Agenda 09/10/2024 Item #16D11 (Resolution- Support of area hospitals that provide services to the low-income citizens of Collier County)09/ 10/2024
EXECUTIVE SUMMARY
Recommendation to approve a Resolution to authorize continued participation in the Local Provider
Participation Fund for the Directed Payment Program and Graduate Medical Education Program, which
will be solely funded by assessments on Collier County hospital -owned property or property used as a
hospital in an amount not to exceed $12,654,900, authorize the County Manager to sign the Directed
Provider Payment Letter of Agreement in the amount of $10,141,128 and the forthcoming Graduate Medical
Education Program Letter of Agreement in an estimated amount of $2,786,495 with the Agency for Health
Care Administration for an estimated total not to exceed $13,194,849 and authorize the 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.
CONSIDERATIONS: The County has participated in the State of Florida's Agency for Health Care
Administration (AHCA) Intergovernmental Transfer Program (IGT). As a participant in the IGT program, the
County provides 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 County 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 Local Provider Participation Fund (LPPF), which includes the Directed
Payment Program (DPP) and the Graduate Medical Education Program (GME).
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 LPPF.
This program is available to hospitals providing inpatient and outpatient services to Medicaid -managed care
enrollees. It is the intent of the LPPF to offset hospitals' Medicaid shortfalls and improve the quality of care
provided to the Florida Medicaid population.
On June 22, 2021, the 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 (Agenda item
16.D.3). Following the passage of Ordinance 2021-23, the Board subsequently approved participation in the
program in FY22 on September 27, 2022 (Agenda Item #16.D.5), as well as for FY23 on September 26, 2023
(Agenda Item #16.D.7).
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 close revenue shortfalls associated with the program.
Leveraging additional federal support through the DPP and GME programs will directly benefit the services
delivered to Medicaid -eligible persons and support their ability to provide critical health care programs. It is
necessary to continue 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 aggregate
will generate sufficient revenue to fund the non-federal share of Medicaid payments associated with Local Services
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09/ 10/2024
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 the Ordinance, as further specified in the resolution.
At the recommendation of the hospitals, the Local Provider Participation Fund Special assessment for FY 2024 will
be 1.18% of net patient revenue and will collect a maximum of $12,654,900 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
approximately $539,949 of program -specific reserves and additional interest to reach a maximum potential
disbursement identified in the Letters of Agreement. The DPP and GME Letters of Agreement between Collier
County and AHCA permit an IGT in an amount not to exceed $13,194,849.
If at the end of the Fiscal Year, additional amounts remain in the LPPF, 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.
Pursuant to section 197.3631, Florida Statutes, the alternative method of collection shall not require the tax
collector or property appraiser to perform those services as provided for in sections 197.3632 and 197.3635, Florida
Statutes. If this item is approved, the Tax Collector and Property Appraiser have no responsibilities under the
alternative assessment process that is proposed. Both offices have expressed that they have no objection to the
County's participation in the program.
DPP and GME Local Intergovernmental Transfers
Program / Amount
State Fiscal Year 2024-2025
LPPF DPP and an estimated GME Assessment
$12,654,900
Total LOA Funding (not to exceed)
$13,194,849
FISCAL IMPACT: The assessment of 1.18% 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 Medicaid Hospital 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 physician training. The information currently available suggests the maximum
assessment collected this year will be $12,654,900 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
$7,997,429
Physicians Regional
$ 4,466,877
Encompass Health Rehabilitation
$58,257
The Willough at Naples
$132,337
$12,654,900
Relative to budget administration, FY25 Budget Amendments are necessary to establish a budget within Local
Provider Participation Fund (1130). The budget will include revenue of $12,654,900 for receipt of the FY24
assessments paid by the hospitals. The Direct Payment Program and Graduate Medical Education letters of
Agreement between Collier County and State of Florida AHCA however permits an IGT in an amount not to
exceed the total of $13,194,849. In addition, a FY25 Budget Amendment is required to recognize carryforward in
the approximate amount of $539,949.
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16.D.11
09/ 10/2024
GROWTH MANAGEMENT IMPACT: There is no Growth Management impact.
LEGAL CONSIDERATIONS: This item is approved as to form and legality and requires a majority vote for
Board action. -CJS
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 $12,654,900. Authorize the County Manager to sign the Directed Provider Payment Letter
of Agreement in the amount of $10,141,128 and the forthcoming Graduate Medical Education Program Letter of
Agreement in an estimated amount of $2,786,495 with the Agency for Health Care Administration for an estimated
total not to exceed $13,194,849 and authorize the necessary Budget Amendments.
Prepared By: Carolyn Noble, Grants Coordinator, Community and Human Services Division
ATTACHMENT(S)
1.42 CFR § 433.68 - Permissible health care -related taxes. _ Electronic Code of Federal Regulations (e-CFR)
_ US Law _ LII _ Legal Information Institute (PDF)
2. ES 9.26.23 (PDF)
3. ES 9.27.22 16.D.5.
(PDF)
4. ordinance 2021-23
(PDF)
5. Resolution 2021-197
(PDF)
6. Resolution 2022-149
(PDF)
7. Resolution 2023-170
(PDF)
8.2024 Resolution CAO appvd (PDF)
9. LoA for CM CAO appvd (PDF)
10. Affidavit for Ad (PDF)
11. ES 9.28.21 16.D.3. (PDF)
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16.D.11
09/10/2024
COLLIER COUNTY
Board of County Commissioners
Item Number: 16.D.11
Doe ID: 29806
Item Summary: Recommendation to approve a Resolution to authorize continued participation in the Local
Provider Participation Fund for the Directed Payment Program and Graduate Medical Education Program, which
will be solely funded by assessments on Collier County hospital -owned property or property used as a hospital in
an amount not to exceed $12,654,900, and authorize the County Manager to sign the Directed Provider Payment
Letter of Agreement in the amount of $10,141,128 and the forthcoming Graduate Medical Education Program
Letter of Agreement in an estimated amount of $2,786,495 with the Agency for Health Care Administration for an
estimated total not to exceed $13,194,849 and authorize the necessary Budget Amendments.
Meeting Date: 09/10/2024
Prepared by:
Title: — Community & Human Services
Name: Carolyn Noble
08/27/2024 11:05 AM
Submitted by:
Title: Manager - Federal/State Grants Operation — Community & Human Services
Name: Kristi Sonntag
08/27/2024 11:05 AM
Approved By:
Review:
Operations & Veteran Services Carolyn Noble OVS Director Review
Public Services Department Carolyn Noble Level 1 Department Review
Community & Human Services Kristi Sonntag CHS Review
Corporate Compliance and Continuous Improvement Megan Gaillard
County Attorney's Office
Office of Management and Budget
County Attorney's Office
Public Services Department
Office of Management and Budget
County Manager's Office
Board of County Commissioners
Carly Sanseverino CAO Reviewer
Debra Windsor Level 3 OMB Gatekeeper Review
Jeffrey A. Klatzkow Level 3 County Attorney's Office Review
Tanya Williams PSD Department Head Review
Blanca Aquino Luque OMB Reviewer
Amy Patterson Level 4 County Manager Review
Geoffrey Willig Meeting Pending
Skipped
08/27/2024 9:50 AM
Skipped
08/27/2024 9:50 AM
Completed
08/27/2024 4:16 PM
Additional Reviewer
Completed
08/30/2024
11:23 AM
Completed
09/04/2024 9:19 AM
Completed
09/04/2024 9:27 AM
Completed
09/04/2024 10:03 AM
Completed
09/04/2024 11:45 AM
Completed
09/04/2024 1:07 PM
Completed
09/04/2024 2:19 PM
09/10/2024 9:00 AM
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LII > Electronic Code of Federal Regulations (e-CFR) > Title 42—Public Health
> CHAPTER IV —CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF
HEALTH AND HUMAN SERVICES
> SUBCHAPTER C—MEDICAL ASSISTANCE PROGRAMS
> PART 433—STATE FISCAL ADMINISTRATION
> Subpart B—General Administrative Requirements State Financial Participation
> § 433.68 Permissible health care -related taxes.
42 CFR § 433.68 - Permissible health care -related taxes.
CFR Table of Popular Names
§ 433.68 Permissible health care -related taxes.
(a) General rule. A State may receive health care -related taxes, without a reduction in
FFP, only in accordance with the requirements of this section.
(b) Permissible health care -related taxes. Subject to the limitations specified in §
433.70, a State may receive, without a reduction in FFP, health care -related taxes if all
of the following are met:
(1) The taxes are broad based, as specified in paragraph (c) of this section;
(2) The taxes are uniformly imposed throughout a jurisdiction, as specified in
paragraph (d) of this section; and
(3) The tax program does not violate the hold harmless provisions specified in
paragraph (f) of this section.
(c) Broad based health care -related taxes.
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(1) A health care -related tax will be considered to be broad based if the tax is
imposed on at least all health care items or services in the class or providers of such
items or services furnished by all non -Federal, non-public providers in the State, and
is imposed uniformly, as specified in paragraph (d) of this section.
(2) If a health care -related tax is imposed by a unit of local government, the tax must
extend to all items or services or providers (or to all providers in a class) in the area
over which the unit of government has jurisdiction.
(3) A State may request a waiver from CMS of the requirement that a tax program
be broad based, in accordance with the procedures specified in § 433.72. Waivers
from the uniform and broad -based requirements will automatically be granted in
cases of variations in licensing and certification fees for providers if the amount of
such fees is not more than $1,000 annually per provider and the total amount
raised by the State from the fees is used in the administration of the licensing or
certification program.
(d) Uniformly imposed health care -related taxes. A health care -related tax will be
considered to be imposed uniformly even if it excludes Medicaid or Medicare
payments (in whole or in part), or both; or, in the case of a health care -related tax
based on revenues or receipts with respect to a class of items or services (or providers
of items or services), if it excludes either Medicaid or Medicare revenues with respect
to a class of items or services, or both. The exclusion of Medicaid revenues must be
applied uniformly to all providers being taxed.
(1) A health care -related tax will be considered to be imposed uniformly if it meets
any one of the following criteria:
(i) If the tax is a licensing fee or similar tax imposed on a class of health care
services (or providers of those health care items or services), the tax is the same
amount for every provider furnishing those items or services within the class.
(ii) If the tax is a licensing fee or similar tax imposed on a class of health care
items or services (or providers of those items or services) on the basis of the
number of beds (licensed or otherwise) of the provider, the amount of the tax is
the same for each bed of each provider of those items or services in the class.
