Agenda 09/26/2023 Item #16D 8 (Approve a Low Income Pool Letter of Agreement with tAgency for Health Care Administration)09/26/2023
EXECUTIVE SUMMARY
Recommendation to approve a Low Income Pool Letter of Agreement with the Agency for Health Care
Administration, in the amount of $469,861 and a companion agreement with Collier Health Services, Inc., to
participate in the Medicaid Low Income Pool Program, generating $647,792 in federal matching funds that
will provide additional health services for the citizens of Collier County; to authorize the County Manager or
designee to sign and execute the AHCA LIP Letter of Agreement; and to authorize the Chairman to execute
the companion agreement with CHSI.
OBJECTIVE: To provide additional health care services to the low-income citizens of Collier County.
CONSIDERATIONS: The Agency for Health Care Administration (AHCA) is a State entity that provides
Medicaid services in Florida and operates the Medicaid Low Income Pool (LIP) Program. The LIP Program
leverages local funds to obtain federal matching dollars. The County's participation in the LIP Program is outlined
in the attached LIP Letter of Agreement between Collier County and AHCA. AHCA requested that the County
execute the LIP Letter of Agreement using DocuSign; therefore, staff is requesting that the Board of County
Commissioners (Board) authorize the County Manager or designee to execute the agreement.
Collier Health Services, Inc. (CHSI) desires and is qualified to administer the LIP Program with AHCA using
County ad valorem tax dollars. The allocation of County and matching funds is as follows:
Collier County
LIP IGT
Federal Matching Funds Provided
to CHSI as Program Administrator
Total Funds Benefiting
Low-Income Persons
$469,861 $647,792 $1,117,653
CHSI will utilize the total funds under the LIP Program to provide additional healthcare services for low -income
individuals in Collier County. A companion agreement that outlines the contractual arrangement between Collier
County and CHSI is presented as part of this Agenda item. These funds may only be allocated to those Federally
Qualified Health Centers (FQHC).
CHSI will make payments in an amount not to exceed $250,000 for eligible medical services authorized by County
staff.
FISCAL IMPACT: Funding in the amount of $469,861 is available within Community & Human Services (CHS)
FY24 Community Mental Health & LIP Support Fund 0001, Cost Center 156010 for the County’s contribution
payment to the State of Florida Agency for Healthcare Administration by October 31, 2023.
GROWTH MANAGEMENT IMPACT: There is no Growth Management impact associated with this action.
LEGAL CONSIDERATIONS: This item has been approved as to form and legality, and requires a majority vote
for Board approval. -DDP
RECOMMENDATION: To approve a Low Income Pool (LIP) Letter of Agreement with the Agency for Health
Care Administration, in the amount of $469,861 and a companion agreement with Collier Health Services, Inc., to
participate in the Medicaid Low Income Pool Program, generating $647,792 in federal matching funds that will
provide additional health services for the citizens of Collier County; to authorize the County Manager or designee
to sign and execute the AHCA LIP Letter of Agreement; and to authorize the Chairman to execute the companion
agreement with CHSI.
Prepared By: Jeffrey Newman, Manager, Financial Operations, Operations and Veteran Services Division
16.D.8
Packet Pg. 1715
09/26/2023
ATTACHMENT(S)
1. Preliminary 2023-24 LIP Model (PDF)
2. SFY 2023-24 LIP LOA - Collier Health Services(PDF)
3. CHSI Agreement FY24 (PDF)
16.D.8
Packet Pg. 1716
09/26/2023
COLLIER COUNTY
Board of County Commissioners
Item Number: 16.D.8
Doc ID: 26422
Item Summary: Recommendation to approve a Low Income Pool Letter of Agreement with the Agency for
Health Care Administration, in the amount of $469,861 and a companion agreement with Collier Health Services,
Inc., to participate in the Medicaid Low Income Pool Program, generating $647,792 in federa l matching funds that
will provide additional health services for the citizens of Collier County; to authorize the County Manager or
designee to sign and execute the AHCA LIP Letter of Agreement; and to authorize the Chairman to execute the
companion agreement with CHSI.
