Backup Documents 09/27/2022 Item #16E7 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 1 6 E
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1.
2.
3. County Attorney Office County Attorney Office 3Akt q/Z 3
4. BCC Office Board of County
Commissioners [ 16//OW g(z7/2t1
5. Minutes and Records Clerk of Court's Office
I
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the addressees
above,may need to contact staff for additional or missing information.
Name of Primary Staff Cherie DuBock Phone Number 239-252-3756
Contact/ Department
Agenda Date Item was 9/27/2022 Agenda Item Number 23422 (/ 7
Approved by the BCC b 1 C�
Type of Document Resolution,LOA,Executive Summary Number of Original 3
Attached Documents Attached
PO number or account
number if document is
to be recorded VS- 1 l
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. _ (Initial) Applicable)
1. Does the document require the chairman's original signature? .CeB"
2. Does the document need to be sent to another agency for additional signatures? If yes, CD
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be CD
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's CD
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the CD
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's CD
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip CD
should be provided to the County Attorney Office at the time the item is input into SIRE.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on 9/27/2022(enter date)and all changes CD N/A is not
made during the meeting have been incorporated in the attached document. The an option for
County Attorney's Office has reviewed the changes,if applicable, this line.
9. Initials of attorney verifying that the attached document is the version approved by the r N/A is not
BCC,all changes directed by the BCC have been made,and the document is ready for the AK an option for
Chairman's signature. (((( this line.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
16E7
Ann P. Jennejohn
From: Ann P.Jennejohn
Sent: Thursday, October 6, 2022 2:31 PM
To: DuBockCheri
Subject: Resolution 2022-151 & LOA (Item #16E7 9-24-22 BCC Meeting)
Attachments: Resolution 2022-151 Item #16E7 (9-27-22 BCC Meeting).pdf
Hi Cheri,
Please see attached for further execution.
I did not copy Kiana Redding because the
date had passed to submit and I didn't know if you
wanted to discuss this with her first because of the deadline?
The offices were closed, after the Board meeting; we didn't get back
until Tuesday, then our office was closed yesterday.
I just saw your memo regarding the October 1 date about an hour ago.
Please let me know if there's anything you'd like me
to regarding the item. I apologize it is late getting to
you.
Ann Jennejohn
BMR Senior Deputy Clerk II
A.,� Clerk to the Value Adjustment Board
'',, Office: 29-252-8406
z Fax: 2393-252-8408 (if applicable)
Ann.Jennejohn@CollierClerk.com
" Y so.e Office of the Clerk of the Circuit Court
& Comptroller of Collier County
3299 Tamiami Trail, Suite #4O1
Naples, FL 34112-5324
www.CollierClerk.com
i
DuBockCherie 1 6 E 7
From: DocuSign NA4 System <dse_NA4@docusign.net> on behalf of Kiana Redding via DocuSign
<dse_NA4@docusign.net>
Sent: Friday, August 19, 2022 3:02 PM
To: DuBockCherie
Subject: Please DocuSign: PEMT SFY 22-23 LOA Docusign
Follow Up Flag: Follow up
Flag Status: Completed
EXTERNAL EMAIL: This email is from an external source. Confirm this is a trusted sender and use extreme caution
when opening attachments or clicking links.
DocuSigrr Cr
Kiana Redding sent you a document to review and sign.
REVIEW DOCUMENT
Kiana Redding
L 0A UOS T be- of J
-, , ° kiana.redding@ahca.myflorida.com ��I S em l�l Iw
PRIVATE MESSAGE P a ko er,n uI l +0
If you are not the correct signer, please use "Assign to Sorrleone Else" under "Other
Actions"
Cher, e . 6 o boci co 1 I. eic oon -5 ov .
Dear Medicaid Providers, J f l cink rk,
.
Please find the attached Letter Of Agreement for the PEMt program for SFY 2022-23.
This letter must be signed and returned to the Agency no later than October 1st, 2022
per FS 409.908. The IGT Questionnaire is located at the following link
(https://ahca.myflorida.com/Medicaid/Finance/finance/LIP-DSH/index.shtml) should be
emailed to SupplementalPayments@ahca.myflorida.com by October 1st, 2022.
i
16E %
RESOLUTION NO.2022- 1 51
RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS OF
COLLIER COUNTY,FLORIDA,TO AUTHORIZE COLLIER COUNTY
EMS TO PARTICIPATE IN INTERGOVERNMENTAL TRANSFERS
WITH THE STATE OF FLORIDA AGENCY FOR HEALTH CARE
ADMINISTRATION AND THE SUPPLEMENTAL PAYMENT
PROGRAM FOR MEDICAID MANAGED CARE PATIENTS;
AUTHORIZING THE CHAIRMAN TO EXECUTE ALL REQUIRED
AGREEMENTS OR DOCUMENTS TO PARTICIPATE IN
INTERGOVERNMENTAL TRANSFERS AND THE SUPPLEMNTAL
PAYMENT PROGRAM FOR MEDICAID MANAGED CARE
PATIENTS SUBJECT TO BOARD RATIFICATION.