(iii) If the tax is imposed on provider revenue or receipts with respect to a class of
items or services (or providers of those health care items or services), the tax is
imposed at a uniform rate for all services (or providers of those items or services)
in the class on all the gross revenues or receipts, or on net operating revenues
relating to the provision of all items or services in the State, unit, or jurisdiction.
Net operating revenue means gross charges of facilities less any deducted
amounts for bad debts, charity care, and payer discounts.
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(iv) The tax is imposed on items or services on a basis other than those specified
in paragraphs (d)(1) (i) through (iii) of this section, e.g., an admission tax, and the
State establishes to the satisfaction of the Secretary that the amount of the tax is
the same for each provider of such items or services in the class. J,
(2) A tax imposed with respect to a class of health care items or services will not be
considered to be imposed uniformly if it meets either one of the following two
criteria:
(i) The tax provides for credits, exclusions, or deductions which have as its
purpose, or results in, the return to providers of all, or a portion, of the tax paid,
and it results, directly or indirectly, in a tax program in which —
(A) The net impact of the tax and payments is not generally redistributive, as
specified in paragraph (e) of this section; and
(B) The amount of the tax is directly correlated to payments under the Medicaid
program.
(ii) The tax holds taxpayers harmless for the cost of the tax, as described in
paragraph (f) of this section.
(3) If a tax does not meet the criteria specified in paragraphs (d)(1)(i) through (iv) of
this section, but the State establishes that the tax is imposed uniformly in
accordance with the procedures for a waiver specified in § 433.72, the tax will be
treated as a uniform tax.
(e) Generally redistributive. A tax will be considered to be generally redistributive if it
meets the requirements of this paragraph. If the State desires waiver of only the
broad -based tax requirement, it must demonstrate compliance with paragraph (e)(1)
of this section. If the State desires waiver of the uniform tax requirement, whether or
not the tax is broad -based, it must demonstrate compliance with paragraph (e)(2) of
this section.
(1) Waiver of broad -based requirement only. This test is applied on a per class basis
to a tax that is imposed on all revenues but excludes certain providers. For example,
a tax that is imposed on all revenues (including Medicare and Medicaid) but
excludes teaching hospitals would have to meet this test. This test cannot be used
when a State excludes any or all Medicaid revenue from its tax in addition to the
exclusion of providers, since the test compares the proportion of Medicaid revenue
being taxed under the proposed tax with the proportion of Medicaid revenue being
taxed under a broad -based tax.
(i) A State seeking waiver of the broad -based tax requirement only must
demonstrate that its proposed tax plan meets the requirement that its plan is
generally redistributive by:
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(A) Calculating the proportion of the tax revenue applicable to Medicaid if the
tax were broad based and applied to all providers or activities within the class
(called 131);
(B) Calculating the proportion of the tax revenue applicable to Medicaid under
the tax program for which the State seeks a waiver (called P2); and
(C) Calculating the value of P1 /P2.
(ii) If the State demonstrates to the Secretary's satisfaction that the value of P1 /P2
is at least 1, CMS will automatically approve the waiver request.
(iii) If a tax is enacted and in effect prior to August 13, 1993, and the State
demonstrates to the Secretary's satisfaction that the value of P1 /P2 is at least
0.90, CMS will review the waiver request. Such a waiver will be approved only if
the following two criteria are met:
(A) The value of P1/P2 is at least 0.90; and
(B) The tax excludes or provides credits or deductions only to one or more of
the following providers of items and services within the class to be taxed:
(1) Providers that furnish no services within the class in the State;
(2) Providers that do not charge for services within the class;
(3) Rural hospitals (defined as any hospital located outside of an urban area
as defined in § 412.62(f)(1)(ii) of this chapter);
(4) Sole community hospitals as defined in § 412.92(a) of this chapter;
(5) Physicians practicing primarily in medically underserved areas as defined
in section 1302(7) of the Public Health Service Act;
(6) Financially distressed hospitals if:
(i) A financially distressed hospital is defined by the State law;
(ii) The State law specifies reasonable standards for determining financially
distressed hospitals, and these standards are applied uniformly to all
hospitals in the State; and
(iii) No more than 10 percent of nonpublic hospitals in the State are exempt
from the tax;
(7) Psychiatric hospitals; or
(8) Hospitals owned and operated by HMOs.
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(iv) If a tax is enacted and in effect after August 13, 1993, and the State
demonstrates to the Secretary's satisfaction that the value of P1 /P2 is at least 76
0.95, CMS will review the waiver request. Such a waiver request will be approved 0
only if the following two criteria are met:
(A) The value of P1/P2 is at least 0.95; and
(B) The tax complies with the provisions of § 433.68(e)(1)(iii)(B).
(2) Waiver of uniform tax requirement. This test is applied on a per class basis to all
taxes that are not uniform. This includes those taxes that are neither broad based
(as specified in § 433.68(c)) nor uniform (as specified in § 433.68(d)).
(i) A State seeking waiver of the uniform tax requirement (whether or not the tax
is broad based) must demonstrate that its proposed tax plan meets the
requirement that its plan is generally redistributive by:
(A) Calculating, using ordinary least squares, the slope (designated as (B) (that
is. the value of the x coefficient) of two linear regressions, in which the
dependent variable is each provider's percentage share of the total tax paid by
all taxpayers during a 12-month period, and the independent variable is the
taxpayer's "Medicaid Statistic". The term "Medicaid Statistic" means the number
of the provider's taxable units applicable to the Medicaid program during a 12-
month period. If, for example, the State imposed a tax based on provider
charges, the amount of a provider's Medicaid charges paid during a 12-month
period would be its "Medicaid Statistic". If the tax were based on provider
inpatient days, the number of the provider's Medicaid days during a 12-month
period would be its "Medicaid Statistic". For the purpose of this test, it is not
relevant that a tax program exempts Medicaid from the tax.
(B) Calculating the slope (designated as 131) of the linear regression, as
described in paragraph (e)(2)(i) of this section, for the State's tax program, if it
were broad based and uniform.
(C) Calculating the slope (designated as 132) of the linear regression, as
described in paragraph (e)(2)(i) of this section, for the State's tax program, as
proposed.
(ii) If the State demonstrates to the Secretary's satisfaction that the value of B1 /132
is at least 1, CMS will automatically approve the waiver request.
(iii) If the State demonstrates to the Secretary's satisfaction that the value of
B1 /B2 is at least 0.95, CMS will review the waiver request. Such a waiver will be
approved only if the following two criteria are met:
(A) The value of 131/132 is at least 0.95; and
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(B) The tax excludes or provides credits or deductions only to one or more of
the following providers of items and services within the class to be taxes:
(1) Providers that furnish no services within the class in the State;
(2) Providers that do not charge for services within the class;
(3) Rural hospitals (defined as any hospital located outside of an urban area
as defined in § 412.62(f)(1)(ii) of this chapter;
(4) Sole community hospitals as defined in § 412.92(a) of this chapter;
(5) Physicians practicing primarily in medically underserved areas as defined
in section 1302(7) of the Public Health Service Act;
(6) Financially distressed hospitals if:
(i) A financially distressed hospital is defined by the State law;
(ii) The State law specifies reasonable standards for determining financially
distressed hospitals, and these standards are applied uniformly to all
hospitals in the State; and
(iii) No more than 10 percent of nonpublic hospitals in the State are exempt
from the tax;
(7) Psychiatric hospitals; or
(8) Providers or payers with tax rates that vary based exclusively on regions,
but only if the regional variations are coterminous with preexisting political
(and not special purpose) boundaries. Taxes within each regional boundary
must meet the broad -based and uniformity requirements as specified in
paragraphs (c) and (d) of this section.
(iv) A 131 /132 value of 0.70 will be applied to taxes that vary based exclusively on
regional variations, and enacted and in effect prior to November 24, 1992, to
permit such variations.
(fl Hold harmless. A taxpayer will be considered to be held harmless under a tax
program if any of the following conditions applies:
(1) The State (or other unit of government) imposing the tax provides for a direct or
indirect non -Medicaid payment to those providers or others paying the tax and the
payment amount is positively correlated to either the tax amount or to the
difference between the Medicaid payment and the tax amount. A positive
correlation includes any positive relationship between these variables, even if not E
consistent over time.
a
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(2) All or any portion of the Medicaid payment to the taxpayer varies based only on
the tax amount, including where Medicaid payment is conditional on receipt of the
tax amount.
(3) The State (or other unit of government) imposing the tax provides for any direct
or indirect payment, offset, or waiver such that the provision of that payment,
offset, or waiver directly or indirectly guarantees to hold taxpayers harmless for all
or any portion of the tax amount.
(A) An indirect guarantee will be determined to exist under a two prong
"guarantee" test. If the health care -related tax or taxes on each health care class
are applied at a rate that produces revenues less than or equal to 6 percent of
the revenues received by the taxpayer, the tax or taxes are permissible under
this test. The phrase "revenues received by the taxpayer" refers to the net
patient revenue attributable to the assessed permissible class of health care
items or services. However, for the period of January 1, 2008 through
September 30, 2011, the applicable percentage of net patient service revenue is
5.5 percent. Compliance in State fiscal year 2008 will be evaluated from January
1, 2008 through the last day of State fiscal year 2008. Beginning with State fiscal
year 2009 the 5.5 percent tax collection will be measured on an annual State
fiscal year basis.
(B) When the tax or taxes produce revenues in excess of the applicable
percentage of the revenue received by the taxpayer, CMS will consider an
indirect hold harmless provision to exist if 75 percent or more of the taxpayers
in the class receive 75 percent or more of their total tax costs back in enhanced
Medicaid payments or other State payments. The second prong of the indirect
hold harmless test is applied in the aggregate to all health care taxes applied to
each class. If this standard is violated, the amount of tax revenue to be offset
from medical assistance expenditures is the total amount of the taxpayers'
revenues received by the State.
(ii) [Reserved]
[57 FIR 55138, Nov. 24, 1992, as amended at 58 FIR 43181, Aug. 13, 1993; 62 FIR 53572,
Oct. 15, 1997; 73 FIR 9698, Feb. 22, 2008]
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16.D.11.b
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 Health 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 County 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' Medicaid 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 w
Hospitals' property interests within the County's jurisdictional limits, for the purpose of establishing and N
maintaining a system of funding for IGTs to support the non-federal share of Medicaid payments. On September M
28, 2021, the Board approved Resolution 2021-197, which established the 2021 Local Provider Participation Fund ri
Special Assessment. The FY 2021 assessment of 1.11% of net patient revenue was collected and when matched by N
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the federal matchingprogram, the Local Provider Participation Fund contributed $12 248 191 to support W low-
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income patient treatment in Collier County. w
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On September 27, 2022, the Board approved Resolution 2022-149, which established the 2022 Local Provider E
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 a
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
Packet Pg. 1038
16.D.11.b
09/26/2023
approximately $2,485,147 of program -specific reserves
disbursement identified in the Letters of Agreement.
