Backup Documents 09/10/2024 Item #16D11 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 9.10.24 BCC M'I'G
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP 16 D 11.
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. Carolyn Noble Community and Human CN 9.10.24
Services
2. County Attorney Office— County Attorney Office
CiS4 `r//42Y
3. BCC Office Board of County
Commissioners CW ,im s q1i jz y
4. Minutes and Records Clerk of Court's Office Ct
/Ail/ie
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the addressees
above,may need to contact staff for additional or missing information.
Name of Primary Staff Carolyn Noble Phone Number 239-450-5186
Contact/ Department
Agenda Date Item was 9.10.24 BCC Mtg Agenda Item Number 16.D.pi
Approved by the BCC
toPi 6 S
Type of Document RESOLUTION FOR APPVL,3 LOA'S FOR CM Number of Original 12 (3 of each
Attached TO SIGN Documents Attached document)
PO number or account �(Jh�� ���
number if document is (�
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A" in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature STAMP OK CN
2. Does the document need to be sent to another agency for additional signatures? If yes, N/A
provide the Contact Information (Name;Agency; Address; Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be Yes
signed by the Chairman, with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's N/A
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the N/A
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's YES
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip N/A
should be provided to the County Attorney Office at the time the item is input into SIRE.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on above date and all changes made during N/A is not
the meeting have been incorporated in the attached document. The County 0siisb an option for
Attorney's Office has reviewed the changes, if applicable. this line.
9. Initials of attorney verifying that the attached document is the version approved by the N/A is not
BCC,all changes directed by the BCC have been made, and the document is ready for the (SS(O an option for
Chairman's signature. this line.
1 6D11
RESOLUTION NO.2024-1 61
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
CAO
1
1 6 D 1
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 1GTs 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.
(CD
2 \
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 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 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.
lf,at the end of the Fiscal Year,additional amounts remain in the local provider participation fund, the
Board is hereby authorized either(a)to refund to Assessed Properties, in proportion to amounts paid in
during the Fiscal Year, all or a portion of the unutilized local provider participation fund, or (b) 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
3 C,10
1 6D11
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: (I)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 10'h day of September 2024.
ATTEST: BOARD OF COUNTY COMMISSIONERS
CRYSTA4" :r. 4Z£I ,CLERK COLLIER COUNTY, FLORIDA
y M t
;' rt• By:
Att. jputy Clerk
CHRIS LL, CHAIRPERSON
Sigl3itl'if" , N
Dated: ' 'Z
(SEAL) Date: Io 12 9
Approval as to form d legality:
Carly nne Sanseverino ca5 $tit
As ' ant County Attorney
S
4
Directed Payment Program Letter of Agreement
THIS LETTER OF AGREEMENT (LOA) is made and entered into in duplicate on the ILA
day of ,$cpl- 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
1. 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
CA O
16D11
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 Count) LPPF_Region 8_DPP LOA_SFY 2024-25
1 6D11 win
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 STATE OF FLORIDA, AGENCY FOR
HEALTH CARE ADMINISTRATION
SIGNED SIGNED
BY: PAAOPV BY:
NAME: Amy Patt on NAME: Tom Wallace
TITLE: County Manager TITLE: Deputy Secretary for Health Care
Finance and Data
//��
DATE: '1 /I Z l 7--f DATE:
Collier County LPPF_Region 8__DPP LOA_SFY 2024-25
CqC)
1 6D11 -.'
Graduate Medical Education Letter of Agreement
THIS LETTER OF AGREEMENT (LOA) is made and entered into in duplicate on the le11
day of '}- 2024, by and between Collier County LPPF (the "IGT Provider") on behalf of Fawcett
Memorial Hospital, and theState of Florida, Agency for Health Care Administration (the
"Agency"), for good and valuable consideration, the receipt and sufficiency of which is
acknowledged.
DEFINITIONS
"Graduate Medical Education (GME)" is the term used for the Graduate Medical Education
Startup Bonus Program, established to provide resources for the education and training of
physicians in specialties that are in a statewide supply-and-demand deficit, as listed in the
General Appropriations Act, Laws of Florida 2024-231.
