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Agenda 06/13/2023 Item #10B (To allocate $10 million from projected excess Infrastructure Sales Surtax Funds)10.B 06/13/2023 EXECUTIVE SUMMARY Recommendation to allocate $10 million from projected excess Infrastructure Sales Surtax Funds for the purposes of constructing additional square footage not funded by the United States Department of Veterans Affairs Construction Grant Program for adult day health care and outpatient therapy services for the proposed State veterans' nursing home project and authorize necessary Budget Amendments. OBJECTIVE: For the Board to allocate $10 million from projected excess Infrastructure Sales Surtax Funds for the purposes of constructing additional square footage not funded by the United States Department of Veterans Affairs (VA) Construction Grant Program for adult day health care and outpatient therapy services for the proposed State veterans' nursing home project. CONSIDERATIONS: The Board previously approved the expenditure of $30 million Infrastructure Sales Surtax Funding to be used as State matching funds for construction and development costs ("Project Costs") of a State Veterans' Nursing Home. These funds have been placed in escrow with the State of Florida Department of Financial Services serving as the Escrow Agent. These funds will be used by the State of Florida to secure federal matching funds to construct a proposed 120 bed skilled nursing facility for veterans. In addition, the County will convey real property within the Golden Gate Golf Course to the State for the facility. On May 25, 2023, the Board conducted a workshop on the veterans' nursing home project. Two outpatient services that were discussed that both the Florida Department of Veterans' Affairs and the Board would like to see incorporated into the building design and service offerings to veterans were adult day health care and outpatient therapy. Outpatient therapy includes services such as physical, occupational, and speech therapy. The provision of therapy services on an outpatient basis can prolong a veteran's ability to remain in their own home until or unless long term care services and supports are needed on a continuing basis. Similarly, adult day health care offers health, therapeutic, and social services for those with serious medical conditions and those at risk of requiring nursing home care due to their need for help with activities of daily living. This service can also provide a much -needed respite for a family caregiver, particularly if they are still part of the workforce and need to continue to generate a steady income to support their family. Currently, none of Florida's existing State veterans' nursing homes offer adult day health care. Where both of these services are covered by the VA as a benefit for veterans, construction of the square footage required to host these services is only considered as part of a construction grant application seeking matching funds for renovation of an existing facility; it cannot be a part of a construction grant application for a new skilled nursing facility. To offer these critical services to our local veterans, the cost must be borne by the State applicant. Though they will not be providing federal construction matching funds, as payor for these services to veterans, the VA still must approve the facility design via a separate application. Via SB 2500, the General Appropriations Act passed by the Legislature during the 2023 Regular Session, the Legislature approved $500,000 for initial site review, to include architectural drawings, which will confirm the ability to build and cost out outpatient and adult day health services on the site. The upcoming 2024 legislative cycle will begin with our local legislative delegation meeting that may occur as early as mid -September. With the support of the Board, it would be my goal to work with our state delegation to obtain $10 million from the Legislature during the 2024 Regular Session to match the excess County surtax funds. The total $20 million applied to the project should be adequate to cover the costs in adding additional square footage to a portion of the skilled nursing facility for the inclusion of these needed outpatient services. Should the State appropriation not occur, or the project fail to proceed to a construction phase, the Board allocated funds will remain in the Infrastructure Sales Tax Fund (Fund No. 318/3018) for other uses. FISCAL IMPACT: The requested budgetary allocation of $10 million is available from Infrastructure Sales Packet Pg. 230 10.B 06/13/2023 Surtax receipts and related earnings in excess of the planned surtax program amount of $420 million. The Surtax Program budget is provided in Infrastructure Sales Tax Fund (318/3018). GROWTH MANAGEMENT IMPACT: There is no immediate growth management impact. ADVISORY COMMITTEE: This item will be presented as an informational item to the Infrastructure Surtax Citizen Oversight Committee at its meeting on June 29, 2023. LEGAL CONSIDERATIONS: This item is approved as to form and legality and requires majority vote for approval. - CMG RECOMMENDATION: That the Board allocate $10 million from projected excess Infrastructure Sales Surtax Funds for the purposes of constructing additional square footage not funded by the United States Department of Veterans Affairs Construction Grant Program for adult day health care and outpatient therapy services for the proposed State veterans' nursing home project and authorize necessary Budget Amendments. Prepared by: Commissioner Burt L. Saunders, Commissioner, District 3 Packet Pg. 231 10.B 06/13/2023 COLLIER COUNTY Board of County Commissioners Item Number: 10.13 Doc ID: 25735 Item Summary: Recommendation to allocate $10 million from projected excess Infrastructure Sales Surtax Funds for the purposes of constructing additional square footage not funded by the United States Department of Veterans Affairs Construction Grant Program for adult day health care and outpatient therapy services for the proposed State veterans' nursing home project and authorize necessary Budget Amendments. (Sponsored by Commissioner Saunders) Meeting Date: 06/13/2023 Prepared by: Title: Communications, Govt. & Public Affairs Director — County Manager's Office Name: John Mullins 06/06/2023 8:30 AM Submitted by: Title: Commissioner District 3 — Board of County Commissioners Name: Burt Saunders 06/06/2023 8:30 AM Approved By: Review: County Attorney's Office County Attorney's Office Office of Management and Budget Community & Human Services County Manager's Office Board of County Commissioners Colleen Greene Level 2 Attorney Review Completed 06/06/2023 3:57 PM Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Completed 06/06/2023 4:08 PM Debra Windsor Level 3 OMB Gatekeeper Review Completed 06/06/2023 4:11 PM Maggie Lopez Additional Reviewer Amy Patterson Level 4 County Manager Review Geoffrey Willig Meeting Pending Completed 06/07/2023 8:57 AM Completed 06/07/2023 10:07 AM 06/13/2023 9:00 AM Packet Pg. 232