Education Letters of Agreement between Collier County
amount not to exceed the total of $13,205,859.81.
and additional interest to reach a maximum potential
The Direct Payment Program and Graduate Medical
and the State of Florida AHCA permit an IGT in an
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 close 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 aggregate
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)
a
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16.D.11.b
09/26/2023
COLLIER COUNTY
Board of County Commissioners
Item Number: 16.D.7
Doe 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
Operations & Veteran Services
Jeff Weir
OVS Director Review
Community & Human Services
Kim Frazier
Additional Reviewer
Public Services Department
Todd Henry
PSD Level 1 Reviewer
Grants
Erica Robinson
Level 2 Grants Review
Operations & Veteran Services
Jeff Weir
Director Review
Public Services Department
Tanya Williams
PSD Department Head Review
Office of Management and Budget
Debra Windsor
Level 3 OMB Gatekeeper Review
County Attorney's Office
Jeffrey A. Klatzkow Level 3 County Attorney's Office Review
Grants
Therese Stanley
Additional Reviewer
Office of Management and Budget
Blanca Aquino Luque Additional Reviewer
County Manager's Office
Dan Rodriguez
Level 4 County Manager Review
Board of County Commissioners
Geoffrey Willig
Meeting Pending
Completed
08/29/2023 3:51 PM
Completed
08/31/2023 3:16 PM
Completed
09/01/2023 12:44 PM
Completed
09/05/2023 9:43 AM
Completed
09/05/2023 11:42 AM
Completed
09/05/2023 12:25 PM
Completed
09/12/2023 11:01 AM
Completed
09/12/2023 11:14 AM
Completed
09/13/2023 10:17 AM
Completed
09/14/2023 8:46 AM
Completed
09/19/2023 8:49 AM
Completed
09/19/2023 1:40 PM
09/26/2023 9:00 AM
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09/27/2022
EXECUTIVE SUMMARY
Recommendation to enact a resolution to authorize continued participation in the Local Provider
Participation Fund for the Directed Payment Program and commence participation in the
Graduate Medical Education Program. These programs will be solely funded by assessments on
Collier County hospitals owned property or property used as a hospital in an amount not to exceed
$5,578,033. Authorize the County Manager to sign Letter of Agreement in an amount not to exceed
the total of $7,231,349 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 AHCA Letter of Agreement
and authorize necessary Budget Amendments.
CONSIDERATIONS: The County has participated in the State's Intergovernmental Transfer Program
(IGT) with the Agency for Health Care Administration (AHCA) program since 2006. As a participant in
the IGT program, the County provides 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 County 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 FY2021 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 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 FY 21 Florida Legislative session, Governor DeSantis, with the full support of the House and
Senate, approved the establishment of the Directed Payment Program (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' Medicaid shortfalls and improve the quality of care provided to the Florida
Medicaid population. In 2021, the program was adopted by Collier County and fourteen Florida counties.
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, 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 of Commissioners of Collier County 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. AHCA has notified the County that the LPPF DPP assessment for FY 2022
will be .69% of net patient revenue and will collect a maximum of $5,578,033 from participating
Hospitals. This amount minus $150,000 in administrative expenses will be submitted 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 $7,231,349.00.
Collier County hospitals are supportive of the DPP and have requested that the program be continued.
This year, NCH led local efforts to use the assessment to fund the Graduate Medical Education Program.
The Graduate Medical Education Program allows and provides funding to qualified participating hospitals
involved in graduate medical education, paving the way for payments designed to prepare the next
generation of healthcare providers in Florida. The hospitals are aware of the assessment process and have
Packet Pg. 1042
16.D.11.c
09/27/2022
all agreed to participate. In order to participate, the County must establish a Local Provider Participation
Fund (LPPF) and Graduate Medical Education (GME) Program via resolution. The proposed resolution
supports 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 close 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 aggregate 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 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 2022-2023
Year One DPP IGTs
$7,231,349
Total Funding
$7,231,349
FISCAL IMPACT: The assessment of .69% 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 Agency for
Health Care Administration (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. The information currently available
suggests the maximum assessment collected will be $5,578,031.89 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. No more than $150,000 will be retained for
administrative expenses.
Packet Pg. 1043
09/27/2022
16.D.11.c
Hospital name
Assessment Amount
NCH Baker Hospital
$3,389,348
Physicians Regional
$1,909,005
Landmark Hospital SW
$162,663
The Willough at Naples
$117,017
$5,578,033
Relative to budget administration, FY 23 budget amendments are necessary to establish budget within
Local Provider Participation Fund (169). The budget will include a revenue of $5,578,033 for receipt of
the FY 23 assessments paid by the hospitals as well as associated expenses of $5,428,033 for the
remittance of FY 23 program funds to AHCA, and $150,000 for reimbursement of County administrative
costs associated with the implementation of the assessment respectively. 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 $7,231,349.00. In addition, a FY23 budget amendment is required to
recognize carryforward in the amount of $2,662,000 and establish a reserve in kind.
GROWTH MANAGEMENT IMPACT: There is no Growth Management impact.
LEGAL CONSIDERATIONS: The documents have an effective date of September 27, 2022. This item
is approved as to form and legality and requires a majority vote for Board action. - RTT
RECOMMENDATION: To enact a resolution to authorize continued participation in the Local Provider
Participation Fund for the Directed Payment Program and commence participation in the Graduate
Medical Education Program. Authorize the County Manager to sign the AHCA Letter of Agreement and
approve necessary Budget Amendments.
Prepared By: Jeffrey Newman, Financial and Operational Support Manager, Operations & Veterans
Services Division
ATTACHMENT(S)
1. Resolution (CAO stamped) - agenda ID 23160 (PDF)
2. 1. Ordinance 2021-23 (PDF)
3. 1. Resolution 2021-197 (PDF)
4. Year 2 Presentation_ Collier (PPTX)
5. DPP _SFY 22-23_LOA(PDF)
6. legal ad - agenda ID 23160 (PDF)
7.Image_001 (PDF)
8. IGT questionnaire statewide DDP 9 19 2022 (XLSX)
Packet Pg. 1044
16.D.11.c
09/27/2022
COLLIER COUNTY
Board of County Commissioners
Item Number: 16.13.5
Doe ID: 23160
Item Summary: Recommendation to enact a resolution to authorize continued participation in the
Local Provider Participation Fund for the Directed Payment Program and commence participation in the
Graduate Medical Education Program. These programs will be solely funded by assessments on Collier
County hospitals owned property or property used as a hospital not to exceed $5,578,033. Authorize the
County Manager to sign Letter of Agreement in an amount not to exceed the total of $7,231,349 with the
Agency for Health Care Administration and provide necessary Budget Amendments
Meeting Date: 09/27/2022
Prepared by:
Title: — Operations & Veteran Services
Name: Jeff Newman
08/31/2022 7:54 AM
Submitted by:
Title: — Operations & Veteran Services
Name: Jeff Newman
08/31/2022 7:54 AM
Approved By:
Review:
Operations & Veteran Services
Jeff Newman
Additional Reviewer
Public Services Department
Jeff Newman
PSD Level 1 Reviewer
Community & Human Services
Kristi Sonntag
Additional Reviewer
Public Services Department
Tanya Williams
PSD Department Head Review
Grants
Erica Robinson
Level 2 Grants Review
County Attorney's Office
Jeffrey A. Klatzkow Level 3 County Attorney's Office Review
Office of Management and Budget
Laura Zautcke
Level 3 OMB Gatekeeper Review
Grants
Therese Stanley
Additional Reviewer
Office of Management and Budget
Christopher Johnson Additional Reviewer
Community & Human Services
Maggie Lopez
Additional Reviewer
County Attorney's Office
Ronald Tomasko
Additional Reviewer
County Manager's Office
Dan Rodriguez
Level 4 County Manager Review
Board of County Commissioners
Geoffrey Willig
Meeting Pending
Completed 08/31/2022 8:05 AM d
M
Completed
09/06/2022 2:52 PM 0
J
Completed
09/06/2022 2:53 PM U
2
Completed
09/07/2022 11:45 AM Q
Completed
09/07/2022 1:28 PM o
00
rn
Completed
09/07/2022 2:11 PM N
Completed
09/07/2022 2:58 PM
Completed
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Completed
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09/16/2022 10:50 AM ti
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09/21/2022 8:40 AM CD
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09/21/2022 11:38 AM
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09/21/2022 3:12 PM E
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09/27/2022 9:00 AM t�v
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16.D.11.d
ORDINANCE NO.2021-_2_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 1S 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
Page 1 of 10
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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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1ti.D.11.d
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 VII1, Section l(f) 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.
Page 3 of 10 gyp
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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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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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- 16.D.11.d
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 the
Board, 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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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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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.
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SECTION 2. APPLICABILITY.
It is hereby intended that this Ordinance shall constitute a uniform law 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 1 ULY ADOPTED by the Board of County Commissioners of Collier County,
Florida, this Aday of , 2021.
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ATTEST: BOARD OF COUNTY COMMISSIONERS
CRYSTAL K KINZEL, CLERK COLLIER/O�N Y, FLORIDA,
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FLORIDA DEPARTMENT Of STATE
RON DESANTIS
Governor
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:
LAUREL M.LEE
Secretary of State
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
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16.D.11.e
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 ("IGTs") provided consistent with federal guidelines, support additional funding for
Medicaid payments to Hospitals; and
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16.D.11.e
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 ,Lune 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
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16.D.11.e
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 I 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
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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 Scone, Basis, and Use. Funds generated from the Assessment
shall be used only to:
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.
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 1.11 % 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. Timina and Method of Collection. The amount of the assessment is to be
collected pursuant to the Alternative Method outlined in § 197.3631, Fla. Stat.
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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 281h day of September, 2021.
ATTEST:
CRYSTAL K. KINZEL, CLERK
Attest as to Ch"A& UTY CL
sirnitui,, only.
