Backup Documents 09/24/2024 Item #11I ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP I 1 1
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 9.24.24 BCC MTG
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#l 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 Attomey 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
I/Zs
3. BCC Office Board of County
Commissioners e(ffl /c T4ks/zy
4. Minutes and Records lerk of Court's Office CN
Originals will be picked up and please E a' 9/96IPf
to Carolyn.noble@colliercountyfl.gov
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 9.24.24 BCC Mtg Agenda Item Number 16.D.5/1 l;a
Approved by the BCC
Type of Document APPVL,1 LOA FOR CHAIR SIGNATURE Number of Original I (4 pages)
Attached Documents Attached
PO number or account
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A" in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature 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 "�� h an option for
Attorney's Office has reviewed the changes, if applicable. �/ 7 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 iJAk'M., an option for
Chairman's signature. this line.
11i
MEMORANDUM
Date: September 25, 2024
To: Carolyn Noble — CHS
From: Yani Fernandez, Deputy Clerk
Minutes & Records Department
Re: Letter of Agreement, Davis Lawrence Center
Attached, an original document (Item #11I— 16D5) adopted by the Board of County
Commissioners on Tuesday, September 24, 2024.
Please return the Original executed document back to our office to be held in the
Board's Official Records
If you have any questions, please feel free to contact me at 252-1029.
Thank you.
Attachment
1 1 I
Low Income Pool Letter of Agreement
tA
THIS LETTER OF AGREEMENT (LOA) is made and entered into in duplicate on the Zy
day of Sep4-. 2024, by and between Collier County (the "IGT Provider") on behalf of
David Lawrence Behavioral Health and the State of Florida, Agency for Health Care
Administration (the "Agency"), for good and valuable consideration, the receipt and
sufficiency of which is acknowledged.
DEFINITIONS
"Charity care" or "uncompensated charity care" means that portion of hospital charges reported
to the Agency for which there is no compensation, other than restricted or unrestricted revenues
provided to a hospital by local governments or tax districts regardless of the method of payment.
Uncompensated care includes charity care for the uninsured but does not include
uncompensated care for insured individuals, bad debt, or Medicaid and Children's Health
Insurance Program (CHIP) shortfall. The state and providers that are participating in Low
Income Pool (LIP) will provide assurance that LIP claims include only costs associated with
uncompensated care that is furnished through a charity care program and that adheres to the
principles of the Healthcare Financial Management Association (HFMA) operated by the
provider.
"Intergovernmental Transfers (IGTs)" means transfers of funds from a non-Medicaid
governmental entity (e.g., counties, hospital taxing districts, providers operated by state or local
government) to the Medicaid agency. IGTs must be compliant with 42 CFR Part 433 Subpart B.
• "Low Income Pool (LIP)" means providing government support for safety-net providers for the
costs of uncompensated charity care for low-income individuals who are uninsured.
Uncompensated care includes charity care for the uninsured but does not include
uncompensated care for insured individuals, "bad debt," or Medicaid and CHIP shortfall.
"Medicaid" means the medical assistance program authorized by Title XIX of the Social Security
Act, 42 U.S.C. §§ 1396 et seq., and regulations thereunder, as administered in Florida by the
Agency.
A. GENERAL PROVISIONS
1. Per 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
$1,719,499.44 if the entire State Fiscal Year (SFY) 24-25 distribution is paid using the
enhanced Federal Medical Assistance Percentage (FMAP) per the Families First
Coronavirus Response Act or if a portion of the SFY24-25 distribution is paid after the
expiration of the end of the enhanced FMAP.
a. The IGT Provider and the Agency have agreed that these IGT funds will only be
used to increase the provision of health services for the charity care of the IGT
Provider and the State of Florida at large.
b. The increased provision of charity care health services will be accomplished
through the following Medicaid programs:
i. LIP payments to hospitals, federally qualified health centers, Medical
School Physician Practices, community behavioral health providers, and
Digitally signed
by CAO
Collier County_David Lawrence Behavioral Health_LIP LOA SFY 2024-25 C/ l o Date:
2024.09.17
10:49:06-04'00'
1 J I
rural health centers pursuant to the approved Centers for Medicare &
Medicaid Services Special Terms and Conditions.
1. The IGT Provider will return the signed LOA to the Agency no later than October 1,
2024.
2. The IGT Provider will pay IGT funds to the Agency in an amount not to exceed the total
of$1,719,499.44 if the entire SFY24-25 distribution is paid prior to the end of the public
health emergency or if a portion of the SFY24-25 distribution is paid after the end of the
public health emergency.
