -$ 2,624,206$ 8.50%
102261 010226100 Homestead Hospital 21,113,451$ 6,722 18.14% 43.01% 1 8.50% 1,794,643$ -$ -$ -$ 1,794,643$ 8.50%
101044 010104400 Indian River Medical Center 10,599,675$ 5,973 10.14% 22.79% 1 8.50% 900,972$ -$ -$ -$ 900,972$ 8.50%
101737 010173700 Jay Hospital 740,554$ 112 5.57% 37.18% 1 8.50% 62,947$ -$ -$ -$ 62,947$ 8.50%
101664 010166400 Lake Wales Medical Center 4,011,121$ 2,445 10.40% 24.71% 1 8.50% 340,945$ -$ -$ -$ 340,945$ 8.50%
101079 010107900 Leesburg Regional Medical Center 5,397,790$ 6,509 9.84% 22.43% 1 8.50% 458,812$ 229,406$ -$ 229,406$ 229,406$ 4.25%
101168 010116800 Manatee Memorial Hospital 21,699,942$ 14,227 16.75% 28.72% 1 8.50% 1,844,495$ 922,248$ -$ 922,248$ 922,247$ 4.25%
101214 010121400 Mariners Hospital 3,246,794$ 62 4.16% 20.61% 1 8.50% 275,977$ -$ -$ -$ 275,977$ 8.50%
101541 010154100 Mease Dunedin Hospital 5,524,676$ 6,318 23.12% 20.95% 1 8.50% 469,597$ -$ -$ -$ 469,597$ 8.50%
101583 010158300 Morton Plant Hospital 29,463,971$ 14,928 13.08% 17.67% 1 8.50% 2,504,438$ -$ -$ -$ 2,504,438$ 8.50%
101508 010150800 Morton Plant North Bay Hospital 13,707,599$ 11,619 18.98% 47.95% 1 8.50% 1,165,146$ -$ -$ -$ 1,165,146$ 8.50%
32975 003297500 Palm Bay Hospital 9,727,482$ 3,542 14.35% 27.18% 1 8.50% 826,836$ -$ -$ -$ 826,836$ 8.50%
103233 010323300 Sacred Heart Hospital on the Emerald Coast 6,788,864$ 2,358 15.99% 23.41% 1 8.50% 577,053$ -$ -$ -$ 577,053$ 8.50%
20127 002012700 Sacred Heart Hospital on the Gulf 1,882,890$ 138 11.01% 42.63% 1 8.50% 160,046$ -$ -$ -$ 160,046$ 8.50%
100986 010098600 South Florida Baptist Hospital 7,871,137$ 3,410 14.19% 30.87% 1 8.50% 669,047$ -$ -$ -$ 669,047$ 8.50%
101087 010108700 South Lake Hospital 11,511,672$ 4,599 9.84% 18.64% 1 8.50% 978,492$ -$ -$ -$ 978,492$ 8.50%
120227 012022700 St. Anthony's Hospital 22,629,871$ 13,790 14.84% 23.59% 1 8.50% 1,923,539$ -$ -$ -$ 1,923,539$ 8.50%
103179 010317900 Uf Health The Villages 2,562,172$ 2,328 3.87% 17.31% 1 8.50% 217,785$ -$ -$ -$ 217,785$ 8.50%
101699 010169900 Winter Haven Hospital 17,637,736$ 16,133 17.78% 32.00% 1 8.50% 1,499,208$ -$ -$ -$ 1,499,208$ 8.50%
Tier 1: High Utilization Private Hospitals 307,261,201$ 178,731 26,117,200$ 2,076,974$ -$ 2,076,974$ 24,040,226$
10,177,873$ 8,100,899$ 10,177,873$
100064 010006400 Bay Medical Center Sacred Heart Health System 8,615,142$ 4,029 12.62% 55.66% 2 100.00% 8,615,142$ -$ -$ -$ 8,615,142$ 100.00%
101567 010156700 Bayfront Health - St Petersburg 23,972,322$ 11,434 20.52% 17.34% 2 100.00% 23,972,322$ -$ -$ -$ 23,972,322$ 100.00%
118079 011807900 Brandon Regional Hospital 28,961,691$ 22,289 21.88% 8.68% 2 100.00% 28,961,691$ -$ -$ -$ 28,961,691$ 100.00%
120405 012040500 Broward Health Coral Springs 7,089,638$ 9,822 22.85% 3.27% 2 100.00% 7,089,638$ 3,330,257$ 152,537$ 3,482,794$ 3,606,844$ 50.87%
108219 010821900 Broward Health Imperial Point 7,362,585$ 6,323 17.22% 4.36% 2 100.00% 7,362,585$ 3,458,470$ 158,409$ 3,616,879$ 3,745,706$ 50.87%
100129 010012900 Broward Health Medical Center 26,929,214$ 46,908 34.14% 10.36% 2 100.00% 26,929,214$ 12,649,618$ 579,393$ 13,229,011$ 13,700,203$ 50.87%
100218 010021800 Broward Health North 16,652,533$ 11,251 17.47% 6.19% 2 100.00% 16,652,533$ 7,822,292$ 358,286$ 8,180,578$ 8,471,955$ 50.87%
119717 011971700 Cape Coral Hospital 12,185,278$ 6,587 9.15% 21.25% 2 100.00% 12,185,278$ 5,723,863$ 262,171$ 5,986,034$ 6,199,244$ 50.87%
101923 010192300 Desoto Memorial Hospital 3,049,468$ 403 10.58%37.91%2 100.00%3,049,468$ -$ -$ -$ 3,049,468$ 100.00%
101036 010103600 Doctors Memorial Hospital 238,204$ 155 9.30% 9.43% 2 100.00% 238,204$ -$ -$ -$ 238,204$ 100.00%
100048 010004800 Ed Fraser Memorial Hospital 2,084,162$ 30 3.03% 32.35% 2 100.00% 2,084,162$ -$ -$ -$ 2,084,162$ 100.00%
100803 010080300 George E. Weems Memorial Hospital 684,887$ 28 9.40% 29.61% 2 100.00% 684,887$ -$ -$ -$ 684,887$ 100.00%
111341 011134100 Gulf Coast Medical Center Lee Memorial Health System 15,707,545$ 7,239 6.87% 17.58% 2 100.00% 15,707,545$ 7,378,398$ 337,954$ 7,716,352$ 7,991,193$ 50.87%
120324 012032400 H. Lee Moffitt Cancer Center & Research Institute Hospital 27,734,966$ 4,189 7.04% 6.95% 2 100.00% 27,734,966$ 6,310,602$ -$ 6,310,602$ 21,424,364$ 77.25%
101842 010184200 Halifax Health Medical Center 33,629,638$ 25,255 18.74% 21.87% 2 100.00% 33,629,638$ 15,797,047$ 723,556$ 16,520,603$ 17,109,035$ 50.87%
100862 010086200 Hendry Regional Medical Center 1,442,590$ 295 11.63% 10.81% 2 100.00% 1,442,590$ -$ -$ -$ 1,442,590$ 100.00%
101061 010106100 Jackson Hospital 1,927,671$ 1,724 13.77% 11.95% 2 100.00% 1,927,671$ -$ -$ -$ 1,927,671$ 100.00%
100421 010042100 Jackson Memorial Hospital 217,472,054$ 146,254 34.26% 18.11% 2 100.00% 217,472,054$ 102,154,427$ 4,679,001$ 106,833,428$ 110,638,626$ 50.87%
101516 010151600 Johns Hopkins All Children's Hospital 5,711,463$ 40,431 71.11% 3.21% 2 100.00% 5,711,463$ -$ -$ -$ 5,711,463$ 100.00%
108227 010822700 Lake Butler Hospital 829,592$ 14 31.82% 110.21% 2 100.00% 829,592$ -$ -$ -$ 829,592$ 100.00%
101443 010144300 Lakeside Medical Center 412,828$ 1,172 17.35% 15.50% 2 100.00% 412,828$ -$ -$ -$ 412,828$ 100.00%
120057 012005700 Larkin Community Hospital 2,307,176$ 6,949 24.96% 24.24% 2 100.00% 2,307,176$ -$ -$ -$ 2,307,176$ 100.00%
119741 011974100 Largo Medical Center 19,344,181$ 11,922 12.47% 7.00% 2 100.00% 19,344,181$ -$ -$ -$ 19,344,181$ 100.00%