Meeting Date: 09/26/2023
Prepared by:
Title: – Operations & Veteran Services
Name: Jeff Newman
08/21/2023 2:20 PM
Submitted by:
Title: – Operations & Veteran Services
Name: Jeff Newman
08/21/2023 2:20 PM
Approved By:
Review:
Community & Human Services Kristi Sonntag Additional Reviewer Completed 08/29/2023 4:06 PM
Operations & Veteran Services Jeff Weir OVS Director Review Completed 08/31/2023 3:17 PM
Community & Human Services Kim Frazier Additional Reviewer Completed 09/01/2023 12:10 PM
Public Services Department Todd Henry PSD Level 1 Reviewer Completed 09/05/2023 2:58 PM
Operations & Veteran Services Todd Henry Director Review Skipped 09/05/2023 2:59 PM
Grants Erica Robinson Level 2 Grants Review Completed 09/05/2023 3:42 PM
Public Services Department Tanya Williams PSD Department Head Review Completed 09/16/2023 6:26 PM
County Attorney's Office Derek D. Perry Additional Reviewer Completed 09/20/2023 8:51 AM
Office of Management and Budget Debra Windsor Level 3 OMB Gatekeeper Review Completed 09/20/2023 8:55 AM
County Attorney's Office Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Completed 09/20/2023 9:45 AM
Grants Therese Stanley Additional Reviewer Completed 09/20/2023 10:28 AM
Office of Management and Budget Blanca Aquino Luque Additional Reviewer Completed 09/20/2023 12:20 PM
County Manager's Office Dan Rodriguez Level 4 County Manager Review Completed 09/20/2023 2:12 PM
Board of County Commissioners Geoffrey Willig Meeting Pending 09/26/2023 9:00 AM
16.D.8
Packet Pg. 1717
FACHC Preliminary 2023-24 FQHC Group LIP Model (Medicaid PPS)
Charity Care % Charity Care LIP Payment IGT Needed Fed Net Portion
Agape Community Health Center $1,276,555 30.42%$388,356 $163,265 $225,091
Banyan Community Health Care $2,773,657 30.42%$843,808 $354,737 $489,071
Bond Community Health Centers, Inc.$877,388 30.42%$266,921 $112,214 $154,707
Borinquen Health Care Center, Inc.$10,286,242 30.42%$3,129,304 $1,315,559 $1,813,745
Brevard Health Alliance $8,147,462 30.42%$2,478,640 $1,042,020 $1,436,620
Broward Community & Family Health Center $1,752,713 30.42%$533,214 $224,163 $309,051
Camillus Health Concern $4,002,195 30.42%$1,217,557 $511,861 $705,696
Care Resource $7,025,951 30.42%$2,137,451 $898,584 $1,238,867
Center for Family and Child Enrichment $823,310 30.42%$250,469 $105,297 $145,172
Central Florida Family Health Centers, Inc. - True Health $5,681,581 30.42%$1,728,464 $726,646 $1,001,817
Central Florida Health Care, Inc $4,615,535 30.42%$1,404,149 $590,304 $813,845
Citrus Health Network $4,812,508 30.42%$1,464,072 $615,496 $848,576
C.L. Brumback Community Health Center - HCD PBC $9,562,307 30.42%$2,909,067 $1,222,972 $1,686,095
Collier Health Services, Inc (HC Ntwrk SW FL)$3,673,804 30.42%$1,117,653 $469,861 $647,792
Community Health Centers, Inc.$9,681,806 30.42%$2,945,421 $1,238,255 $1,707,166
Community Health Centers of Pinellas, Inc $5,085,794 30.42%$1,547,212 $650,448 $896,764
Community Health of South Florida, Inc. (CHI)$15,354,260 30.42%$4,671,108 $1,963,734 $2,707,374
Empower-U $785,987 30.42%$239,115 $100,524 $138,591
Community Health Northwest Florida (ECC)$4,418,964 30.42%$1,344,347 $565,164 $779,184
Family Health Center of Southwest Florida, Inc $6,538,608 30.42%$1,989,190 $836,256 $1,152,935
Aza Health $2,602,564 30.42%$791,758 $332,855 $458,903
Florida Community Health Centers, Inc $4,747,087 30.42%$1,444,170 $607,129 $837,041
FoundCare $2,890,365 30.42%$879,314 $369,663 $509,650
Genesis Community Health $894,573 30.42%$272,149 $114,412 $157,738
Gracepoint - Look-Alike $98,579 30.42%$29,990 $12,608 $17,382
Health Care Center for the Homeless, Inc. (Orange Blossom)$3,334,809 30.42%$1,014,523 $426,505 $588,018
Heart of Florida Health Center $2,908,869 30.42%$884,943 $372,030 $512,913
Jessie Trice Community Health Center, Inc.$17,096,430 30.42%$5,201,115 $2,186,549 $3,014,566
Lee Community Healthcare - Look-Alike $1,303,177 30.42%$396,455 $166,670 $229,786
MCR Health $19,647,067 30.42%$5,977,075 $2,512,763 $3,464,313
Metro Inclusive Health - Look-Alike $694,050 30.42%$211,146 $88,766 $122,380
Miami Beach Community Health Center $15,124,288 30.42%$4,601,145 $1,934,322 $2,666,824
Neighborhood Medical Center $1,160,208 30.42%$352,961 $148,385 $204,576
New River CHC - Union CHD $437,459 30.42%$133,085 $55,949 $77,136
North Broweard Hospital District $4,162,251 30.42%$1,266,250 $532,331 $733,918
North Florida Medical Centers, Inc $1,723,889 30.42%$524,445 $220,477 $303,969
