Agenda 09/26/2023 Item #16D 7 (Resolution: Continued participation in the Local Provider Participation Fund for the Direct Payment Program and Granduate Medical Education Program)09/26/2023
EXECUTIVE SUMMARY
Recommendation to enact a resolution to authorize continued participation in the Local Provider
Participation Fund for the Directed Payment Program and Graduate Medical Education Program. These
programs will be solely funded by assessments on Collier County hospital-owned property or property used
as a hospital in an amount not to exceed $10,657,446. Authorize the County Manager to sign a Letters of
Agreement in an amount not to exceed the total of $13,205,859.81 with the Agency for Health Care
Administration and approve necessary Budget Amendments.
OBJECTIVE: To enact a resolution in support of area hospitals that provide health services to the low-income
citizens of Collier County. Authorize the County Manager to sign the Agency for He alth Care Administration
(AHCA) Letter of Agreement and authorize necessary Budget Amendments.
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 historically provided 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 Coun ty 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 FY21 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’ Med icaid shortfalls and improve the quality of care
provided to the Florida Medicaid population. In 2021, Collier County and fourteen (14) other Florida counties
created assessments to fund DPP. Another six (6) counties created assessment for DPP in 2022.
Florida also has established a program to support Graduate Medical Education (GME) for the next generation of
physicians. Collier County's hospital assessment has evolved to generate funds to provide the nonfederal share for
this program, in addition to DPP.
On June 22, 2021, the Board of County Commissioners (Board) 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, 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 approved Resolution 2022-149, which established the 2022 Local Provider
Participation Fund Special Assessment. The FY 2022 assessment of .69% of net patient revenue was collected and
when matched by the federal matching program, the Local Provider Participation Fund contributed $15,187,944 to
support low-income patient treatment in Collier County.
At the recommendation of the hospitals, the Local Provider Participation Fund Special assessment for FY 2023 will
be 1.09% of net patient revenue and will collect a maximum of $10,657,446 from participating Hospitals. This
amount, plus the carryforward balance from prior LPPF special assessments, less $150,000 in administrative
expenses will be submitted to AHCA. Budget Amendments may also be necessary during the year to shift
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approximately $2,485,147 of program-specific reserves and additional interest to reach a maximum potential
disbursement identified in the Letters of Agreement. The Direct Payment Program and Graduate Medical
Education Letters of Agreement between Collier County and the State of Florida AHCA permit an IGT in an
amount not to exceed the total of $13,205,859.81.
Collier County hospitals are supportive of the assessment and have requested that the program be continued. In
order to continue participating, the County must establish a 2023 special assessment rate via resolution. The
proposed resolution supports both the DPP and GME programs.
At the request of the hospitals annually, the County will impose a non-ad valorem assessment upon real property
owned or used by the hospitals to help fund the non-federal share of the State’s Medicaid Program. This assessment
will provide additional funding for Medicaid payments to clos e revenue shortfalls associated with the program.
Leveraging additional federal support through the DPP and GME program will directly benefit the services
delivered to Medicaid-eligible persons and support their ability to provide critical health care programs. It is
necessary to establish the LPPF program to ensure that the hospitals will have the opportunity to secure all funds
available in the upcoming state fiscal year.
The proposed resolution will enable the County to levy a uniform non-ad valorem special assessment in compliance
with 42 C.F.R. 433.68(d). The assessment shall be fairly and reasonably apportioned among each of the hospital’s
properties within the County limits. Annually, the Board shall set the assessment in amounts that in the aggregat e
will generate sufficient revenue to fund the non-federal share of Medicaid payments associated with Local Services
to be funded by the assessment. The assessment shall constitute a lien upon the assessed properties. Revenue
generated by the proposed assessment shall be held in a separate account called the Local Provider Participation
Fund (LPPF) and will be used only to: (1) provide 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 forthcoming assessment resolution.
If at the end of the Fiscal Year, additional amounts remain in the Local Provider Participation Fund, the Board is
authorized to roll funds over to or make a refund to assessed properties in proportion to amounts paid in during the
Fiscal Year.