Approved as to form and legE
Jennifer A. Belpedio
Assistant County Attorney
BOARD OF COUNTY COMMISSIONERS
COLLIER O TY, FLORID
By: amo�ll
PENNY TA OR, CHAIRPERSON
m
I, Crystal .1Cmzel, Cleof Courts-r. and for �oiiier C !unty
[}� do hearby,::ertify ...at. the aoc,- a i, istrumnt is a true a— correct
cop of :yen igina t in C l.lfer C�FjjorOa
6y Deputy Clerk
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16.D.11.f
RESOLUTION NO. # 2022 - 1 4 9
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, covcrs 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
U S_Activ e\ 118603232%V-1
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16.D.11.f
WHEREAS, the County acknowledges that the Hospital properties assessed will have
increased income potential 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, 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.
2
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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 duty 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 codified
in Chapter 126 of the Collier County Code of Ordinances.
Tax Collector means the Collier County Tax Collector.
Section 2. Authority. Pursuant to Article VIII, Section l (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
enhanced Medicaid payments from programs, including the hospital directed payment program and
graduate medical education program, that will benefit the Assessed Properties for Local Services.
US ACtiVM11860323ZV-1
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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 Scone, 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
medical 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) 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 o.69% 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
location at which payment will be accepted, (4) the date on which the Assessment is due, and (5) a
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statement that the Assessment constitutes alien 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. Per the notice provided on September 7, 2022, 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 27"' day of September, 2022.
BOARD OF COUNTY COMMISSIONERS
ATTEST
COLLIER COUNTY, FLORIDA
CRYST , CLERK 4
BY: By:
Willia M a
Approval as t fo a legaht.
40 County Attorney
V�_
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DocuSign Envelope ID: E3FFE20D-F565-4C4F-AC38-A33COD29C3C1
16.D.11.f
Directed Payment Program Letter of Agreement
THIS LETTER OF AGREEMENT (LOA) is made and entered into in duplicate on the 279
day of 2022, by and between Collier County (the "IGT
Provider"') 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 House Bill 5001, the General Appropriations Act of State Fiscal Year 2022-
2023,passed by the 2022 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 $7,231,349.00 . The IGT Provider and the Agency have agreed that these IGT
funds will only be used for the DPP program.
2. The IGT Provider will return the signed LOA to the Agency.
3. The IGT Provider will pay IGT funds to the Agency in an amount not to exceed the total
of $7,231,349.00 The IGT Provider will transfer payments to the Agency in the
following manner:
a. Per Florida Statute 409.908, annual payments for the months of July 2022
through June 2023 are due to the Agency no later than October 31, 2022, unless
an alternative plan is specifically approved by the agency.
b. The Agency will bill the IGT Provider when payment is due.
4. 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 in
accordance with public records laws and established retention schedules.
a. AUDITS AND RECORDS
i. IGT Provider agrees to maintain books, records, and documents (including
Collier County
_DPP LOA_SFY 2022-23
Region 8
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16.D.11.f
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. 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. IGT Provider agrees to comply with public record laws as outlined in section
119.0701, Florida Statutes.
b. RETENTION OF RECORDS
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.
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. 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
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.
5. 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.
6. 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 supplemental payments in order to satisfy non -
Medicaid, non -uninsured, and non-underinsured activities.
Collier County
_DPP LOA_SFY 2022-23
Region 8
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16.D.11.f
7. IGT Provider agrees the following provision shall be included in any agreements between
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 and used secondarily for other purposes.
8. This LOA covers the period of July 1, 2022 through June 30. 2023 and shall be terminated
September 30. 2023, 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 2022-2023
Estimated IGTs _
$7,231,349.00
_
Total Funding Not to Exceed
$7,231,349.00
IN WITNESS WHEREOF, the parties have caused this page Letter of Agreement to be
executed by their undersigned officials as duly authorized.
DcC : .
SIGNED
C'
BY:
NAME: Wilfam L. McDaniel, Jr., Chairman
STATE OF FLORIDA, AGENCY FOR
HEALTH CARE ADMINISTRATION
SIGNED
BY:
NAME:
TITLE: GAA:1/nA17 TITLE:
DATE: y7/ZGZ DATE:
ATTES P
CRY ST EL,CLERK
Approv1}�,
BY: •.
Jeffrey A. K ayeo AAtbrney
k
Collier County
DPP LOA SFY 2022-23
Region 8
Packet Pg. 1069
RESOLUTION NO.2023 -1 70
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.
[23-G RC-01401 / 1810806/ 11
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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-01401/1810806/1] 3 LCX
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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:
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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16.D.11.g
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, "fax
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 lorce 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.
k " n
ATTE T:
Crystal R}, true 'lerk of Courts
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B
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sign turd cnly'
P
;° i Approved sPto foL and lWlity:
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Jeffrey A. Klatzkow, County Attorney
f
[23-GRC-01401/1810806/11
BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY, FLORIDA
By: /-------_.
Rick LoCastro, Chairman
Packet Pg. 1074
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[Attachment- Assessment Roll]
MCD ID A
I Organization I
Facility
Hospital Address
Parcel #
Rate
Mandatory Payment
10314400
ICHS
11Physicians Regional Medical Center - Pi
6101 Pine Ride Rd., Naples, FL 34119
80670080001
1.09% NPR
5 3,855,801
1
10031500
INCH Healthcare System
INCH Baker Hospital Downtown
1350 7th St. N, Naples, Ft 34102
14038880000
1.09% NPR
5 6,642,259
104063
[Oglethorpe
IThe Willough at Naples
19001 Tamiami Trail East, Naples, fL 33862
551D0120000
1.09% NPR
5 159,386
County Phone Number: (239( 252-8999
BCC Address: Collier County Government (enter, 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
6 .1CAy!
123-GRC-01401 / 1810806/ 11 `
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- I
Graduate Medical Education Letter of Agreement
THIS LETTER OF AGREEMENT (LOA) is made and entered into in duplicate on the
day of�L2023, by and between Collier LPPF (the "IGT Provider') on behalf of Naples
Community Hospital, and lheState 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
T
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16.D.11.g
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
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16.D.11.g
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
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16.D.11.g
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: BY:
NAME:
TITLE:
DATE: - t ! Z ) 12 UZ 3
NAME: Thomas Wallace
TITLE: Deputy Director, Division
Of Medicaid
DATE:
Collier LPPF _GME LOA_SFY 2021-2022
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Directed Payment Program Letter of Agreement
THIS LETTER OF AGREEMENT (LOA) is made and entered into in duplicate on the
day of%k2023, 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 $11,295,409.36. 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
Packet Pg. 1080
16.D.11.g
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
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16.D.11.g
7. Collier County LPPF agrees the following provision shall be included in any agreements
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
SIGNED6-�V*BY:Qru��V
NAME:
R44e vs6n
TITLE:
9 /2-912-OZ-3
DATE:
STATE OF FLORIDA, AGENCY FOR
HEALTH CARE ADMINISTRATION
SIGNED
BY:
NAME: Thomas Wallace
TITLE: Deputy Secretary, Division of
Medicaid
DATE:
Collier County LPPF_Region 8 _DPP LOA_SFY 2023-24
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RESOLUTION NO.2024-
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 property 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") 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
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
(CA O
Packet Pg. 1083
16.D.11.i
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 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.
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.
,0)
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16.D.11.i
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 codified in Chapter
126 of the Collier County Code of Ordinances.
Tax Collector means the Collier County Tax Collector.
Section 2. Authority. Pursuant to Article VIII, Section I(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 enhanced
Medicaid payments from programs, including the hospital directed payment program and graduate
medical education 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 payments, including the hospital directed payment program and
graduate medical 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) 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 1.18% 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
Packet Pg. 1085
16.D.11.i
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 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. 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 101 day of September 2024.
ATTEST:
CRYSTAL K. KINZEL, CLERK
Deputy Clerk
Dated:
(SEAL)
Approval as to form and legality:
Carly Jeanne Sanseverino !✓ $�ti1
Assistant County Attorney
BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY, FLORIDA
CHRIS HALL, CHAIRPERSON
Date:
G'40
Packet Pg. 1086
16.D.11.j
Directed Payment Program Letter of Agreement
THIS LETTER OF AGREEMENT (LOA) is made and entered into in duplicate on the
day of 2024, by and between Collier County LPPF (the "IGT Provider") on behalf
of Region 8, 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
"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
2024-231, 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
Per House Bill 5001, the General Appropriations Act of State Fiscal Year 2024-2025,
passed by the 2024 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 $10,141,128.00. 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 $10,141,128.00. 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 2024
through June 2025 are due to the Agency no later than October 31, 2024, 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 2024-25
Packet Pg. 1087
16.D.11.j
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
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.
ASSIGNMENT AND SUBCONTRACTS
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 2024-25
Packet Pg. 1088
16.D.11.j
7. Collier County LPPF agrees the following provision shall be included in any agreements
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, 2024, through June 30, 2025, and shall be
terminated September 30, 2025, 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 2024-2025
Estimated IGTs
$10,141,128.00
Total Funding Not to Exceed
$10,141,128.00
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
SIGNED
BY:
NAME: Amy Patterson
TITLE: County Manager
DATE:
STATE OF FLORIDA, AGENCY FOR
HEALTH CARE ADMINISTRATION
SIGNED
BY:
NAME: Tom Wallace
TITLE: Deputy Secretary for Health Care
Finance and Data
DATE:
Collier County LPPF _Region 8—DPP LOA_SFY 2024-25
Packet Pg. 1089
16.D.11.k
* LocaliQ
Florida
GANNETT
AFFIDAVIT OF PUBLICATION
Ann LoBosco
Ana Lobosco
Cc Housinghuman Veteran Sery
3299 Tamiami TRL E 4 700
Naples FL 34112-5749
STATE OF WISCONSIN, COUNTY OF BROWN
Before the undersigned authority personally appeared, who
on oath says that he or she is the Legal Advertising
Representative of the Naples Daily News, a newspaper
published in Collier County, Florida; that the attached copy
of advertisement, being a Legal Ad in the matter of Public
Notices, was published on the publicly accessible website of
Collier and Lee Counties, Florida, or in a newspaper by print
in the issues of, on:
08/15/2024
Affiant further says that the website or newspaper complies
with all legal requirements for publication in chapter 50,
Florida Statutes.