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.
3. The IGT Provider and the Agency agree that the Agency will maintain necessary records
and supporting documentation applicable to health services covered by this LOA.
a. Audits and Records
i. The IGT Provider agrees to maintain books, records, and documents
(including electronic storage media) pertinent to performance under this L
O A in accordance with generally accepted accounting procedures and
practices, which sufficiently and properly reflect all revenues and
expenditures of funds provided.
ii. The IGT Provider agrees to assure that these records shall be subject at
all reasonable times to inspection, review, or audit by state personnel and
other personnel duly authorized by the Agency, as well as by federal
personnel.
iii. The IGT Provider agrees to comply with public record laws as outlined in
section 119.0701, Florida Statutes.
b. Retention of Records
i. The IGT Provider agrees to retain all financial records, supporting
documents, statistical records, and any other documents (including
electronic storage media) pertinent to performance under this LOA for a
period of six (6) years after termination of this LOA, or if an audit has
been initiated and audit findings have not been resolved at the end of
six (6) years, the records shall be retained until resolution of the audit
findings.
ii. Persons duly authorized by the Agency and federal auditors shall have full
access to and the right to examine any of said records and documents.
Collier County_David Lawrence Behavioral Health_LIP LOA SFY 2024-25
,11 I
i. The rights of access in this section must not be limited to the required
retention period but shall last as long as the records are retained.
c. Monitoring
i. The IGT Provider agrees to permit persons duly authorized by the
Agency to inspect any records, papers, and documents of the IGT
Provider which are relevant to this LOA.
d. Assignment and Subcontracts
i. The IGT Provider agrees to neither assign the responsibility of this LOA
to another party nor subcontract for any of the work contemplated under
this LOA without prior written approval of the Agency. No such approval
by the Agency of any assignment or subcontract shall be deemed in any
event or in any manner to provide for the incurrence of any obligation of
the Agency in addition to the total dollar amount agreed upon in this
LOA. All such assignments or subcontracts shall be subject to the
conditions of this LOA and to any conditions of approval that the Agency
shall deem necessary.
4. This LOA may only be amended upon written agreement signed by both parties.
The IGT Provider and the Agency agree that any modifications to this LOA shall be in
the same form, namely the exchange of signed copies of a revised LOA.
5. The IGT Provider confirms that there are no pre-arranged agreements (contractual or
otherwise) between the respective counties, taxing districts, and/or the providers to re-
direct any portion of these aforementioned charity care supplemental payments in order
to satisfy non-Medicaid, non-uninsured, and non-underinsured activities.
6. The IGT Provider agrees the following provision shall be included in any agreements
between the IGT Provider and local providers where IGT funding is provided pursuant
to this LOA: "Funding provided in this Agreement shall be prioritized so that designated
IGT funding shall first be used to fund the Medicaid program (including LIP or DSH) and
used secondarily for other purposes."
7. This LOA covers the period of July 1, 2024, through June 30, 2025, and shall
be terminated September 30, 2025, which includes the states certified forward
period.
8. This LOA may be executed in multiple counterparts, each of which shall constitute an
original, and each of which shall be fullybindingon any
party signing at least one
counterpart.
Collier County_David Lawrence Behavioral Health_LIP LOA SFY 2024-25
1 1 I
LIP Local Intergovernmental Transfers (IGTs)
Program I Amount State Fiscal Year 2024-2025
Estimated IGTs
$1,719,499.44
Total Funding Not to Exceed
$1,719,499.44
WITNESSETH:
IN WITNESS WHEREOF, the parties have caused this (4) page Letter of Agreement
to be executed by their undersigned officials as duly authorized.
COLLIER COUNTY STATE OF FLORIDA, AGENCY FOR
HEALTH CARE ADMINISTRATION
SIGNED ekdgenk SIGNED
BY: BY:
NAME: Tom Wallace
Chris Hall, Chairman
TITLE: Deputy Secretary for Medicaid
Finance and Data
DATE: l/2 yl 2 y DATE:
ATTEST -- .