If this item is approved, the Tax Collector and Property Appraiser have no responsibilities under the alternative
assessment process that is proposed. The alternative method of collection pursuant to F.S. 197.3631 states this
method shall not require the tax collector or property appraiser to perform those services as provided for in F.S.
197.3632 and 197.3635. Pursuant to Section 197.3632 additional authority is granted to local governments to
impose and collect non-ad-valorem assessments supplemental to the home rule powers. In future years County staff
may elect to recommend that the Board update the ordinance and adopt a future resolution to implement a uniform
assessment process that involves the services of the Tax Collector and Property Appraiser. The Tax Collector and
Property Appraiser have previously been coordinated with and they have no objection to the adoption of the
program.
DPP Local Intergovernmental Transfers
Program / Amount State Fiscal Year 2023-2024
LPPF DPP and GME Assessment $10,657,446
Total LOA Funding (not to exceed) $13,205,859.81
FISCAL IMPACT: The assessment of 1.09% of net patient revenue enacted by the resolution will take hospital
funds collected through a non-ad valorem assessment and direct those dollars to the AHCA to fund the non-federal
share of the State’s Medicaid Program, including the Direct Payment Program and Graduate Medical Education
Program. This funding structure ultimately results in enhanced funding returned to the hospitals for the Medicaid
shortfall and for physician training. The information currently available suggests the maximum assessment
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collected this year will be $10,657,446 from participating hospitals. The collected assessment will be transmitted to
AHCA and will not exceed the actual amount of assessment dollars received by the County less administrative
costs.
Hospital name Assessment Amount
NCH Baker Hospital $6,642,259
Physicians Regional $3,855,801
The Willough at Naples $159,386
$10,657,446
Relative to budget administration, FY24 Budget Amendments are necessary to establish a budget within Local
Provider Participation Fund (1130). The budget will include revenue of $10,657,446 for receipt of the FY23
assessments paid by the hospitals as well as associated expenses of $10,507,446 for the remittance of program
funds to AHCA. The Direct Payment Program letter of Agreement between Collier County and State of Florida
AHCA however permits an IGT in an amount not to exceed the total of $13,205,859.81. In addition, a FY24
Budget Amendment is required to recognize carryforward in the approximate amount of $413,600.
GROWTH MANAGEMENT IMPACT: There is no Growth Management impact.
LEGAL CONSIDERATIONS: The documents have an effective date of September 26, 2023. This item is
approved as to form and legality and requires a majority vote for Board action. -JAK
RECOMMENDATION: To enact a resolution to authorize continued participation in the Local Provider
Participation Fund for the Directed Payment Program and the Graduate Medical Education Program. Authorize the
County Manager to sign the AHCA Letter of Agreement and approve Budget Amendments as necessary throughout
FY24.
Prepared By: Jeffrey Newman, Manager - Financial Operations, Operations & Veterans Services Division
ATTACHMENT(S)
1. 2023 LPPF Resolution - JAK signed (PDF)
2. 1. Ordinance 2021-23 (PDF)
3. 1. Resolution 2021-197 (PDF)
4. Resolution 2022-149 (PDF)
5. Year 3 Presentation_Collier (PPTX)
6. legal ad - Agenda ID 26410 (PDF)
7. DPP LOA FY23-24 - COA stamped (PDF)
8. GME LOA FY23-24 - CAO stamped (PDF)
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COLLIER COUNTY
Board of County Commissioners
Item Number: 16.D.7
Doc ID: 26410
Item Summary: Recommendation to enact a resolution to authorize continued participation in the Local Provider
Participation Fund for the Directed Payment Program and Graduate Medical Education Program. These programs
will be solely funded by assessments on Collier County hospital -owned property or property used as a hospital in
an assessment amount of $10,657,446. Authorize the County Manager to sign a Letters of Agreement in an amount
not to exceed the total of $13,205,859.81 with the Agency for Health Care Administration and approve necessary
Budget Amendments.