PanCare Health $5,682,349 30.42%$1,728,697 $726,744 $1,001,953
NE Florida - Pierson Medical Center $1,180,982 30.42%$359,281 $151,042 $208,239
Pinellas HHS Homeless $1,739,139 30.42%$529,085 $222,427 $306,658
Osceola Community Health Services $1,382,318 30.42%$420,532 $176,792 $243,740
Premier Community HealthCare Group, Inc $4,999,762 30.42%$1,521,039 $639,445 $881,594
CenterPlace Health $4,360,150 30.42%$1,326,455 $557,642 $768,813
Rural Health Network of Monroe County $194,964 30.42%$59,312 $24,935 $34,378
Sulzbacher Center $1,286,597 30.42%$391,412 $164,549 $226,862
Suncoast Community Health Centers, Inc $11,273,410 30.42%$3,429,622 $1,441,813 $1,987,809
Tampa Family Health Center, Inc $15,868,281 30.42%$4,827,485 $2,029,474 $2,798,010
Langley Health Services $1,825,519 30.42%$555,364 $233,475 $321,889
Treasure Coast Community Health $3,588,745 30.42%$1,091,776 $458,983 $632,794
Palms Medical Group (Trenton)$5,777,592 30.42%$1,757,672 $738,925 $1,018,747
Walton CHC (CHD)$641,253 30.42%$195,084 $82,013 $113,070
Whole Family Health Center - Look-Alike $726,914 30.42%$221,143 $92,969 $128,175
$246,530,267 $75,000,000 $31,530,000 $43,470,000
Charity Care % IGT % FMAP %
30.42% 42.04% 57.96%
Data current as of July 2023
16.D.8.a
Packet Pg. 1718 Attachment: Preliminary 2023-24 LIP Model (26422 : LIP Collier Health Services FY24)
Collier County BoCC _LIP LOA SFY 2022-23
Low Income Pool Letter of Agreement
THIS LETTER OF AGREEMENT (LOA) is made and entered into in duplicate on the
day of 2023, by and between Collier County BoCC (the “IGT Provider”) on behalf of
Healthcare Network (Collier Health Services), 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
“Charity care” or “uncompensated charity care” means that portion of hospital charges reported
to the Agency for which there is no compensation, other than restricted or unrestricted revenues
provided to a hospital by local governments or tax districts regardless of the method of payment.
Uncompensated care includes charity care for the uninsured but does not include
uncompensated care for insured individuals, bad debt, or Medicaid and Children’s Health
Insurance Program (CHIP) shortfall. The state and providers that are participating in Low
Income Pool (LIP) will provide assurance that LIP claims include only costs associated with
uncompensated care that is furnished through a charity care program and that adheres to the
principles of the Healthcare Financial Management Association (HFMA) operated by the
provider.
“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.
“Low Income Pool (LIP)” means providing government support for safety-net providers for the
costs of uncompensated charity care for low-income individuals who are uninsured.
Uncompensated care includes charity care for the uninsured but does not include
uncompensated care for insured individuals, “bad debt,” or Medicaid and CHIP shortfall.
“Medicaid” means the medical assistance program authorized by Title XIX of the Social Security
Act, 42 U.S.C. §§ 1396 et seq., and regulations thereunder, as administered in Florida by the
Agency.
A. GENERAL PROVISIONS
1. Per Senate Bill 2500, the General Appropriations Act of State Fiscal Year 2023-2024,
passed by the 2023 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
$469,861.29 if the entire State Fiscal Year (SFY) 23-24 distribution is paid using the
enhanced Federal Medical Assistance Percentage (FMAP) per the Families First
Coronavirus Response Act or if a portion of the SFY23-24 distribution is paid after the
expiration of the end of the enhanced FMAP.
a. The IGT Provider and the Agency have agreed that these IGT funds will only be
used to increase the provision of health services for the charity care of the IGT
Provider and the State of Florida at large.
b. The increased provision of charity care health services will be accomplished
through the following Medicaid programs:
i. LIP payments to hospitals, federally qualified health centers, Medical
School Physician Practices, community behavioral health providers, and
CAO
16.D.8.b
Packet Pg. 1719 Attachment: SFY 2023-24 LIP LOA - Collier Health Services (26422 : LIP Collier Health Services FY24)
Collier County BoCC _LIP LOA SFY 2022-23
rural health centers pursuant to the approved Centers for Medicare &
Medicaid Services Special Terms and Conditions.
1. The IGT Provider will return the signed LOA to the Agency no later than October 1,
2023.