101109 010110900 Lee Memorial Hospital 39,654,318$ 47,391 23.73% 17.58% 2 100.00% 39,654,318$ 18,627,056$ 853,179$ 19,480,235$ 20,174,083$ 50.87%
103454 010345400 Memorial Hospital Miramar 8,023,590$ 6,704 22.60% 6.81% 2 100.00% 8,023,590$ 3,768,968$ 172,631$ 3,941,599$ 4,081,991$ 50.87%
102229 010222900 Memorial Hospital Pembroke 16,978,002$ 4,604 14.81% 26.30% 2 100.00% 16,978,002$ 7,975,176$ 365,289$ 8,340,465$ 8,637,537$ 50.87%
102521 010252100 Memorial Hospital West 23,846,705$ 13,985 13.90% 11.16% 2 100.00% 23,846,705$ 11,201,653$ 513,072$ 11,714,725$ 12,131,980$ 50.87%
100200 010020000 Memorial Regional Hospital 69,548,642$ 59,460 26.11% 19.35% 2 100.00% 69,548,642$ 32,669,492$ 1,496,368$ 34,165,860$ 35,382,782$ 50.87%
40876 004087600 Nemours Children's Hospital 1,404,512$ 17,913 74.69% 2.16% 2 100.00% 1,404,512$ -$ -$ -$ 1,404,512$ 100.00%
100609 010060900 Nicklaus Children's Hospital 469,131$ 35,170 62.01% 0.28% 2 100.00% 469,131$ -$ -$ -$ 469,131$ 100.00%
SFY 2022-23
PROJECTED NET PAYMENTS FOR LIP
Self-Funded Tiers Model
% of Net
Payment to
Charity Care Cost
% Gross
Charity
Payment
Total LIP Payment Total LIP IGTs
Provided
Net (Total LIP
Payment - LIP IGTs) Medicaid ID Provider Charity Care Cost
Ratio of Charity
Care Costs to
Commercial
Costs
Medicaid ID Tier
Additional LIP
IGTs Provided for
1% Minimum, Tier
1, and Tier 4
LIP IGTs
Provided to
Fund Tier
Medicaid Days Medicaid
Utilization
2 of 6
Agency for Health Care Administration
Medicaid Program Finance
August 24, 2021
16.D.12.c
Packet Pg. 1486 Attachment: SFY2022-23_LIP_Model (23428 : LIP Collier Health Services)
SFY 2022-23
PROJECTED NET PAYMENTS FOR LIP
Self-Funded Tiers Model
% of Net
Payment to
Charity Care Cost
% Gross
Charity
Payment
Total LIP Payment Total LIP IGTs
Provided
Net (Total LIP
Payment - LIP IGTs) Medicaid ID Provider Charity Care Cost
Ratio of Charity
Care Costs to
Commercial
Costs
Medicaid ID Tier
Additional LIP
IGTs Provided for
1% Minimum, Tier
1, and Tier 4
LIP IGTs
Provided to
Fund Tier
Medicaid Days Medicaid
Utilization
100102 010010200 Parrish Medical Center 4,963,256$ 3,319 13.20% 15.84% 2 100.00% 4,963,256$ 2,331,419$ 106,787$ 2,438,206$ 2,525,050$ 50.87%
101761 010176100 Sarasota Memorial Hospital 14,402,023$ 30,553 15.06% 8.40% 2 100.00% 14,402,023$ 6,765,147$ 309,865$ 7,075,012$ 7,327,011$ 50.87%
100765 010076500 Sacred Heart Hospital 30,083,589$ 33,088 27.87% 15.90% 2 100.00% 30,083,589$ 14,131,341$ 647,261$ 14,778,602$ 15,304,987$ 50.87%
101486 010148600 St. Mary's Medical Center 15,685,386$ 41,480 40.62% 2.54% 2 100.00% 15,685,386$ -$ -$ -$ 15,685,386$ 100.00%
100994 010099400 Tampa General Hospital 80,310,454$ 71,163 26.31% 20.03% 2 100.00% 80,310,454$ 37,724,701$ 1,727,913$ 39,452,614$ 40,857,840$ 50.87%
100030 010003000 UF Health Shands Hospital 57,054,154$ 82,044 26.97% 14.83% 2 100.00% 57,054,154$ 26,800,383$ 1,227,544$ 28,027,927$ 29,026,227$ 50.87%
100676 010067600 UF Health Jacksonville 59,823,998$ 48,066 31.86% 46.68% 2 100.00% 59,823,998$ 28,101,478$ 1,287,138$ 29,388,616$ 30,435,382$ 50.87%
10064106 023960157 Wolfson Children's Hospital 1,321,779$ - 54.47% 1.37% 2 100.00% 1,321,779$ -$ -$ -$ 1,321,779$ 100.00%
879,299,225$ 855,614$ 887,914,367$ 354,721,790$ 15,958,352$ 370,680,142$ 517,234,225$
39.95% 13,024,965$
101290 010129000 AdventHealth Orlando 125,438,306$ 127,253 18.31% 14.23% 3 100.00% 125,438,306$ 62,454,788$ -$ 62,454,788$ 62,983,518$ 50.21%
120375 012037500 Aventura Hospital and Medical Center 22,630,817$ 14,395 14.29% 13.52% 3 100.00% 22,630,817$ -$ -$ 22,630,817$ 100.00%
100463 010046300 Mount Sinai Medical Center 19,754,521$ 13,584 11.24% 15.12% 3 100.00% 19,754,521$ -$ -$ 19,754,521$ 100.00%
101338 010133800 Orlando Health 109,237,427$ 109,537 25.39% 15.41% 3 100.00% 109,237,427$ 54,388,493$ -$ 54,388,493$ 54,848,934$ 50.21%
119881 011988100 Regional Medical Center Bayonet Point 15,412,723$ 9,390 12.24% 10.67% 3 100.00% 15,412,723$ -$ -$ -$ 15,412,723$ 100.00%
292,473,794$ 274,159$ 292,473,794$ 116,843,281$ -$ 116,843,281$ 175,630,513$
113,977,038$ 113,977,038$ 116,843,281$
102202 010220200 Cleveland Clinic Hospital 2,884,318$ 2,397 3.70% 2.60% 4 8.50% 245,167$ -$ -$ -$ 245,167$ 8.50%
120138 012013800 Kendall Regional Medical Center 27,364,679$ 22,833 20.31% 2.60% 4 8.50% 2,325,998$ -$ -$ -$ 2,325,998$ 8.50%
100536 010053600 Larkin Community Hospital Palm Springs Campus 130,656$ 2,265 8.10% 1.88% 4 8.50% 11,106$ -$ -$ -$ 11,106$ 8.50%
100722 010072200 Mayo Clinic 2,399,090$ 1,991 2.36% 1.72% 4 8.50% 203,923$ -$ -$ -$ 203,923$ 8.50%
108626 010862600 North Florida Regional Medical Center 21,297,630$ 20,022 15.61% 1.10% 4 8.50% 1,810,299$ -$ -$ -$ 1,810,299$ 8.50%
120073 012007300 Oak Hill Hospital 9,324,703$ 9,464 11.61% 6.21% 4 8.50% 792,600$ -$ -$ -$ 792,600$ 8.50%
109886 010988600 Ocala Regional Medical Center 28,181,996$ 13,302 10.15% 2.97% 4 8.50% 2,395,470$ -$ -$ -$ 2,395,470$ 8.50%
101389 010138900 Osceola Regional Medical Center 32,403,047$ 20,609 18.00% 2.35% 4 8.50% 2,754,259$ -$ -$ -$ 2,754,259$ 8.50%
100471 010047100 University of Miami Hospital and Clinics 6,395,001$ 15,364 14.59% 0.88% 4 8.50% 543,575$ 271,788$ -$ 271,788$ 271,787$ 4.25%
Tier 4: Low Utilization Statutory Teaching Hospitals 2,449,954,836$ 2,356,359$ 11,082,397$ 271,788$ -$ 271,788$ 10,810,609$
705,393$ 0.03% 680,320$ (408,532)$ (136,744)$
100943 010094300 AdventHealth Carrollwood 6,376,763$ 2,549 9.62% 11.42% 5 1.00% 63,768$ 25,507$ -$ 25,507$ 38,261$ 0.60%