Meeting Date: 09/26/2023
Prepared by:
Title: – Operations & Veteran Services
Name: Jeff Newman
08/17/2023 8:11 AM
Submitted by:
Title: – Operations & Veteran Services
Name: Jeff Newman
08/17/2023 8:11 AM
Approved By:
Review:
Community & Human Services Kristi Sonntag Additional Reviewer Completed 08/29/2023 3:51 PM
Operations & Veteran Services Jeff Weir OVS Director Review Completed 08/31/2023 3:16 PM
Community & Human Services Kim Frazier Additional Reviewer Completed 09/01/2023 12:44 PM
Public Services Department Todd Henry PSD Level 1 Reviewer Completed 09/05/2023 9:43 AM
Grants Erica Robinson Level 2 Grants Review Completed 09/05/2023 11:42 AM
Operations & Veteran Services Jeff Weir Director Review Completed 09/05/2023 12:25 PM
Public Services Department Tanya Williams PSD Department Head Review Completed 09/12/2023 11:01 AM
Office of Management and Budget Debra Windsor Level 3 OMB Gatekeeper Review Completed 09/12/2023 11:14 AM
County Attorney's Office Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Completed 09/13/2023 10:17 AM
Grants Therese Stanley Additional Reviewer Completed 09/14/2023 8:46 AM
Office of Management and Budget Blanca Aquino Luque Additional Reviewer Completed 09/19/2023 8:49 AM
County Manager's Office Dan Rodriguez Level 4 County Manager Review Completed 09/19/2023 1:40 PM
Board of County Commissioners Geoffrey Willig Meeting Pending 09/26/2023 9:00 AM
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Packet Pg. 1655 Attachment: 2023 LPPF Resolution - JAK signed (26410 : AHCA: Local Provider Participation Fund - Direct Payment Program 2023-2024)
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Packet Pg. 1656 Attachment: 2023 LPPF Resolution - JAK signed (26410 : AHCA: Local Provider Participation Fund - Direct Payment Program 2023-2024)
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Packet Pg. 1657 Attachment: 2023 LPPF Resolution - JAK signed (26410 : AHCA: Local Provider Participation Fund - Direct Payment Program 2023-2024)
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Packet Pg. 1658 Attachment: 2023 LPPF Resolution - JAK signed (26410 : AHCA: Local Provider Participation Fund - Direct Payment Program 2023-2024)
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Packet Pg. 1659 Attachment: 2023 LPPF Resolution - JAK signed (26410 : AHCA: Local Provider Participation Fund - Direct Payment Program 2023-2024)
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Packet Pg. 1660 Attachment: 2023 LPPF Resolution - JAK signed (26410 : AHCA: Local Provider Participation Fund - Direct Payment Program 2023-2024)
ORDINANCE NO.2021- 9 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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Packet Pg. 1661 Attachment: 1. Ordinance 2021-23 (26410 : AHCA: Local Provider Participation Fund - Direct Payment Program 2023-2024)
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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Packet Pg. 1662 Attachment: 1. Ordinance 2021-23 (26410 : AHCA: Local Provider Participation Fund - Direct Payment Program 2023-2024)
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 VIII, Section 1(0 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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Packet Pg. 1663 Attachment: 1. Ordinance 2021-23 (26410 : AHCA: Local Provider Participation Fund - Direct Payment Program 2023-2024)
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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Packet Pg. 1664 Attachment: 1. Ordinance 2021-23 (26410 : AHCA: Local Provider Participation Fund - Direct Payment Program 2023-2024)
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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Packet Pg. 1665 Attachment: 1. Ordinance 2021-23 (26410 : AHCA: Local Provider Participation Fund - Direct Payment Program 2023-2024)
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 theBoard, 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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Packet Pg. 1666 Attachment: 1. Ordinance 2021-23 (26410 : AHCA: Local Provider Participation Fund - Direct Payment Program 2023-2024)
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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Packet Pg. 1667 Attachment: 1. Ordinance 2021-23 (26410 : AHCA: Local Provider Participation Fund - Direct Payment Program 2023-2024)
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.
Page 8oflO
0
16.D.7.b
Packet Pg. 1668 Attachment: 1. Ordinance 2021-23 (26410 : AHCA: Local Provider Participation Fund - Direct Payment Program 2023-2024)
SECTION 2. APPLICABILITY.