Subscribed and sworn to before me, by the legal clerk, who
is personally known to me, on 08/15/2024
Legal
otary, tate of ount rown
5•/5-a :7
My commission expires
Publication Cost: $549.50
Tax Amount:
$0.00
Payment Cost:
$549.50
Order No:
10472882 # of Copies:
Customer No:
1125695 1
PO #:
THIS IS NOT AN INVOICE!
Please do not use this form for payment remittance.
7NANCY HEYRMAN
otary Public
e of Wisconsin
PO Box 631244 Cincinnati, OH 45263-1244
Page 1 of 2
Packet Pg. 1090
NOTICE OF HEARING
REGARDING IMPOSING AND
16.D.11.k
COLLECTING A NON -AD
VALOREM
SPECIAL
ASSESSMENT
FROM SPECIFIED HOSPITAL
PROPERTIES
Notice is hereby given that the
Board of County Commissioners of
Collier County, Florida, will conduct
a public hearing pursuant to Ordi-
nance No. 2021-23 to consider the
approval of the imposition and
collection of a non -ad valorem
special assessment against each
private toand
and not -for -profit
hospital that inpatient
hospital services and that holds a
right of possession and right of use
to real Property in Collier Coun IY
(each, on "Assessed Property").
The 1151 of affected hospitals is
included at the conclusion of this
notice.
The assessment is intended to
finance intergovernmental trans-
0
fers, provided consistent with
L.
federal guidelines, that fund the non-
a
federal share of certain supplemen-
tal payment programs. As a result,
the assessment directly and
0
specially benefits Assessed Proper-
ties and supports the provision of
health care services to Medicaid,
++
(Q
indigent, and uninsured members of
the County's community.
The public hearing will be held in
.a
the Board of County Commissioners
Chambers at the Collier Countv
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Government Center, 3299 Tomiami
Trail East, Naples, Florida, on
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September 10, 2024, at 9:00 a.m., or
as soon thereafter as the matter can
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be heard. At that time, the Board
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will receive Public comment on the
Proposed special assessment.
The Collier County office has
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prepared the Non -Ad Valorem
Assessment Roll being considered
for approval. The roll contains the
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names of the Assessed Properties,
the assessment rate, and the amount
of the special assessment to be
each
imposed 090 inst each Assessed
Property. The Valorem
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Assessment Roll is available for
inspection at the Collier County
budget office during regular busi-
ness hours from August 15' 2024
through September 10, 2024. The
assessment rate set forth in the Non-
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Ad Valorem Assessment Roll to be
levied against the net patient
revenue of each Assessed Property
is 1.18%.
At the date and time set forth In this
notice, the Board of County Corr is-
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sioners may: (1) approve the Non -
Ad Valorem Assessment Roll, with
such amendments as It deems lust
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and right, and (2) adopt a resolution
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(the "Assessment Resolution") that
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describes: (a) the supplemental
PaYmenI programs proposed for
funding from proceeds of the assess-
ment, (b) the benefits to the
Assessed Properties, (c) the
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methodology for computing the
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assessed amounts, and (d) the
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method of collection, including how
and when the assessment is to be
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Paid.
All interested persons hove a right
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to appear at the hearing and to file
written oblections with the Board
Prior to the resolution vote. All
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obiections to the Non -Ad Valorem
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Assessment Roll being considered
for for approval must be made in writ-
ing and filed with the County by
September 10, 2024. Written cafe,
tions should be sent to the attention
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of Board of Countv Commissioners
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at 3299 Tomiami Trail East, Naples,
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FL 34112.
The amount of the assessment is to
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be collected pursuant to an addi-
tional and alternative method, as
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authorized by § 197.3631, FIa Sint.
Details will be included in the
Assessment Resolution.
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If you are a person with disability
who needs on accommodation to
Particl pate In this proceeding, you
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are entitled at no cost to You, to the
,
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provision of certain assistance.
4711
Please contact the Collier County
Facilities Management Division at
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(239) 252-8380 at least forty-eight
(48) hours prior to the public hear-
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ing if you need special accommoda-
tions.
Pursuant to § 286.0105, Fla Slat., if o
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Person decides to appeal any deci-
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sign of the Board of County Commis-
sioners on any matter considered at
the Public hearing, he or she will
need a record of the Proceedings.
'
Forsuch Purpose, a Person appeal-
ing the decision may need to ensure
the creation of a verbatim record,
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which captures the testimony and
evidence upon which the appeal is
based.
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Collier County, FLORIDA
List of Affected Properties:
The special assessment is to be
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levied against each private for -profit
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and not -for -profit hospital operating
under a Florida hospital license
affiliated with the following
Providers of inpatient hospital
services that holds a right of posses-
s ion and right of use to real property
in Collier County, Florida:
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Hospital Name: Physicians
Regional Medical Center - Pine
Ridge Hospital Address: 6101 Pine
Ridge Rd., Naples, FL 34119
Parcel I D : 80670080001
Hospital Name: NCH Baker Hospi-
tal Downtown Hospital Address: 350
7th St. N. Naples, FL 34102 Parcel
ID: 14038880000
Hospital Name: The Wlllough at
NaPles
Hospital Address: 9001 Tomiami
Trail East, Naples, FL 33862 Parcel
I D: 55100120000
Hospital Name: Encompass Health
Rehobill Lotion Hospital of Naples
Hospital Address: 4042 Wolfe Rd.,
Naples, FI 204790006 Parcel ID: Packet Pg. 1091
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I Packet Pg. 1093
16.D.11.1
09/28/2021
EXECUTIVE SUMMARY
Recommendation to adopt a Resolution authorizing non -ad valorem special assessment on hospital -
owned properties or properties used as a hospital as authorized by the Local Provider Participation
Fund for the Directed Payment Program established by Ordinance No 2021-23 and authorize the
necessary budget amendment; and to authorize the County Manager or designee to sign the Letter
of Agreement in an amount not to exceed the total of $6,687,755 with the Agency for Health Care
Administration to participate in the Local Provider Participation Fund that will provide additional
health services for the citizens of Collier County.
OBJECTIVE: To adopt a Resolution authorizing a non -ad valorem special assessment on hospital -
owned property or property used as a hospital with such assessment to be used to leverage federal funding
in support of area hospitals that provide health services to the low-income citizens of Collier County.
CONSIDERATIONS: On June 8, 2021, the Board of County Commissioners (Board) approved Agenda
Item No. 16076 authorizing the advertisement of an ordinance establishing a Local Provider Participation
Fund (LPPF) for the Directed Payment Program to be solely funded by assessments on hospital -owned
property or property used as a hospital. On June 22, 2021, the Board adopted Ordinance No. 2021-23. At
that time, Agency for Health Care Administration (AHCA) was in the process of finalizing its modeling
of the amount for non-federal share (the assessment) needed for the program. The modeling has since
been completed and a resolution containing the appropriate assessment rate has been developed and is
now presented.
Also, the County is required to enter into a Letter of Agreement with AHCA to provide for a mechanism
for the collection of the funds in the LPPF and for their provision. AHCA is a State entity that provides
Medicaid services in Florida and operates the LPPF. The County's participation in the LPPF Program is
outlined in the contractual arrangement between Collier County and AHCA, which is presented as part of
this Item.
As background, Hospitals in Collier County annually provide millions of dollars of uncompensated care
to persons who qualify for Medicaid because Medicaid, on average, covers only sixty percent (60%) of
the costs of the health care services provided by Hospitals to Medicaid eligible persons, leaving hospitals
with significant uncompensated costs. As a direct result of this revenue shortfall, during the FY21
Legislative session, the Governor with the full support of the House and Senate approved the
establishment of the Directed Payment Program (DPP). This program is available to hospitals providing
inpatient and outpatient services to Medicaid -managed care enrollees. It is the intent of the program to
offset hospitals' Medicaid shortfall and improve the quality of care provided to the Florida Medicaid
population. At the time Ordinance 2021-23 was considered, this program had been adopted by three (3)
Counties, Escambia, Brevard, and Walton.
In April, the County was approached by the hospitals and requested the County participate in the Directed
Payment Program. To participate in this program, the County was required to establish a Local Provider
Participation Fund (LPPF) via an Ordinance. Ordinance No. 2021-23 establishes the parameters of the
LPPF program. The County, at the request of the hospitals annually, will impose a non -ad valorem
assessment upon real property owned 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 Naples
Community Hospital, Landmark Hospital, The Willough at Naples, and Physicians Regional Medical
Center to address the Medicaid shortfall. The leveraging of additional federal support through the DPP
program will directly benefit the health care services delivered to Medicaid -eligible persons and support
their ability to provide critical services.
Packet Pg. 1094
16.D.11.1
09/28/2021
Ordinance No. 2021-23 enables 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. 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. Approval will allow the County to
establish and maintain a system of funding to support the non-federal share of Medicaid payments that
will directly benefit the Hospital properties. The assessment shall constitute a lien upon the assessed
properties. The proposed assessment shall be held in a separate account called the local provider
participation fund (LPPF) 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 forthcoming Assessment Resolution.
Annually 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. 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.
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.
The Resolution was advertised, as required, in the Naples Daily News on September 8, 2021. The
Resolution sets forth the assessment details and provides authority to make the assessment, invoice and
collect the assessment, and then provide the appropriate share to the Agency for Health Care
Administration.
Accordingly, notices of invoice have been mailed to the affected four (4) properties (Landmark Hospital
of Southwest Florida, NCH Baker Hospital, and Physicians Regional Medical Center) on August 23,
2021, and (The Willough at Naples) on August 27, 2021. The notice includes the proposed assessment
amount for each hospital. All hospitals are required to participate and should any choose not to participate
the assessment will not go forward.
Per Senate Bill 2500, the General Appropriations Act of State Fiscal Year 2021-2022, passed by the 2021
Florida Legislature, the Collier County LPPF and the Agency for Health Care Administration agree that
the Collier County LPPF will remit Intergovernmental Transfers (IGT) funds to the Agency in an amount
not to exceed the total of $6,687,755 as per the referenced Letter of Agreement that is presented. The
Collier County LPPF and the Agency have agreed that these IGT funds will only be used for the DPP
Packet Pg. 1095
16.D.11.1
09/28/2021
program.
DPP Local Intergovernmental Transfers
Program / Amount
State Fiscal Year 2021-2022
Year One DPP IGTs
$6,687,755
Total Funding
$6,687,755
FISCAL IMPACT: The Directed Payment Program is a funding mechanism that takes hospitals' funds
collected through a non -ad valorem assessment and directs those dollars to the AHCA to fund the non-
federal share of the State's Medicaid program ultimately resulting in enhanced funding returned to the
hospitals. AHCA is currently working on the implementation plan for the Directed Payment Program.