101877 010187700 AdventHealth DeLand 7,210,846$ 5,194 16.68% 16.27% 5 1.00% 72,108$ -$ -$ -$ 72,108$ 1.00%
102288 010228800 Adventhealth Heart Of Florida Regional Medical Center 5,048,373$ 3,986 12.95% 5.12% 5 1.00% 50,484$ -$ -$ -$ 50,484$ 1.00%
101869 010186900 Adventhealth Memorial Medical Center//Advent Health Daytona 9,292,097$ 9,552 10.45% 5.46% 5 1.00% 92,921$ -$ -$ -$ 92,921$ 1.00%
101834 010183400 Adventhealth New Smyrna 4,518,290$ 1,676 7.64% 8.85% 5 1.00% 45,183$ 18,073$ -$ 18,073$ 27,110$ 0.60%
101613 010161300 AdventHealth North Pinellas 4,632,035$ 3,503 14.87% 7.41% 5 1.00% 46,320$ -$ -$ -$ 46,320$ 1.00%
101176 010117600 Adventhealth Ocala 13,471,793$ 13,807 16.85% 12.44% 5 1.00% 134,718$ -$ -$ -$ 134,718$ 1.00%
101893 010189300 Adventhealth Palm Coast 5,855,633$ 2,463 6.78% 10.19% 5 1.00% 58,556$ -$ -$ -$ 58,556$ 1.00%
100901 010090100 Adventhealth Sebring 5,505,154$ 7,082 14.20% 7.03% 5 1.00% 55,052$ -$ -$ -$ 55,052$ 1.00%
101095 010109500 AdventHealth Waterman 10,037,064$ 8,582 14.02% 8.62% 5 1.00% 100,371$ 40,148$ -$ 40,148$ 60,223$ 0.60%
54568 005456800 Adventhealth Wesley Chapel 5,143,903$ 2,201 8.02% 2.99% 5 1.00% 51,439$ -$ -$ -$ 51,439$ 1.00%
100731 010073100 Ascension St Vincent'S Riverside 15,523,625$ 10,781 11.64% 7.42% 5 1.00% 155,236$ -$ -$ -$ 155,236$ 1.00%
97013 009701300 Ascension St. Vincent'S Clay County 5,883,367$ 2,672 10.69% 10.53% 5 1.00% 58,834$ -$ -$ -$ 58,834$ 1.00%
103730 010373000 Ascension St Vincent'S Southside 8,112,078$ 3,591 11.57% 1.24% 5 1.00% 81,121$ -$ -$ -$ 81,121$ 1.00%
100749 010074900 Baptist Hospital Inc 13,065,131$ 16,197 17.72% 5.64% 5 1.00% 130,651$ -$ -$ -$ 130,651$ 1.00%
100358 010035800 Baptist Hospital Of Miami 29,124,405$ 22,229 12.21% 7.29% 5 1.00% 291,244$ -$ -$ -$ 291,244$ 1.00%
102326 010232600 Baptist Medical Center - Beaches 7,175,734$ 2,330 7.94% 16.16% 5 1.00% 71,757$ -$ -$ -$ 71,757$ 1.00%
100641 010064100 Baptist Medical Center Jacksonville 50,341,605$ 23,313 11.85% 13.49% 5 1.00% 503,416$ -$ -$ -$ 503,416$ 1.00%
100871 010087100 Bayfront Health Brooksville 8,373,009$ 6,141 15.60% 2.55% 5 1.00% 83,730$ -$ -$ -$ 83,730$ 1.00%
100285 010028500 Bayfront Health Port Charlotte 5,738,826$ 5,844 11.94% 10.85% 5 1.00% 57,388$ -$ -$ -$ 57,388$ 1.00%
100277 010027700 Bayfront Health Punta Gorda 3,753,636$ 3,356 10.32% 1.98% 5 1.00% 37,536$ -$ -$ -$ 37,536$ 1.00%
119989 011998900 Bayfront Health Seven Rivers 3,624,370$ 2,683 10.19% 3.91% 5 1.00% 36,244$ -$ -$ -$ 36,244$ 1.00%
101401 010140100 Bethesda Hospital East 14,028,284$ 20,178 21.91% 6.41% 5 1.00% 140,283$ 56,113$ -$ 56,113$ 84,170$ 0.60%
110213 011021300 Blake Medical Center 18,376,092$ 7,911 10.10% 10.90% 5 1.00% 183,761$ -$ -$ -$ 183,761$ 1.00%
101419 000100168 Boca Raton Regional Hospital 1,306,950$ 2,621 3.32% 0.47% 5 1.00% 13,070$ -$ -$ -$ 13,070$ 1.00%
100269 010026900 Calhoun Liberty Hospital 74,229$ 95 10.17% 1.24% 5 1.00% 742$ -$ -$ -$ 742$ 1.00%
119806 011980600 Capital Regional Medical Center 16,693,396$ 12,439 17.90% 0.38% 5 1.00% 166,934$ -$ -$ -$ 166,934$ 1.00%
101788 010178800 Central Florida Regional Hospital 16,465,008$ 8,007 15.61% 3.62% 5 1.00% 164,650$ -$ -$ -$ 164,650$ 1.00%
102199 010219900 Citrus Memorial Hospital 7,211,442$ 4,777 10.01% 7.23% 5 1.00% 72,114$ -$ -$ -$ 72,114$ 1.00%
109606 010960600 Coral Gables Hospital 4,916,676$ 3,340 11.09% 5.97% 5 1.00% 49,167$ -$ -$ -$ 49,167$ 1.00%
120090 012009000 Delray Medical Center 8,412,039$ 11,000 9.59% 2.70% 5 1.00% 84,120$ -$ -$ -$ 84,120$ 1.00%
103543 010354300 Doctors Hospital 3,214,815$ 1,181 4.49% 4.52% 5 1.00% 32,148$ -$ -$ -$ 32,148$ 1.00%
119954 011995400 Doctors Hospital Of Sarasota 5,516,325$ 1,684 5.25% 2.07% 5 1.00% 55,163$ -$ -$ -$ 55,163$ 1.00%
Tier 2: All Publics, All Children's, All RPICCs, High Utilization Teaching Hospitals, and High Utilization Private Hospitals
Tier 3: High Utilization Statutory Teaching Hospitals
3 of 6
Agency for Health Care Administration
Medicaid Program Finance
August 24, 2021
16.D.12.c
Packet Pg. 1487 Attachment: SFY2022-23_LIP_Model (23428 : LIP Collier Health Services)
SFY 2022-23
PROJECTED NET PAYMENTS FOR LIP
Self-Funded Tiers Model
% of Net
Payment to
Charity Care Cost
% Gross
Charity
Payment
Total LIP Payment Total LIP IGTs
Provided
Net (Total LIP
Payment - LIP IGTs) Medicaid ID Provider Charity Care Cost
Ratio of Charity
Care Costs to
Commercial
Costs
Medicaid ID Tier
Additional LIP
IGTs Provided for
1% Minimum, Tier
1, and Tier 4
LIP IGTs
Provided to
Fund Tier
Medicaid Days Medicaid
Utilization
101800 010180000 Doctors' Memorial Hospital 260,593$ 138 9.01% 4.64% 5 1.00% 2,606$ -$ -$ -$ 2,606$ 1.00%
102539 010253900 Englewood Community Hospital 2,121,953$ 657 5.25% 2.04% 5 1.00% 21,220$ -$ -$ -$ 21,220$ 1.00%
117463 011746300 Fawcett Memorial Hospital 4,214,735$ 4,057 7.44% 3.42% 5 1.00% 42,147$ -$ -$ -$ 42,147$ 1.00%
101711 010171100 Flagler Hospital 8,034,892$ 8,817 12.41% 9.40% 5 1.00% 80,349$ 32,140$ -$ 32,140$ 48,209$ 0.60%
111325 011132500 Fort Walton Beach Medical Center 17,435,880$ 11,982 15.07% 0.97% 5 1.00% 174,359$ -$ -$ -$ 174,359$ 1.00%
101524 010152400 Good Samaritan Medical Center 9,865,971$ 7,310 15.89% 5.77% 5 1.00% 98,660$ 39,464$ -$ 39,464$ 59,196$ 0.60%
117617 011761700 Gulf Coast Regional Medical Center 14,675,416$ 14,553 23.66% 2.51% 5 1.00% 146,754$ -$ -$ -$ 146,754$ 1.00%