It is hereby intended that this Ordinance shall constitute a uniform Iaw 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 13ULY ADOPTED by the Board of County Commissioners of Collier County,
Florida,this aorday of J u,ne, ,2021.
Page 9 of 10
16.D.7.b
Packet Pg. 1669 Attachment: 1. Ordinance 2021-23 (26410 : AHCA: Local Provider Participation Fund - Direct Payment Program 2023-2024)
ATTEST: BOARD OF COUNTY COMMISSIONERS
CRYSTAL K KINZEL,CLERK COLLIER O Y, FLORIDA
By—:)(By:
DEPUT PENNY TAYL ,CHAIRP SON
Attest as to Chaim an's •••.
signature only.
Approved as to form
and legality:
e i r A.Bel edio 1Jna p 5PAssistantCountyAtto
I i
This ordinance flied with t1'xs:
Secr tort' of State's
day of
and acknowledgement of that
filing received ihis
day
By Deouty C erk,
Page 10 of 10
0G
16.D.7.b
Packet Pg. 1670 Attachment: 1. Ordinance 2021-23 (26410 : AHCA: Local Provider Participation Fund - Direct Payment Program 2023-2024)
r .
FLORIDA DEPARTMENT Of STATE
RON DESANTIS LAUREL M. LEE
Governor Secretary of State
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:
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
16.D.7.b
Packet Pg. 1671 Attachment: 1. Ordinance 2021-23 (26410 : AHCA: Local Provider Participation Fund - Direct Payment Program 2023-2024)
RESOLUTION NO. 2021 — 197
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, the State of Florida (the "State") received federal authority to establish the
Statewide Medicaid Managed Care Hospital directed payment program (the "DPP") to offset
hospitals' uncompensated Medicaid costs and improve quality of care provided to Florida's
Medicaid population; and
WHEREAS, Hospitals have asked Collier County (the "County") to impose 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 ("1GTs") provided consistent with federal guidelines, support additional funding for
Medicaid payments to Hospitals; and
C,gQ
1
16.D.7.c
Packet Pg. 1672 Attachment: 1. Resolution 2021-197 (26410 : AHCA: Local Provider Participation Fund - Direct Payment Program 2023-2024)
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
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, leveraging additional federal support through the above-described IGTs to
fund Medicaid payments to the Hospitals for health care services directly and specifically benefits
the Hospitals' property interests and supports their continued ability to provide those services; 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
2001-23,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
CA0
16.D.7.c
Packet Pg. 1673 Attachment: 1. Resolution 2021-197 (26410 : AHCA: Local Provider Participation Fund - Direct Payment Program 2023-2024)
otherwise defined herein or in the Ordinance, shall have the meanings below, unless the context
otherwise requires.
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 No.
20021-23.
Tax Collector means the Collier County Tax Collector.
Section 2. Authority. Pursuant to 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
3 11Q
16.D.7.c
Packet Pg. 1674 Attachment: 1. Resolution 2021-197 (26410 : AHCA: Local Provider Participation Fund - Direct Payment Program 2023-2024)
the County. Proceeds from the Assessment shall be used to benefit Assessed Properties through a
directed payment program that will benefit the Assessed Properties for Local Services.
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 Scope, 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 managed care hospital directed 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 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)if requested to do so by the Assessed Properties,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 1.11% 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.
4 9Q
16.D.7.c
Packet Pg. 1675 Attachment: 1. Resolution 2021-197 (26410 : AHCA: Local Provider Participation Fund - Direct Payment Program 2023-2024)
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
statement that the Assessment constitutes a lien against assessed property and/or improvements equal
in rank and dignity with the liens of all state, county, district 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. As required by §197.3631, Fla. Stat. 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 28th day of September. 2021.