CRYSTAL '. t ,
r tr" b
BY: ►. _
Attest a, t, Chairrn'an's
:,signature only
I
1
Approved. to rtn and legality
; '
Jeffrey A. latzko County Attorney
i ,
Collier County_David Lawrence Behavioral Health_LIP LOA SFY 2024-25
DLC Treatment Services
• Collier's trusted, comprehensive Behavioral Health provider since
• Available to ALL in need
• 95% of funding is non -county funding
• County funding is vital to ensure desperately needed access to care in
a growing community with growing behavioral health challenges
• County funding helps leverage other funding sources(State, LIP}
• Integral partner in Collier
Jail
Collier County Sheriff's Office
Baker Act
Marchman Act
Diversion for voluntary treatment
Law Enforcement Officers have discri
to transport individuals directly to DL
a hospital when appropriate
Naples
Community
Hospital
Physicians
Regional
Hospital
David
Lawrence
Center
(DLC)
14
Collier County Courts
Treatment Courts: Regular Courts:
Mental Health Court Misdemeanor Court
•'• Drug Court Felony Court
VA Court Delinquency/ Dependency
100% of clients are Most court ordered
referred to DLC assessments and treatment
are referred to DLC
Collier County
Public Schools
11
Fire & EMS
Collier County
Government
provides support to
the organizations on
this map through
general fund
appropriations, staff
technical and
administrative
assistance for grants,
and coordination of
the Criminal Justice
Mental Health and
Substance Abuse
Planning Council.
1750
1500
YEAR I Total 1250
2006 1 377
W111191
2010 1 796
750
2016 1 1338
2023 1 1622 1 500
250
x
CCSO BAKER ACTS
01/01/2006 - 12/31/2023
2006 2010 2016 2023
Information provided by the Collier County Sheriff's Office
2012-2023 Fiscal Year Growth of Total Services Provided to Children and Adults Compared to
Collier County Population*
450,000
4
407,972 16,131
399,973
400,000 384,902 392,130
372,880 378,488
3
357,305 65,136
348,777 349,075
350,000 338987
329,849 -
300,000
250,000
200,000
146,986
150,000
100,000
165,062
276,989
264,924
222,015 228,5
209,224
FY 14 FY 15 FY 16 FY 17 FY 18
Services Collier Population
314,
302,754
294,247
Population Growth:
26.16%
*Census information complied from US Census bureau and Collier County Government Statistics, 2020 population is based on estimate of previous 4
Collier Countv Data
■ 2005 — 2008 Collier Jail Daily Average = 1f162
■ 2008 CIT launched with purposeful intention to deflect into mental health
and addiction treatment as much as possible
• To date, ❑ver 1,500 persons have been CIT trained including all CCSO Law
Enforcement, Fire/EMS personnel, Naples and Marco PD, Judges,
Probation, COPS, etc.
■ 2022 Collier Jail Daily Average =713
• Reduction of 449 per clay, or 39% daily reduction
• Cost of incarceration per year (range) _ $31,000 — $60,000
• Avg. _ $45,500 annually or $124.66 p/day
• 449 x $124.66 x 365 = $ 20,430,000 annual cost avoidance
20%
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
Uninsured Rates
18%
National Top Performing States Florida Collier County Sarasota County Manatee County Charlotte County
Lee County
httos://www.cou ntvhea It ranki ngs.orelexolore- hea Ith-ra n kineslcounty-health-rankines- mod eI/health-factorslcIinica I-ca relaccess-tc-careh ninsured ?yea r=202Mcou ntv=12021
httos://www.census.eov/l 1hra rvl visualizationslinteractivel000uIat!on-without-hea Ith -i n s u rance-coveraee-2019-and-2021. htmI
Challenges
• Increased community behaviors
and related to the psychological
requires increased response and
health needs of a growing community
tolls of the pandemic, hurricanes, etc.;
resources
• State continues to be of the worst in the nation for per capita funding for
M H and Addiction Services
• Florida
has higher
uninsured
rates than national
average
(15% vs 8%)
Collier
county
has
one of
the
highest
uninsured
rates
in our region
(18%).
• To stay within
industry
market
and competitive to
retain and recruit
professionals
for SWFL,
salary
requirements
have
risen significantly.
• NCH closed its only inpatient psychiatric unit care (12 beds), effective July
1, 2022. No psychiatric supports are available via PRIVIC either.
Community "Return on Investment"
• Benefits: LIP funding leverages needed funding by securing match
funding to assist with high levels of charity care provided for these
eligible services by specified treatment providers
• Benefits: Individuals, Families, Businesses and community
• Benefits: health, well-being and safety
• DLC is a not -for -profit organization; services available to ALL in need
• Diversion and deflection into treatment reaps cost -avoidance in other
areas such as judiciary and law enforcement
rJeCollier County
Agency for Health Care
Administration (AHCA) Low Inc e
Pool (LIP) Letter of Agreement'r
David Lawrence Center r
BCC Meeting Date: 9.24.24
Agenda Item: 16.D.5.