101885 010188500 Healthmark Regional Medical Center 160,131$ 190 13.60% 8.68% 5 1.00% 1,601$ -$ -$ -$ 1,601$ 1.00%
100412 010041200 Hialeah Hospital 7,369,810$ 11,483 23.20% 6.28% 5 1.00% 73,698$ -$ -$ -$ 73,698$ 1.00%
100897 010089700 Highlands Regional Medical Center 2,506,417$ 1,214 9.02% 7.13% 5 1.00% 25,064$ -$ -$ -$ 25,064$ 1.00%
100188 010018800 Holy Cross Hospital 6,229,087$ 6,088 8.30% 5.42% 5 1.00% 62,291$ -$ -$ -$ 62,291$ 1.00%
101460 010146000 JFK Medical Center 38,489,824$ 32,477 20.15% 4.66% 5 1.00% 384,898$ 153,959$ -$ 153,959$ 230,939$ 0.60%
120294 000100253 Jupiter Medical Center 1,840,717$ 2,036 4.02% 2.82% 5 1.00% 18,407$ -$ -$ -$ 18,407$ 1.00%
119768 011976800 Lake City Medical Center 5,620,399$ 2,237 8.21% 2.44% 5 1.00% 56,204$ -$ -$ -$ 56,204$ 1.00%
101796 011976800 Lake City Medical Center Suwannee Campus 5,620,399$ 61 7.24% 2.37% 5 1.00% 56,204$ -$ -$ -$ 56,204$ 1.00%
101648 010164800 Lakeland Regional Medical Center 49,886,020$ 34,007 14.06% 11.08% 5 1.00% 498,860$ -$ -$ -$ 498,860$ 1.00%
103420 010342000 Lakewood Ranch Medical Center 2,912,310$ 1,146 4.65% 4.07% 5 1.00% 29,123$ -$ -$ -$ 29,123$ 1.00%
119695 011969500 Lawnwood Regional Medical Center & Heart Institute 27,876,733$ 27,320 24.94% 1.35% 5 1.00% 278,767$ -$ -$ -$ 278,767$ 1.00%
101117 010111700 Lehigh Regional Medical Center 434,988$ 1,649 15.40% 4.01% 5 1.00% 4,350$ -$ -$ -$ 4,350$ 1.00%
101192 010119200 Lower Keys Medical Center 5,387,756$ - 12.91% 3.75% 5 1.00% 53,878$ -$ -$ -$ 53,878$ 1.00%
101150 010115000 Madison County Memorial Hospital 173,093$ 139 1.83% 6.38% 5 1.00% 1,731$ -$ -$ -$ 1,731$ 1.00%
120081 012008100 Mease Countryside Hospital 5,524,676$ 6,462 9.99% 10.62% 5 1.00% 55,247$ -$ -$ -$ 55,247$ 1.00%
105520 010552000 Medical Center Of Trinity 14,185,065$ 12,010 18.31% 7.71% 5 1.00% 141,851$ -$ -$ -$ 141,851$ 1.00%
101931 010193100 Memorial Hospital Jacksonville 29,401,548$ 20,817 19.01% 6.28% 5 1.00% 294,015$ -$ -$ -$ 294,015$ 1.00%
112798 011279800 Memorial Hospital Of Tampa 10,338,877$ 7,693 18.08% 8.44% 5 1.00% 103,389$ -$ -$ -$ 103,389$ 1.00%
100315 010031500 Naples Community Hospital 10,524,992$ 14,665 10.84% 16.70% 5 1.00% 105,250$ -$ -$ -$ 105,250$ 1.00%
115193 011519300 Northside Hospital 13,372,920$ 4,647 9.89% 13.24% 5 1.00% 133,729$ -$ -$ -$ 133,729$ 1.00%
100072 010007200 North Florida Regional Medical Center Starke Campus 1,392,290$ 100 10.64% 1.78% 5 1.00% 13,923$ -$ -$ -$ 13,923$ 1.00%
101265 010126500 North Okaloosa Medical Center 3,051,105$ 2,597 13.16% 6.24% 5 1.00% 30,511$ -$ -$ -$ 30,511$ 1.00%
100498 010049800 North Shore Medical Center 23,832,223$ 32,142 26.71% 12.53% 5 1.00% 238,322$ -$ -$ -$ 238,322$ 1.00%
101907 010190700 Northwest Florida Community Hospital 100,955$ 223 3.63% 0.83% 5 1.00% 1,010$ -$ -$ -$ 1,010$ 1.00%
104591 010459100 Northwest Medical Center 10,921,617$ 10,878 18.92% 2.04% 5 1.00% 109,216$ -$ -$ -$ 109,216$ 1.00%
111741 011174100 Orange Park Medical Center 28,704,205$ 20,135 19.83% 2.23% 5 1.00% 287,042$ -$ -$ -$ 287,042$ 1.00%
101354 010135400 Orlando Health - Health Central 15,625,932$ 7,914 14.13% 9.92% 5 1.00% 156,259$ -$ -$ -$ 156,259$ 1.00%
210941 021094100 Oviedo Medical Center 6,649,011$ - 11.10% 0.85% 5 1.00% 66,490$ -$ -$ -$ 66,490$ 1.00%
102105 010210500 Palm Beach Gardens Medical Center 5,433,129$ 3,798 8.15% 5.11% 5 1.00% 54,331$ 21,732$ -$ 21,732$ 32,599$ 0.60%
104604 010460400 Palmetto General Hospital 14,648,885$ 15,432 20.69% 5.85% 5 1.00% 146,489$ -$ -$ -$ 146,489$ 1.00%
120111 012011100 Palms Of Pasadena Hospital 4,245,921$ 2,168 8.53% 5.50% 5 1.00% 42,459$ -$ -$ -$ 42,459$ 1.00%
120260 012026000 Palms West Hospital 7,567,522$ 13,234 26.59% 2.92% 5 1.00% 75,675$ 30,270$ -$ 30,270$ 45,405$ 0.60%
103144 010314400 Physicians Regional Medical Center - Pine Ridge 8,244,049$ 3,614 5.83% 1.77% 5 1.00% 82,440$ -$ -$ -$ 82,440$ 1.00%
120006 012000600 Plantation General Hospital 26,019,590$ 29,670 24.55% 5.42% 5 1.00% 260,196$ -$ -$ -$ 260,196$ 1.00%
92683 009268300 Poinciana Medical Center 6,737,378$ 2,209 12.77% 2.82% 5 1.00% 67,374$ -$ -$ -$ 67,374$ 1.00%
113514 011351400 Putnam Community Medical Center 6,202,263$ 2,350 11.37% 5.87% 5 1.00% 62,023$ -$ -$ -$ 62,023$ 1.00%
119750 011975000 Raulerson Hospital 4,001,151$ 1,361 8.92% 8.57% 5 1.00% 40,012$ -$ -$ -$ 40,012$ 1.00%
100111 010011100 Rockledge Regional Medical Center 5,191,464$ 5,344 12.65% 1.29% 5 1.00% 51,915$ -$ -$ -$ 51,915$ 1.00%
101745 010174500 Santa Rosa Medical Center 3,734,082$ 1,888 11.49% 4.34% 5 1.00% 37,341$ -$ -$ -$ 37,341$ 1.00%
100331 010033100 Shands Lake Shore Regional Medical Center 385,319$ 1,418 31.41% 0.93% 5 1.00% 3,853$ -$ -$ -$ 3,853$ 1.00%
119946 011994600 South Bay Hospital 3,633,460$ 1,184 4.83% 13.99% 5 1.00% 36,335$ -$ -$ -$ 36,335$ 1.00%
100587 010058700 South Miami Hospital 10,641,362$ 15,229 22.00% 5.64% 5 1.00% 106,414$ -$ -$ -$ 106,414$ 1.00%
103462 010346200 St Cloud Regional Medical Center 3,928,882$ 827 9.90% 1.09% 5 1.00% 39,289$ -$ -$ -$ 39,289$ 1.00%
100978 010097800 St. Joseph's Hospital 51,301,088$ 53,658 22.59% 14.93% 5 1.00% 513,011$ -$ -$ -$ 513,011$ 1.00%
119971 011997100 St Lucie Medical Center 10,659,951$ 5,623 11.16% 0.79% 5 1.00% 106,600$ -$ -$ -$ 106,600$ 1.00%
120103 012010300 St Petersburg General Hospital 8,316,798$ 3,682 15.60% 8.64% 5 1.00% 83,168$ -$ -$ -$ 83,168$ 1.00%
101133 010113300 Tallahassee Memorial Hospital 21,768,098$ 25,092 19.29% 6.74% 5 1.00% 217,681$ -$ -$ -$ 217,681$ 1.00%