ATTEST: BOARD OF COUNTY COMMISSIONERS
CRYSTAL K. KINZEL, CLERK COLLIER 0 TY, FLORID
By:By:
Attest as to CSairdiafillUTY CL PENNY TA OR, CHAIRPERSON
sir natu:n cr 1y,
Approved as to form and legality:
1 Y t,Crystal+..K inzel,Cleft(of Courts and for oiiier C:unty
do hearby:ertify..at the ao re i,istrurn nt is a true a...;correct
llllll
Jenni er A. Belpedio ` rd` cop of:`te,origina led'in Clier County,Flo%a
Deputy Clerk
Assistant County Attorney By: in`\\
5
70
16.D.7.c
Packet Pg. 1676 Attachment: 1. Resolution 2021-197 (26410 : AHCA: Local Provider Participation Fund - Direct Payment Program 2023-2024)
16.D.7.d
Packet Pg. 1677 Attachment: Resolution 2022-149 (26410 : AHCA: Local Provider Participation Fund - Direct Payment Program 2023-2024)
16.D.7.d
Packet Pg. 1678 Attachment: Resolution 2022-149 (26410 : AHCA: Local Provider Participation Fund - Direct Payment Program 2023-2024)
16.D.7.d
Packet Pg. 1679 Attachment: Resolution 2022-149 (26410 : AHCA: Local Provider Participation Fund - Direct Payment Program 2023-2024)
16.D.7.d
Packet Pg. 1680 Attachment: Resolution 2022-149 (26410 : AHCA: Local Provider Participation Fund - Direct Payment Program 2023-2024)
16.D.7.d
Packet Pg. 1681 Attachment: Resolution 2022-149 (26410 : AHCA: Local Provider Participation Fund - Direct Payment Program 2023-2024)
16.D.7.d
Packet Pg. 1682 Attachment: Resolution 2022-149 (26410 : AHCA: Local Provider Participation Fund - Direct Payment Program 2023-2024)
16.D.7.d
Packet Pg. 1683 Attachment: Resolution 2022-149 (26410 : AHCA: Local Provider Participation Fund - Direct Payment Program 2023-2024)
16.D.7.d
Packet Pg. 1684 Attachment: Resolution 2022-149 (26410 : AHCA: Local Provider Participation Fund - Direct Payment Program 2023-2024)
LO CAL PROVIDER PA RTICIPAT ION FUND
Ye ar 2 Review, Year 3 Preparation
16.D.7.e
Packet Pg. 1685 Attachment: Year 3 Presentation_Collier (26410 : AHCA: Local Provider Participation Fund - Direct
AG ENDA
2022 Directed Payment Program Summary
2022 Directed Payment Program Changes
2023 Directed Payment Program Process
2023 County Timeline
16.D.7.e
Packet Pg. 1686 Attachment: Year 3 Presentation_Collier (26410 : AHCA: Local Provider Participation Fund - Direct
2022 DIRECTED PAY MENT
PROGRAM SUMMARY
16.D.7.e
Packet Pg. 1687 Attachment: Year 3 Presentation_Collier (26410 : AHCA: Local Provider Participation Fund - Direct
MEDICAID OVERVIEW
•Medicaid is the nation’s public health insurance program for low-income
children, families, elders, and people with disabilities.
•1 in 5 Florida residents is enrolled.
•The program supports the health care system and safety-net and
increases the state’s capacity to address health challenges.
16.D.7.e
Packet Pg. 1688 Attachment: Year 3 Presentation_Collier (26410 : AHCA: Local Provider Participation Fund - Direct
MEDICAID
OV ERVIEW
•Medicaid is jointly funded
by the states and federal
government.
•The state contributes, and
the federal government
provides matching funds.
16.D.7.e
Packet Pg. 1689 Attachment: Year 3 Presentation_Collier (26410 : AHCA: Local Provider Participation Fund - Direct
UNLOCKING AN OPPORTUNITY
In November 2020,
Governor DeSantis
included in his
recommended budget
direction for the
state’s Medicaid
agency to seek federal
approval for a directed
payment program
designed to narrow
the reimbursement
gap.
16.D.7.e
Packet Pg. 1690 Attachment: Year 3 Presentation_Collier (26410 : AHCA: Local Provider Participation Fund - Direct
PROGRAM REVIEW
Collier County’s Local Provider Participation Fund is a non-ad
valorem special assessment that allows nonpublic hospitals in the
jurisdiction to access available federal dollars.
