Agenda 03/14/2023 Item #16D7 (Transfer reserves within the Local Provider Participation Fund to remittance to other governments)16.D.7
03/14/2023
EXECUTIVE SUMMARY
Recommendation to authorize Budget Amendments totaling $725,185; transferring reserves within the Local
Provider Participation Fund (169) to remittances to other governments, for the purpose of remitting
payment to the Agency for Health Care Administration as part of the Direct Payment Program
Intergovernmental Transfers of State Fiscal Year (SFY) 2022-2023, pursuant to Senate Bill 2500, the
General Appropriations Act of SFY 2022-2023.
OBJECTIVE: To authorize Budget Amendments within the Local Provider Participation Fund (169) transferring
$725,185 from reserves to remittances to other governments. These Budget Amendments are necessary to allow the
County to remit payments to the Agency for Health Care Administration of the State of Florida for
intergovernmental charges totaling $5,753,218 and additional payments of up to $400,000 depending upon
hospitals meeting quality metrics as determined by the Agency for Health Care Administration (AHCA). This
transfer will support local area hospitals that provide health services to the low-income citizens of Collier County.
CONSIDERATIONS: The County has participated in the State's Intergovernmental Transfer Program (IGT) with
the AHCA program since 2006. As a participant in the IGT program, the County provides funding to support the
federal matching program for uncompensated care known as the Low -Income Pool Program (LIP). Since 2014,
hospitals have elected to no longer participate in the LIP program. However, the County continues to participate in
the minor LIP program with Collier Health Services, Inc., the County's Federally Qualified Healthcare Center
(FQHC). A similar IGT program was established by the Florida Legislature in FY2021 and is known as the
Directed Payment Program (DPP).
Nationwide, and especially in Florida, hospitals continue to struggle with the shortfall in Medicaid reimbursement
rates. Hospitals in Collier County provide millions of dollars of care to persons who qualify for Medicaid annually,
because on average, Medicaid only covers sixty percent (60%) of the costs of the health care services provided by
Hospitals to eligible persons. As a direct result of continued revenue shortfalls, during the FY21 Florida Legislative
session, Governor DeSantis, with the full support of the House and Senate, approved the establishment of the DPP.
This program is available to hospitals providing inpatient and outpatient services to Medicaid -managed care
enrollees. It is the intent of the DPP to offset hospitals' Medicaid shortfalls and improve the quality of care
provided to the Florida Medicaid population. In 2021, the program was adopted by Collier County and fourteen
(14) Florida counties.
On June 22, 2021, the Board of County Commissioners (Board) adopted Ordinance 2021-23 Agenda Item #17A,
enabling the County to levy a uniform non -ad valorem special assessment, which is fairly and reasonably
apportioned among the Hospitals' property interests within the County's jurisdictional limits, for the purpose of
establishing and maintaining a system of funding for IGTs to support the non-federal share of Medicaid payments.
On September 28, 2021, the Board approved Resolution #2021-197, which established the 2021 Local Provider
Participation Fund Special Assessment. The FY 2021 assessment of 1.11 % of net patient revenue was collected and
when matched by the federal matching program, the Local Provider Participation Fund contributed $12,248,191 to
support low-income patient treatment in Collier County.
On September 27, 2022, the Board enacted Resolution #2022-149 Agenda Item #16D5 to continue participation in
the Local Provider Participation Fund for the Direct Payment Program and commenced participation in the
Graduate Medical Education Program. AHCA advised the County that the LPPF DPP assessment for FY2022 was
.69% of net patient revenue and the County could collect a maximum of $5,578,033 from participating Hospitals.
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16.D.7
03/14/2023
This amount minus $150,000 in administrative expenses was the anticipated amount required to be submitted to
AHCA. The Direct Payment Program letter of Agreement between Collier County and the State of Florida AHCA
however permits an IGT in an amount not to exceed the total of $7,231,349. The County in FY23 has collected
$5,578,033 from participating Hospitals in keeping with Resolution #2022-149 and Ordinance 2021-23.
