Resolution 2023-170 RESOLUTION NO. 2023 -1 7 0
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
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
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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
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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123-CRC-01401/1810806/1] 2
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.
2021-23, as codified in Chapter 126, Article VI of the Collier County Code of Ordinances.
Tax Collector means the Collier County Tax Collector.
Section 2. Authority. Pursuant to Article VIII, Section 1(f) of the Constitution of the
State of Florida, Chapter 125 of the Florida Statutes, and the Collier County Local Provider
Participation Fund Ordinance, the Board is hereby authorized to impose a special assessment
against private for-profit and not-for-profit hospitals located within the County to fund the non-
federal share of Medicaid payments associated with Local Services.
Section 3. Special Assessment. The non-ad valorem special assessment discussed
herein shall be imposed, levied, collected, and enforced against Assessed Properties located within
the County. Proceeds from the Assessment shall be used to benefit Assessed Properties through a
directed payment program that will benefit the Assessed Properties for Local Services.
[23-GRC-01401/1810806/I] 3 CO
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 payments, including the hospital directed payment program and graduate
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) 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 1.09% of net
patient revenue for each Assessed Property specified in the attached Non-Ad Valorem Assessment
Roll.The amount of the Assessment required of each Assessed Property may not exceed an amount
that, when added to the amount of other hospital assessments levied by the state or local
government, exceeds the maximum percent of the aggregate net patient revenue of all Assessed
Hospitals in the County permitted by 42 C.F.R. § 433.68(f)(3)(i)(A). Assessments for each
Assessed Property will be derived from data contained in cost reports and/or in the Florida Hospital
Uniform Reporting System, as available from the Florida Agency for Health Care Administration.
Section 6. Timing and Method of Collection. The amount of the assessment is to be
collected pursuant to the Alternative Method outlined in §197.3631, Fla Stat.
The County shall provide Assessment bills by first class mail to the owner of each affected
Hospital. The bill or accompanying explanatory material shall include: (1) a reference to this
Resolution, (2) the total amount of the hospital's Assessment for the appropriate period, (3) the
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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 26th day of September, 2023.
ATTEST: BOARD OF COUNTY COMMISSIONERS
Crystal If, tnze ' lerk of Courts COLLIER COUNTY, FLORIDA
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a: to 4 hairm4rfteputy lerk Rick LoCastro, Chairman
signature only
Approved as to form andlegAIity:
1 v
Jeffrey A. l.latzkow,County Attorney
CAD!
[23-GRC-01401/1810806/11 5
[Attachment- Assessment Roll]
MCD ID U Organization Facility Hospital Address Parcel U Rate Mandatory Payment
10314400 CHS Physicians Regional Medical Center-Pi 6101 Pine Ridge Rd.,Naples,FL 34119 80670080001 1.09%NPR 5 3,855,801
10031500 NCH Healthcare System NCH Baker Hospital Downtown 350 7th St.N,Naples,FL 34102 14038880000 1.09%NPR 5 6,642,259
104063 Oglethorpe The Willough at Naples 9001 Tamiami Trail East,Naples,FL 33862 55100120000 1.09%NPR 5 159,386
County Phone Number:(239)252-8999
BCC Address:Collier County Government Center,3299 Tamiami Trail East,Ste.303,Naples,FL 34112
Ordinance Date:June 22,2021
Resolution Date:September 26,2023
Disability Contact:Collier County Facilities Management Division at(239)252-8380
Mandatory Payments Due Date:Upon receipt of invoice
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[23-G12C-01401/1810806/1] 6
Graduate Medical Education Letter of Agreement
THIS LETTER OF AGREEMENT (LOA)is made and entered into in duplicate on the -
day of S0,4, 2023, by and between Collier LPPF (the"IGT Provider") on behalf of Naples
Community Hospital, and theState of Florida, Agency for Health Care Administration (the
"Agency"), for good and valuable consideration, the receipt and sufficiency of which is
acknowledged.
DEFINITIONS
"Graduate Medical Education(GME)" is the term used for the Graduate Medical Education
Startup Bonus Program, established to provide resources for the education and training of
physicians in specialties that are in a statewide supply-and-demand deficit, as listed in the
General Appropriations Act, Laws of Florida 2021-036.
"Intergovernmental Transfers (IGTs)" means transfers of funds from a non-Medicaid
governmental entity (e.g., counties, municipalities, hospital taxing districts, providers operated
by state or local government) to the Medicaid agency. IGTs must be considered a bona fide
donation pursuant to 42 CFR §433.54.
"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.
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 Collier LPPF and the Agency agree that the
Collier LPPF will remit IGT funds to the Agency in an amount not to exceed the total of
$1,910,450.46. The Collier LPPF and the Agency have agreed that these IGT funds will
only be used in accordance with §409.909, Florida Statutes (2021).
2. The Collier LPPF will return the signed LOA to the Agency no later than October 1,
2023.