The assessment qualifies as a “provider tax” under federal law
that is eligible for federal match because it is:
Broad Based
Uniform
Entails No Hold-Harmless Guarantee
Does Not Exceed 6% of revenues
16.D.7.e
Packet Pg. 1691 Attachment: Year 3 Presentation_Collier (26410 : AHCA: Local Provider Participation Fund - Direct
LPPFS WHO FUNDED DPP IN 2022
In 2021, 15 Florida counties
adopted Local Provider
Participation Fund ordinances
and passed resolutions levying
non-ad valorem special
assessments for the hospital
directed payment program.
In 2022, another 6 jurisdictions
passed resolutions for the
program.
16.D.7.e
Packet Pg. 1692 Attachment: Year 3 Presentation_Collier (26410 : AHCA: Local Provider Participation Fund - Direct
FLOW OF FUNDS FOR DPPS
After submission of the IGTs, the
Agency for Health Care
Administration applied the
matching funds and distributed
sums to the managed care
organizations for dispersal to
hospitals across the state.
Hospitals began receiving the
added Medicaid reimbursement in
April 2023 and will receive all DPP
Ye ar 2 funds by the end of June
2023.
16.D.7.e
Packet Pg. 1693 Attachment: Year 3 Presentation_Collier (26410 : AHCA: Local Provider Participation Fund - Direct
FLORIDA MANAGED MEDICAID PLANS SERVICING EACH REGION
1 2 3 4 5 6 7 8 9 10 11 Tota l
Aetna Better Health X X X 3
Community Care Plan X 1
Florida Community Care X X X X X X X X X X X 11
Humana Medical Plan X X X X X X X X X X X 11
Light house Health Plan X X 2
Miami Children's X X 2
Molina Healthc are X X 2
Pres tige X X 2
Simply Healthcare X X X X X 5
Staywell X X X X X X X X X X 10
Sunshine Healt h X X X X X X X X X X X 11
United Healthcare X X X X 4
Vivida Health X 1
Re gion
MCO
16.D.7.e
Packet Pg. 1694 Attachment: Year 3 Presentation_Collier (26410 : AHCA: Local Provider Participation Fund - Direct
MONEY TO YOUR
COUNTY’S
HOSPITALS
Hospitals in Collier County
received over $15 million from
this program.
The funds received enabled your
healthcare leaders to provide care
to the most vulnerable in your
community and to sustain
initiatives designed to meet
medical needs.
16.D.7.e
Packet Pg. 1695 Attachment: Year 3 Presentation_Collier (26410 : AHCA: Local Provider Participation Fund - Direct
2022 DIRECTED PAY MENT
PROGRAM CHANGES
16.D.7.e
Packet Pg. 1696 Attachment: Year 3 Presentation_Collier (26410 : AHCA: Local Provider Participation Fund - Direct
ADDITION OF QUALITY METRICS
Beginning in Ye ar 2, the Agency for Health Care Administration applied 3
quality metrics to incentivize improvements in performance for Florida’s
Medicaid-providing hospitals. The three quality measures involve:
Cesarean Sections
Po tentially Preventable Hospital Readmissions
Follow-Up after Hospitalization for Mental Health
16.D.7.e
Packet Pg. 1697 Attachment: Year 3 Presentation_Collier (26410 : AHCA: Local Provider Participation Fund - Direct
METRICS EXPLAINED
Each metric is associated with a 2% withhold.
The state calls for an IGT of the amount the hospitals are eligible
to receive.
Because each county’s rate must be set in advance, the rate
recommendation will assume satisfaction of all metrics.
Any remaining funds in the Local Provider Participation Fund
remain in the account and roll into next year. Next year ’s rate will
reflect the new projected need.
16.D.7.e
Packet Pg. 1698 Attachment: Year 3 Presentation_Collier (26410 : AHCA: Local Provider Participation Fund - Direct
2023 DIRECTED PAY MENT
PROGRAM PROCESS
16.D.7.e
Packet Pg. 1699 Attachment: Year 3 Presentation_Collier (26410 : AHCA: Local Provider Participation Fund - Direct
STAT E BUDGET AUTHORITY
In May 2023 , Florida’s legislature adopted a
budget with proviso language that:
•Directs AHCA to seek federal
reauthorization for the Directed Payment
Program
•Requires AHCA to submit a request for state
legislative authority (via the legislative
budget commission) to move funds to again
implement the program, if approved
16.D.7.e
Packet Pg. 1700 Attachment: Year 3 Presentation_Collier (26410 : AHCA: Local Provider Participation Fund - Direct
FEDERAL PREPRINT SUBMISSION
At the federal level, the Directed Payment Program
reauthorization is under review.