On February 20, 2023, the County received an invoice from the Agency for Health Care Administration in the
amount of $5,753,218 for the Direct Payment Program Intergovernmental Transfer of State Fiscal Year (SFY)
2022-2023, pursuant to Senate Bill 2500, the General Appropriations Act of SFY 2022-2023. The amount collected
pursuant to the Board approved the resolution for 2022 was $5,587,033; which included a $150,000 administrative
fee. After the administrative fee is deducted from the total collected, $5,428,033 is available to be remitted to the
Agency for Health Care Administration within Local Provider Participation Fund (169) Remittances to Other
Governments.
The difference between the invoiced remittance and the amount available for payment is $325,185. Participating
hospitals are also entitled to potentially receive up to approximately $400,000 for meeting quality metrics as
defined by AHCA. Therefore $725,185 needs to be transferred within Local Provider Participation Fund (169),
from Reserves into remittances to other governments. Any funds that are not invoiced by AHCA will remain within
Fund (169).
AHCA LPPF-IGT Budget Amendment
Collected
5,578,033.00
Collection Administative Fee
(150,000.00)
Available
5,42-8,033.00
Invoiced Amount
$
(5,753,219.00)
Current Encumbered
$
5,428,033.00
Funding Required
$
(325,185.00)
Quality Metric AHCA
Upcoming Maximum Possible
$
(400,000.00)
*To be Determined
Funding Required
$
_ (32-5,185.00)
Proposed Solution Quality Metric
$
_ (400,000.00)
BudgetAmendment
$
725,185.00
Post -Approval
$
There are currently $2,662,000 in program -related reserves. The reserves were created from carry -forward revenues
that were programmed as reserves as part of the Board approved resolution on September 27, 2022. These reserve
funds are specifically for the support of the Direct Payment Program - Local Provider Participation Fund and were
retained by the County for future use to support the program. The transfer from reserves to remittances to other
governments requires Board approval.
FISCAL IMPACT: The Budget Amendment will; reduce the Local Provider Participation Fund (169) reserve of
$2,662,000 by $725,185 to $1,936,815. The Remittances to Other Governments will be correspondingly increased
by $725,185 to $6,153,218. There are no additional Fiscal impacts.
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16.D.7
03/14/2023
GROWTH MANAGEMENT IMPACT: There is no Growth Management impact.
LEGAL CONSIDERATIONS: My understanding of the program is that we assess the local hospitals, then
transfer that money to the State, where additional matching funds are added, and the total sum is then sent back to
the hospitals. No Collier County taxpayer dollars are involved. This item has been reviewed by the County
Attorney, is approved as to form and legality and requires a majority vote for Board action. -JAK
RECOMMENDATION: To authorize Budget Amendments within the Local Provider Participation Fund (169)
transferring $725,185 from reserves to remittances to other governments. These budget amendments are necessary
to allow the County to remit payments to the Agency for Health Care Administration of the State of Florida for
intergovernmental charges totaling $5,753,218 and an additional $400,000 dependent upon the hospital achieving
quality metrics as set by AHCA.
Prepared By: Jeffrey Newman, Manager - Financial Operations, Operations & Veterans Services Division
ATTACHMENT(S)
1.Ordinance 2021-23 (PDF)
2. Resolution 2022-149 (PDF)
3. Collier County (PDF)
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16.D.7
03/14/2023
COLLIER COUNTY
Board of County Commissioners
Item Number: 16.D.7
Doc ID: 24805
Item Summary: Recommendation to authorize Budget Amendments totaling $725,185; transferring reserves
within the Local Provider Participation Fund (169) to remittances to other governments, for the purpose of
remitting payment to the Agency for Health Care Administration as part of the Direct Payment Program
Intergovernmental Transfers of State Fiscal Year (SFY) 2022-2023, pursuant to Senate Bill 2500, the General
Appropriations Act of SFY 2022-2023.