"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 House Bill 5001, the General Appropriations Act of State Fiscal Year 2024-2025,
passed by the 2024 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
$3,934.14. The IGT Provider and the Agency have agreed that these IGT funds will only
be used in accordance with §409.909, Florida Statutes (2021).
2. The IGT Provider will return the signed LOA to the Agency no later than October 1,
2024.
3. The IGT Provider will pay IGT funds to the Agency in an amount not to exceed the
total of$3,934.14. 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 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 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 the GME program covered by this
LOA in accordance with public records laws and established retention schedules.
Collier County LPPF_Fawcett Memorial Hospital_GME LOA_SFY 2024-2025
Cqn '
a. AUDITS AND RECORDS
i. The IGT Provider 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 IGT Provider agrees to assure that these records shall be subject at all
reasonable times to inspection, review, or audit by state personnel and other
personnel duly authorized by the Agency, as well as by federal personnel.
iii. The IGT Provider agrees to comply with public record laws as outlined in
section 119.0701, Florida Statutes.
b. RETENTION OF RECORDS
i. The IGT Provider agrees to retain all financial records, supporting documents,
statistical records, and any other documents (including electronic storage
media) pertinent to performance under this LOA for a period of six (6) years
after termination of this LOA, or if an audit has been initiated and audit findings
have not been resolved at the end of six (6) years, the records shall 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 IGT Provider agrees to permit persons duly authorized by the Agency to
inspect any records, papers, and documents of the IGT Provider which are
relevant to this LOA.
d. ASSIGNMENT AND SUBCONTRACTS
i. The IGT Provider agrees to neither assign the responsibility of this LOA to
another party nor subcontract for any of the work contemplated under this LOA
without prior written approval of the Agency. No such approval by the Agency of
any assignment or subcontract shall be deemed in any event or in any manner to
provide for the incurrence of any obligation of the Agency in addition to the total
dollar amount agreed upon in this LOA. All such assignments or subcontracts
shall be subject to the conditions of this LOA and to any conditions of approval
that the Agency shall deem necessary.
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 bein
the same form, namely the exchange of signed copies of a revised LOA.
Collier County LPPF_Fawcett Memorial Hospital_GME LOA_SFY 2024-2025
CA0
16D11
1. The IGT Provider confirms that there are no pre-arranged agreements (contractual or
otherwise) between the respective counties, taxing districts, and/or the providers to re-
direct any portion of these aforementioned charity care supplemental payments in order
to satisfy non-Medicaid, non-uninsured, and non-underinsured activities.
2. The IGT Provider agrees the following provision shall be included in any agreements
between the IGT Provider and local providers where IGT funding is provided pursuant to
this LOA. "Funding provided in this agreement shall be prioritized so that designated IGT
funding shall first be used to fund the Medicaid program and used secondarily for other
purposes."
3. This LOA covers the period of July 1, 2024, through June 30, 2025, and shall
be terminated September 30, 2025, which includes the state's 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 County LPPF_Fawcett Memorial Hospital_GME LOA_SFY 2024-2025
Cq0
GME Local Intergovernmental Transfers
Program / Amount State Fiscal Year 2024-2025
Estimated IGTs $3,934.14
Total Funding $3,934.14
IN WITNESS WHEREOF, the parties have caused this page Letter of Agreement to be
executed by their undersigned officials as duly authorized.
COLLIER COUNTY LPPF STATE OF FLORIDA, AGENCY FOR
HEALTH CARE ADMINISTRATION
SIGNED SIGNED
BY: ROVLKZ11)/&— BY:
NAME: Amy Pa erson NAME: Tom Wallace
TITLE: County Manager TITLE: Deputy Secretary for Health Care
p� Finance and Data
DATE: ! [ l 2- 2.c( DATE:
Lee Health_Fawcett Memorial Hospital_GME LOA_SFY 2024-2025
CAo
16D11
Graduate Medical Education Letter of Agreement
THIS LETTER OF AGREEMENT (LOA) is made and entered into in duplicate on the 10�h
day of Seo
f 2024, by and between Collier LPPF (the "IGT Provider") on behalf of Naples
Commun ty Hospital, and theState of Florida, Agency for Health Care Administration (the
"Agency"), for good and valuable consideration, the receipt and sufficiency of which is
acknowledged.
