Backup Documents 05/28/2024 Item #16F10 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 F 1 C
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1.
2.
3. County Attorney Office County Attorney Office „
C 5121
4. BCC Office Board of County
Commissioners Ctf if )I
5. Minutes and Records Clerk of Court's Office
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the addressees
above,may need to contact staff for additional or missing informa
Name of Primary Staff Cherie DuBock/EMS Phone Number 239-252-3756
Contact/ Department
Agenda Date Item was 5/28/2024 Agenda Item Number 28898
Approved by the BCC 16 F I d
Type of Document Agreement Amendment#1 Number of Original 1
Attached Public Consulting Group Documents Attached
PO number or account
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature? CD
2. Does the document need to be sent to another agency for additional signatures? If yes, CD
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be CD
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's CD
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the CD
document or the fmal negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's CD
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip CD
should be provided to the County Attorney Office at the time the item is input into SIRE.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on 5/28/2024(enter date)and all changes N/A is not
made during the meeting have been incorporated in the attached document. The an option for
County Attorney's Office has reviewed the changes,if applicable. this line.
9. Initials of attorney verifying that the attached document is the version approved by the N/A is not
BCC,all changes directed by the BCC have been made,and the document is ready for the 6551,40 an option for
Chairman's signature. ( this line.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
1 6F 10
FIRST AMENDMENT TO AGREEMENT No. 21-021-NS
FOR
PUBLIC EMERGENCY MEDICAL TRANSPORTATION (PEMT)
MEDICAID REIMBURSEMENT PROGRAM
THIS FIRST AMENDMENT made and entered into on this 2.6 day of
2024, by and between Public Consulting Group LLC (the "PCG" or "Contractor") and C llier
County, a political subdivision of the State of Florida, (the "County") (collectively, the "Parties"):
WHEREAS, on June 22,2021 (Agenda Item 16.E.1), the County entered into Agreement
No. 21-021-NS (the "Agreement") with Contractor to provide reporting and consulting services
pertaining to the Public Emergency Medical Transportation (PEMT) Reimbursement Program; and
WHEREAS, the Agreement is set to expire on June 21, 2024; and
WHEREAS, the Parties desire to continue the services under the Agreement for an
additional three year period; and
WHEREAS, the Parties also wish to amend Attachment B, Compensation, providing for a
twelve percent (12%) contingency fee to be paid to Contractor.
NOW, THEREFORE, in consideration of the mutual promises and covenants herein
contained, it is agreed by the Parties as follows:
1. The above recitals are hereby incorporated into this First Amendment as if fully set forth herein.
2. Section 2 of the Agreement is hereby amended as follows:
Unless terminated ca lic ,this ^ ent-shall-be-fer a three(3)year term beginning on the Effective
Date: The Agreement shall be effective from the Effective Date through June 21, 2027, unless
terminated earlier pursuant to Section 4 or extended by written agreement of the parties.
CONTRACTOR will commence performance for Contracted Services under this Agreement and
will complete performance until additional Medicaid revenues are generated and received for the
service periods outlined in Attachment A and Attachment B. Unless otherwise specified by
COUNTY in writing, CONTRACTOR will provide the Contracted Services for the full duration of
this AGREEMENT. CONTRACTOR and COUNTY acknowledge that the program services
described in Attachments A and B are dependent on receiving state and federal program approval,
and it may be necessary to extend the term of this AGREEMENT to receive additional incremental
revenues.
Upon the expiration or termination of this Agreement for any reason all rights granted hereunder
shall immediately terminate except for those concerning compensation,confidentiality, intellectual
property,or any other provision that,by its terms,is intended to survive the expiration or termination
of this Agreement. Specifically, notwithstanding the expiration or termination of the Agreement,
COUNTY will compensate PCG as set forth herein with respect to any reimbursements COUNTY
receives after the expiration or termination of this Agreement that are the result of the Contracted
Services."
Page I of 5
First Amendment to Agreement No. 21.021-NS C40
1 6 F 1 0
3. Attachments A and B of the Agreement are hereby replaced with the Exhibit A,attached hereto
and incorporated herein by reference.
4. This First Amendment shall take effect on June 22, 2024.
5. Except as amended herein,all other terms and conditions of the Agreement shall remain in full
force and effect.
IN WITNESS WHEREOF, the Parties have executed this First Amendment on the date and year
first written above by an authorized person or agent.
ATTEST:
Crystal K. Kinzel, Clerk of the Circuit BOARD OF COUNTY COMMISSIONERS
Court and Comptroller COLLIER COUNTY, FLORIDA
By: By:
244? 41(
Chr 11, Chairman
Dated: !�(J
(SEAL) :Attest as ttt Chairman's
signature. !*nit.