Meeting Date: 03/14/2023
Prepared by:
Title: — Operations & Veteran Services
Name: Jeff Newman
03/01/2023 7:29 AM
Submitted by:
Title: — Operations & Veteran Services
Name: Jeff Newman
03/01/2023 7:29 AM
Approved By:
Review:
Operations & Veteran Services
Community & Human Services
Public Services Department
Community & Human Services
Public Services Department
Office of Management and Budget
County Attorney's Office
Office of Management and Budget
Community & Human Services
County Manager's Office
Board of County Commissioners
Jeff Newman
Additional Reviewer
Kristi Sonntag
Additional Reviewer
Todd Henry
PSD Level 1 Reviewer
Maggie Lopez
Additional Reviewer
Tanya Williams
PSD Department Head Review
Debra Windsor
Level 3 OMB Gatekeeper Review
Jeffrey A. Klatzkow Level 3 County Attorney's Office Review
Christopher Johnson Additional Reviewer
Maggie Lopez
Additional Reviewer
Dan Rodriguez
Level 4 County Manager Review
Geoffrey Willig
Meeting Pending
Completed
03/01/2023 9:02 AM
Completed
03/02/2023 8:00 AM
Completed
03/02/2023 9:28 AM
Completed
03/07/2023 1:58 PM
Completed
03/02/2023 10:30 AM
Completed
03/03/2023 8:33 AM
Completed
03/03/2023 9:19 AM
Completed
03/05/2023 10:36 AM
Completed
03/06/2023 8:37 AM
Completed
03/06/2023 1:09 PM
03/14/2023 9:00 AM
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16.D.7.a
ORDINANCE NO.2021-_2_3_
AN ORDINANCE OF THE BOARD OF COUNTY COMMISSIONERS OF
COLLIER COUNTY, FLORIDA, TO BE CODIFIED IN CHAPTER 114 AS
ARTICLE VI OF THE COLLIER COUNTY CODE OF LAWS AND
ORDINANCES AUTHORIZING THE CREATION OF THE COLLIER
COUNTY LOCAL PROVIDER PARTICIPATION FUND ("FUND")
UNDER THE AUTHORITY OF SECTION 1(F), ARTICLE VIII OF THE
CONSTITUTION OF THE STATE OF FLORIDA SPECIFYING THE
METHOD OF SETTING AND COMPUTING ANNUAL NON -AD
VALOREM SPECIAL ASSESSMENTS TO BE DEPOSITED INTO THE
FUND AND SPECIFYING AUTHORIZED USES FOR THE FUND;
PROVIDING FOR CONFLICT AND SEVERABILITY; PROVIDING FOR
INCLUSION IN THE CODE OF LAWS AND ORDINANCES; AND
PROVIDING FOR AN EFFECTIVE DATE OF JULY 1, 2021 UNLESS
THE ENABLING LEGISLATION IS NOT APPROVED BY THE
GOVERNOR OF THE STATE OF FLORIDA.
RECITALS:
WHEREAS, the hospitals in Collier County's jurisdiction (the "Hospitals") annually
provide millions of dollars of uncompensated care to persons who qualify for Medicaid because
Medicaid, on average, covers only 60% of the costs of the health care services actually provided
by Hospitals to Medicaid eligible persons, leaving hospitals with significant uncompensated
costs ("Medicaid shortfall'); and
WHEREAS, the State of Florida (the "State") has received federal authority to establish
the Statewide Medicaid Managed Care hospital directed payment program (the "DPP") to offset
hospitals' Medicaid shortfall and improve quality of care provided to Florida's Medicaid
population; and
WHEREAS, impacted Hospitals have asked Collier County (the "County") to impose an
assessment upon certain real property owned by the Hospitals to help finance the non-federal
share of the State's Medicaid program; and
WHEREAS, the only properties to be assessed in these localities are the real property
sites of such Hospitals; and
WHEREAS, the County recognizes that one or more Hospitals within the County's
boundaries may be located upon real property leased from governmental entities and that such
Hospitals may be assessed because courts do not make distinctions on the application of special
assessments based on "property interests" but rather on the distinction of the classifications of
real property being assessed; and
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WHEREAS, the funding raised by the County assessment will, through
intergovernmental transfers ("IGTs") provided consistent with federal guidelines, support
additional funding for Medicaid payments to Hospitals to address the Medicaid shortfall; and
WHEREAS, the County acknowledges that the Hospital properties assessed will benefit
directly and especially from the assessment as a result of the above -described additional funding
provided to said Hospitals; and
WHEREAS, the County has determined that a logical relationship exists between the
Medicaid services provided by the Hospitals, which will be supported by the assessment, and the
special and particular benefit to the real property of the Hospitals; and
WHEREAS, the County has an interest in promoting access to health care for its low-
income and under -insured residents; and
WHEREAS, leveraging additional federal support through the above -described IGTs to
fund payments to the Hospitals for health care services provided to Medicaid eligible persons
