Resolution 2022-149 RESOLUTION NO.#2022- 1 4 9
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,Hospitals in Collier County(the"County")support a non-ad valorem special
assessment upon certain real property interests held by the Hospitals to help finance the non-
federal share of the State's Medicaid program; and
WHEREAS, the only real properties interests that will be subject to the non-ad valorem
assessments authorized herein are those belonging to the Hospitals;and
WHEREAS,the County recognizes that one or more of the Hospitals within the County's
boundaries may be located upon real property leased from governmental entities and that such
Hospitals may be assessed because courts do not make distinctions on the application of special
assessments based on"property interests"but rather on the distinction of the classifications of real
property being assessed; and
WHEREAS,the funding raised by the County assessment will,through intergovernmental
transfers ("IGTs") provided consistent with federal guidelines, support additional funding for
Medicaid payments to Hospitals; and
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WHEREAS, the County acknowledges that the Hospital properties assessed will have
increased income potential 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, 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
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, 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
otherwise defined herein or in the Ordinance, shall have the meanings below,unless the context
otherwise requires.
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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 codified
in Chapter 126 of the Collier County Code of Ordinances.
Tax Collector means the Collier County Tax Collector.
Section 2. Authority. Pursuant to Article VIII, Section 1(f) of 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
the County. Proceeds from the Assessment shall be used to benefit Assessed Properties through
enhanced Medicaid payments from programs,including the hospital directed payment program and
graduate medical education program,that will benefit the Assessed Properties for Local Services.
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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 Scone.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 payments, including the hospital directed payment program and graduate
medical education program,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) 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 o.69% 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.
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: (I) 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
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statement that the Assessment constitutes a hen against assessed property and/or improvements equal
in rank and dignity with the liens of all state, county, distnct 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. Per the notice provided on September 7, 2022, 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 27`h day of September,2022.
BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY, FLORIDA
ATTES
CRYST•i , t ,CLFitK
BY: 111.. By: C,V•
Willis M a
Approval as tglfu ap� legality
-.11100,114101iveiff--
County Attorney
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t7'.
DocuSign Envelope ID:E3FFE20D-F565-4C4F-AC38-A33COD29C3C1
Directed Payment Program Letter of Agreement
THIS LETTER OF AGREEMENT (LOA) is made and entered into in duplicate on the 27
day of t.ediee. 2022, by and between Collier County (the "IGT
Providers') on behalf of Region 8 , and the State of Florida,
Agency for Health Care Administration (the "Agency"), for good and valuable consideration,
the receipt and sufficiency of which is acknowledged.
DEFINITIONS
"Intergovernmental Transfers (IGTs)" means transfers of funds from a non-Medicaid
governmental entity (e.g., counties, hospital taxing districts, providers operated by state or local
government)to the Medicaid agency. IGTs must be compliant with 42 CFR Part 433 Subpart B.
"Medicaid" means the medical assistance program authorized by Title XIX of the Social Security
Act, 42 US.C. §§ 1396 et seq., and regulations thereunder, as administered in Florida by the
Agency.
"Directed Payment Program (DPP)," pursuant to the General Appropriation Act, Laws of Florida
2021-156, 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 $7,231,349.00 . 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 $7,231,349.00 . 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
Collier County
_DPP LOA_SFY 2022-23
Region 8
DocuSign Envelope ID:E3FFE20D-F565-4C4F-AC3B-A33C0D29C3C1
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.
Collier County
_DPP LOA_SFY 2022-23
Region 8
DocuSign Envelope ID E3FFE20D-F565-4C4F-AC3B-A33C0D29C3C1
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 $7,231,349.00
Total Funding Not to Exceed $7,231,349.00 7
IN WITNESS WHEREOF, the parties have caused this page Letter of Agreement to be
executed by their undersigned officials as duly authorized.
(3CC. : STATE OF FLORIDA, AGENCY FOR
CO HEALTH CARE ADMINISTRATION
SIGNED J / C• SIGNED
BY: BY:
NAME: Wil4am L. McDaniel,Jr., Chairman NAME:
TITLE: C.-Ael. lair TITLE:
DATE: j/2 7/2e-2 DATE:
�r I
ATTESt ZEL,CLERK
CRYST.'
: , Approv bgality
JeffreyA. K atz
'+C�eWAgl+AAlttirney
Collier County
DPP LOA SFY 2022-23
Region 8