Contractor's Witnesses: CONTRACTOR:
PUBLIC CONSULTING GROUP LLC
•first Witness
By: o ,1 �- C Q. S gnature
TType/print witness nameT
►\\. SiaX twS i ftrts.
TType/print signature and thief
/2.7Second Witness Date
T'I•ype/print tress nameT
Approved as to Form and Legality:
Carly 19 ire Sanseverino G33 r/(/,l44
Assistant County Attorney
Page 2 of 5
First Amendment to Agreement No.21.021-NS \ '
16F10
Exhibit A to First Amendment
ATTACHMENT A
CONTRACTED SERVICES
For
Public Emergency Medical Transportation(PEMT) Program
CONTRACTOR agrees to provide the Contracted Services for three State Fiscal Year cost
reporting cycles, defined as: FY24 (July 1, 2023 to June 30, 2024) FY25 (July 1, 2024 to June
30, 2025)and FY26(July 1, 2025 to June 30, 2026)
A. CONTRACTOR shall be familiar with the PEMT Program in the State of Florida and all the rules,
regulations and requirements associated with the Program.
B. CONTRACTOR shall have the knowledge, skills,and ability to fully complete the required cost
reports to the Agency for Health Care Administration (AHCA)within the time frame prescribed by the
AHCA.
C. CONTRACTOR shall have knowledge of the data and cost reporting principles specified in Chapter
401, Florida Statutes.
D. CONTRACTOR shall have knowledge and experience in the completion of all ten (10) Schedules as
required by the Program.
E. COUNTY will provide CONTRACTOR with all of the required data needed to complete the
Schedules; however,CONTRACTOR is responsible for accurate completion of the Schedules.
F. CONTRACTOR shall be able to accept from COUNTY, in electronic submission form,all information
via a secure connection in accordance with the Health Insurance Portability and Accountability Act
(HIPAA).
G. If the completed cost report is rejected by the AHCA,CONTRACTOR shall work with COUNTY to
make the necessary corrections and/or modifications and resubmit the report before the required filing
deadline.
H. CONTRACTOR shall keep COUNTY informed of all updates relating to managed care and estimate
the impact of future changes in managed care reimbursement.
1. CONTRACTOR shall support COUNTY in establishing the legal and operational ground to participate
in the Managed Care program.
J. CONTRACTOR shall draft supporting documentation and flow processes for presentation to
COUNTY and assist with messaging and review presentations for governmental relationship staff as
needed.
Page 3 of 5
First Amendment to Agreement No.21.021-NS cq�
16F10
K. CONTRACTOR shall provide guidance and support to enter into contracts with Managed Care
Organizations.
L. CONTRACTOR shall be familiar with the Managed Care program in the State of Florida and all the
rules, regulations and managed care reporting requirements.
M. CONTRACTOR shall monitor claims and cash flows of Managed Care program to ensure COUNTY
receives appropriate benefit from the program and has met documentation needs.
N. CONTRACTOR agrees to receive compensation for Contracted Services on a contingency fee basis.
This compensation will be based on payments received by COUNTY under the PEMT Program.
O. If,as a result of an audit by the ACHA, a refund is required by COUNTY, CONTRACTOR agrees to
return the portion of the compensation fee that was paid on the amount being refunded.
Page 4 of 5
First Amendment to Agreement No. 21.02I-NS CA0
1 6 F 1 0
ATTACHMENT 13
COMPENSATION
All revenue due COUNTY from the Florida PEMT shall be paid in full directly to COUNTY from the payer.
After payment is received in full from the payer, in consideration of the professional services to be performed
for PEMT under this Agreement,COUNTY shall pay CONTRACTOR a fee of Twelve Percent(12%)of the
payments received by COUNTY under the PEMT program for the State Fiscal Year cost reporting cycles set
forth in Attachment A.
CONTRACTOR will not receive any compensation until the Medicaid FFS or Medicaid MCO incremental
revenues are received by COUNTY. All incremental revenue realized by COUNTY from the supplemental
payment program for EMS shall be paid in full directly from the State of Florida to COUNTY.CONTRACTOR
will invoice and receive revenue upon the receipt of revenue by COUNTY for either initiative,meaning revenue
does not have to be generated for both Medicaid FFS and Medicaid MCO programs, rather revenue simply
needs to be generated for either initiative to allow the CONTRACTOR to generate invoices. CONTRACTOR
will invoice COUNTY based on the supplemental payments amounts within 45 days of receipt of funds by
COUNTY.
This AGREEMENT can be extended at the mutual consent of both parties through written notification and
execution of an amendment.
Page 5 of 5
First Amendment to Agreement No. 21.021-NS Cqr,