2. The IGT Provider will pay IGT funds to the Agency in an amount not to exceed the total
of $469,861.29 if the entire SFY23-24 distribution is paid prior to the end of the public
health emergency or if a portion of the SFY23-24 distribution is paid after the end of the
public health emergency.
a. Per Florida Statute 409.908, annual payments for the months of July 2023 through
June 2024 are due to the Agency no later than October 31, 2023, unless an
alternative plan is specifically approved by the agency.
b. The Agency will bill the IGT Provider when payment is due.
3. 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.
a. Audits and Records
i. The IGT Provider agrees to maintain books, records, and documents
(including electronic storage media) pertinent to performance under this L
O A in accordance with generally accepted accounting procedures and
practices, which sufficiently and properly reflect all revenues and
expenditures of funds provided.
ii. The 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. The IGT Provider agrees to comply with public record laws as outlined in
section 119.0701, Florida Statutes.
b. Retention of Records
i. The IGT Provider agrees to retain all financial records, supporting
documents, statistical records, and any other documents (including
electronic storage media) pertinent to performance under this LOA for a
period of six (6) years after termination of this LOA, or if an audit has
been initiated and audit findings have not been resolved at the end of
six (6) years, the records shall be retained until resolution of the audit
findings.
ii. Persons duly authorized by the Agency and federal auditors shall have full
access to and the right to examine any of said records and documents.
CAO
16.D.8.b
Packet Pg. 1720 Attachment: SFY 2023-24 LIP LOA - Collier Health Services (26422 : LIP Collier Health Services FY24)
Collier County BoCC _LIP LOA SFY 2022-23
i. 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. The IGT Provider agrees to permit persons duly authorized by the
Agency to inspect any records, papers, and documents of the IGT
Provider which are relevant to this LOA.
d. Assignment and Subcontracts
i. The IGT Provider agrees to neither assign the responsibility of this LOA
to another party nor subcontract for any of the work contemplated under
this LOA without prior written approval of the Agency. No such approval
by the Agency of any assignment or subcontract shall be deemed in any
event or in any manner to provide for the incurrence of any obligation of
the Agency in addition to the total dollar amount agreed upon in this
LOA. All such assignments or subcontracts shall be subject to the
conditions of this LOA and to any conditions of approval that the Agency
shall deem necessary.
4. 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.
5. The 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 charity care supplemental payments in order
to satisfy non-Medicaid, non-uninsured, and non-underinsured activities.
6. The IGT Provider agrees the following provision shall be included in any agreements
between the 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 (including LIP or DSH) and
used secondarily for other purposes.”
7. This LOA covers the period of July 1, 2023, through June 30, 2024, and shall
be terminated September 30, 2024, which includes the states certified forward
period.
8. 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.
CAO
16.D.8.b
Packet Pg. 1721 Attachment: SFY 2023-24 LIP LOA - Collier Health Services (26422 : LIP Collier Health Services FY24)
Collier County BoCC _LIP LOA SFY 2022-23
LIP Local Intergovernmental Transfers (IGTs)
Program / Amount State Fiscal Year 2023-2024
Estimated IGTs $469,861.29
Total Funding Not to Exceed $469,861.29
WITNESSETH:
IN WITNESS WHEREOF, the parties have caused this page Letter of Agreement to be
executed by their undersigned officials as duly authorized.
Collier County BoCC STATE OF FLORIDA, AGENCY FOR
HEALTH CARE ADMINISTRATION
SIGNED
BY:
SIGNED
BY:
NAME: NAME: Thomas Wallace
TITLE: TITLE: Deputy Director, Division
Of Medicaid
DATE: DATE:
Approved as to Form and Legality:
_________________________________
Derek D. Perry
Assistant County Attorney 9/19/
2
0
2
3
CAO
16.D.8.b
Packet Pg. 1722 Attachment: SFY 2023-24 LIP LOA - Collier Health Services (26422 : LIP Collier Health Services FY24)
16.D.8.c
Packet Pg. 1723 Attachment: CHSI Agreement FY24 (26422 : LIP Collier Health Services FY24)
16.D.8.c
Packet Pg. 1724 Attachment: CHSI Agreement FY24 (26422 : LIP Collier Health Services FY24)
16.D.8.c
Packet Pg. 1725 Attachment: CHSI Agreement FY24 (26422 : LIP Collier Health Services FY24)
16.D.8.c
Packet Pg. 1726 Attachment: CHSI Agreement FY24 (26422 : LIP Collier Health Services FY24)
16.D.8.c
Packet Pg. 1727 Attachment: CHSI Agreement FY24 (26422 : LIP Collier Health Services FY24)
16.D.8.c
Packet Pg. 1728 Attachment: CHSI Agreement FY24 (26422 : LIP Collier Health Services FY24)