The Agency for Health Care Administration submitted the
preprint in January 2023 .
16.D.7.e
Packet Pg. 1701 Attachment: Year 3 Presentation_Collier (26410 : AHCA: Local Provider Participation Fund - Direct
2023 COUNTY TIMELINE
16.D.7.e
Packet Pg. 1702 Attachment: Year 3 Presentation_Collier (26410 : AHCA: Local Provider Participation Fund - Direct
RESOURCES FOR RESOLUTION PASSAGE
Like last year, the Legislative Budget Commission must authorize
the Agency for Health Care Administration to call for IGTs. The
Agency prepares the amendment in August for September
consideration.
To facilitate passage of a 2023 resolution, the County will once
again receive:
Draft agenda item
Draft mail notice, with invoice
Draft publication notice
Draft invoices
Draft LOA questionnaire responses
16.D.7.e
Packet Pg. 1703 Attachment: Year 3 Presentation_Collier (26410 : AHCA: Local Provider Participation Fund - Direct
TIMELINE FOR RESOLUTION PA SSAGE
The deadline for mail notice and notice by publication is 20 days before the September 26 resolution vote:
The target date for Collier County’s assessment resolution is:
The LOA deadline for all IGTs is:
September 6, 2023
September 26, 2023
October 1, 2023
16.D.7.e
Packet Pg. 1704 Attachment: Year 3 Presentation_Collier (26410 : AHCA: Local Provider Participation Fund - Direct
RESULTS OF COUNTY EFFORTS
Collier County’s hospitals wish to
express gratitude for the County’s
efforts to establish a Local Provider
Participation Fund.
This continued partnership enables
their success as care providers and
community partners.
Continuing to draw down available
resources ensures Collier County’s
hospitals will remain competitive
providers, reliable employers, and
healthcare leaders.
16.D.7.e
Packet Pg. 1705 Attachment: Year 3 Presentation_Collier (26410 : AHCA: Local Provider Participation Fund - Direct
QUESTIONS?
16.D.7.e
Packet Pg. 1706 Attachment: Year 3 Presentation_Collier (26410 : AHCA: Local Provider Participation Fund - Direct
16.D.7.f
Packet Pg. 1707 Attachment: legal ad - Agenda ID 26410 (26410 : AHCA: Local Provider Participation Fund - Direct Payment Program 2023-2024)
16.D.7.g
Packet Pg. 1708 Attachment: DPP LOA FY23-24 - COA stamped (26410 : AHCA: Local Provider Participation Fund - Direct Payment Program 2023-2024)
16.D.7.g
Packet Pg. 1709 Attachment: DPP LOA FY23-24 - COA stamped (26410 : AHCA: Local Provider Participation Fund - Direct Payment Program 2023-2024)
16.D.7.g
Packet Pg. 1710 Attachment: DPP LOA FY23-24 - COA stamped (26410 : AHCA: Local Provider Participation Fund - Direct Payment Program 2023-2024)
16.D.7.h
Packet Pg. 1711 Attachment: GME LOA FY23-24 - CAO stamped (26410 : AHCA: Local Provider Participation Fund - Direct Payment Program 2023-2024)
16.D.7.h
Packet Pg. 1712 Attachment: GME LOA FY23-24 - CAO stamped (26410 : AHCA: Local Provider Participation Fund - Direct Payment Program 2023-2024)
16.D.7.h
Packet Pg. 1713 Attachment: GME LOA FY23-24 - CAO stamped (26410 : AHCA: Local Provider Participation Fund - Direct Payment Program 2023-2024)
16.D.7.h
Packet Pg. 1714 Attachment: GME LOA FY23-24 - CAO stamped (26410 : AHCA: Local Provider Participation Fund - Direct Payment Program 2023-2024)