3. The Collier LPPF will pay IGT funds to the Agency in an amount not to exceed the total
of$1,910,450.46. The Collier LPPF will transfer payments to the Agency in the
following manner:
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,
unlessan alternative plan is specifically approved by the agency.
b. The Agency will bill the Collier LPPF when payment is due.
4. The Collier LPPF and the Agency agree that the Agency will maintain necessary
records and supporting documentation applicable to the GME program covered by this
LOA in accordance with public records laws and established retention schedules.
Collier LPPF_GME LOA_SFY 2021-2022
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a. AUDITS AND RECORDS
i. The Collier LPPF agrees to maintain books, records, and documents (including
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. The Collier LPPF 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 Collier LPPF agrees to comply with public record laws as outlined in
section 119.0701, Florida Statutes.
b. RETENTION OF RECORDS
i. The Collier LPPF 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 beretained
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. The Collier LPPF agrees to permit persons duly authorized by the Agency to
inspect any records, papers, and documents of the Collier LPPF which are
relevant to this LOA.
d. ASSIGNMENT AND SUBCONTRACTS
i. The Collier LPPF 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 Collier LPPF and the Agency agree that any modifications to this LOA shall bein
the same form, namely the exchange of signed copies of a revised LOA.
Collier LPPF_GME LOA_SFY 2021-2022
1. The Collier LPPF 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.
2. The Collier LPPF agrees the following provision shall be included in any agreements
between the Collier LPPF 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."
3. 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.
4. 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.
Collier LPPF_GME LOA_SFY 2021-2022
c°,
GME Local Intergovernmental Transfers
Program / Amount State Fiscal Year 2023-2024
Estimated IGTs $1,910,450.46
Total Funding $1,910,450.46
IN WITNESS WHEREOF, the parties have caused this page Letter of Agreement to be
executed by their undersigned officials as duly authorized.
Collier LPPF STATE OF FLORIDA,AGENCY FOR
HEALTH CARE ADMINISTRATION
SIGNED SIGNED
BY: Qn,�� BY:
NAME: l) `N 4 k r Son NAME: Thomas Wallace
TITLE: NW-411 MGtV\a er TITLE: Deputy Director, Division
Of Medicaid
C�
DATE: r f 7-6 ' 2 OZ 3 DATE:
iI
Collier LPPF_GME LOA_SFY 2021-2022
6i)
Directed Payment Program Letter of Agreement
THIS LETTER OF AGREEMENT (LOA) is made and entered into in duplicate on the
day ofc44111602023, by and between (the"Collier County LPPF") 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 Senate Bill 2500, the General Appropriations Act of State Fiscal Year 2023-2024,
passed by the 2023 Florida Legislature, the Collier County LPPF and the Agency agree
that the Collier County LPPF will remit IGT funds to the Agency in an amount not to exceed
the total of$11,295,409.36. The Collier County LPPF and the Agency have agreed that
these IGT funds will only be used for the DPP program.
2. The Collier County LPPF will return the signed LOA to the Agency.
3. The Collier County LPPF will pay IGT funds to the Agency in an amount not to exceed
the total of $11,296,409.35. The Collier County LPPF will transfer payments to the
Agency in the following manner:
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 Collier County LPPF when payment is due.
4. The Collier County LPPF 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. Collier County LPPF agrees to maintain books, records,and documents(including
electronic storage media) pertinent to performance under this LOA in accordance
Collier County LPPF_Region 8_DPP LOA_SFY 2023-24
d i
it
I,
with generally accepted accounting procedures and practices, which sufficiently
and properly reflect all revenues and expenditures of funds provided.
ii. Collier County LPPF 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. Collier County LPPF agrees to comply with public record laws as outlined in
section 119.0701, Florida Statutes.
b. RETENTION OF RECORDS
i. The Collier County LPPF 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. Collier County LPPF agrees to permit persons duly authorized by the Agency to
inspect any records, papers, and documents of the Collier County LPPF which are
relevant to this LOA.
d. ASSIGNMENT AND SUBCONTRACTS
i. The Collier County LPPF 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 Collier County LPPF 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. Collier County LPPF 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 LPPF_Region 8_DPP LOA_SFY 2023-24
0
7. Collier CountyLPPF agreesthe following
provision shall be included in any agreements l '
between Collier County LPPF 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, 2023, through June 30, 2024, and shall be
terminated September 30, 2024, 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 2023-2024
Estimated IGTs $11,295,409.35
Total Funding Not to Exceed $11,295,409.35
IN WITNESS WHEREOF, the parties have caused this page Letter of Agreement to be
executed by their undersigned officials as duly authorized.
Collier County LPPF STATE OF FLORIDA,AGENCY FOR
HEALTH CARE ADMINISTRATION
SIGNEDPdt)(7 .016 SIGNED
BY: j� BY:
NAME: '�h'1y (� - 4e 1SOr NAME: Thomas Wallace
TITLE: blarp17 'AO
TITLE: Deputy Secretary, Division of
L � r Medicaid
DATE: Z81202.3 DATE: •
Collier County LPPF_Region 8_DPP LOA_SFY 2023-24
0