Kristi Sonntag, Community and Human Services Director
David Lawrence Center and State
Match Requirement
$21326,315,,46
Section 394. 76 (3) (b ), Florida Statutes, requires local
participation on a 75-to-25 percent state -to -local ratio of
funding for all contracted community alcohol and mental
health services
State funds for community alcohol and mental health services
shall be matched by local matching funds. The governing
bodies shall be required to participate in the funding of alcohol
and mental health services under the jurisdiction of such
governing bodies. The amount of the participation shall be at
least that amount which, when added to other available local
matching funds, is necessary to match state funds.
Example:
• Match Obligation 1M
• Other Sources 470K
• Local Government 530K
Local Match
AG Pam Bondi opinion
12/2011
"The statute, therefore, clearly
acknowledges that there may be
multiple sources for contributing to
the local match amount and, in
defining local matching funds, gives
an open-ended range of sources
that may be included."
State Approved Sod,rces
of Latch
Client Fees
Volunteer Hours
Local Government
Municipalities
Taxing Districts
Donations
In -Kind
Other community Sources
DLC FY 25 Match Request
$213261315
DLC is requesting Collier County use it General Fund
match funds of $ 1,415,500 to support the match
obligation and $522,000 4pioid Settlement
DLC is requesting all GF dollars be forward to AHCA as
part of the LIP program
DLC will have a separate 4pioid agreement
Low Income Pool Program
History of LIP DLC Qualifications
LIP funds are provided
for eligible providers to
cover health care costs
for which compensation
was not available from
other payors.
LIP provided government
support for providers
that furnished
uncompensated care to
the Medicaid,
underi nsu red, and
uninsured populations
Enrolled in Medicaid
Program
DLC implemented a 15-
bed expansion in
October 2022
Interim step toward a
Central Receiving
Facility
DLC secured a recurring
legislative appropriation
in 2023 - allowing DLC to
participate in the LIP
program
Collier County
General Fund LIP
IGT
Req
FY25
Tentative
Varian
Federal Matching ITotal Funds Benefiting Low -
Funds Provided to I Income Persons
17,►'110l WAYA:J � ►10 �
CENTER
Collier County
f
RECOMMENDATION
Fo approve and authorize the Chairman to sign a Low -
Income Pool Letter of Agreement with the Agency for Health
Care Administration, in the amount not to exceed
$1,719,499.44 to participate in the Medicaid Central
Receiving Facility Low Income Pool Program and
Authorize necessary budget amendments to the FY25
budget in the amount $303,999.44.
Medicaid /Medicare Low Income Pool,.(LIP)
Medicaid is the nation's
public health insurance
program for low-income
children, families, elders,
and people with disabilities.
1 in 5 Florida residents is
enrolled.
LIP was established to
ensure continued
government support for the
provision ❑f heath care
services t❑ Medicaid,
underinsured and uninsured
populations.
5 Year Local Match History I,
273357934 21327,889 173157066 173157006 11467,339 0
5687675
LIP Funding-FQ3807596
DLC Base277167530 17315,066 2707276451,4677339 0.00
LIP Funding CRF 5687000 0
LIP Funding303,999.44
additional
Federal FundingJ-ja• ■ 903,089.31
ARP ending
3.30.25
Opioid Settlement5007000 522,093
DLC Total All Fund2,706,530• ■ .; 0690■; •; 3144,682
County's General, Fund and LIP
Allocations
The current ❑LC state -required match obligation is $2,326,315.46. The
tentative FY 25 budget has allocated $1,415, 500, along with $522,093 of
Opioid funding for a total of $1,937,593 in County support, thus creating
a match shortfall of $3887722.46
To meet the required match obligation, DLC is reauestine an additional
5303.999.44 for the Collier Countv LIP IGT local match in the FY 25
budget for a total of $1,719,499.44
Through the remittance of these funds, the County will meet all but
$84,723.02 of the state -required match obligation
NOTE: It is important to note that the Countv is not solelv responsible
for the ❑LC state -required match though the Countv has historically
supported the entire DLC state -required match obligation without local
support from other agencies. In prior vears, the County has often
exceeded the required match in support of DLC.
The 5303,999.44 increase in the Countv's local LIP IGT will increase DLC
federal matching dollars for the LIP Program by $709,782.44 from
$3,304,926 to $4,014,708.44.
DLC will receive a total of 54.014.708 in LIP funding to support mental
healthcare services for low-income individuals in Collier County through
its central receiving facility.