directly and specifically benefits the Hospitals' properties and supports their continued ability to
provide those services; and
WHEREAS, imposing an assessment limited to Hospital properties to help fund the
provision of Medicaid services and the achievement of certain quality standards by the Hospitals
to residents of the County is a valid public purpose that benefits the health, safety, and welfare of
the citizens of the County; and
WHEREAS, the assessment ensures the financial stability and viability of the Hospitals
providing Medicaid services; and
WHEREAS, the Hospitals are important contributors to the overall County's economy,
and the financial benefit to these Hospitals directly and specifically supports their mission, as
well as their ability to grow, expand, and maintain their facilities in concert with the population
growth in the jurisdiction of the County; and
WHEREAS, the County finds the assessment will enhance the Hospitals' ability to grow,
expand, maintain, improve and increase the value of their properties and facilities under all
present circumstances and those of the foreseeable future; and
WHEREAS, the County is proposing a properly apportioned assessment by which all
Hospitals will be assessed a uniform amount that is compliant with 42 C.F.R. § 433.68(d); and
WHEREAS, the adoption of this Ordinance will enable the County to levy a uniform
non -ad valorem special assessment, which is fairly and reasonably apportioned among the
Hospitals' properties within the County's jurisdictional limits, to establish and maintain a system
of funding for IGTs to support the non-federal share of Medicaid payments that will directly and
specially benefit Hospital properties.
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WHEREAS, for the first year of the assessment the County finds that the alternative
method, as specified in § 197.3631, Fla. Stat., for the assessment and collection of the non -ad
valorem special assessment is appropriate but in future tax years may elect to use the uniform
method if approved by the Board.
NOW, THEREFORE, BE IT ORDAINED BY THE BOARD OF COUNTY
COMMISSIONERS OF COLLIER COUNTY, FLORIDA, that:
SECTION 1. Chapter 126 of the Collier County Code of Laws and Ordinances, is hereby
amended, by adding a new Article VI as follows:
Sec. 126-211. - Title
This Article VI shall be known and may be cited as the "Collier County Local Provider
Participation Fund Ordinance."
Sec, 126-212. - Authority.
Pursuant to Article VII1, Section l(f) of the Constitution of the State of Florida and Florida
Statutes 125, the Board is hereby authorized to impose a special assessment against private for -
profit and not -for -profit hospitals located within the County to fund the non-federal share of
Medicaid payments associated with Local Services.
Sec. 126-213. - Purpose.
The non -ad valorem special assessment authorized by this Article shall be imposed, levied,
collected, and enforced against Assessed Properties located within the County. Proceeds from the
Assessment shall be used to benefit Assessed Properties through enhanced Medicaid payments
for Local Services. When imposed, the Assessment shall constitute a lien upon the Assessed
Properties equal in rank and dignity with the liens of all state, county, district, or municipal taxes
and other non -ad valorem assessments. Failure to pay may cause foreclosure proceedings, which
could result in loss of title, to commence. The Assessment shall be computed and assessed only
in the manner provided in this Ordinance.
Sec. 126-214. - Alternative Method.
This Ordinance shall be deemed to provide an additional and alternative method, as specified in
§ 197.3631, Fla. Stat., for the assessment and collection of the non -ad valorem special
assessment described herein. The Ordinance shall be regarded as supplemental and additional to
powers conferred by other laws and shall not be regarded as in derogation of any powers now
existing or which may exist hereafter. This Ordinance, being necessary for the health, safety, and
welfare of the inhabitants of the County, shall be liberally construed to effect the purposes
hereof.
Sec. 126-215. - Definitions.
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When used in this Ordinance, the following terms shall have the meanings below, unless the
context clearly requires otherwise:
Annual Final Assessment Resolution means the resolution described in Sections 126-224
and 126-225 hereof, which shall be the final proceeding for the imposition of an Assessment,
establishing the rate for the non -ad valorem assessment for a specific Fiscal Year.