WHEREAS, Collier County provides emergency ambulance transportation services
throughout Collier County; and
WHEREAS, the State of Florida has created a supplemental payment program for
Medicaid managed care patients who are transported to the hospital by public emergency
medical transportation providers and has appropriated an additional $54 million for this
program; and
WHEREAS,Collier County EMS transports more than 1,500 Medicaid managed care
patients annually to hospitals and receives approximately$163 per patient for this service;and
WHEREAS, by participating in the supplemental payment program for Medicaid
managed care patients, Collier County EMS can substantially increase its Medicaid managed
care patient transport revenue and provide better services to the community.
NOW THEREFORE, IT IS RESOLVED BY THE BOARD OF COUNTY
COMMISSIONERS OF COLLIER COUNTY,FLORIDA,that:
1. Authorizes Collier County EMS to participate in intergovernmental transfers
with the State of Florida Agency Health Care Administration and the supplemental payment
program for Medicaid managed care patients.
2. Authorizes the Collier County Chairman to execute any and all agreements or
documents necessary for Collier County EMS to participate in intergovernmental transfers or
the Medicaid managed care supplemental payment program subject to ratification by this Board.
[22-EMS-01129/1745019/i]
I 6 E 7
This Resolution adopted on this 27th day of September, 2022, after motion, second and
majority vote favoring adoption.
ATT ?' • • BOARD OF COUNTY COMMISSIONERS
Cry $ K..Kinzel, Clerk of Courts COLLIER CO �y"' : ' DA
(J.) 1 0400
By".,, ,ak . By: .. _
(i ... u C rk Will' L. McDaniel,Jr., Chairman
i. /
Mb t b'Q'11a1 an'S
l at to
Approve' ` "and legality:
R
Jeffrey w, County Attorney
[22-EMS-01129/1745019/I]
DocuSign Envelope ID:887C07CB-9677-4ADC-975A-C4CE8A9B3E97
ibE �
Public Emergency Medical Transportation Letter of Agreement
THIS LETTER OF AGREEMENT (LOA) is made and entered into in duplicate on the 13th day of
September 2022, by and between Collier County (the "IGT Provider") on behalf of Collier County
EMS, and the State of Florida, Agency for Health Care Administration (the"Agency"), for good and
valuable consideration, the receipt and sufficiency of which is acknowledged.
DEFINITIONS
"Intergovernmental Transfers (IGTs)" means transfers of funds from a non-Medicaid governmental entity
(e.g., counties, hospital taxing districts, providers operated by state or local government) to the Medicaid
agency. IGTs must be compliant with 42 CFR Part 433 Subpart B.
"Medicaid" means the medical assistance program authorized by Title XIX of the Social Security Act, 42
US.C. §§ 1396 et seq., and regulations thereunder, as administered in Florida by the Agency.
"Public Emergency Medical Transportation (PEMT)," pursuant to the General Appropriation Act, Laws of
Florida 2022-156 is the program that provides supplemental payments for eligible Public Emergency
Medical Transportation (PEMT) entities that meet specified requirements and provide emergency
medical transportation services to Medicaid beneficiaries.
A. GENERAL PROVISIONS
1. Per 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
$602,602.07. The IGT Provider and the Agency have agreed that these IGT funds will only
be used for the PEMT 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
$602,602.07. 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
Jun 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
_PEMT LOA_SFY 2022-23
DocuSign Envelope ID:887C07CB-9677-4ADC-975A-C4CE8A9B3E97 i b E
i. IGT Provider agrees to maintain books, records, and documents (including
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
PEMT LOA SFY 2022-23
DocuSign Envelope ID:887C07CB-9677-4ADC-975A-C4CE8A9B3E97 I 6 E /
of these aforementioned supplemental payments in order to satisfy non-Medicaid, non-
uninsured, and non-underinsured activities.
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.
PEMT Local Intergovernmental Transfers
Program /Amount State Fiscal Year 2022-2023
Estimated IGTs $602,602.07
Total Funding Not to Exceed $602,602.07
IN WITNESS WHEREOF, the parties have caused this page Letter of Agreement to be
executed by their undersigned officials as duly authorized.
IGT Provider Board • •• • Commissioners STATE OF FLORIDA, AGENCY FOR
�o�C. County, id• il
HEALTH CARE ADMINISTRATION
SIGNED ��i' / C• . 1111111° SIGNED
BY: —•r" " BY:
NAME: W./iam L. McDaniel, Jr. NAME:
TITLE: Chairman TITLE:
DATE: -1 /2 7/2 2_ DATE:
�:'� 'ril'8ST Q^ Approve a f, and legality 1
' t6TAa It igNZEL,CLERK
;4*,,,;*r, ..4ipi--.6, ; ' feta Ift. _, ,
.. ter ,,,,,�,. Jeffrey A. •tz ,w,County Attorney
..: • to Ch. art:;
+ Tv
�'`•''"ring `nature only.
PEMT LOA SFY 2022-23
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