101257 010125700 Twin Cities Hospital 2,428,420$ 660 7.50% 1.59% 5 1.00% 24,284$ -$ -$ -$ 24,284$ 1.00%
112801 011280100 University Hospital And Medical Center 9,603,847$ 7,362 14.58% 7.30% 5 1.00% 96,038$ -$ -$ -$ 96,038$ 1.00%
119733 010007000 Venice Regional Bayfront Health 3,296,112$ 1,598 4.34% 0.97% 5 1.00% 32,961$ -$ -$ -$ 32,961$ 1.00%
31588 003158800 Viera Hospital 2,976,595$ 849 4.87% 5.23% 5 1.00% 29,766$ -$ -$ -$ 29,766$ 1.00%
102130 010213000 Wellington Regional Medical Center 7,849,003$ 9,606 16.63% 2.64% 5 1.00% 78,490$ 31,396$ -$ 31,396$ 47,094$ 0.60%
120243 012024300 West Boca Medical Center 6,147,284$ 5,595 16.57% 1.19% 5 1.00% 61,473$ 24,589$ -$ 24,589$ 36,884$ 0.60%
113212 011321200 West Florida Hospital 16,827,196$ 12,794 14.14% 0.67% 5 1.00% 168,272$ -$ -$ -$ 168,272$ 1.00%
4 of 6
Agency for Health Care Administration
Medicaid Program Finance
August 24, 2021
16.D.12.c
Packet Pg. 1488 Attachment: SFY2022-23_LIP_Model (23428 : LIP Collier Health Services)
SFY 2022-23
PROJECTED NET PAYMENTS FOR LIP
Self-Funded Tiers Model
% of Net
Payment to
Charity Care Cost
% Gross
Charity
Payment
Total LIP Payment Total LIP IGTs
Provided
Net (Total LIP
Payment - LIP IGTs) Medicaid ID Provider Charity Care Cost
Ratio of Charity
Care Costs to
Commercial
Costs
Medicaid ID Tier
Additional LIP
IGTs Provided for
1% Minimum, Tier
1, and Tier 4
LIP IGTs
Provided to
Fund Tier
Medicaid Days Medicaid
Utilization
32265 003226500 West Kendall Baptist Hospital 9,309,903$ 4,421 12.28% 11.44% 5 1.00% 93,099$ -$ -$ -$ 93,099$ 1.00%
100625 010062500 Westchester General Hospital 600,689$ 3,256 13.10% 16.42% 5 1.00% 6,007$ -$ -$ -$ 6,007$ 1.00%
112305 011230500 Westside Regional Medical Center 10,577,694$ 5,499 9.12% 3.17% 5 1.00% 105,777$ -$ -$ -$ 105,777$ 1.00%
981,042,668$ 780,230 9,810,427$ 473,391$ -$ 473,391$ 9,337,036$
(473,391)$ -$
4,910,031,724$ 4,445,093$ 1,227,398,185$ 474,387,224$ 15,958,352$ 490,345,576$ 737,052,609$
7,627,508$
005527800 005527800 Florida International University 1,500,000$ 1 100.00% 1,500,000$ 599,250$ -$ 599,250$ 900,750$ 60.05%
276305209 276305209 Florida State University 145,000$ 1 100.00% 145,000$ 57,928$ -$ 57,928$ 87,072$ 60.05%
53386600 053386600 University of Florida Gainesville 19,053,884$ 1 100.00%19,053,884$ 7,612,027$ -$ 7,612,027$ 11,441,857$ 60.05%
373978300 373978300 University of Florida Jacksonville 25,391,805$ 1 100.00% 25,391,805$ 10,144,026$ -$ 10,144,026$ 15,247,779$ 60.05%
273179700 273179700 University of Miami 43,000,000$ 1 100.00% 43,000,000$ 17,178,500$ -$ 17,178,500$ 25,821,500$ 60.05%
53079400 053079400 University of South Florida 8,737,390$ 1 100.00% 8,737,390$ 3,490,587$ -$ 3,490,587$ 5,246,803$ 60.05%
97,828,079$ 97,828,079$ 39,082,318$ -$ 39,082,318$ 58,745,761$
17234400 017234400 Agape Community Health Center 1,427,013$ 1 26.94% 384,488$ 153,603$ -$ 153,603$ 230,885$ 16.18%
29543400 029543400 Aza Health 3,529,660$ 1 26.94% 951,015$ 379,931$ -$ 379,931$ 571,085$ 16.18%
13881900 013881900 Banyan Community Health Care 4,337,983$ 1 26.94% 1,168,806$ 466,938$ -$ 466,938$ 701,868$ 16.18%
60551400 060551400 Bond Community Health Center 1,083,179$ 1 26.94% 291,847$ 116,593$ -$ 116,593$ 175,254$ 16.18%
29554000 029554000 Borinquen Health Care Center 10,865,516$ 1 26.94% 2,927,554$ 1,169,558$ -$ 1,169,558$ 1,757,996$ 16.18%
688693100 688693100 Brevard Health Alliance 9,888,562$ 1 26.94% 2,664,328$ 1,064,399$ -$ 1,064,399$ 1,599,929$ 16.18%
680027100 680027100 Broward Community & Family Health Centers 2,930,609$ 1 26.94% 789,610$ 315,449$ -$ 315,449$ 474,161$ 16.18%
8037100 008037100 C.L. Brumback Primary Care Clinics 10,628,515$ 1 26.94% 2,863,698$ 1,144,047$ -$ 1,144,047$ 1,719,651$ 16.18%
680002500 680002500 Camillus Health Concern 5,646,926$ 1 26.94% 1,521,482$ 607,832$ -$ 607,832$ 913,650$ 16.18%
3407900 003407900 Care Resource Community Health Centers 11,209,370$ 1 26.94% 3,020,201$ 1,206,570$ -$ 1,206,570$ 1,813,630$ 16.18%
10930500 010930500 Center for Family and Child Enrichment 1,804,062$ 1 26.94% 486,078$ 194,188$ -$ 194,188$ 291,890$ 16.18%
25148200 025148200 CenterPlace Health 4,247,274$ 1 26.94% 1,144,366$ 457,174$ -$ 457,174$ 687,192$ 16.18%
29549300 029549300 Central Florida Health Care, Inc 8,249,931$ 1 26.94% 2,222,823$ 888,018$ -$ 888,018$ 1,334,805$ 16.18%
688571300 688571300 Citrus Health Network 7,147,945$ 1 26.94% 1,925,909$ 769,401$ -$ 769,401$ 1,156,508$ 16.18%
29565500 029565500 Community Health Centers of Pinellas 11,743,100$ 1 26.94% 3,164,007$ 1,264,021$ -$ 1,264,021$ 1,899,986$ 16.18%
29545100 029545100 Community Health Centers, Inc. 6,010,472$ 1 26.94% 1,619,434$ 646,964$ -$ 646,964$ 972,470$ 16.18%
692990700 692990700 Community Health Northwest Florida 20,057,516$ 1 26.94% 5,404,204$ 2,158,980$ -$ 2,158,980$ 3,245,225$ 16.18%
29572800 029572800 Community Health of South Florida 896,480$ 1 26.94% 241,541$ 96,497$ -$ 96,497$ 145,045$ 16.18%
10739700 010739700 Empower-U 8,284,872$ 1 26.94% 2,232,237$ 891,779$ -$ 891,779$ 1,340,459$ 16.18%
29570100 029570100 Family Health Centers of Southwest Florida 7,468,994$ 1 26.94% 2,012,411$ 803,958$ -$ 803,958$ 1,208,453$ 16.18%
687955100 687955100 Family Health Source 1,761,268$ 1 26.94% 474,548$ 189,582$ -$ 189,582$ 284,966$ 16.18%
684660200 684660200 Florida Community Health Centers, Inc. 6,713,745$ 1 26.94% 1,808,920$ 722,664$ -$ 722,664$ 1,086,257$ 16.18%