Assessed Property means an Institutional Health Care Provider holding a right of
possession and right of use of real property in the County through an ownership or leasehold
interest, thus making the property subject to the Assessment.
Assessment means a non -ad valorem special assessment imposed by the County on
Institutional Health Care Providers located in the County limits to fund the non-federal share of
Medicaid and Medicaid managed care payments directed to hospitals providing Local Services in
the County.
Assessment Coordinator means the person appointed by the County Manager or designee
to administer the Assessment imposed pursuant to this Article, or such person's designee.
Assessment Resolution means the resolution described in Section 126-219 hereof.
Board means the Board of County Commissioners of Collier County, Florida.
County means Collier County, Florida.
Fiscal Year means the period commencing on October 1 of each year and continuing
through the next succeeding September 30, or such other period as may be prescribed by law as
the fiscal year for the County.
Institutional Health Care Provider means a private for -profit or not -for -profit hospital
that provides inpatient hospital services.
Local Services means the provision of inpatient and outpatient hospital services to
Medicaid, indigent, and uninsured members of the Collier County community.
Non Ad Valorem Assessment Roll means the special assessment roll prepared by the
County.
Ordinance means the Collier County Local Provider Participation Fund Ordinance as it
may be codified in Chapter 114 as Article VI in the Collier County Code of Laws and
Ordinances.
Tax Collector means the Collier County Tax Collector.
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Sec. 126-216. - Interpretation.
Unless the context indicates otherwise, the terms "hereof," "hereby," "herein," "hereto,"
"hereunder" and similar terms refer to this Article. The term "hereafter" means after and the term
"heretofore" means before the effective date of the Ordinance.
Sec. 126-217. - Assessment.
Pursuant to § 125.01, Fla. Stat., the Board is hereby authorized to create a non -ad valorem
special assessment that shall be imposed, levied, collected, and enforced against Assessed
Property to fund the non-federal share of Medicaid payments benefitting Assessed Properties
providing Local Services in the County. Funds generated as a result of the Assessment shall be
held in a separate account called the local provider participation fund and shall be available to be
used only to: (1) provide to the Florida Agency for Health Care Administration the non-federal
share for Medicaid payments to be made directly or indirectly in support of hospitals serving
Medicaid beneficiaries and (2) reimburse the County for administrative costs associated with the
implementation of the Assessment authorized by this Ordinance, as further specified in the
Assessment Resolution.
The Assessment will be broad based, and the amount of the Assessment must be uniformly
imposed on each Assessed Property. The Assessment may not hold harmless any Institutional
Health Care Provider, as required under 42 U.S.C. § 1396b (w). As set forth in Section 126-213,
the Assessment shall constitute a lien upon the Assessed Properties equal in rank and dignity
with the liens of all state, county, district, or municipal taxes and other non -ad valorem
assessments. In addition to other remedies available at law or equity, the enforcement of the
aforesaid Assessment shall be at the same time and in like manner as ad valorem taxes and
subject to all ad valorem tax enforcement procedures afforded to the official annual real property
tax notice.
Creation and implementation of the Assessment will not result in any additional pecuniary
obligation on the County, Board, or County residents. The Assessment shall be imposed, levied,
collected, and enforced against only Assessed Properties, and the Assessment Resolution shall
provide that the County's administrative costs shall be reimbursed from the collected amounts.
The County's administrative costs shall not exceed $150,000.
Any reasonable expenses the County incurs to collect delinquent assessments, including any
attorney's fees incurred as a result of contracting with an attorney to represent the county in
seeking and enforcing the collection of delinquent assessments, are not subject to the limitation
on administrative costs.
Sec. 126-218.- Computation of Assessment.
The annual Assessment shall be specified for each Assessed Property. The Board shall set the
Assessment in amounts that in the aggregate will generate sufficient revenue to fund the non-
federal share of Medicaid payments associated with Local Services to be funded by the
Assessment.
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The amount of the Assessment required of each Assessed Property may not exceed an amount
that, when added to the amount of other required assessments, equals an amount of revenue that
exceeds the maximum percent of the aggregate net patient revenue of all Assessed Hospitals in
the County permitted by 42 C.F.R. § 433.68(f)(3)(i)(A). Assessments for each Assessed Property
will be derived from data contained in the Florida Hospital Uniform Reporting System, as
available from the Florida Agency for Health Care Administration.