Once AHCA finalizes its modeling the amount of non-federal share (the assessment) needed to fund the
Directed Payment Program will become available. The Assessment shall equal 1.11% of net patient
revenue for each Assessed Property. 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). No more than $150,000
will be retained for administrative expenses. The total non -ad valorem special assessment that will be
collected for fiscal year 2021 from the Affected Properties is $9,327,890.
Hospital Name
Assessment Amount
NCH Baker Hospital
$5,780,701
Physicians Regional Medical Center
$3,059,745
Landmark Hospital of Southwest Florida
$288,404
The Willough at Naples
$199,040
Total
$9,327,890
Relative to budget administration, a Budget Amendment is necessary to establish a Local Provider
Participation Fund (169). The budget will include a revenue account (363100 Special Assessment) for
receipt of assessments paid by the hospitals in the amount of $9,327,890 and expense accounts (881400
Remit to Other Government) for the remittance of program funds to ACHA and (634980
Interdepartmental Payment for Service) for reimbursement of County administrative costs associated with
the implementation of the assessment. Advertising fees are $763.
Additionally, the Collier County LPPF will pay IGT funds to the Agency for Health Care Administration
in an amount not to exceed the total of $6,687,755. Per Florida Statute 409.908, annual payments for the
months of July 2021 through June 2022 are due to the Agency for Health Care Administration no later
than October 31, 2021, unless an alternative plan is specifically approved by the agency. Funds will be
available in Local Provider Participation Fund (169).
GROWTH MANAGEMENT IMPACT: There is no Growth Management impact.
LEGAL CONSIDERATIONS: This item is approved as to form and legality and requires a majority
vote for Board action. -JAB
RECOMMENDATION: To adopt a Resolution authorizing non -ad valorem special assessment on
hospital -owned properties or properties used as a hospital as authorized by the Local Provider
Participation Fund for the Directed Payment Program established by Ordinance No 2021-23 and authorize
the necessary budget amendment, and to authorize the County Manager or designee to sign the Letter of
Packet Pg. 1096
16.D.11.1
09/28/2021
Agreement in an amount not to exceed the total of $6,687,755 with the Agency for Health Care
Administration to participate in the Direct Payment Program that will provide additional health services
for the citizens of Collier County.
Prepared By: Irene Takla, Accountant, Operations and Veteran Services Division
ATTACHMENT(S)
1. 1. Ordinance 2021-23 (PDF)
2.2. Resolution Hospital Assessment CAO approved (PDF)
3.3. Collier County Roll (PDF)
4.4. Collier Description of Properties to be Assessed (PDF)
5. 5. Advertisement 9.8.21(PDF)
6.6. Landmark Invoice 09.29.2021 (PDF)
7.7. NCH Baker Invoice 09.29.2021 (PDF)
8. 8. Physicians Regional Invoice 09.29.2021 (PDF)
9.9. The Willough Invoice 09.29.2021 (PDF)
10. legal ad - agenda ID 19976 (PDF)
11. DPP LOA (PDF)
12. IGT questionnaire statewide DDP (XLSX)
Packet Pg. 1097
16.D.11.1
09/28/2021
COLLIER COUNTY
Board of County Commissioners
Item Number: 16.13.3
Doe ID: 19976
Item Summary: Recommendation to adopt a Resolution authorizing non -ad valorem special
assessment on hospital -owned properties or properties used as a hospital as authorized by the Local
Provider Participation Fund for the Directed Payment Program established by Ordinance No 2021-23 and
authorize the necessary budget amendment; and to authorize the County Manager or designee to sign the
Letter of Agreement in an amount not to exceed the total of $6,687,755 with the Agency for Health Care
Administration to participate in the Local Provider Participation Fund that will provide additional health
services for the citizens of Collier County.
Meeting Date: 09/28/2021
Prepared by:
Title: — Public Services Department
Name: Todd Henry
09/03/2021 1:17 PM
Submitted by:
Title: Department Head — Public Services Department
Name: Dan Rodriguez
09/03/2021 1:17 PM
Approved By:
Review:
Community & Human Services
Operations & Veteran Services
Public Services Department
Public Services Department
County Attorney's Office
Office of Management and Budget
County Attorney's Office
Office of Management and Budget
County Manager's Office
Board of County Commissioners
Kristi Sonntag Additional Reviewer
Kimberley Grant Additional Reviewer
Todd Henry Public Services Department
Dan Rodriguez PSD Department Head
Jennifer Belpedio Level 2 Attorney of Record Review
Debra Windsor Level 3 OMB Gatekeeper Review
Jeffrey A. Klatzkow Level 3 County Attorney's Office Review
Susan Usher Additional Reviewer
Sean Callahan Level 4 County Manager Review
Geoffrey Willig Meeting Pending
Completed
09/03/2021 5:37 PM
Completed
09/03/2021 5:59 PM
Completed
09/07/2021 7:58 AM
Completed
09/07/2021 9:52 AM
Completed
09/08/2021 10:57 AM
Completed 09/08/2021 11:03 AM ri
6
Completed 09/08/2021 4:21 PM 6
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Completed 09/08/2021 4:54 PM N
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Completed 09/20/2021 9:52 AM N
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09/28/2021 9:00 AM W
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Packet Pg. 1098
16.D.11.1
ORDINANCE NO.2021-_2_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 1S 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
Page 1 of 10
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Packet Pg. 1099
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.
Page 2 of 10
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Packet Pg. 1100
1ti.D.11.1
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 VII1, Section l(f) 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.
Page 3 of 10 gyp
Packet Pg. 1101
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.
Page 4 of 10 c'y
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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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- 16.D.11.1
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 the
Board, 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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16.D.11.1
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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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.
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Packet Pg. 1106
SECTION 2. APPLICABILITY.
It is hereby intended that this Ordinance shall constitute a uniform law 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 1 ULY ADOPTED by the Board of County Commissioners of Collier County,
Florida, this Aday of , 2021.
Page 9 of 10 n
Packet Pg. 1107
ATTEST: BOARD OF COUNTY COMMISSIONERS
CRYSTAL K KINZEL, CLERK COLLIQO�N Y, FLORIDA,
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Page 10 of 10
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16.D.11.1
FLORIDA DEPARTMENT Of STATE
RON DESANTIS
Governor
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:
LAUREL M.LEE
Secretary of State
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
Packet Pg. 1109
16.D.11.1
RESOLUTION NO.
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 ("IGTs") provided consistent with federal guidelines, support additional funding for
Medicaid payments to Hospitals; and
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16.D.11.1
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
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16.D.11.1
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
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16.D.11.1
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.
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 1.11 % 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 fin?
Packet Pg. 1113
16.D.11.1
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 Hearin. 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 28`h day of September, 2021.
ATTEST: BOARD OF COUNTY COMMISSIONERS
CRYSTAL K. KINZEL, CLERK COLLIER COUNTY, FLORIDA
M.
, DEPUTY CLERK
Approved as to form and legality:
Jennifer A. Belpedio
Assistant County Attorney
M.
PENNY TAYLOR, CHAIRPERSON
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Facility
Street
Street
Street
Street
Real Estate
Name
Street Address
Legal Description
Type
City
State
Zip
County
Parcel Number
PHYSICIANS REGIONAL
6101 Pine Ridge
VINEYARDS UNIT ONE, THE TRACT "B" AND THAT PORTION OF SEC 8 TWP
Hospital
MEDICAL CENTER - PINE
Naples
FL
34119
Collier
80670080001
RIDGE
Rd
RNG 26 AS DESC IN OR 2313 PG 3115
CREEKSIDE COMMERCE PARK EAST, PART OF TR 5 DESC AS FOLL; COM AT
LANDMARK HOSPITAL
CNR 27-48-25 ALG E U 50109 43E 696.85FT, THENCE S88 50 17W 559.33F
Hospital
OF SOUTHWEST
Creekside
Naples
FL
34109
Collier
29331180612
TO POB. THENCE SOOW 245.17FT, THENCE 126.74FT ALG ARC TO NW,
FLORIDA
Blvd
Blvd
B
THENCE S84 26 05W 428.11FT, THENCE 39.26FT ALG ARC, THENCE N05 35
40W 353.51FT, THENCE N90E 565.33FT TO POB. 4.36 AC
NAPLES T 7 BILKS 24 & 23, T 8 BILKS 23 & 24 & ALL VAC E/W & N/S ALLEYS !
Hospital
NCH BAKER HOSPITAL
350 7th St N
Naples
FL
34102
Collier
14038880000
THAT VACATED PORT OF 3RD AVE N LY BETWEEN 6TH ST & 8TH ST & THA"
VACATED PORT OF 7TH ST LY BETWEEN SECOND AVE N & FOURTH AVE N
LELY EST ST ANDREWS W A PORTION OF TR J DESC AS: COMM SE CNR SEC
THE WILLOUGH AT
9001 Tamiami
19, N 39 DEG W 359.82FTTO POB, S 50 DEG W 473.35FT E RW US 41, N 3S
Hospital
Naples
FL
33862
Collier
55100120000
NAPLES
Trail East
DEG W 550FT, N 50 DEG E 604.72FT, S 58 DEG E 580.78FT, S 50 DEG W
324.20FT TO POB OR 996 PG 1813-14 OR 1079 PG 1333
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16.D.11.1
NOTICE OF PUBLIC HEARING TO CONSIDER THE IMPOSITION AND COLLECTION
OF A NON -AD VALOREM SPECIAL ASSESSMENT
Notice is hereby given that the Board of County Commissioners of Collier County, Florida, will
conduct a public hearing to consider the approval of the imposition and collection of a non -ad
valorem special assessment against each private for -profit and not -for -profit hospital that
provides inpatient hospital services and that holds a right of possession and right of use to real
property in Collier County, Florida (each, an "Assessed Property"). The list of affected hospitals
is included at the conclusion of this notice.
The assessment is intended to finance intergovernmental transfers provided consistent with
federal guidelines to fund the non-federal share of certain Medicaid and/or Medicaid managed
care payments. As a result, the assessment directly and specially benefits Assessed Properties
and supports the provision of health care services to Medicaid, indigent, and uninsured members
of the County's community.
The public hearing will be held at Administration Building, located at 3299 Tamiami Trail East,
Suite 303, Naples, FL 34112-5746, on September 28 at 9 a.m., or as soon thereafter as the
matter can be heard. At that time, the Board will receive public comment on the proposed special
assessment.