1182600 001182600 FoundCare 6,237,220$ 1 26.94% 1,680,528$ 671,371$ -$ 671,371$ 1,009,157$ 16.18%
6608600 006608600 Genesis Community Health 1,338,711$ 1 26.94% 360,696$ 144,098$ -$ 144,098$ 216,598$ 16.18%
29152800 029152800 Healthcare Network of Southwest Florida 3,682,452$ 1 26.94% 992,183$ 396,377$ -$ 396,377$ 595,806$ 16.18%
1718300 001718300 Heart of Florida Health Center 4,288,843$ 1 26.94% 1,155,566$ 461,649$ -$ 461,649$ 693,917$ 16.18%
29540000 029540000 Jessie Trice Community Health System 11,212,797$ 1 26.94% 3,021,124$ 1,206,939$ -$ 1,206,939$ 1,814,185$ 16.18%
29547700 029547700 Langley Health Services 2,944,965$ 1 26.94% 793,478$ 316,994$ -$ 316,994$ 476,483$ 16.18%
14789100 014789100 Lee Community Healthcare 1,723,390$ 1 26.94% 464,342$ 185,505$ -$ 185,505$ 278,837$ 16.18%
29561200 029561200 MCR Health 13,666,355$ 1 26.94% 3,682,199$ 1,471,039$ -$ 1,471,039$ 2,211,161$ 16.18%
29544200 029544200 Miami Beach Community Health Center 12,448,047$ 1 26.94% 3,353,944$ 1,339,901$ -$ 1,339,901$ 2,014,044$ 16.18%
262263700 262263700 Neighborhood Medical Center 1,700,653$ 1 26.94% 458,216$ 183,057$ -$ 183,057$ 275,159$ 16.18%
27973100 027973100 New River Community Health Center 611,006$ 1 26.94% 164,627$ 65,768$ -$ 65,768$ 98,858$ 16.18%
60075002 060075002 North Broward Hospital District 2,335,226$ 1 26.94% 629,192$ 251,362$ -$ 251,362$ 377,830$ 16.18%
29568000 029568000 North Florida Medical Centers 2,214,611$ 1 26.94% 596,695$ 238,379$ -$ 238,379$ 358,315$ 16.18%
687429100 687429100 Orange Blossom Family Health 4,385,363$ 1 26.94% 1,181,572$ 472,038$ -$ 472,038$ 709,534$ 16.18%
20530900 020530900 Osceola Community Health Services 1,896,423$ 1 26.94% 510,964$ 204,130$ -$ 204,130$ 306,834$ 16.18%
29506000 029506000 Palms Medical Group 6,676,561$ 1 26.94% 1,798,902$ 718,661$ -$ 718,661$ 1,080,240$ 16.18%
689693600 689693600 PanCare Health 4,885,137$ 1 26.94% 1,316,229$ 525,833$ -$ 525,833$ 790,395$ 16.18%
688412100 688412100 Pinellas Health and Human Services 2,141,712$ 1 26.94% 577,053$ 230,533$ -$ 230,533$ 346,520$ 16.18%
29550700 029550700 Premier Community HealthCare Group 5,453,730$ 1 26.94% 1,469,428$ 587,036$ -$ 587,036$ 882,391$ 16.18%
6558500 006558500 Rural Health Network of Monroe County 222,800$ 1 26.94% 60,030$ 23,982$ -$ 23,982$ 36,048$ 16.18%
686032000 686032000 Sulzbacher Center 2,298,916$ 1 26.94% 619,409$ 247,454$ -$ 247,454$ 371,955$ 16.18%
29557400 029557400 Suncoast Community Health Centers 12,427,690$ 1 26.94% 3,348,459$ 1,337,709$ -$ 1,337,709$ 2,010,750$ 16.18%
29548500 029548500 Tampa Family Health Centers 14,875,758$ 1 26.94% 4,008,055$ 1,601,218$ -$ 1,601,218$ 2,406,837$ 16.18%
680005000 680005000 Treasure Coast Community Health 4,216,442$ 1 26.94% 1,136,059$ 453,855$ -$ 453,855$ 682,203$ 16.18%
Totals Group 2 - Medical Schools Physician Practices
Totals Group 1 - Hospitals
Tier 5: Low Utilization Private Hospitals
5 of 6
Agency for Health Care Administration
Medicaid Program Finance
August 24, 2021
16.D.12.c
Packet Pg. 1489 Attachment: SFY2022-23_LIP_Model (23428 : LIP Collier Health Services)
SFY 2022-23
PROJECTED NET PAYMENTS FOR LIP
Self-Funded Tiers Model
% of Net
Payment to
Charity Care Cost
% Gross
Charity
Payment
Total LIP Payment Total LIP IGTs
Provided
Net (Total LIP
Payment - LIP IGTs) Medicaid ID Provider Charity Care Cost
Ratio of Charity
Care Costs to
Commercial
Costs
Medicaid ID Tier
Additional LIP
IGTs Provided for
1% Minimum, Tier
1, and Tier 4
LIP IGTs
Provided to
Fund Tier
Medicaid Days Medicaid
Utilization
29551500 029551500 True Health 6,867,140$ 1 26.94% 1,850,251$ 739,175$ -$ 739,175$ 1,111,075$ 16.18%
27976500 027976500 Walton Community Health Center 845,455$ 1 26.94% 227,795$ 91,004$ -$ 91,004$ 136,791$ 16.18%
22558502 022558502 Whole Family Health Center 829,497$ 1 26.94% 223,496$ 89,287$ -$ 89,287$ 134,209$ 16.18%
278,359,890$ 74,999,998$ 29,962,500$ -$ 29,962,500$ 45,037,498$
016911900 Apalachee Center 825,540$ 1 100.00% 825,540$ 329,803$ -$ 329,803$ 495,737$ 60.05%
011030400 Aspire Health Partners 5,334,109$ 1 100.00% 5,334,109$ 2,130,977$ -$ 2,130,977$ 3,203,132$ 60.05%
060291400 Circles of Care, Inc. 3,272,000$ 1 100.00% 3,272,000$ 1,307,164$ -$ 1,307,164$ 1,964,836$ 60.05%
060280905 Centerstone of Florida 737,514$ 1 100.00% 737,514$ 294,637$ -$ 294,637$ 442,877$ 60.05%
060272800 Gracepoint 1,960,166$ 1 100.00% 1,960,166$ 783,086$ -$ 783,086$ 1,177,080$ 60.05%
060338400 Henderson Behavioral Health 275,502$ 1 100.00% 275,502$ 110,063$ -$ 110,063$ 165,439$ 60.05%
016556800 Lifestream Behavioral Health 1,822,645$ 1 100.00% 1,822,645$ 728,147$ -$ 728,147$ 1,094,498$ 60.05%
017645900 Park Place Behavioral 467,059$ 1 100.00% 467,059$ 186,590$ -$ 186,590$ 280,469$ 60.05%
060293113 Mental Health Resource Center 4,440,623$ 1 100.00% 4,440,623$ 1,774,029$ -$ 1,774,029$ 2,666,594$ 60.05%
017706400 SMA Behavioral 786,030$ 1 100.00% 786,030$ 314,019$ -$ 314,019$ 472,011$ 60.05%
Citrus Behavioral Health 957,046$ 1 100.00%957,046$ 382,340$ -$ 382,340$ 574,706$ 60.05%
Cove - DACCO Behavioral Health 255,329$ 1 100.00%255,329$ 102,004$ -$ 102,004$ 153,325$ 60.05%
Tri County Behavioral Health 2,152,893$ 1 100.00%2,152,893$ 860,081$ -$ 860,081$ 1,292,812$ 60.05%
Peace River Behavioral Health 811,564$ 1 100.00%811,564$ 324,220$ -$ 324,220$ 487,344$ 60.05%
24,098,020$ 24,098,020$ 9,627,160$ -$ 9,627,160$ 14,470,860$