Sec. 126-219. - Assessment Resolution.
The Assessment Resolution shall describe: (a) the Medicaid payments proposed for funding from
proceeds of the Assessment; (b) the benefits to the Assessment Properties associated with the
Assessment; (c) the methodology for computing the assessed amounts; and (d) the method of
collection, including how and when the Assessment must paid.
Sec. 126-220. - Non -Ad Valorem Assessment Roll.
The Assessment Coordinator shall prepare, or direct the preparation of, the Non -Ad Valorem
Assessment Roll, which shall contain the following:
a) The names of the Assessed Properties; and
b) The Assessment rate and amount of the Assessment to be imposed against each
Assessed Property based on the Assessment Resolution.
The Non -Ad Valorem Assessment Roll shall be retained by the Assessment Coordinator and
shall be open to public inspection. The foregoing shall not be construed to require that the
Assessment Roll be in printed form if the amount of the Assessment for each Assessed Property
can be determined by use of a computer terminal available to the public.
Sec. 126-221. - Notice by Publication.
Upon completion of the Non -Ad Valorem Assessment Roll, the Assessment Coordinator shall
publish once in a newspaper of general circulation within the County a notice stating that the
Board, at a regular, adjourned, or special meeting on a certain day and hour, not earlier than 20
calendar days from such publication, will hear objections of all interested persons to approve the
aforementioned Non -Ad Valorem Assessment Roll. Such notice shall include:
a) The Assessment rate;
b) The procedure for objecting to the Assessment rate;
c) The method by which the Assessment will be collected; and
d) A statement that the Non -Ad Valorem Special Assessment Roll is available for
inspection at the Office of the Assessment Coordinator.
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Sec. 126-222. - Notice by Mail.
In addition to the published notice required by Section 126-221, but only for the first fiscal year
in which an Assessment is imposed by the Board against Assessed Properties, the Assessment
Coordinator shall provide notice of the proposed Assessment by first class mail to the Assessed
Properties. Such notice shall include:
a) The purpose of the Assessment;
b) The Assessment rate to be levied against each Assessed Property;
c) The unit of measurement applied to determine the Assessment;
d) The total revenue to be collected by the County from the Assessment;
e) A statement that failure to pay the Assessment will cause a tax certificate to be issued
against the property or foreclosure proceedings, either of which may result in a loss of
title to the property;
f) A statement that all affected and/or interested parties have a right to appear at the
hearing and to file written objections with the Board within 20 days of the notice; and
g) The date, time, and place of the hearing.
Notice shall be mailed at least 20 calendar days prior to the hearing to each Assessed Property at
such address as is shown on the Assessment Roll. Notice shall be deemed mailed upon delivery
thereof to the possession of the United States Postal Service. The Assessment Coordinator may
provide proof of such notice by affidavit. Failure of the Assessed Property to receive such notice,
because of mistake or inadvertence, shall not affect the validity of the Assessment Roll or release
or discharge any obligation for payment of the Assessment imposed by the Board pursuant to
this Article.
Sec. 126-223. - Adoption of Assessment Resolution and Non -Ad Valorem Assessment Roll.
At the time named in the notice, the Board shall receive and consider any written objections of
interested persons. All objections to the Assessment Resolution and Non -Ad Valorem
Assessment Roll shall be made in writing and filed with the Assessment Coordinator at or before
the time or adjourned time of such hearing. At the date and time named in the notice, the Board
may adopt the Assessment Resolution and Non -Ad Valorem Assessment Roll which shall:
a) Set the rate of the Assessment to be imposed;
b) Approve the Non -Ad Valorem Assessment Roll, with such amendments as it deems just
and right; and
c) Affirm the method of collection.
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Sec. 126-224. - Annual Final Assessment Resolution.
The Board may revise the Non -Ad Valorem Assessment Roll during the Fiscal Year to modify
the Assessment rate. However, the Board must adopt an Annual Final Assessment Resolution
during the Fiscal Year to memorialize the final rate applicable for the Fiscal Year.
Sec. 126-225. - Effect of Annual Final Assessment Resolution.