The County has prepared the Non -Ad Valorem Assessment Roll being considered for approval
based on information provided by the hospitals. The roll contains the names of the hospitals; the
tax parcel identification numbers of the parcels; the section, township, and range of the parcels
assessed; the parcel owner's name; the address and the names and addresses of any leaseholders
of the Assessed Properties; the assessment rate; and the amount of the special assessment to be
imposed against each Assessed Property. The Non -Ad Valorem Assessment Roll will be
available for inspection at the Collier County Operations & Veterans Services, located at 3339
Tamiami Trail East Suite 212, Naples, FL 34112, during regular business hours from September
8, 2021, until the hearing concludes on Tuesday, September 21, 2021. The assessment rate set
forth in the Non -Ad Valorem Assessment Roll to be levied against the net patient revenue of
each Assessed Property is 1.11%.
At the date and time set forth in this notice, the Board of County Commissioners may:
(1) approve the Non -Ad Valorem Assessment Roll, with such amendments as it deems just and
right and (2) adopt a resolution (the "Assessment Resolution") that describes (a) the Medicaid
payments proposed for funding from proceeds of the assessment, (b) the benefits to the Assessed
Properties, (c) the methodology for computing the assessed amounts, and (d) the method of
collection, including how and when the assessment is to be paid.
All interested persons have a right to appear at the public hearing and to file written objections
with the Board prior to the resolution vote. All written objections to the Non -Ad Valorem
Assessment being considered for approval shall be filed with the County by September 27, 2021.
Written objections should be sent to the attention of Collier County Operations & Veterans
Services, located at 3339 Tamiami Trail East Suite 212, Naples, FL 34112.
Packet Pg. 1117
16.D.11.1
The amount of the assessment is to be collected pursuant an additional and alternative method, as
specified in § 197.3631, Fla. Stat., for the assessment and collection of a non -ad valorem special
assessment. Details will be included in the Assessment Resolution.
If you are a person with disability who needs any accommodation to participate in this
proceeding, you are entitled, at no cost to you, to the provision of certain assistance. Please
contact Collier County Facilities Management Division at (239) 252-8380 at least three days
prior to the public hearing if you need special accommodations.
Collier County, FLORIDA
List of Affected Properties:
The special assessment is to be levied against each private for -profit and not -for -profit hospital
operating under a Florida hospital license affiliated with the following providers of inpatient
hospital services that holds a right of possession and right of use to real property in Collier
County, Florida:
Physicians Regional Medical Center
6101 Pine Ridge Rd
Naples, FL 34119
Parcel #: 80670080001
Landmark Hospital of Southwest Florida
1285 Creekside Blvd
Naples FL 34109
Parcel #: 29331180612
NCH Baker Hospital
350 7th St N
Naples FL 34102
Parcel #: 14038880000
The Willough at Naples
9001 Tamiami Trail East
Naples, FL 33862
Parcel #: 55100120000
Packet Pg. 1118
Corley County
Public Services Department
Community & Human Services Division
September 29, 2021
Daniel Dunmyer
Landmark Hospital of Southwest Florida
1285 Creekside Blvd
Naples FL 34109
Re: Parcel Number 29331180612
Collier County Local Provider Participation Fund Assessment
Dear Hospital Administrator:
Attached is your invoice for the annual mandatory payment for the Collier County Local
Provider Participation Fund ("LPPF").
The mandatory payment rate for Fiscal Year 2021 has been set at 1.11 % of your net patient
revenue. Net patient revenue is based on the Hospital's most recently filed Medicare Cost
report, which is filed with the Centers of Medicare and Medicaid services. The mandatory
payments will be deposited into the LPPF. These funds will be used for the non-federal
share of a Medicaid supplemental payment program. The LPPF is broad based; it applies
to all non-public hospitals located in Collier County that provide inpatient hospital services.
The formula for calculating the mandatory payments is the same for each hospital. No
hospitals are held harmless or exempt from paying the mandatory payments.
The mandatory payments are assessed annually but paid in installments due in accordance
with the schedule below:
Questions regarding your assessment and the process for collection may be directed to
the Operations & Veterans Services Division of Collier County at County at (239) 252-
83 87.
16.D.11.1
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Community & Human Services Division • 3339 Tamiami Trail East, Suite 211 • Naples, Florida 34112-5361
239-252-CARE (2273) • 239-252-CAFE (2233) • 239-252-4230 (RSVP) • v#Awvlf.colliergov.neUhumanservices Packet Pg. 1119
16.D.11.1
* * * * THIS IS AN INVOICE * * * *
COLLIER COUNTY LOCAL PROVIDER PARTICIPATION FUND
Landmark Hospital of Southwest Florida
Parcel Number 29331180612
Amount of assessment attributed to hospital: $288,404
Number of annual payments: 1
Total amount of annual payments: $288,404
Amount Due: $288,404
Due by Date: October 15, 2021
Make check payable to: Collier County Board of County Commissioners
C/O Operations & Veterans Services
3339 Tamiami Trail East Suite 212
Naples, FL 34112
* * * * THIS IS AN INVOICE * * * *
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16.D.11.1
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Co 7 County
Public Services Department
Community & Human Services Division
September 29, 2021
Rick Wyles
350 7th Street North
Naples, FL 34102
Re: Parcel Number 14038880000
Collier County Local Provider Participation Fund Assessment
Dear Hospital Administrator:
Attached is your invoice for the annual mandatory payment for the Collier County Local
Provider Participation Fund ("LPPF").
The mandatory payment rate for Fiscal Year 2021 has been set at 1.11 % of your net patient
revenue. Net patient revenue is based on the Hospital's most recently filed Medicare Cost
report, which is filed with the Centers of Medicare and Medicaid services. The mandatory
payments will be deposited into the LPPF. These funds will be used for the non-federal
share of a Medicaid supplemental payment program. The LPPF is broad based; it applies
to all non-public hospitals located in Collier County that provide inpatient hospital services.
The formula for calculating the mandatory payments is the same for each hospital. No
hospitals are held harmless or exempt from paying the mandatory payments.
The mandatory payments are assessed annually but paid in installments due in accordance
with the schedule below:
Questions regarding your assessment and the process for collection may be directed to
the Operations & Veterans Services Division of Collier County at County at (239) 252-
83 87.
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Community & Human Services Division • 3339 Tamiami Trail East, Suite 211 • Naples, Florida 34112-5361
239-252-CARE (2273) • 239-252-CAFE (2233) • 239-252-4230 (RSVP) • www.colliergov.net/humanservices Packet Pg. 1121
16.D.11.1
* * * * THIS IS AN INVOICE * * * *
COLLIER COUNTY LOCAL PROVIDER PARTICIPATION FUND
NCH Baker Hospital
Parcel Number 14038880000
Amount of assessment attributed to hospital: $ 5,780,701
Number of annual payments: 1
Total amount of annual payments: $ 5,780,701
Amount Due: $ 5,780,701
Due by Date: October 15, 2021
Make check payable to: Collier County Board of County Commissioners
C/O Operations & Veterans Services
3339 Tamiami Trail East Suite 212
Naples, FL 34112
* * * * THIS IS AN INVOICE * * * *
Packet Pg. 1122
16.D.11.1
CO 7eY Ci014 tty
Public Services Department
Community & Human Services Division
September 29, 2021
Lynne Mitchell
8300 Collier Boulevard
Naples, Florida 34114
Re: Parcel Number 80670080001
Collier County Local Provider Participation Fund Assessment
Dear Hospital Administrator:
Attached is your invoice for the annual mandatory payment for the Collier County Local
Provider Participation Fund ("LPPF").
The mandatory payment rate for Fiscal Year 2021 has been set at 1.11 % of your net patient
revenue. Net patient revenue is based on the Hospital's most recently filed Medicare Cost
report, which is filed with the Centers of Medicare and Medicaid services. The mandatory
payments will be deposited into the LPPF. These funds will be used for the non-federal
share of a Medicaid supplemental payment program. The LPPF is broad based; it applies
to all non-public hospitals located in Collier County that provide inpatient hospital services.
The formula for calculating the mandatory payments is the same for each hospital. No
hospitals are held harmless or exempt from paying the mandatory payments.
The mandatory payments are assessed annually but paid in installments due in accordance
with the schedule below:
Questions regarding your assessment and the process for collection may be directed to
the Operations & Veterans Services Division of Collier County at County at (239) 252-
8387.
Community & Human Services Division • 3339 Tamiami Trail East, Suite 211 • Naples, Florida 34112-5361
239-252-CARE (2273) • 239-252-CAFE (2233) • 239-252-4230 (RSVP) • wvvw.colliergov.net/humanservices Packet Pg. 1123
16.D.11.1
* * * * THIS IS AN INVOICE * * * *
COLLIER COUNTY LOCAL PROVIDER PARTICIPATION FUND
Physicians Regional Medical Center
Parcel Number 80670080001
Amount of assessment attributed to hospital: $3,059,745
Number of annual payments: 1
Total amount of annual payments: $3,059,745
Amount Due: $3,059,745
Due by Date: October 15, 2021
Make check payable to: Collier County Board of County Commissioners
C/O Operations & Veterans Services
3339 Tamiami Trail East Suite 212
Naples, FL 34112
* * * * THIS IS AN INVOICE * * * *
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16.D.11.1
Co Ier County
Public Services Department
Community & Human Services Division
September 29, 2021
Rick Bennett
The Willough at Naples
9001 Tamiami Trail East
Naples, FL 33862
Re: Parcel Number: 55100120000
Collier County Local Provider Participation Fund Assessment
Dear Hospital Administrator:
Attached is your invoice for the annual mandatory payment for the Collier County Local
Provider Participation Fund ("LPPF").
The mandatory payment rate for Fiscal Year 2021 has been set at 1.11 % of your net patient
revenue. Net patient revenue is based on the Hospital's most recently filed Medicare Cost
report, which is filed with the Centers of Medicare and Medicaid services. The mandatory
payments will be deposited into the LPPF. These funds will be used for the non-federal
share of a Medicaid supplemental payment program. The LPPF is broad based; it applies
to all non-public hospitals located in Collier County that provide inpatient hospital services.
The formula for calculating the mandatory payments is the same for each hospital. No
hospitals are held harmless or exempt from paying the mandatory payments.
The mandatory payments are assessed annually but paid in installments due in accordance
with the schedule below:
Questions regarding your assessment and the process for collection may be directed to
the Operations & Veterans Services Division of Collier County at County at (239) 252-
8387.