5,310,317,713$ 1,424,324,282$ 553,059,202$ 15,958,352$ 569,017,554$ 855,306,728$
569,017,551$ 555,059,173$ 39.95%
1,424,324,289.61$ (3)$
9,170,325$
Tier 1 (8,356,847)$
Estimated payments may vary based on providers meeting all LIP participation requirements and IGT availability. The proposed payments may be adjusted and disbursed to eligible providers up to 100% of charity care costs.
For Group 1 Hospitals, of the $15,958,352 in additional IGTs from Tier 2, $3,445,875 is used to fund a minimum of 1% base payment, $4,155,630 to fund Tier 4, and the remaining $8,356,847 is used for additional funding for Tier 1.
LIP IGT projections are based on historical IGT amounts.
Grand Totals
Totals Group 4 - Behavioral Health Providers
Totals Group 3 - FQHCs/RHCs
6 of 6
Agency for Health Care Administration
Medicaid Program Finance
August 24, 2021
16.D.12.c
Packet Pg. 1490 Attachment: SFY2022-23_LIP_Model (23428 : LIP Collier Health Services)
[22-SOC-00954/1745398/1] Page 1 of 6
AGREEMENT
THIS AGREEMENT is made and entered on the 27th day of September 2022, by and
between Collier County, Florida, a political subdivision of the State of Florida, hereinafter referred
to as "the County", and Collier Health Services, Inc., d/b/a Healthcare Network of Southwest
Florida, a Florida not for profit incorporated under the laws of the State of Florida, and a Federal
Health Qualified Center, hereinafter referred to as "Center".
RECITALS:
WHEREAS, Section 125.01(1)(e), Florida Statutes, authorizes the County to provide
health welfare programs for the residents of Collier County to the extent not inconsistent with
general or special law.
WHEREAS, the establishment and maintenance of such programs are in the common
interest of the people of Collier County.
WHEREAS, The County desires the Center to become a community health partner to assist
in providing payments for health prevention programs, and mental health services to residents of
the County.
WHEREAS, The Center desires to be a community health partner and is willing to
voluntarily provide payments for such services, subject to the terms and conditions hereinafter set
forth.
NOW THEREFORE, in consideration of the covenants herein contained, the parties hereby
agree as follows:
ARTICLE I
SERVICES TO BE PERFORMED
1. The Center shall provide documentation and monthly reports to the County related to
payment for the delivery of hospital services, designated primary health care services,
specialty health care services and other health care services.
2. The Center and/or its sub-contractor shall provide timely responses to contract
requirements. Responses to inquiries from the Public Services Department or designee
regarding any aspect of payment of services being provided shall be as indicated below.
a. Emergency room, secondary and tertiary care for those patients determined eligible by
the County Human Services Division.
b. Secondary and tertiary services shall be provided upon the referring physician or
designated physician's order. The referral order shall distinguish between a referral for
specific therapeutic services and a diagnostic workup.
3. Nothing in this contract shall be construed to limit access for a patient to any service
provided by a Health Services provider that is medically necessary and approved by the
County.
CAO
16.D.12.d
Packet Pg. 1491 Attachment: [1745398] CHSI Agreement FY23 - DDP Cert (23428 : LIP Collier Health Services)
[22-SOC-00954/1745398/1] Page 2 of 6
ARTICLE II
PAYMENTS
The County shall make intergovernmental transfers, on behalf of Collier Health Services in
connection with the LIP program to the State of Florida, hereinafter referred to as "State", in
accordance with the Letter of Agreement between the County and the Agency for Health Care
Administration.
1. The county will remit to the State an amount not to exceed a grand total of $396,376.99.
The County will transfer payments to the State in the following manner:
a. The payments for the months July 2022 - June 2023 are due by October 31, 2023, to
the State.
2. Center will make payments in an amount not to exceed $250,000 for eligible medical
services authorized by County staff. Back up documentation will be provided for services.
3. The following document is hereby incorporated by reference as Attachment A to this
Agreement.
a. Low Income Pool Agreement (LIP) with State of Florida AHCA reflecting the
anticipated annual distributions for State Fiscal Year 2022-2023 (Attachment A).
ARTICLE Ill
CLAIMS VALUATION AND CLAIMS PROCESSING
1. As the claims processing entity, the Center will provide quarterly financial reports to the
County in such detail as required by the County.
2. Prompt payment of invoices as presented to the Center should be made within 30 business
days of receipt from the County.
3. Copies of all checks issued are to be sent to the County for record keeping.
ARTICLE IV
TERMS OF AGREEMENT AND TERMINATION
1. The term of this Agreement shall be October 1, 2022 through September 30, 2023 with no
renewal, or to the date upon which all funds under the agreement are disbursed by the
Center, in accordance with Article VIII.
2. Either party may terminate this Agreement thirty (30) calendar days after receipt by the
other party of written notice of intent to terminate. In the event of termination, the County
shall pay for services rendered, prorated to the date of termination.