The adoption of the Annual Final Assessment Resolution shall be the final adjudication of the
issues presented (including, but not limited to, the method of apportionment and Assessment, the
Assessment rate, the initial rate of Assessment, the Non -Ad Valorem Assessment Roll, and the
levy and lien of the Assessments), unless proper steps shall be initiated in a court of competent
jurisdiction to secure relief within 20 days from the date of Board action on the Annual Final
Assessment Resolution. The Non -Ad Valorem Assessment Roll shall be delivered to the Tax
Collector or such other official as the Board by resolution shall designate.
Sec. 126-226. - Method of Collection.
The amount of the assessment is to be collected pursuant to the Alternative Method, as specified
in the Assessment Resolution.
Sec. 126-227. - Refunds.
If, at the end of the Fiscal Year, additional amounts remain in the local provider participation
fund, the Board is hereby authorized to make refund to Assessed Properties in proportion to
amounts paid in during the Fiscal Year for all or a portion of the unutilized local provider
participation fund.
Sec. 126-228. - Responsibility for Enforcement.
The County and its agent, if any, shall maintain the duty to enforce the prompt collection of the
Assessment by the means provided herein. The duties related to collection of assessments may
be enforced at the suit of any holder of obligations in a court of competent jurisdiction by
mandamus or other appropriate proceedings or actions.
Sec. 126-229. - Correction of Errors and Omissions.
No act of error or omission on the part of the Comptroller, Property Appraiser, Tax Collector,
Assessment Coordinator, Board, or their deputies or employees shall operate to release or
discharge any obligation for payment of the Assessment imposed by the Board under the
provision of this Chapter.
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SECTION 2. APPLICABILITY.
It is hereby intended that this Ordinance shall constitute a uniform law applicable in all
unincorporated areas of Collier County, Florida, and to all incorporated areas of Collier County
where there is no existing conflict of law or municipal ordinance.
SECTION 3. SEVERABILITY.
In the event this Ordinance conflicts with any other Ordinance of Collier County or other
applicable law, deemed a separate, distinct and independent provision and such holding shall
not affect the validity of the remaining portion.
SECTION 4. RESOLUTION OF CONFLICT OF LAWS.
In all instances where Florida law, as evidenced by the Florida Administrative Code, Florida
Statutes, applicable case law, or otherwise mandates standards or requirements that are stricter
than the provisions of this Ordinance, or where a matter is addressed by Florida law that is not
addressed by this Ordinance, then said law shall govern. In situations where this Ordinance
addresses a matter in a manner that is stricter than that of Florida law, the provisions of this
Ordinance shall control.
SECTION 5. INCLUSION IN THE COLLIER COUNTY CODE.
The provisions of this Ordinance shall be included and incorporated in the Collier County Code,
as an addition or amendment thereto, and shall be appropriately renumbered to conform to the
uniform numbering system of the Collier County Code, once established. The word 'ordinance"
may be changed to "section," "article," or other appropriate word or phrase necessary to
accomplish such intentions.
SECTION 6. FILING OF ORDINANCE.
In accordance with the provisions of § 125.66, Fla. Stat., a certified copy of this Ordinance shall
be filed with the Florida Department of State.
SECTION 7. EFFECTIVE DATE.
This Ordinance shall become effective July 1, 2021 unless the enabling legislation is not
approved by the Governor of the State of Florida.
PASSED AND 1 ULY ADOPTED by the Board of County Commissioners of Collier County,
Florida, this Aday of , 2021.
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ATTEST: BOARD OF COUNTY COMMISSIONERS
CRYSTAL K KINZEL, CLERK COLLIER/O�N Y, FLORIDA,
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16.D.7.a
FLORIDA DEPARTMENT Of STATE
RON DESANTIS
Governor
July 1, 2021
Ms. Martha Vergara, BMR & VAB Senior Deputy Clerk
Office of the Clerk of the Circuit Court
& Comptroller of Collier County
3329 Tamiami Trail E, Suite #401
Naples, Florida 34112
Dear Ms. Vergara:
LAUREL M.LEE
Secretary of State
Pursuant to the provisions of Section 125.66, Florida Statutes, this will acknowledge receipt of your
electronic copy of Collier County Ordinance No. 2021-23, which was filed in this office on July 1, 2021
Sincerely,
Anya Grosenbaugh
Program Administrator
AG/lb
R. A. Gray Building . 500 South Bronough Street • Tallahassee, Florida 32399-0250
Telephone: (850) 245-6270
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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 offtcio Clerk to the Board, or other
such person as may be duty 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(0 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.