DEFINITIONS
"Graduate Medical Education (GME)" is the term used for the Graduate Medical Education
Startup Bonus Program, established to provide resources for the education and training of
physicians in specialties that are in a statewide supply-and-demand deficit, as listed in the
General Appropriations Act, Laws of Florida 2024-231.
"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 House Bill 5001, the General Appropriations Act of State Fiscal Year 2024-2025,
passed by the 2024 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
$2,782,560.97. The IGT Provider and the Agency have agreed that these IGT funds will
only be used in accordance with § 409.909, Florida Statutes (2021).
2. The IGT Provider will return the signed LOA to the Agency no later than October 1,
2024.
3. The IGT Provider will pay IGT funds to the Agency in an amount not to exceed the
total of$2,782,560.97. 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 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 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 the GME program covered by this
LOA in accordance with public records laws and established retention schedules.
Collier LPPF_Naples Community Hospital_GME LOA_SFY 2024-2025
CI
a. AUDITS AND RECORDS
i. The IGT Provider 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 IGT Provider agrees to assure that these records shall be subject at all
reasonable times to inspection, review, or audit by state personnel and other
personnel duly authorized by the Agency, as well as by federal personnel.
iii. The IGT Provider agrees to comply with public record laws as outlined in
section 119.0701, Florida Statutes.
b. RETENTION OF RECORDS
i. The IGT Provider agrees to retain all financial records, supporting documents,
statistical records, and any other documents (including electronic storage
media) pertinent to performance under this LOA for a period of six (6) years
after termination of this LOA, or if an audit has been initiated and audit findings
have not been resolved at the end of six (6) years, the records shall 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 IGT Provider agrees to permit persons duly authorized by the Agency to
inspect any records, papers, and documents of the IGT Provider which are
relevant to this LOA.
d. ASSIGNMENT AND SUBCONTRACTS
i. The IGT Provider agrees to neither assign the responsibility of this LOA to
another party nor subcontract for any of the work contemplated under this LOA
without prior written approval of the Agency. No such approval by the Agency of
any assignment or subcontract shall be deemed in any event or in any manner to
provide for the incurrence of any obligation of the Agency in addition to the total
dollar amount agreed upon in this LOA. All such assignments or subcontracts
shall be subject to the conditions of this LOA and to any conditions of approval
that the Agency shall deem necessary.
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 bein
the same form, namely the exchange of signed copies of a revised LOA.
Collier LPPF_Naples Community Hospital_GME LOA_SFY 2024-2025
C'4O
1. The IGT Provider confirms that there are no pre-arranged agreements (contractual or
otherwise) between the respective counties, taxing districts, and/or the providers to re-
direct any portion of these aforementioned charity care supplemental payments in order
to satisfy non-Medicaid, non-uninsured, and non-underinsured activities.
2. The IGT Provider agrees the following provision shall be included in any agreements
between the IGT Provider and local providers where IGT funding is provided pursuant to
this LOA. "Funding provided in this agreement shall be prioritized so that designated IGT
funding shall first be used to fund the Medicaid program and used secondarily for other
purposes."
3. This LOA covers the period of July 1, 2024, through June 30, 2025, and shall
be terminated September 30, 2025, which includes the state's 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_Naples Community Hospital_GME LOA_SFY 2024-2025
Cq0
16D11
GME Local Intergovernmental Transfers
Program /Amount State Fiscal Year 2024-2025
Estimated IGTs $2,782,560.97
Total Funding $2,782,560.97
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: Amy Patte on NAME: Tom Wallace
TITLE: County Manager TITLE: Deputy Secretary for Health Care
Finance and Data
DATE: ( 12_I '2J-4 DATE:
Collier LPPF_Naples Community Hospital_GME LOA_SFY 2024-2025
CAO