3. Upon breach of this Agreement, the aggrieved party may, by written notice of breach to
the breaching party, terminate the whole or any part of this Agreement. Termination shall
be upon no less than twenty-four (24) hours’ notice, in writing, delivered by certified mail,
CAO
16.D.12.d
Packet Pg. 1492 Attachment: [1745398] CHSI Agreement FY23 - DDP Cert (23428 : LIP Collier Health Services)
[22-SOC-00954/1745398/1] Page 3 of 6
telegram or in person. Waiver by either party of breach of any provisions of this Agreement
shall not be deemed to be a waiver of any other or subsequent breach and shall not be
construed to be a modification of the terms of this Agreement.
4. It is further agreed that in the event general funds to finance all or part of this Agreement
do not become available, the obligations of each party hereunder may be terminated upon
no less than twenty-four (24) hours’ notice in writing to the other party. Said notice shall
be delivered by certified mail, telegram or in person. The County shall be the final authority
as to the availability of funds and as to how any available funds will be allocated among
its various service providers.
ARTICLE V
ASSIGNMENT
The Center and/or its sub-contractor shall not assign or transfer this Agreement, or any interest,
right or duty herein, without the prior written consent of the County, which consent shall not be
unreasonably withheld by the County. Without obtaining prior consent by the County, the Center
shall be allowed to assign or transfer this Agreement or any of the Center's obligations hereunder
to affiliates or wholly owned subsidiaries of the Center. This Agreement shall run to the County
and its successors.
ARTICLE VI
SUBCONTRACTING
The parties agree that the Center shall be permitted to execute subcontracts for the purchase by the
Center of such services, articles, supplies, and equipment, which is both necessary and incidental
to the performance of the work, required under this Agreement. However, the Center expressly
understands that it shall assume the primary responsibility for performing the services outlined in
Article I of this Agreement.
ARTICLE VII
INSURANCE, SAFETY AND INDEMNIFICATION
1. Indemnity. To the maximum extent permitted by Florida law, the Center and/or its sub-
contractor shall indemnify and hold harmless the County against any claims, damages,
losses, and expenses, including reasonable attorneys' fees and costs, arising out of or
resulting from the Center's failure to pay for services or performance under this
Agreement. This indemnification obligation shall not be construed to negate, abridge or
reduce any other rights or remedies which otherwise may be available to an indemnified
party or person described in this paragraph.
Center shall jointly and severally indemnify and hold harmless Collier County for all
claims, demands, actions, suits, losses, costs, charges, expenses, damages and liabilities
whatsoever which the County may pay, sustain, suffer or incur by reason of or in
CAO
16.D.12.d
Packet Pg. 1493 Attachment: [1745398] CHSI Agreement FY23 - DDP Cert (23428 : LIP Collier Health Services)
[22-SOC-00954/1745398/1] Page 4 of 6
connection with this agreement including payment of all legal costs, including but not
limited to, attorney's fees paid by the County.
2. Insurance Required: During the term of this agreement the Center shall procure and
maintain liability insurance coverage. The liability insurance coverage shall be in
amounts not less than $1,000,000 per person and $2,000,000 per incident of occurrence
for personal injury, death, and property damage or any other claims for damages caused
by or resulting from the activities under this Agreement. Such policies of insurance shall
name the County as an additional insured. The Center shall purchase all policies of
insurance from a financially responsible insurer duly authorized to do business in the
State of Florida. The Center shall be financially responsible for any loss due to failure to
obtain adequate insurance coverage and the failure to maintain such policies or certificate
in the amounts set forth herein shall constitute a breach of this agreement.
ARTICLE VIII
BILLING PROCEDURES
The Center has standard, acceptable billing procedures that the Center will utilize in the
performance of its obligations under this Agreement.
The County shall direct the Center to make payments pursuant to this Agreement once the County
has verified the validity of the invoices to be paid by the Center. The Center will not pay any
invoices prior to the County's approval.
The Center will provide copies of checks for payments as they are remitted. The Center shall also
provide quarterly reports showing invoices paid and pending payments.
ARTICLE IX
RECORDS
1. The Center and/or its sub-contractor shall keep orderly and complete records of its accounts
and operations related to the services provided under this Agreement for the entire term of
the Agreement plus three (3) years. The Center and/or its sub-contractor shall keep open
these records to inspection by County personnel at reasonable hours during the entire term
of this agreement. If any litigation, claim, or audit is commenced prior to the expiration of
the three (3) year period and extends beyond this period the records must remain available
until any litigation, claim or audits have been resolved. Any person duly authorized by the
County shall have full access to and the right to examine any of said records during said
period. Access to PHI shall be in compliance with federal laws and HIPAA.
[Space Intentionally Left Blank]
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16.D.12.d
Packet Pg. 1494 Attachment: [1745398] CHSI Agreement FY23 - DDP Cert (23428 : LIP Collier Health Services)
[22-SOC-00954/1745398/1] Page 5 of 6
ARTICLE X
CIVIL RIGHTS
1. There will be no discrimination against any employee or person served on account of race,
color, sex, age, religion, ancestry, national origin, handicap, or marital status in the
performance of the Agreement.
2. It is expressly understood that, upon receipt of evidence of such discrimination, the County
shall have the right to terminate this Agreement for breach of agreement.
3. The Center and/or its sub-contractor shall comply with Title VI of the Civil Rights Act of
1964 (42 USC 2000d) in regard to persons served.
4. The Center and/or its sub-contractor shall comply with Title VII of the Civil Rights Act of
1964 (42 USC 2000c) in regard to employees or applicants for employment.
5. The Center and/or its sub-contractor shall comply with Section 504 of the Rehabilitation
Act of 1973 in regard to employees or applicants for employment and clients served.
ARTICLE XI
OTHER CONDITIONS
1. Any alterations, variations, modifications, or waivers of provisions of this Agreement shall
only be valid when they have been reduced to writing, duly signed, and attached to the
original of this Agreement. The parties agree to renegotiate the Agreement if revision of
any applicable laws or regulations makes changes in the Agreement necessary.
2. This Agreement contains all the terms and conditions agreed upon by the parties. All items
incorporated by reference are as though physically attached. No other agreements, oral or
otherwise, regarding the subject matter of this Agreement, shall be deemed to exist or to
bind any of the parties hereto.
3. The Center and/or its sub-contractor shall obtain and possess throughout the term of this
Agreement all licenses and permits applicable to its operations under federal, state, and
local laws, and shall comply with all fire, health, and other applicable regulatory codes.
4. The Center and/or its sub-contractor agrees to comply with all applicable requirements and
guidelines prescribed by the County for recipients of funds.
5. The Center and/or its sub-contractor agree to safeguard the privacy of information pursuant
to the Health Insurance Portability and Accountability Act of 1996 (HIPAA),
CAO
16.D.12.d
Packet Pg. 1495 Attachment: [1745398] CHSI Agreement FY23 - DDP Cert (23428 : LIP Collier Health Services)
[22-SOC-00954/1745398/1] Page 6 of 6
IN WITNESS WHEREOF, the parties have executed this Agreement on the dates indicated below.
ATTEST:
CRYSTAL K. KINZEL, CLERK
By: _______________________________
Deputy Clerk
AS TO THE COUNTY:
BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY, FLORIDA
By: _________________________________
William L. McDaniel, Jr., Chairman
Dated: September 27, 2022
__________________________________
Witness #1 Signature
__________________________________
Witness #1 Printed Name
__________________________________
Witness #2 Signature
__________________________________
Witness #2 Printed Name
Approved as to form and legality:
________________________________
Derek D. Perry
Assistant County Attorney
AS TO THE CENTER:
COLLIER HEALTH SERVICES, INC.,
D/B/A HEALTHCARE NETWORK OF
SOUTHWEST FLORIDA
By: _________________________________
Printed Name: ________________________
Title: _______________________________
Dated: ______________________________
CAO9/20/202216.D.12.d
Packet Pg. 1496 Attachment: [1745398] CHSI Agreement FY23 - DDP Cert (23428 : LIP Collier Health Services)