Community & Human Services Division • 3339 Tamiami Trail East, Suite 211 - Naples, Florida 34112-5361
239-252-CARE (2273) • 239-252-CAFE (2233) • 239-252-4230 (RSVP) - www.colliergov.neUhumanservices Packet Pg. 1125
16.D.11.1
* * * * THIS IS AN INVOICE * * * *
COLLIER COUNTY LOCAL PROVIDER PARTICIPATION FUND
The Willough at Naples
Parcel Number: 55100120000
Amount of assessment attributed to hospital: $199,040
Number of annual payments: 1
Total amount of annual payments: $199,040
Amount Due: $199,040
Due by Date: October 15, 2021
Make check payable to: Collier County Board of County Commissioners
C/O Operations & Veterans Services
3339 Tamiami Trail East Suite 212
Naples, FL 34112
* * * * THIS IS AN INVOICE * * * *
Packet Pg. 1126
16.D.11.1
I `= -76
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NOTICE OF PUBLIC HEARING TO CONSIDER THE IMPOSITION
AND COLLECTION OF A NON -AD VALOREM
SPECIAL ASSESSMENT
Notice is hereby given that the Board of County Commission-
ers of Collier County, Florida, will conduct a public hearing to
consider the approval of the imposition and collection of a
non -ad valorem special assessment against each private for -
profit and not -for -profit hospital that provides inpatient hospi-
tal services and that holds a right of possession and right of
use to real property in Collier County, Florida (each, an "As-
sessed Property"). The list of affected hospitals is included at
the conclusion of this notice.
The assessment is intended to finance intergovernmental trans-
fers Pravided consistent with federal guidelines to fund the
non-federal share of certain Medicaid and/or Medicaid man-
aged care payments. As a result, the assessment directly and
specially benefits Assessed Properties and supports the provi-
sion of health care services to Medicaid, indigent, and unin-
sured members of the County's community.
The public hearing will be held at Administration Building, lo-
cated at 3299 Tamiami Trail East, Suite 303, Naples, Ft. 34112-
5746, on September 28 at 9 a.m., or ,as soon thereafter as the
matter can be heard. At that time, the Board will receive pub-
lic comment on the proposed special assessment.
The County has prepared the Non -Ad Valorem Assessment Roll
being considered for approval based on information provided
by the hospitals. The roll contains the names of the hospitals;
the tax parcel identification numbers of the parcels; the sec-
tion, township, and range of the parcels assessed; the parcel
owner's name; the address and the names and addresses of
any leaseholders of the Assessed Properties; the assessment
rate; and the amount of the special assessment to be imposed
against each Assessed Property. The Nort-Ad Valorem Assess-
ment Roll will be available for inspection at the Collier County
Operations & Veterans Services, located at 3339 Tamiami Trail
East Suite 212, Naples, FL 34112, during regular business
hours from September 8, 2021, until the hearing concludes on
Tuesday, September 21, 2021. The assessment rate set forth in
the Non -Ad Valorem Assessment Roll to be levied against the
net patient revenue of each Assessed Property is 1.11 %.
At the date and time set forth in this notice, the Board of
County Commissioners may: (1) approve the Non -Ad Valorem
Assessment Roll, with such amendments as it deems just and
right and (2) adopt a resolution (the "Assessment Resolution")
that describes (a) the Medicaid payments proposed for fund-
ing from proceeds of the assessment, (b) the benefits to the As-
sessed Properties, (c) the methodology forcomputing the as-
sessed amounts, and (d) the method of collection, including
how and when the assessment is to be paid.
All interested persons have a right to appear at the. public
hearing and to file written objections with the Board prior to
the resolution vote. All written objections to the Non -Ad
Valorem Assessment being considered for approval shall be
filed with the County by September 27, 2021. Written objec-
tions should be sent to the attention of Collier County Opera-
tions & Veterans Services, located at 3339 Tamiami Trail East
Suite 212, Naples, FL 34112.
The amount of the assessment is to be collected pursuant an
additional and alternative method, as specified in § 197,3631,
Fla. Stat., for the assessment and collection of a non -ad
valorem special assessment. Details will be included in the As-
sessment Resolution.
I '
It you are a person with disability who needs any accommoda-
tion to participate in this proceeding, you are entitled, at no
cost to �ou, to the provision of certain assistance. Please con-
tact Co KierCounty Facilities Management Division at (239)
252-8380 at least three days prior to the public hearing it you
need special accommodations.
Collier County, FLORIDA
List of Affected Properties:
The special assessment is to be levied against each private for -
profit and not -for -profit hospital operating under a Florida
hospital license affiliated with the following providers of inpa-
tient hospital services that holds a right of possession and
right of use to real property in Collier County, Florida:
Physicians Regional Medical Center
6101 Pine Ridge Rd
Naples, FL 34119
Parcel #: 8067.0080001
Landmark Hospital of Southwest Florida
1285 Creekside Blvd
Naples FL 34109
Parcel #: 29331180612
NCH Baker Hospital
350 7th St N
Naples FL 34102
Parcel #: 14038880000
The Willough at Naples
9001 Tamiami Trail East -
Naples, FL 33862
Parcel #:
Pub: September8, 2021 - 4888777
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16.D.11.1
A.
Directed Payment Program Letter of Agreement
THIS LETTER OF AGREEMENT (LOA) is made and entered into in duplicate on the
day of 2021, by and between 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
2021-111, 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.
GENERAL PROVISIONS
1. Per Senate Bill 2500, the General Appropriations Act of State Fiscal Year 2021-2022,
passed by the 2021 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 $6,687,755. 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 $6,687,766, 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 2021 N
through June 2022 are due to the Agency no later than October 31, 2021 unless
an alternative plan is specifically approved by the agency. o
b. The Agency will bill the Collier County LPPF when payment is due. N
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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 w
in accordance with public records laws and established retention schedules.
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a. AUDITS AND RECORDS E
i. Collier County LPPF agrees to maintain books, records, and documents a
(including electronic storage media) pertinent to performance under this LOA in
Collier County LPPF_Region B, DPP LOA_SFY 2021-22
Packet Pg. 1128
16.D.11.1
accordance 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
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
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 small 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 S_DPP LOA_SFY 2021-22
Packet Pg. 2971
16.D.11.1
7. Collier County LPPF agrees the following provision shall be included in any agreements
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, 2021 through June 30, 2022 and shall be terminated
June 30, 2022.
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 1 Amount
State Fiscal Year 2021-2022
Year One DPP IGTs
$6,687,755 1
Total Funding
$6,687,755
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
SIGNED
BY:
NAME:
TITLE:
DATE:
ATTEST
CRYSTAL K, KINZEL, CLERK
BY:
STATE OF FLORIDA, AGENCY FOR
HEALTH CARE ADMINISTRATION
SIGNED
BY:
NAME:
TITLE:
DATE:
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Packet Pg. 1130
16.D.11.1
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IGT Provider Name:
Health Care Provider Name:
IGT Amount:
State Fiscal Year Ending:
1.
Count
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3
f other, please explain
No
Amount
$ 6,687,755
a.
f other, please explain
Yes
f no, please explain
4. Does your organization have taxing authority?
Yes
5. If the source of IGT funding is from taxes, please answer the following questions:
a. Is the tax a state, county, city, or hospital district tax?
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16.D.11.1
Count
If other, please explain
b. What entities are taxed?
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d. WI-
Licensed non-public hospitals in Collier County
iat is the tax structure i.e. property tax, percentage of revenue, assessment, etc.)?
Special assessment
iat is ine amount or percent or the tax r
1.11 % of Net Patient Revenue
e. uoes at least tia -/o oT the DUraen oT the tax revenue Tau on neaan care proviaers as aeTlnea In 4z LrK
§433.55? (Provide the total tax revenue and the health care provider tax burden) If so, please answer
the following questions:
Amount
Total Tax Burden $ 9,327,890
Healthcare Provider Tax Burden $ 9,327,890
100.00%
i) Is the tax broad based? A broad based tax can be defined as a tax that is imposed on at least all
health care items or services in the class or providers of such items or services furnished by all non -
Federal, non-public providers in the State, and is imposed uniformly, pursuant to 42 CFR § 433.68.
Yes
If no, please explain
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16.D.11.1
ii) Is the tax uniform across all entities being taxed? Based on 42 CFR § 433.68, a health care -related
tax will be considered to be imposed uniformly even if it excludes Medicaid or Medicare payments
(in whole or in part), or both; or in the case of health care -related tax based on revenue or receipts
with respect to a class of items or services, if it excludes either Medicaid or Medicare revenue with
respect to a class of items or services, or both. The exclusion of Medicaid revenue must be applied
uniformly to all providers being taxed.
Yes
If no, please explain
iii) Is the tax generally redistributive and a waiver of the broad -based or uniform tax requirement was
granted in accordance with 42 CFR §433.68(e)?
No
If no, please explain
No waiver was requested
iv) Does the tax program comply with the hold harmless provisions included in 42 CFR § 433.68(f)?
Yes
If no, please explain
v) Does every tax paying entity receive a supplemental payment equal to or exceeding its tax cost?
If yes, please explain
The county is not involved in the distribution of funds following federal match. The county is not in
position to speak to the ultimate distribution to hospitals from the managed care organizations.
6. Please answer the following regarding provider funds received from the healthcare entity and/or other
health care entities.
a. Are provider voluntary payments or in -kind services received by the organization as defined in 42 CFR
§ 433.52?
No
b. How much of the organization's revenue is received from provider -related donations (Provide the total
revenue and the provider -related donation amounts)?
Amount
Total Revenue
Provider Related Donations
c. Do individual provider donations exceed $5,000 per year or $50,000 per year for a health care
organizational entity?
No
Packet Pg. 1133
16.D.11.1
If yes, please list the provider and payment amount.
Provider Name Funding Source Amount
d. Does any portion of the provider donation constitute as a "bona fide donation" pursuant to 42 CFR §
433.54? 42 CFR § 433.54 requires donations will not be returned to the individual provider, the provider
class, or related entity under a hold harmless provision.
e. Is there an agreement between the IGT provider and the health care entity? If so, please specify
whether the agreement is written and provide the details.
Vo
7. Were funds utilized for the IGT specifically appropriated by the organization's board?
No
If yes, provide the board minutes and date of the appropriation.
I certify that the statements and information contained
in this submittal are true, accurate, and complete.
Signature of Officer or Administrator
Title
Date
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