If, at the end of the Fiscal Year, additional amounts remain in the local provider participation fund,
the Board is hereby authorized either (a) to refund to Assessed Properties, in proportion to amounts
paid in during the Fiscal Year, all or a portion of the unutilized local provider participation fund,
or (b) 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. Timina 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: (1) a reference to this
Resolution, (2) the total amount of the hospital's Assessment for the appropriate period, (3) the
location at which payment will be accepted, (4) the date on which the Assessment is due, and (5) a
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statement that the Assessment constitutes alien 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. Severabilit•. 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`i' day of September, 2022,
BOARD OF COUNTY COMMISSIONERS
ATTES
COLLIER COUNTY, FLORIDA
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CRYST ZEL,CLMK
BY: By: _/ �``'
Willis M a
Approval as talf64 A legality
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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 27t.(
day of 2022, by and between Collier County (the "IGT
Provide ') 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
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DocuSign Envelope ID: E3FFE20D-F565-4C4F-AC3B-A33COD29C3C1
16. D.7. b
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
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
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
Region 8
_DPP LOA_SFY 2022-23
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DocuSign Envelope ID E3FFE20D-F565-4C4F-AC3B-A33COD29C3C1
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 j
Total Funding Not to Exceed
$7,231,349.00
IN WITNESS WHEREOF, the parties have caused this page Letter of Agreement to be
executed by their undersigned officials as duly authorized.
ACC
e/1
SIGNED
BY: `
NAME: Wilfam L. McDaniel, Jr., Chairman
TITLE: (—A A'-1
DATE: y;7
ATT ' ZEL,CLERK
CRYST " rLN
BY:
i
Collier County
Region 8
STATE OF FLORIDA, AGENCY FOR
HEALTH CARE ADMINISTRATION
SIGNED
BY:
NAME:
TITLE:
DATE:
I
Approve4 ipilry
Jcfirey A. K atztcbW,(f�rpgey
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DPP LOA SFY 2022-23
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16.D.7.c
February 20, 2023
Yahaira Magee
Collier County LPPF
3299 Tamiami Trail East
Naples, FL 34112
Dear Yahaira Magee:
RON DESANTIS
GOVERNOR
JASON WEIDA
SECRETARY
This document shall serve as a formal invoice for the purpose of billing for Medicaid payments,
which are outlined in the transfer agreement executed between the Agency for Health Care
Administration and the Collier County LPPF on behalf of Region 8. You are being billed the
amount of $5,753,218 for the Directed Payment Program Intergovernmental Transfers of State
Fiscal Year (SFY) 2022-2023, pursuant to Senate Bill 2500, the General Appropriations Act of
SFY 2022-2023.
In an effort to increase our efficiency and decrease the turnaround times on payments we are
requesting that you please notify us when you are sending your payments. This will allow us to
release payment to providers in a timely manner. Please notify me via email at
Supplemental payments@ahca.myflorida.com with the following information:
- If you are sending a check, please select the overnight or 2-Day option, and provide the
tracking number and notifications to my aforementioned email address;
- If you are sending a wire or ACH, please specify which electronic funds transfer you are
requesting along with the confirmation numbers at the time of transaction.
Please submit your payment with a copy of this invoice to the following address:
Agency for Health Care Administration
Medicaid Program Finance
Attn: Supplemental Payments
2727 Mahan Drive
Building 3, Mail Stop 23
Tallahassee, FL 32308
Should you have questions regarding this matter or need technical assistance, please contact
me at (850) 412-4109.
Sincerely, E
U
Kristin Sokoloski
Acting Bureau Chief
2727 Mahan Drive • Mail Stop #23 ,;E Facebook.com/AHCAFIorida
Tallahassee, FL 32308 Youtube.com/AHCAFIorida
AHCA.MyFlorida.com �t�l Twitter.com/AHCA_FL
SIideShare.net/AHCAFIorida
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